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<!doctype html><html data-n-head-ssr lang="en" data-n-head="%7B%22lang%22:%7B%22ssr%22:%22en%22%7D%7D"><head ><meta data-n-head="ssr" charset="utf-8"><meta data-n-head="ssr" name="viewport" content="width=device-width, initial-scale=1"><meta data-n-head="ssr" name="msapplication-TileColor" content="#247CB3"><meta data-n-head="ssr" name="msapplication-TileImage" content="https://asset.jmir.pub/assets/static/images/mstile-144x144.png"><meta data-n-head="ssr" name="description" content="Background: Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support. Objective: In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff&#8217;s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals. Methods: Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167/485) for the first and 40.6% (210/517) for the second measure. Results: Collaborative reflection was increased (P=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (r=.61, P&#60;.001). Conclusions: The findings provide evidence for an effect of the apps on hospital employees&#8217; reflection behavior. Apps that foster reflective learning can increase health care professionals&#8217; reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps. "><meta data-n-head="ssr" name="keywords" content="null"><meta data-n-head="ssr" name="DC.Title" content="Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff"><meta data-n-head="ssr" name="DC.Subject" content="null"><meta data-n-head="ssr" name="DC.Description" content="Background: Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support. Objective: In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff&#8217;s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals. Methods: Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167/485) for the first and 40.6% (210/517) for the second measure. Results: Collaborative reflection was increased (P=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (r=.61, P&#60;.001). Conclusions: The findings provide evidence for an effect of the apps on hospital employees&#8217; reflection behavior. Apps that foster reflective learning can increase health care professionals&#8217; reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps. "><meta data-n-head="ssr" name="DC.Publisher" content="Journal of Medical Internet Research"><meta data-n-head="ssr" name="DC.Publisher.Address" content="JMIR Publications // 130 Queens Quay East, Unit 1100 // Toronto, ON, M5A 0P6"><meta data-n-head="ssr" name="DC.Date" scheme="ISO8601" content="2014-03-17"><meta data-n-head="ssr" name="DC.Type" content="Text.Serial.Journal"><meta data-n-head="ssr" name="DC.Format" scheme="IMT" content="text/xml"><meta data-n-head="ssr" name="DC.Identifier" content="doi:10.2196/jmir.3040"><meta data-n-head="ssr" name="DC.Language" scheme="ISO639-1" content="EN"><meta data-n-head="ssr" name="DC.Relation" content="World"><meta data-n-head="ssr" name="DC.Source" content="J Med Internet Res 2014;16(3):e85 https://www.jmir.org/2014/3/e85"><meta data-n-head="ssr" name="DC.Rights" content=""><meta data-n-head="ssr" property="og:title" content="Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff"><meta data-n-head="ssr" property="og:type" content="article"><meta data-n-head="ssr" property="og:url" content="https://www.jmir.org/2014/3/e85"><meta data-n-head="ssr" property="og:image" content="https://asset.jmir.pub/assets/edc1a7150087d5665159ca24ffb46786.JPG"><meta data-n-head="ssr" property="og:site_name" content="Journal of Medical Internet Research"><meta data-n-head="ssr" name="twitter:card" content="summary_large_image"><meta data-n-head="ssr" name="twitter:site" content="@jmirpub"><meta data-n-head="ssr" name="twitter:title" content="Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff"><meta data-n-head="ssr" name="twitter:description" content="Background: Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support. Objective: In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff&#8217;s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals. Methods: Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167/485) for the first and 40.6% (210/517) for the second measure. Results: Collaborative reflection was increased (P=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (r=.61, P&#60;.001). Conclusions: The findings provide evidence for an effect of the apps on hospital employees&#8217; reflection behavior. Apps that foster reflective learning can increase health care professionals&#8217; reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps. "><meta data-n-head="ssr" name="twitter:image" content="https://asset.jmir.pub/assets/edc1a7150087d5665159ca24ffb46786.JPG"><meta data-n-head="ssr" name="citation_title" content="Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff"><meta data-n-head="ssr" name="citation_journal_title" content="Journal of Medical Internet Research"><meta data-n-head="ssr" name="citation_publisher" content="JMIR Publications Inc., Toronto, Canada"><meta data-n-head="ssr" name="citation_doi" content="10.2196/jmir.3040"><meta data-n-head="ssr" name="citation_issue" content="3"><meta data-n-head="ssr" name="citation_volume" content="16"><meta data-n-head="ssr" name="citation_firstpage" content="e3040"><meta data-n-head="ssr" name="citation_date" content="2014-03-17"><meta data-n-head="ssr" name="citation_abstract_html_url" content="https://www.jmir.org/2014/3/e85"><meta data-n-head="ssr" name="citation_abstract_pdf_url" content="https://www.jmir.org/2014/3/e85/PDF"><meta data-n-head="ssr" name="DC.Creator" content="Bettina"><meta data-n-head="ssr" name="DC.Contributor" content="Bettina Renner"><meta data-n-head="ssr" name="DC.Contributor" content="Joachim Kimmerle"><meta data-n-head="ssr" name="DC.Contributor" content="Dominik Cavael"><meta data-n-head="ssr" name="DC.Contributor" content="Volker Ziegler"><meta data-n-head="ssr" name="DC.Contributor" content="Lisa Reinmann"><meta data-n-head="ssr" name="DC.Contributor" content="Ulrike Cress"><meta data-n-head="ssr" name="citation_authors" content="Bettina Renner"><meta data-n-head="ssr" name="citation_authors" content="Joachim Kimmerle"><meta data-n-head="ssr" name="citation_authors" content="Dominik Cavael"><meta data-n-head="ssr" name="citation_authors" content="Volker Ziegler"><meta data-n-head="ssr" name="citation_authors" content="Lisa Reinmann"><meta data-n-head="ssr" name="citation_authors" content="Ulrike Cress"><title>Journal of Medical Internet Research - Web-Based Apps for Reflection: A 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(mhealth) (3079) </a><a href="/themes/57" data-test="article-collection" aria-label="754 articles belongs to e-Learning and Digital Medical Education e-collection/theme issue" class="collection__link"> e-Learning and Digital Medical Education (754) </a></div></div> <div class="row"><div class="main col-lg-9 mb-1"> <div data-test="details" class="details"><div><p id="main-content" tabindex="0"> Published on <time datetime="17.03.2014">17.03.2014 </time> in <span data-test="issue-info"><a href="/2014/3" class="nuxt-link-active"> Vol 16<span>, No 3</span> (2014)<span>: March</span></a></span></p> </div> <div></div></div> <div class="info mt-3"><div class="info__article-img"><div data-v-10f10a3e><img data-srcset="https://asset.jmir.pub/assets/edc1a7150087d5665159ca24ffb46786.JPG 480w,https://asset.jmir.pub/assets/edc1a7150087d5665159ca24ffb46786.JPG 960w,https://asset.jmir.pub/assets/edc1a7150087d5665159ca24ffb46786.JPG 1920w,https://asset.jmir.pub/assets/edc1a7150087d5665159ca24ffb46786.JPG 2500w" alt="Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff" title="Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff" aria-label="Article Thumbnail Image" src="https://asset.jmir.pub/placeholder.svg" data-v-10f10a3e></div> <div data-test="article-img-info" class="info__article-img-info"><span aria-hidden="true" class="icon fas fa-search-plus"></span></div></div> <div class="info__title-authors"><h1 tabindex="0" aria-label="Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff" class="h3 mb-0 mt-0">Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff</h1> <h2 class="info__hidden-title"> Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff </h2> <div class="mt-3"><p tabindex="0" class="authors-for-screen-reader"> Authors of this article: </p> <span data-test="authors-info" class="info__authors"><span><a href="/search?term=Bettina%20Renner&type=author&precise=true&authorlink=true" aria-label="Bettina Renner. Search more articles by this author."> Bettina Renner<sup>1</sup> </a></span>  <span style="margin-left: -2px;"> ; </span></span><span data-test="authors-info" class="info__authors"><span><a href="/search?term=Joachim%20Kimmerle&type=author&precise=true&authorlink=true" aria-label="Joachim Kimmerle. Search more articles by this author."> Joachim Kimmerle<sup>1</sup> </a></span>  <span style="margin-left: -2px;"> ; </span></span><span data-test="authors-info" class="info__authors"><span><a href="/search?term=Dominik%20Cavael&type=author&precise=true&authorlink=true" aria-label="Dominik Cavael. Search more articles by this author."> Dominik Cavael<sup>2</sup> </a></span>  <span style="margin-left: -2px;"> ; </span></span><span data-test="authors-info" class="info__authors"><span><a href="/search?term=Volker%20Ziegler&type=author&precise=true&authorlink=true" aria-label="Volker Ziegler. Search more articles by this author."> Volker Ziegler<sup>2</sup> </a></span>  <span style="margin-left: -2px;"> ; </span></span><span data-test="authors-info" class="info__authors"><span><a href="/search?term=Lisa%20Reinmann&type=author&precise=true&authorlink=true" aria-label="Lisa Reinmann. Search more articles by this author."> Lisa Reinmann<sup>2</sup> </a></span>  <span style="margin-left: -2px;"> ; </span></span><span data-test="authors-info" class="info__authors"><span><a href="/search?term=Ulrike%20Cress&type=author&precise=true&authorlink=true" aria-label="Ulrike Cress. Search more articles by this author."> Ulrike Cress<sup>1, 3</sup> </a></span>  </span></div> </div></div> <div role="tablist" aria-label="Article" class="tabs"><a href="/2014/3/e85/" aria-current="page" role="tab" aria-label="Article" data-test="tabs" class="nuxt-link-exact-active nuxt-link-active active"> Article </a><a href="/2014/3/e85/authors" role="tab" aria-label="Authors" data-test="tabs"> Authors </a><a href="/2014/3/e85/citations" role="tab" aria-label="Cited by (13)" data-test="tabs"> Cited by (13) </a><a href="/2014/3/e85/tweetations" role="tab" aria-label="Tweetations (6)" data-test="tabs"> Tweetations (6) </a><a href="/2014/3/e85/metrics" role="tab" aria-label="Metrics" data-test="tabs"> Metrics </a></div> <div class="container"><div class="row"><div class="col-lg-3 mb-5 sidebar-sections"><div class="sidebar-nav"><div class="sidebar-nav-sticky"><ul></ul></div></div></div> <div data-test="keyword-links" class="col-lg-9 article"><main id="wrapper" class="wrapper ArticleMain clearfix"><section class="inner-wrapper clearfix"><section class="main-article-content clearfix"><article class="ajax-article-content"><h4 class="h4-original-paper"><span class="typcn typcn-document-text"></span>Original Paper</h4><div class="authors-container"><div class="authors clearfix"></div></div><div class="authors-container"><div class="authors clearfix"></div></div><div class="authors-container"><div class="authors clearfix"><ul class="clearfix"><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Bettina+Renner" class="btn-view-author-options">Bettina Renner<sup><small>1</small></sup><sup>*</sup>, Dipl Psych</a>; </li><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Joachim+Kimmerle" class="btn-view-author-options">Joachim Kimmerle<sup><small>1</small></sup><sup>*</sup>, Dr rer nat</a>; </li><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Dominik+Cavael" class="btn-view-author-options">Dominik Cavael<sup><small>2</small></sup>, MA</a>; </li><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Volker+Ziegler" class="btn-view-author-options">Volker Ziegler<sup><small>2</small></sup>, Dr med</a>; </li><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Lisa+Reinmann" class="btn-view-author-options">Lisa Reinmann<sup><small>2</small></sup>, BA (Hons)</a>; </li><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Ulrike+Cress" class="btn-view-author-options">Ulrike Cress<sup><small>1,</small></sup><sup><small>3</small></sup>, Dr rer soc</a></li></ul><div class="author-affiliation-details"><p><sup>1</sup>Knowledge Media Research Center (KMRC) , Tuebingen, Germany</p><p><sup>2</sup>Neurological Clinic Bad Neustadt, Bad Neustadt, Germany</p><p><sup>3</sup>University of Tuebingen, Tuebingen, Germany</p><p>*these authors contributed equally</p></div></div><div class="corresponding-author-and-affiliations clearfix"><div class="corresponding-author-details"><h3>Corresponding Author:</h3><p>Joachim Kimmerle, Dr rer nat</p><p></p><p>Knowledge Media Research Center (KMRC) </p><p>Schleichstr 6</p><p>Tuebingen, 72076</p><p>Germany</p><p>Phone: 49 7071979363</p><p>Fax:49 7071979100</p><p>Email: <a href="mailto:j.kimmerle@iwm-kmrc.de">j.kimmerle@iwm-kmrc.de</a></p><br></div></div></div><section class="article-content clearfix"><article class="abstract"><h3 id="Abstract" class="navigation-heading" data-label="Abstract">Abstract</h3><p><span class="abstract-sub-heading">Background: </span>Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support.<br></p><p><span class="abstract-sub-heading">Objective: </span>In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff’s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals.<br></p><p><span class="abstract-sub-heading">Methods: </span>Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167/485) for the first and 40.6% (210/517) for the second measure.<br></p><p><span class="abstract-sub-heading">Results: </span>Collaborative reflection was increased (<i>P</i>=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (<i>r</i>=.61, <i>P</i><.001).<br></p><p><span class="abstract-sub-heading">Conclusions: </span>The findings provide evidence for an effect of the apps on hospital employees’ reflection behavior. Apps that foster reflective learning can increase health care professionals’ reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps.<br></p><strong class="h4-article-volume-issue">J Med Internet Res 2014;16(3):e85</strong><br><br><span class="article-doi"><a href="https://doi.org/10.2196/jmir.3040">doi:10.2196/jmir.3040</a></span><br><br><h3 class="h3-main-heading" id="Keywords">Keywords</h3><div class="keywords"><span><a href="/search?type=keyword&term=computer%20applications%20software">computer applications software</a>; </span><span><a href="/search?type=keyword&term=mobile%20applications">mobile applications</a>; </span><span><a href="/search?type=keyword&term=learning">learning</a>; </span><span><a href="/search?type=keyword&term=education,%20continuing">education, continuing</a>; </span><span><a href="/search?type=keyword&term=job%20satisfaction">job satisfaction</a>; </span><span><a href="/search?type=keyword&term=hospitals">hospitals</a>; </span><span><a href="/search?type=keyword&term=longitudinal%20studies">longitudinal studies</a>; </span><span><a href="/search?type=keyword&term=self%20report">self report</a> </span></div><div id="trendmd-suggestions"></div></article><br><article class="main-article clearfix"><br><h3 class="navigation-heading h3-main-heading" id="-Introduction" data-label="-Introduction"> Introduction</h3><h4>Background</h4><p class="abstract-paragraph">Learning and the continuing development of employees are important issues in hospitals. Confronted with complex problems and stressful situations, nurses and physicians always need to keep their skills up to date and develop them further [<span class="footers"><a class="citation-link" href="#ref1" rel="footnote">1</a></span>-<span class="footers"><a class="citation-link" href="#ref3" rel="footnote">3</a></span>]. This happens not only through formal training but also informally in the daily routine of health care professionals [<span class="footers"><a class="citation-link" href="#ref4" rel="footnote">4</a></span>-<span class="footers"><a class="citation-link" href="#ref6" rel="footnote">6</a></span>]. Hospital management needs not only skilled and competent employees but also contented employees, since dissatisfied nurses and physicians are more likely to resign [<span class="footers"><a class="citation-link" href="#ref7" rel="footnote">7</a></span>,<span class="footers"><a class="citation-link" href="#ref8" rel="footnote">8</a></span>]. Job satisfaction of health care staff is related to patient satisfaction [<span class="footers"><a class="citation-link" href="#ref8" rel="footnote">8</a></span>] and patient care (for an overview see [<span class="footers"><a class="citation-link" href="#ref7" rel="footnote">7</a></span>]) and therefore plays an important role when it comes to the quality of medical care.</p><p class="abstract-paragraph">The aim of the present study is to examine an easy and efficient way of supporting reflective learning in hospital staff. For this purpose, we tested the suitability of application software (apps) that support reflection. Our aim was also to examine the relationship between reflection and job satisfaction of hospital staff.</p><p class="abstract-paragraph">We present theoretical and empirical considerations of reflection processes in the workplace and of job satisfaction, with each presentation leading to a concrete hypothesis. Then we describe the methods of this longitudinal study and its results. Concluding, we discuss our findings with respect to their practical implications and suggestions for future research in medical informatics.</p><h4>Reflection</h4><p class="abstract-paragraph">One informal way of learning at work is through reflecting on work situations that employees themselves or colleagues have experienced [<span class="footers"><a class="citation-link" href="#ref9" rel="footnote">9</a></span>,<span class="footers"><a class="citation-link" href="#ref10" rel="footnote">10</a></span>]. Reflection is a process “in which people recapture their experience, think about it, mull it over and evaluate it” [<span class="footers"><a class="citation-link" href="#ref11" rel="footnote">11</a></span>]. Reflection is considered to be an important process in organizations, for example, for innovation [<span class="footers"><a class="citation-link" href="#ref12" rel="footnote">12</a></span>] or for organizational learning [<span class="footers"><a class="citation-link" href="#ref13" rel="footnote">13</a></span>,<span class="footers"><a class="citation-link" href="#ref14" rel="footnote">14</a></span>]. Although reflection is quite a natural process [<span class="footers"><a class="citation-link" href="#ref9" rel="footnote">9</a></span>], people often do not use it consciously or intentionally as a skill to improve learning and performance [<span class="footers"><a class="citation-link" href="#ref15" rel="footnote">15</a></span>]. Moreover, there are several other preconditions for the successful application of reflection in the workplace. On the part of the individual, not only a lack of awareness of the benefits of reflection, but also an absence of motivation for reflective thinking, as well as a lack of metacognitive skills like self-monitoring and self-evaluating might hinder reflective learning [<span class="footers"><a class="citation-link" href="#ref16" rel="footnote">16</a></span>]. On the part of the organization, there are also certain conditions necessary to foster reflective thinking. An organization that wants employees to engage in reflection needs to give them opportunities to participate in shaping their work environment, at least in some areas. If an organization is characterized by strong hierarchies and employees are not involved in decision-making processes, the potential for change through reflective thinking is quite limited [<span class="footers"><a class="citation-link" href="#ref16" rel="footnote">16</a></span>]. In sum, reflection, whether carried out individually or in teams, does not tend to occur by itself [<span class="footers"><a class="citation-link" href="#ref12" rel="footnote">12</a></span>], rather, it needs support [<span class="footers"><a class="citation-link" href="#ref13" rel="footnote">13</a></span>].</p><p class="abstract-paragraph">One area where reflection and reflective thinking are broadly researched topics is in the health care sector [<span class="footers"><a class="citation-link" href="#ref3" rel="footnote">3</a></span>,<span class="footers"><a class="citation-link" href="#ref17" rel="footnote">17</a></span>-<span class="footers"><a class="citation-link" href="#ref20" rel="footnote">20</a></span>]. A special focus of previous research has been on the education of nurses [<span class="footers"><a class="citation-link" href="#ref17" rel="footnote">17</a></span>-<span class="footers"><a class="citation-link" href="#ref21" rel="footnote">21</a></span>] and physicians [<span class="footers"><a class="citation-link" href="#ref1" rel="footnote">1</a></span>,<span class="footers"><a class="citation-link" href="#ref22" rel="footnote">22</a></span>-<span class="footers"><a class="citation-link" href="#ref26" rel="footnote">26</a></span>]. In hospitals, reflection helps the staff combine theory and practice [<span class="footers"><a class="citation-link" href="#ref3" rel="footnote">3</a></span>,<span class="footers"><a class="citation-link" href="#ref20" rel="footnote">20</a></span>] and enables them to turn experiences into learning opportunities [<span class="footers"><a class="citation-link" href="#ref27" rel="footnote">27</a></span>]. In this way, reflection and reflective work behavior foster continuing professional development [<span class="footers"><a class="citation-link" href="#ref28" rel="footnote">28</a></span>]. Research findings in this field suggest, however, that reflectivity is indeed not an easily applied skill. Instead, guidance and support are needed to achieve higher levels of reflection [<span class="footers"><a class="citation-link" href="#ref21" rel="footnote">21</a></span>].</p><p class="abstract-paragraph">Since reflection is rare, but important and valuable for health care professionals, research needs to find approaches that can support this process [<span class="footers"><a class="citation-link" href="#ref23" rel="footnote">23</a></span>]. One option that is relevant from a medical informatics perspective is the development of Web-based or mobile apps [<span class="footers"><a class="citation-link" href="#ref29" rel="footnote">29</a></span>-<span class="footers"><a class="citation-link" href="#ref31" rel="footnote">31</a></span>] to assist individuals and teams in their reflection processes in hospitals. These apps are supposed to support staff in exercising different aspects of reflection. Apps can remind people to reflect on their experiences and therefore compensate for low awareness or motivation. They can also extend the range of situations and experiences a single person faces, for example, by making additional experiences possible through virtual worlds or computer simulations. Moreover, apps can support collaborative reflection. Through collaborative reflection, people can learn from others and benefit from their experiences [<span class="footers"><a class="citation-link" href="#ref32" rel="footnote">32</a></span>]. Since memories of experiences can become imprecise over time, it is important to capture them in such a way that they can be used for further reflection [<span class="footers"><a class="citation-link" href="#ref33" rel="footnote">33</a></span>]. Apps can foster reflection in different ways, by providing experiences (eg, in virtual settings), documenting experiences, triggering reflection about experiences, and supporting communication and cooperation in collaborative reflection. So the first hypothesis of the current study is that (1) apps designed to foster reflection of health care professionals have a positive impact on the reflection activity of hospital staff.</p><h4>Job Satisfaction</h4><p class="abstract-paragraph">One reason why people learn for their job is that the tasks of the job require it. But this is not the only motive. People also learn because it helps them in their career and because they have certain personal goals [<span class="footers"><a class="citation-link" href="#ref6" rel="footnote">6</a></span>]. These goals comprise, among others, a need for personal achievement and development, and a feeling of autonomy [<span class="footers"><a class="citation-link" href="#ref6" rel="footnote">6</a></span>]. Job satisfaction can be interpreted as the sum of the job expectations employees have that are met [<span class="footers"><a class="citation-link" href="#ref34" rel="footnote">34</a></span>]. This means not only monetary expectations but also the wish to reach personal goals of development and achievement.</p><p class="abstract-paragraph">Consequently, we expect that job satisfaction is increased by good learning conditions. Some empirical evidence already exists for the potential influence of learning on job satisfaction. In different studies, significant correlations between organizational learning and job satisfaction [<span class="footers"><a class="citation-link" href="#ref35" rel="footnote">35</a></span>], as well as between workplace learning and job satisfaction [<span class="footers"><a class="citation-link" href="#ref36" rel="footnote">36</a></span>-<span class="footers"><a class="citation-link" href="#ref38" rel="footnote">38</a></span>] have been found. Other authors have identified organizational learning culture as a predictor for general job satisfaction [<span class="footers"><a class="citation-link" href="#ref39" rel="footnote">39</a></span>,<span class="footers"><a class="citation-link" href="#ref40" rel="footnote">40</a></span>]. There is also support for the assumption of a relationship between learning and job satisfaction in the health sector. A strong correlation has been identified between professional growth and job satisfaction among nurse practitioners [<span class="footers"><a class="citation-link" href="#ref41" rel="footnote">41</a></span>].</p><p class="abstract-paragraph">Because reflective learning is one type of informal learning that enables employees to develop and shape their working environment to a certain degree, we hypothesize that fostering reflection leads to an increase in job satisfaction. So the second hypothesis to be tested in this study is that (2) reflection is positively related to the job satisfaction of hospital staff.</p><br><h3 class="navigation-heading h3-main-heading" id="Methods" data-label="Methods">Methods</h3><h4>Study Design and Setting</h4><p class="abstract-paragraph">A longitudinal study was designed with the staff of a neurological hospital as participants. The study represented a 2 × 2 factorial design with reflection apps and time of measurement as between-subject factors. Due to privacy protection regulations, it was not possible to connect the data of the two measurement points on an individual level. Therefore, time of measurement could not be treated as a within-subject factor. Accordingly, we cannot completely rule out that the samples at the two points of measurement included slightly different individuals. But there was a low turnover rate in this hospital (around 3%); during the study, only two members left the unit that served as the experimental group. Reflection and job satisfaction were measured both before (2010) and after the introduction of the apps (2012).</p><p class="abstract-paragraph">The staff in one ward of the hospital participated as the experimental group. Participants in this group had the opportunity to use the apps. The staff in all the other wards of the hospital served as the control group. Participants in this group were not acquainted with the apps. The experimental group were ward personnel caring for patients suffering from acute strokes and other neurological emergencies (“Stroke Unit”). The staff of this ward consisted mainly of nurses and physicians. Participants of the control group were staff either of a ward treating all different kinds of neurological injuries, of a neurological intensive care unit, of a rehabilitation unit, or interdivisional staff.</p><h4>Procedure and Material</h4><p class="abstract-paragraph">In the period between the two data collections, participants were involved in user studies and workshops in order to examine the reflection behavior and needs of hospital staff. Those findings were accounted for in the development of the apps. After the development stage, participants in the experimental group tested the apps in workshops and used them during their everyday work. The developing and testing phases together covered the entire time span between the two points of measurement. During this time, several 1-day workshops as well as two user studies were conducted in order to give the entire staff the chance to participate. The participants were provided with devices to make sure everyone could use the apps and nobody was prevented from participation. The apps addressed the different aspects of reflection as described above.</p><p class="abstract-paragraph">DocTrain is an app for mobile phones as well as a Web application. It was developed to support physicians during their specialist training. It reminds its users to reflect upon their experiences and helps them document their tasks and capture and share with their mentor their progress in training elements. The app provides a list of tasks, and the users can connect them via the barcode of a patient case with a particular patient. Users can also add personal notes. Data can then be used to reflect about a case individually or with a mentor [<span class="footers"><a class="citation-link" href="#ref42" rel="footnote">42</a></span>].</p><p class="abstract-paragraph">CLinIC-The Virtual Tutor is a serious game. It was created to help nursing staff and physicians reflect on and prepare for difficult situations with patients. With the help of the game, users are provided with virtual experiences in handling difficult conversations with patients in order to be better prepared for corresponding situations in real life. A virtual tutor provides feedback and advice. Users can also take notes to reflect on them later. The set of tasks in the game is complemented by so-called mini games. These mini games are integrated into the branching stories of the game as a whole. They allow users to practice skills that are required in the health sector, such as recognizing emotional facial expressions and reflecting on them [<span class="footers"><a class="citation-link" href="#ref43" rel="footnote">43</a></span>,<span class="footers"><a class="citation-link" href="#ref44" rel="footnote">44</a></span>].</p><p class="abstract-paragraph">Finally, the Talk Reflection App allows users to reflect collaboratively on difficult situations with patients and relatives [<span class="footers"><a class="citation-link" href="#ref45" rel="footnote">45</a></span>]. It consists of a forum where users can contribute experiences with difficult conversations and reflect on them asynchronously together with colleagues. Users can document problematic experiences, share them with others, and add their own thoughts about the situations privately or publicly. Others can then contribute to this topic. In addition, users can document their reflection outcomes [<span class="footers"><a class="citation-link" href="#ref46" rel="footnote">46</a></span>]. So the app facilitates reflection by capturing data and provides support for coordination and communication in collaborative reflection.</p><h4>Data Collection</h4><p class="abstract-paragraph">A survey with the hospital staff was conducted twice during the study. The first data collection took place in November and December 2010. The second measurement point was October/November 2012. The response rate was 34.4% in 2010 and 40.6% in 2012.</p><h4>Participants</h4><p class="abstract-paragraph">In 2010, 167 employees of the hospital participated in the survey: 21 individuals worked in the Stroke Unit, 132 individuals in other wards of the hospital, and 14 did not indicate their ward affiliation. In 2012, 210 employees answered the questionnaire: 17 members of the Stroke Unit, 164 staff members of other wards, and 29 participants did not indicate their ward. The difference in group sizes between the experimental and the control group is due to the fact that the participants of the Stroke Unit were compared to the staff of all the other wards of the hospital; however, response rates did not differ between conditions (all <i>P</i>s>.05). Staff consisted of nurses, different kinds of therapists, physicians, and administration staff. Participants not indicating their ward were excluded from further analyses, so 334 individuals were considered for the investigation.</p><h4>Instruments</h4><p class="abstract-paragraph">A 10-item questionnaire was used to measure reflection. Items were created during the research project MIRROR [<span class="footers"><a class="citation-link" href="#ref47" rel="footnote">47</a></span>] on the basis of those aspects of reflection specified in the literature that were relevant to this study. Particularly relevant are the needs to reflect and to develop through reflection [<span class="footers"><a class="citation-link" href="#ref48" rel="footnote">48</a></span>]. These aspects concern the motivational side of reflection, since motivation is considered an important precondition for the occurrence of reflection [<span class="footers"><a class="citation-link" href="#ref10" rel="footnote">10</a></span>]. Another important requirement is the absence of barriers such as time pressure [<span class="footers"><a class="citation-link" href="#ref4" rel="footnote">4</a></span>,<span class="footers"><a class="citation-link" href="#ref10" rel="footnote">10</a></span>]. The positive consequences of collaborative reflection in terms of sharing and discussing experiences and different perspectives are described by several authors (eg, [<span class="footers"><a class="citation-link" href="#ref4" rel="footnote">4</a></span>,<span class="footers"><a class="citation-link" href="#ref9" rel="footnote">9</a></span>,<span class="footers"><a class="citation-link" href="#ref10" rel="footnote">10</a></span>,<span class="footers"><a class="citation-link" href="#ref13" rel="footnote">13</a></span>,<span class="footers"><a class="citation-link" href="#ref49" rel="footnote">49</a></span>]). Collaborative reflection includes team reasoning, that is, the collective analysis of problems [<span class="footers"><a class="citation-link" href="#ref9" rel="footnote">9</a></span>,<span class="footers"><a class="citation-link" href="#ref12" rel="footnote">12</a></span>,<span class="footers"><a class="citation-link" href="#ref50" rel="footnote">50</a></span>]. Collaborative reflection also includes support by a person with greater experience, such as a mentor or a supervisor [<span class="footers"><a class="citation-link" href="#ref9" rel="footnote">9</a></span>]. To make sure that the items were comprehensible to the participants, their content was discussed with various hospital representatives beforehand, and some revisions were made [<span class="footers"><a class="citation-link" href="#ref47" rel="footnote">47</a></span>]. The items that resulted from this procedure are listed in <span class="footers"><a class="citation-link" href="#table1" rel="footnote">Table 1</a></span>. Participants rated these items on 4-point Likert scales from 1=totally disagree to 4=totally agree.</p><p class="abstract-paragraph">In addition, participants were also asked 8 questions regarding general job satisfaction (<span class="footers"><a class="citation-link" href="#table2" rel="footnote">Table 2</a></span>). Participants rated these items also on 4-point Likert scales from 1=totally disagree to 4=totally agree. Moreover, they were asked to indicate their occupation group and the ward they worked in.</p><div class="figure-table"><figcaption><span class="typcn typcn-clipboard"></span>Table 1. Reflection items.</figcaption><table width="614" border="0" cellpadding="7" cellspacing="0" rules="groups" frame="hsides"><col width="40" span="1"><col width="546" span="1"><thead><tr valign="top"><td rowspan="1" colspan="1">No.</td><td rowspan="1" colspan="1">Item</td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">I often have the need to think about my work experiences.</td></tr><tr valign="top"><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">I am provided with enough time to reflect upon my experiences at work.</td></tr><tr valign="top"><td rowspan="1" colspan="1">3</td><td rowspan="1" colspan="1">It helps me for my development to think about my work experiences.</td></tr><tr valign="top"><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">We discuss on a regular basis if we work successfully together as a team.</td></tr><tr valign="top"><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">If things do not work out as they should, we try as a team to find the reason.</td></tr><tr valign="top"><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">We as a team think about how we can learn from past experiences.</td></tr><tr valign="top"><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with colleagues how I could improve.</td></tr><tr valign="top"><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with my supervisor how I could improve.</td></tr><tr valign="top"><td rowspan="1" colspan="1">9</td><td rowspan="1" colspan="1">I often think about how we can improve things in our organization.</td></tr><tr valign="top"><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">In our organization we are encouraged to reflect upon our experiences at work.</td></tr></tbody></table></div><div class="figure-table"><figcaption><span class="typcn typcn-clipboard"></span>Table 2. Job satisfaction items.</figcaption><table width="614" border="0" cellpadding="7" cellspacing="0" rules="groups" frame="hsides"><col width="40" span="1"><col width="546" span="1"><thead><tr valign="top"><td rowspan="1" colspan="1">No.</td><td rowspan="1" colspan="1">Item</td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1"><br></td><td rowspan="1" colspan="1">In general, I am satisfied with...</td></tr><tr valign="top"><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">…my work situation.</td></tr><tr valign="top"><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">…the advanced and professional training.</td></tr><tr valign="top"><td rowspan="1" colspan="1">3</td><td rowspan="1" colspan="1">…the work climate.</td></tr><tr valign="top"><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">…the communication.</td></tr><tr valign="top"><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">…the operational procedures.</td></tr><tr valign="top"><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">…the quality of care.</td></tr><tr valign="top"><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">…the leadership of my supervisor.</td></tr><tr valign="top"><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">…the neurological hospital as employer.</td></tr></tbody></table></div><h4>Statistical Analysis</h4><p class="abstract-paragraph">To assess the internal consistencies of the scales, we calculated Cronbach alpha values and conducted an exploratory factor analysis for the reflection scale. For testing hypothesis 1, we conducted a contrast analysis [<span class="footers"><a class="citation-link" href="#ref51" rel="footnote">51</a></span>]. The second time of measurement (2012) in the Stroke Unit ward was tested against the three other conditions (Stroke Unit 2010; other wards 2010 and 2012). For conducting the contrast analysis, we treated the 2 (2010 vs 2012) × 2 (Stroke Unit vs other wards) factors as a 1 × 4 design. The hypothesis that there was a higher level of reflection in the Stroke Unit in 2012 than in all other conditions (A>B=C=D) is represented in the focal contrast with the coefficients 3 -1 -1 -1. We also conducted an analysis of single items using <i>t</i> tests. For testing hypothesis 2, we calculated Pearson product-moment correlations for both the complete scales and for single items. Statistical analyses were conducted using IBM SPSS Statistics 20.</p><h4>Ethical Considerations</h4><p class="abstract-paragraph">Data collection was approved by the hospital’s works council and the data protection officer. Participants signed a consent form that was also approved by the works council and the data protection officer.</p><br><h3 class="navigation-heading h3-main-heading" id="Results" data-label="Results">Results</h3><h4>Internal Consistency and Factor Analysis</h4><p class="abstract-paragraph">The complete reflection scale had an internal consistency of alpha=.84. To further explore the structure of the scale, a factor analysis was conducted extracting two factors, using a Varimax rotation. The two factors explained 56% of the variance that emerged (factor 1: 37%, factor 2: 19%). After rotation, all items had factor loadings of at least .50 on one of the two factors and not more than .40 on the respective other factor. The first factor was labeled <i>collaborative reflection</i> and the second factor labeled <i>individual reflection</i>. The collaborative reflection subscale consisted of 7 items (items 2, 4-8, and 10 in <span class="footers"><a class="citation-link" href="#table1" rel="footnote">Table 1</a></span>) and had an internal consistency of alpha=.85. The corrected item-total correlations of these items are presented in <span class="footers"><a class="citation-link" href="#table3" rel="footnote">Table 3</a></span>. The individual reflection subscale consisted of 3 items (items 1, 3, and 9 in <span class="footers"><a class="citation-link" href="#table1" rel="footnote">Table 1</a></span>) and had only an internal consistency of alpha=.59. Therefore, we had to exclude this subscale from further analyses. The internal consistency of the job satisfaction scale was alpha=.89.</p><div class="figure-table"><figcaption><span class="typcn typcn-clipboard"></span>Table 3. Corrected item-total correlations of the collaborative reflection items.</figcaption><table width="800" border="0" cellpadding="7" cellspacing="0" rules="groups" frame="hsides"><col width="400" span="1"><col width="150" span="1"><thead><tr valign="top"><td rowspan="1" colspan="1">Item</td><td rowspan="1" colspan="1">Corrected item-total correlations</td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1">I am provided with enough time to reflect upon my experiences at work.</td><td rowspan="1" colspan="1">.38</td></tr><tr valign="top"><td rowspan="1" colspan="1">We discuss on a regular basis if we work successfully together as a team.</td><td rowspan="1" colspan="1">.66</td></tr><tr valign="top"><td rowspan="1" colspan="1">If things do not work out as they should, we try as a team to find the reason.</td><td rowspan="1" colspan="1">.68</td></tr><tr valign="top"><td rowspan="1" colspan="1">We as a team think about how we can learn from past experiences.</td><td rowspan="1" colspan="1">.75</td></tr><tr valign="top"><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with colleagues how I could improve myself.</td><td rowspan="1" colspan="1">.59</td></tr><tr valign="top"><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with my supervisor how I could improve myself.</td><td rowspan="1" colspan="1">.64</td></tr><tr valign="top"><td rowspan="1" colspan="1">In our organization we are encouraged to reflect upon our experiences at work.</td><td rowspan="1" colspan="1">.62</td></tr></tbody></table></div><h4>Reflection</h4><p class="abstract-paragraph">To test whether there was more reflection in the Stroke Unit in 2012 compared to 2010 and to the other wards (hypothesis 1), we conducted a contrast analysis with collaborative reflection as a dependent variable. To check whether there was systematic variance besides the variance of the focal contrast, we computed additional orthogonal contrasts. If the hypothesis of the focal contrast was correct, only the focal contrast but not the residual contrasts should be significant.</p><p class="abstract-paragraph">Regarding collaborative reflection, the hypothesis was supported by the data. There was a significant effect of the focal contrast: <i>F</i><sub>(1, 327)</sub>=3.97, <i>P</i>=.047, eta squared=.01. But there was no effect of the associated orthogonal effects: <i>F</i><sub>(1, 327)</sub>=1.90, <i>P</i>=.17. So the contrast analysis shows that collaborative reflection increased in the Stroke Unit from 2010 (mean 2.84, SD 0.72) to 2012 (mean 3.06, SD 0.63) but not in the other wards (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68).</p><p class="abstract-paragraph">In order to provide more information regarding their construct validity [<span class="footers"><a class="citation-link" href="#ref52" rel="footnote">52</a></span>], we also considered the particular items of the scale and compared the data of the Stroke Unit in 2012 with the combined other conditions on item level. Results are presented in <span class="footers"><a class="citation-link" href="#table4" rel="footnote">Table 4</a></span>. For five of the seven collaborative reflection items, we found significantly higher means for the Stroke Unit in 2012 compared to the other conditions.</p><div class="figure-table"><figcaption><span class="typcn typcn-clipboard"></span>Table 4. Collaborative reflection items: means, standard deviations, <i>t</i>, and <i>P</i> values.</figcaption><table width="1000" border="0" cellpadding="7" cellspacing="0" rules="groups" frame="hsides"><col width="180" span="1"><col width="120" span="1"><col width="110" span="1"><col width="65" span="1"><col width="70" span="1"><thead><tr valign="top"><td rowspan="1" colspan="1">Item</td><td rowspan="1" colspan="1">Stroke Unit 2012, mean (SD)</td><td rowspan="1" colspan="1">Other conditions, mean (SD)</td><td rowspan="1" colspan="1"><i>t</i> (df)</td><td rowspan="1" colspan="1"><i>P</i> (one-tailed)</td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1">I am provided with enough time to reflect upon my experiences at work.</td><td rowspan="1" colspan="1">2.81 (0.91)</td><td rowspan="1" colspan="1">2.38 (0.79)</td><td rowspan="1" colspan="1">2.14 (323)</td><td rowspan="1" colspan="1">.02</td></tr><tr valign="top"><td rowspan="1" colspan="1">We discuss on a regular basis if we work successfully together as a team.</td><td rowspan="1" colspan="1">3.35 (0.70)</td><td rowspan="1" colspan="1">2.53 (0.99)</td><td rowspan="1" colspan="1">4.59 (19.65)</td><td rowspan="1" colspan="1"><.001</td></tr><tr valign="top"><td rowspan="1" colspan="1">If things do not work out as they should, we try as a team to find the reason.</td><td rowspan="1" colspan="1">3.41 (0.71)</td><td rowspan="1" colspan="1">2.96 (0.93)</td><td rowspan="1" colspan="1">2.00 (328)</td><td rowspan="1" colspan="1">.02</td></tr><tr valign="top"><td rowspan="1" colspan="1">We as a team think about how we can learn from past experiences.</td><td rowspan="1" colspan="1">3.35 (0.61)</td><td rowspan="1" colspan="1">2.90 (0.91)</td><td rowspan="1" colspan="1">2.00 (329)</td><td rowspan="1" colspan="1">.02</td></tr><tr valign="top"><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with colleagues how I could improve myself.</td><td rowspan="1" colspan="1">3.00 (0.87)</td><td rowspan="1" colspan="1">2.98 (0.93)</td><td rowspan="1" colspan="1">0.08 (326)</td><td rowspan="1" colspan="1">.47</td></tr><tr valign="top"><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with my supervisor how I could improve myself.</td><td rowspan="1" colspan="1">2.88 (1.17)</td><td rowspan="1" colspan="1">2.37 (1.03)</td><td rowspan="1" colspan="1">1.98 (326)</td><td rowspan="1" colspan="1">.03</td></tr><tr valign="top"><td rowspan="1" colspan="1">In our organization we are encouraged to reflect upon our experiences at work.</td><td rowspan="1" colspan="1">2.65 (1.00)</td><td rowspan="1" colspan="1">2.50 (0.91)</td><td rowspan="1" colspan="1">0.67 (322)</td><td rowspan="1" colspan="1">.25</td></tr></tbody></table></div><h4>Job Satisfaction</h4><p class="abstract-paragraph">In order to test hypothesis 2, we computed a Pearson product-moment correlation to analyze the relationship between collaborative reflection and job satisfaction measurements. As expected, the collaborative reflection scale was positively correlated to the job satisfaction scale (<i>r</i>=.61, <i>P</i><.001).</p><p class="abstract-paragraph">Analogous to the presentation of the reflection results, we considered the single items of the collaborative reflection scale in order to provide more information regarding their construct validity. For this purpose, we computed Pearson product-moment correlations for job satisfaction with the individual items of the collaborative reflection scale. As shown in <span class="footers"><a class="citation-link" href="#table5" rel="footnote">Table 5</a></span>, all items of the collaborative reflection scale were positively correlated to job satisfaction (all <i>P</i>s<.001).</p><div class="figure-table"><figcaption><span class="typcn typcn-clipboard"></span>Table 5. Significant correlations of the collaborative reflection items with job satisfaction.</figcaption><table width="612" border="0" cellpadding="7" cellspacing="0" rules="groups" frame="hsides"><col width="503" span="1"><col width="81" span="1"><thead><tr valign="top"><td rowspan="1" colspan="1">Item</td><td rowspan="1" colspan="1"><i>r</i></td></tr></thead><tbody><tr valign="top"><td rowspan="1" colspan="1">I am provided with enough time to reflect upon my experiences at work.</td><td rowspan="1" colspan="1">.43</td></tr><tr valign="top"><td rowspan="1" colspan="1">We discuss on a regular basis if we work successfully together as a team.</td><td rowspan="1" colspan="1">.38</td></tr><tr valign="top"><td rowspan="1" colspan="1">If things do not work out as they should, we try as a team to find the reason.</td><td rowspan="1" colspan="1">.49</td></tr><tr valign="top"><td rowspan="1" colspan="1">We as a team think about how we can learn from past experiences.</td><td rowspan="1" colspan="1">.45</td></tr><tr valign="top"><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with colleagues how I could improve.</td><td rowspan="1" colspan="1">.37</td></tr><tr valign="top"><td rowspan="1" colspan="1">When I think I did not do a good job, I discuss with my supervisor how I could improve.</td><td rowspan="1" colspan="1">.42</td></tr><tr valign="top"><td rowspan="1" colspan="1">In our organization we are encouraged to reflect upon our experiences at work.</td><td rowspan="1" colspan="1">.58</td></tr></tbody></table></div><br><h3 class="navigation-heading h3-main-heading" id="Discussion" data-label="Discussion">Discussion</h3><h4>Main Findings</h4><p class="abstract-paragraph">The first goal of this study was to test whether the introduction of apps that support reflection would affect hospital staff’s actual reflection behavior at the workplace. We found an increase in collaborative reflection for those hospital employees who had the opportunity to use the apps. With regard to the contents of the reflection items, our findings illustrate which aspects of reflection the apps were particularly able to support. The apps facilitated the conjoint aspects of reflection. In 2012, participants in the Stroke Unit indicated to a higher degree that they discuss on a regular basis their work as a team. They also stated an increased effort to collaboratively learn from past experiences and to find reasons if something did not work out as it was intended. App users also indicated they increased communication with their supervisors. These are aspects that were explicitly addressed by the apps, since they aimed directly at collaborative reflection. The Talk Reflection app, for instance, was designed with the ambition of fostering collaborative reflection. DocTrain was not only designed for individual reflection but also for reflecting with a mentor. Finally, CLinIC simulated colleagues in the game and allowed for collaborative reflection as an opportunity to improve performance.</p><p class="abstract-paragraph">As expected, there was a positive relationship between reflection behavior and job satisfaction, indicating that higher levels of collaborative reflection processes go along with enhanced job satisfaction among participants in the hospital. This further supports the findings of other authors regarding a relationship between informal learning and job satisfaction as introduced above. The content of our collaborative reflection scale suggests that being provided with sufficient time to reflect, reflecting collaboratively in a team, and discussing work with a supervisor go along with a higher level of job satisfaction.</p><h4>Limitations and Future Work</h4><p class="abstract-paragraph">A limitation of this study is that there were three different reflection apps. Thus, it is not possible to say whether it was the co-actions of all the apps or only a particular app with certain features that led to the increase in reflection. The DocTrain app, for instance, mainly captures data for reflection. CLinIC provides users with additional experiences in a virtual world where they can test different reactions to a situation without doing any harm. But even a single app might itself foster reflection in diverse ways. In the case of the Talk Reflection app, for example, it could be that just writing down their problems helps users to think about them in a different way. But it could also be that the comments of their colleagues help them to acquire new insights. Future studies with single specific reflection apps should be designed to shed light on these questions.</p><p class="abstract-paragraph">Another issue is the topic of collaborative reflection. All apps aimed at fostering collaborative reflection. And in fact, participants in the experimental condition indicated that there was more reflection in the team after the introduction of the apps. However, it remains unclear whether this increase in reflective activity was directly affected by the apps, or whether it just happened that people started to talk about the experiences they had using the apps, or a combination of both. Our data do not ultimately indicate how often and in which way participants used the apps during their everyday work. Future studies should be designed in a way that allows capturing pertinent data about usage. In addition, we did not entirely evaluate the extent to which each individual item of the collaborative reflection scale represented typical reflection behavior from the perspective of the participants. Further research using qualitative methods should assess the representativeness of these items with respect to collaborative reflection.</p><p class="abstract-paragraph">Another limitation of the study is the character of the analysis of the relationship between reflection and job satisfaction. As the relationship could only be shown here correlatively, future research should study this relationship in more detail in order to find out under which conditions reflection apps increase general job satisfaction. Finally, it might be worthwhile for future research to examine the connection between app-induced reflection and other socio-emotional experiences of health care professionals over and above job satisfaction.</p><h4>Conclusions</h4><p class="abstract-paragraph">The current study shows that collaborative technology is relevant for health care professionals [<span class="footers"><a class="citation-link" href="#ref53" rel="footnote">53</a></span>] and that apps that support reflection have an impact on the collaborative reflection behavior of hospital staff. App designers should therefore have a special eye on the issue of collaborative reflection. Developers should also keep in mind that apps might preferably be used by the whole team of a hospital unit. In order to accommodate this preference, developers should consider the different occupation groups in their app design in order to facilitate multidisciplinary collaboration. Reflection apps should provide opportunities for simple and self-evident interactions with colleagues.</p><p class="abstract-paragraph">We also found that collaborative reflection is related to the job satisfaction of hospital staff, further indicating the high relevance of reflection for health care professionals. This provides an additional reason for designers of medical apps to look into this topic. Reflection apps seem to have strong potential in various respects. They may not only facilitate users’ cognitive processes, such as improving their ways of learning and working. Apps that foster reflection also seem to have the potential to support health care professionals on a socio-emotional level.</p></article><p><h4 class="h4-border-top">Acknowledgments</h4></p><p class="abstract-paragraph">This study was funded by a grant of the European Commission (grant number: 257617). For their important contributions to the development of the apps that were applied in this study, we would like to thank: Michael Prilla, Martin Degeling, Kada Benadjemia, and Jan Nierhoff (Information and Technology Management at the Institute for Applied Work Science, Ruhr University of Bochum, Germany); Lars Müller and Andreas Übelhör (FZI Research Center for Information Technologies, Karlsruhe, Germany); and the team of imaginary srl (Milan, Italy).</p><h4 class="h4-border-top">Conflicts of Interest</h4><p><p class="abstract-paragraph">None declared.</p></p><div class="footnotes"><h4 id="References" class="h4-border-top navigation-heading" data-label="References">References</h4><ol><li><span id="ref1">Aronson L, Niehaus B, Lindow J, Robertson PA, O'Sullivan PS. Development and pilot testing of a reflective learning guide for medical education. Med Teach 2011;33(10):e515-e521. 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Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.03.2014. </p><small class="article-license"><p class="abstract-paragraph">This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.</p></small><br></section></article></section></section></main> </div></div></div></div> <aside data-test="sidebar-exists" class="sidebar-citation col-lg-3 mb-5"> <div><h2 class="h4 green-heading-underline width-fit-content"> Citation </h2> <p class="fw-bold"> Please cite as: </p> <p><span> Renner B<span>,</span></span><span> Kimmerle J<span>,</span></span><span> Cavael D<span>,</span></span><span> Ziegler V<span>,</span></span><span> Reinmann L<span>,</span></span><span> Cress U</span> <br> <span>Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff</span> <br> <span>J Med Internet Res 2014;16(3):e85</span> <br> <span>doi: <span><a aria-label="DOI number 10.2196/jmir.3040" data-test="article-doi" target="_blank" href="https://doi.org/10.2196/jmir.3040"> 10.2196/jmir.3040 </a></span></span> <span 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Psych\u003C\u002Fa\u003E; \u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"\u002Fsearch\u002FsearchResult?field%5B%5D=author&criteria%5B%5D=Joachim+Kimmerle\" class=\"btn-view-author-options\"\u003EJoachim Kimmerle\u003Csup\u003E\u003Csmall\u003E1\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E\u003Csup\u003E*\u003C\u002Fsup\u003E, Dr rer nat\u003C\u002Fa\u003E; \u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"\u002Fsearch\u002FsearchResult?field%5B%5D=author&criteria%5B%5D=Dominik+Cavael\" class=\"btn-view-author-options\"\u003EDominik Cavael\u003Csup\u003E\u003Csmall\u003E2\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E, MA\u003C\u002Fa\u003E; \u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"\u002Fsearch\u002FsearchResult?field%5B%5D=author&criteria%5B%5D=Volker+Ziegler\" class=\"btn-view-author-options\"\u003EVolker Ziegler\u003Csup\u003E\u003Csmall\u003E2\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E, Dr med\u003C\u002Fa\u003E; \u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"\u002Fsearch\u002FsearchResult?field%5B%5D=author&criteria%5B%5D=Lisa+Reinmann\" class=\"btn-view-author-options\"\u003ELisa Reinmann\u003Csup\u003E\u003Csmall\u003E2\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E, BA (Hons)\u003C\u002Fa\u003E; \u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"\u002Fsearch\u002FsearchResult?field%5B%5D=author&criteria%5B%5D=Ulrike+Cress\" class=\"btn-view-author-options\"\u003EUlrike Cress\u003Csup\u003E\u003Csmall\u003E1,\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E\u003Csup\u003E\u003Csmall\u003E3\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E, Dr rer soc\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003C\u002Ful\u003E\u003Cdiv class=\"author-affiliation-details\"\u003E\u003Cp\u003E\u003Csup\u003E1\u003C\u002Fsup\u003EKnowledge Media Research Center (KMRC) , Tuebingen, Germany\u003C\u002Fp\u003E\u003Cp\u003E\u003Csup\u003E2\u003C\u002Fsup\u003ENeurological Clinic Bad Neustadt, Bad Neustadt, Germany\u003C\u002Fp\u003E\u003Cp\u003E\u003Csup\u003E3\u003C\u002Fsup\u003EUniversity of Tuebingen, Tuebingen, Germany\u003C\u002Fp\u003E\u003Cp\u003E*these authors contributed equally\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"corresponding-author-and-affiliations clearfix\"\u003E\u003Cdiv class=\"corresponding-author-details\"\u003E\u003Ch3\u003ECorresponding Author:\u003C\u002Fh3\u003E\u003Cp\u003EJoachim Kimmerle, Dr rer nat\u003C\u002Fp\u003E\u003Cp\u003E\u003C\u002Fp\u003E\u003Cp\u003EKnowledge Media Research Center (KMRC) \u003C\u002Fp\u003E\u003Cp\u003ESchleichstr 6\u003C\u002Fp\u003E\u003Cp\u003ETuebingen, 72076\u003C\u002Fp\u003E\u003Cp\u003EGermany\u003C\u002Fp\u003E\u003Cp\u003EPhone: 49 7071979363\u003C\u002Fp\u003E\u003Cp\u003EFax:49 7071979100\u003C\u002Fp\u003E\u003Cp\u003EEmail: \u003Ca href=\"mailto:j.kimmerle@iwm-kmrc.de\"\u003Ej.kimmerle@iwm-kmrc.de\u003C\u002Fa\u003E\u003C\u002Fp\u003E\u003Cbr\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Csection class=\"article-content clearfix\"\u003E\u003Carticle class=\"abstract\"\u003E\u003Ch3 id=\"Abstract\" class=\"navigation-heading\" data-label=\"Abstract\"\u003EAbstract\u003C\u002Fh3\u003E\u003Cp\u003E\u003Cspan class=\"abstract-sub-heading\"\u003EBackground: \u003C\u002Fspan\u003EReflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support.\u003Cbr\u003E\u003C\u002Fp\u003E\u003Cp\u003E\u003Cspan class=\"abstract-sub-heading\"\u003EObjective: \u003C\u002Fspan\u003EIn this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff’s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals.\u003Cbr\u003E\u003C\u002Fp\u003E\u003Cp\u003E\u003Cspan class=\"abstract-sub-heading\"\u003EMethods: \u003C\u002Fspan\u003EReflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167\u002F485) for the first and 40.6% (210\u002F517) for the second measure.\u003Cbr\u003E\u003C\u002Fp\u003E\u003Cp\u003E\u003Cspan class=\"abstract-sub-heading\"\u003EResults: \u003C\u002Fspan\u003ECollaborative reflection was increased (\u003Ci\u003EP\u003C\u002Fi\u003E=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (\u003Ci\u003Er\u003C\u002Fi\u003E=.61, \u003Ci\u003EP\u003C\u002Fi\u003E<.001).\u003Cbr\u003E\u003C\u002Fp\u003E\u003Cp\u003E\u003Cspan class=\"abstract-sub-heading\"\u003EConclusions: \u003C\u002Fspan\u003EThe findings provide evidence for an effect of the apps on hospital employees’ reflection behavior. Apps that foster reflective learning can increase health care professionals’ reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps.\u003Cbr\u003E\u003C\u002Fp\u003E\u003Cstrong class=\"h4-article-volume-issue\"\u003EJ Med Internet Res 2014;16(3):e85\u003C\u002Fstrong\u003E\u003Cbr\u003E\u003Cbr\u003E\u003Cspan class=\"article-doi\"\u003E\u003Ca href=\"https:\u002F\u002Fdoi.org\u002F10.2196\u002Fjmir.3040\"\u003Edoi:10.2196\u002Fjmir.3040\u003C\u002Fa\u003E\u003C\u002Fspan\u003E\u003Cbr\u003E\u003Cbr\u003E\u003Ch3 class=\"h3-main-heading\" id=\"Keywords\"\u003EKeywords\u003C\u002Fh3\u003E\u003Cdiv class=\"keywords\"\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=computer%20applications%20software\"\u003Ecomputer applications software\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=mobile%20applications\"\u003Emobile applications\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=learning\"\u003Elearning\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=education,%20continuing\"\u003Eeducation, continuing\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=job%20satisfaction\"\u003Ejob satisfaction\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=hospitals\"\u003Ehospitals\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=longitudinal%20studies\"\u003Elongitudinal studies\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=self%20report\"\u003Eself report\u003C\u002Fa\u003E \u003C\u002Fspan\u003E\u003C\u002Fdiv\u003E\u003Cdiv id=\"trendmd-suggestions\"\u003E\u003C\u002Fdiv\u003E\u003C\u002Farticle\u003E\u003Cbr\u003E\u003Carticle class=\"main-article clearfix\"\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"-Introduction\" data-label=\"-Introduction\"\u003E Introduction\u003C\u002Fh3\u003E\u003Ch4\u003EBackground\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003ELearning and the continuing development of employees are important issues in hospitals. Confronted with complex problems and stressful situations, nurses and physicians always need to keep their skills up to date and develop them further [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref1\" rel=\"footnote\"\u003E1\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref3\" rel=\"footnote\"\u003E3\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. This happens not only through formal training but also informally in the daily routine of health care professionals [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref4\" rel=\"footnote\"\u003E4\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref6\" rel=\"footnote\"\u003E6\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Hospital management needs not only skilled and competent employees but also contented employees, since dissatisfied nurses and physicians are more likely to resign [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref7\" rel=\"footnote\"\u003E7\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref8\" rel=\"footnote\"\u003E8\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Job satisfaction of health care staff is related to patient satisfaction [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref8\" rel=\"footnote\"\u003E8\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] and patient care (for an overview see [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref7\" rel=\"footnote\"\u003E7\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]) and therefore plays an important role when it comes to the quality of medical care.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EThe aim of the present study is to examine an easy and efficient way of supporting reflective learning in hospital staff. For this purpose, we tested the suitability of application software (apps) that support reflection. Our aim was also to examine the relationship between reflection and job satisfaction of hospital staff.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EWe present theoretical and empirical considerations of reflection processes in the workplace and of job satisfaction, with each presentation leading to a concrete hypothesis. Then we describe the methods of this longitudinal study and its results. Concluding, we discuss our findings with respect to their practical implications and suggestions for future research in medical informatics.\u003C\u002Fp\u003E\u003Ch4\u003EReflection\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EOne informal way of learning at work is through reflecting on work situations that employees themselves or colleagues have experienced [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref9\" rel=\"footnote\"\u003E9\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref10\" rel=\"footnote\"\u003E10\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Reflection is a process “in which people recapture their experience, think about it, mull it over and evaluate it” [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref11\" rel=\"footnote\"\u003E11\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Reflection is considered to be an important process in organizations, for example, for innovation [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref12\" rel=\"footnote\"\u003E12\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] or for organizational learning [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref13\" rel=\"footnote\"\u003E13\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref14\" rel=\"footnote\"\u003E14\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Although reflection is quite a natural process [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref9\" rel=\"footnote\"\u003E9\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], people often do not use it consciously or intentionally as a skill to improve learning and performance [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref15\" rel=\"footnote\"\u003E15\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Moreover, there are several other preconditions for the successful application of reflection in the workplace. On the part of the individual, not only a lack of awareness of the benefits of reflection, but also an absence of motivation for reflective thinking, as well as a lack of metacognitive skills like self-monitoring and self-evaluating might hinder reflective learning [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref16\" rel=\"footnote\"\u003E16\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. On the part of the organization, there are also certain conditions necessary to foster reflective thinking. An organization that wants employees to engage in reflection needs to give them opportunities to participate in shaping their work environment, at least in some areas. If an organization is characterized by strong hierarchies and employees are not involved in decision-making processes, the potential for change through reflective thinking is quite limited [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref16\" rel=\"footnote\"\u003E16\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. In sum, reflection, whether carried out individually or in teams, does not tend to occur by itself [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref12\" rel=\"footnote\"\u003E12\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], rather, it needs support [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref13\" rel=\"footnote\"\u003E13\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EOne area where reflection and reflective thinking are broadly researched topics is in the health care sector [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref3\" rel=\"footnote\"\u003E3\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref17\" rel=\"footnote\"\u003E17\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref20\" rel=\"footnote\"\u003E20\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. A special focus of previous research has been on the education of nurses [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref17\" rel=\"footnote\"\u003E17\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref21\" rel=\"footnote\"\u003E21\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] and physicians [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref1\" rel=\"footnote\"\u003E1\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref22\" rel=\"footnote\"\u003E22\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref26\" rel=\"footnote\"\u003E26\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. In hospitals, reflection helps the staff combine theory and practice [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref3\" rel=\"footnote\"\u003E3\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref20\" rel=\"footnote\"\u003E20\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] and enables them to turn experiences into learning opportunities [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref27\" rel=\"footnote\"\u003E27\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. In this way, reflection and reflective work behavior foster continuing professional development [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref28\" rel=\"footnote\"\u003E28\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Research findings in this field suggest, however, that reflectivity is indeed not an easily applied skill. Instead, guidance and support are needed to achieve higher levels of reflection [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref21\" rel=\"footnote\"\u003E21\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003ESince reflection is rare, but important and valuable for health care professionals, research needs to find approaches that can support this process [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref23\" rel=\"footnote\"\u003E23\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. One option that is relevant from a medical informatics perspective is the development of Web-based or mobile apps [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref29\" rel=\"footnote\"\u003E29\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref31\" rel=\"footnote\"\u003E31\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] to assist individuals and teams in their reflection processes in hospitals. These apps are supposed to support staff in exercising different aspects of reflection. Apps can remind people to reflect on their experiences and therefore compensate for low awareness or motivation. They can also extend the range of situations and experiences a single person faces, for example, by making additional experiences possible through virtual worlds or computer simulations. Moreover, apps can support collaborative reflection. Through collaborative reflection, people can learn from others and benefit from their experiences [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref32\" rel=\"footnote\"\u003E32\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Since memories of experiences can become imprecise over time, it is important to capture them in such a way that they can be used for further reflection [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref33\" rel=\"footnote\"\u003E33\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Apps can foster reflection in different ways, by providing experiences (eg, in virtual settings), documenting experiences, triggering reflection about experiences, and supporting communication and cooperation in collaborative reflection. So the first hypothesis of the current study is that (1) apps designed to foster reflection of health care professionals have a positive impact on the reflection activity of hospital staff.\u003C\u002Fp\u003E\u003Ch4\u003EJob Satisfaction\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EOne reason why people learn for their job is that the tasks of the job require it. But this is not the only motive. People also learn because it helps them in their career and because they have certain personal goals [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref6\" rel=\"footnote\"\u003E6\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. These goals comprise, among others, a need for personal achievement and development, and a feeling of autonomy [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref6\" rel=\"footnote\"\u003E6\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Job satisfaction can be interpreted as the sum of the job expectations employees have that are met [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref34\" rel=\"footnote\"\u003E34\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. This means not only monetary expectations but also the wish to reach personal goals of development and achievement.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EConsequently, we expect that job satisfaction is increased by good learning conditions. Some empirical evidence already exists for the potential influence of learning on job satisfaction. In different studies, significant correlations between organizational learning and job satisfaction [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref35\" rel=\"footnote\"\u003E35\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], as well as between workplace learning and job satisfaction [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref36\" rel=\"footnote\"\u003E36\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref38\" rel=\"footnote\"\u003E38\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] have been found. Other authors have identified organizational learning culture as a predictor for general job satisfaction [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref39\" rel=\"footnote\"\u003E39\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref40\" rel=\"footnote\"\u003E40\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. There is also support for the assumption of a relationship between learning and job satisfaction in the health sector. A strong correlation has been identified between professional growth and job satisfaction among nurse practitioners [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref41\" rel=\"footnote\"\u003E41\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EBecause reflective learning is one type of informal learning that enables employees to develop and shape their working environment to a certain degree, we hypothesize that fostering reflection leads to an increase in job satisfaction. So the second hypothesis to be tested in this study is that (2) reflection is positively related to the job satisfaction of hospital staff.\u003C\u002Fp\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"Methods\" data-label=\"Methods\"\u003EMethods\u003C\u002Fh3\u003E\u003Ch4\u003EStudy Design and Setting\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EA longitudinal study was designed with the staff of a neurological hospital as participants. The study represented a 2 × 2 factorial design with reflection apps and time of measurement as between-subject factors. Due to privacy protection regulations, it was not possible to connect the data of the two measurement points on an individual level. Therefore, time of measurement could not be treated as a within-subject factor. Accordingly, we cannot completely rule out that the samples at the two points of measurement included slightly different individuals. But there was a low turnover rate in this hospital (around 3%); during the study, only two members left the unit that served as the experimental group. Reflection and job satisfaction were measured both before (2010) and after the introduction of the apps (2012).\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EThe staff in one ward of the hospital participated as the experimental group. Participants in this group had the opportunity to use the apps. The staff in all the other wards of the hospital served as the control group. Participants in this group were not acquainted with the apps. The experimental group were ward personnel caring for patients suffering from acute strokes and other neurological emergencies (“Stroke Unit”). The staff of this ward consisted mainly of nurses and physicians. Participants of the control group were staff either of a ward treating all different kinds of neurological injuries, of a neurological intensive care unit, of a rehabilitation unit, or interdivisional staff.\u003C\u002Fp\u003E\u003Ch4\u003EProcedure and Material\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EIn the period between the two data collections, participants were involved in user studies and workshops in order to examine the reflection behavior and needs of hospital staff. Those findings were accounted for in the development of the apps. After the development stage, participants in the experimental group tested the apps in workshops and used them during their everyday work. The developing and testing phases together covered the entire time span between the two points of measurement. During this time, several 1-day workshops as well as two user studies were conducted in order to give the entire staff the chance to participate. The participants were provided with devices to make sure everyone could use the apps and nobody was prevented from participation. The apps addressed the different aspects of reflection as described above.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EDocTrain is an app for mobile phones as well as a Web application. It was developed to support physicians during their specialist training. It reminds its users to reflect upon their experiences and helps them document their tasks and capture and share with their mentor their progress in training elements. The app provides a list of tasks, and the users can connect them via the barcode of a patient case with a particular patient. Users can also add personal notes. Data can then be used to reflect about a case individually or with a mentor [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref42\" rel=\"footnote\"\u003E42\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003ECLinIC-The Virtual Tutor is a serious game. It was created to help nursing staff and physicians reflect on and prepare for difficult situations with patients. With the help of the game, users are provided with virtual experiences in handling difficult conversations with patients in order to be better prepared for corresponding situations in real life. A virtual tutor provides feedback and advice. Users can also take notes to reflect on them later. The set of tasks in the game is complemented by so-called mini games. These mini games are integrated into the branching stories of the game as a whole. They allow users to practice skills that are required in the health sector, such as recognizing emotional facial expressions and reflecting on them [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref43\" rel=\"footnote\"\u003E43\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref44\" rel=\"footnote\"\u003E44\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EFinally, the Talk Reflection App allows users to reflect collaboratively on difficult situations with patients and relatives [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref45\" rel=\"footnote\"\u003E45\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. It consists of a forum where users can contribute experiences with difficult conversations and reflect on them asynchronously together with colleagues. Users can document problematic experiences, share them with others, and add their own thoughts about the situations privately or publicly. Others can then contribute to this topic. In addition, users can document their reflection outcomes [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref46\" rel=\"footnote\"\u003E46\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. So the app facilitates reflection by capturing data and provides support for coordination and communication in collaborative reflection.\u003C\u002Fp\u003E\u003Ch4\u003EData Collection\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EA survey with the hospital staff was conducted twice during the study. The first data collection took place in November and December 2010. The second measurement point was October\u002FNovember 2012. The response rate was 34.4% in 2010 and 40.6% in 2012.\u003C\u002Fp\u003E\u003Ch4\u003EParticipants\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EIn 2010, 167 employees of the hospital participated in the survey: 21 individuals worked in the Stroke Unit, 132 individuals in other wards of the hospital, and 14 did not indicate their ward affiliation. In 2012, 210 employees answered the questionnaire: 17 members of the Stroke Unit, 164 staff members of other wards, and 29 participants did not indicate their ward. The difference in group sizes between the experimental and the control group is due to the fact that the participants of the Stroke Unit were compared to the staff of all the other wards of the hospital; however, response rates did not differ between conditions (all \u003Ci\u003EP\u003C\u002Fi\u003Es>.05). Staff consisted of nurses, different kinds of therapists, physicians, and administration staff. Participants not indicating their ward were excluded from further analyses, so 334 individuals were considered for the investigation.\u003C\u002Fp\u003E\u003Ch4\u003EInstruments\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EA 10-item questionnaire was used to measure reflection. Items were created during the research project MIRROR [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref47\" rel=\"footnote\"\u003E47\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] on the basis of those aspects of reflection specified in the literature that were relevant to this study. Particularly relevant are the needs to reflect and to develop through reflection [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref48\" rel=\"footnote\"\u003E48\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. These aspects concern the motivational side of reflection, since motivation is considered an important precondition for the occurrence of reflection [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref10\" rel=\"footnote\"\u003E10\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Another important requirement is the absence of barriers such as time pressure [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref4\" rel=\"footnote\"\u003E4\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref10\" rel=\"footnote\"\u003E10\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. The positive consequences of collaborative reflection in terms of sharing and discussing experiences and different perspectives are described by several authors (eg, [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref4\" rel=\"footnote\"\u003E4\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref9\" rel=\"footnote\"\u003E9\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref10\" rel=\"footnote\"\u003E10\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref13\" rel=\"footnote\"\u003E13\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref49\" rel=\"footnote\"\u003E49\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]). Collaborative reflection includes team reasoning, that is, the collective analysis of problems [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref9\" rel=\"footnote\"\u003E9\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref12\" rel=\"footnote\"\u003E12\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref50\" rel=\"footnote\"\u003E50\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Collaborative reflection also includes support by a person with greater experience, such as a mentor or a supervisor [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref9\" rel=\"footnote\"\u003E9\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. To make sure that the items were comprehensible to the participants, their content was discussed with various hospital representatives beforehand, and some revisions were made [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref47\" rel=\"footnote\"\u003E47\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. The items that resulted from this procedure are listed in \u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#table1\" rel=\"footnote\"\u003ETable 1\u003C\u002Fa\u003E\u003C\u002Fspan\u003E. Participants rated these items on 4-point Likert scales from 1=totally disagree to 4=totally agree.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EIn addition, participants were also asked 8 questions regarding general job satisfaction (\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#table2\" rel=\"footnote\"\u003ETable 2\u003C\u002Fa\u003E\u003C\u002Fspan\u003E). Participants rated these items also on 4-point Likert scales from 1=totally disagree to 4=totally agree. Moreover, they were asked to indicate their occupation group and the ward they worked in.\u003C\u002Fp\u003E\u003Cdiv class=\"figure-table\"\u003E\u003Cfigcaption\u003E\u003Cspan class=\"typcn typcn-clipboard\"\u003E\u003C\u002Fspan\u003ETable 1.\n Reflection items.\u003C\u002Ffigcaption\u003E\u003Ctable width=\"614\" border=\"0\" cellpadding=\"7\" cellspacing=\"0\" rules=\"groups\" frame=\"hsides\"\u003E\u003Ccol width=\"40\" span=\"1\"\u003E\u003Ccol width=\"546\" span=\"1\"\u003E\u003Cthead\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003ENo.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EItem\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Fthead\u003E\u003Ctbody\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E1\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EI often have the need to think about my work experiences.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EI am provided with enough time to reflect upon my experiences at work.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E3\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIt helps me for my development to think about my work experiences.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E4\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe discuss on a regular basis if we work successfully together as a team.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E5\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIf things do not work out as they should, we try as a team to find the reason.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E6\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe as a team think about how we can learn from past experiences.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E7\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with colleagues how I could improve.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E8\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with my supervisor how I could improve.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E9\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EI often think about how we can improve things in our organization.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E10\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIn our organization we are encouraged to reflect upon our experiences at work.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Ftbody\u003E\u003C\u002Ftable\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"figure-table\"\u003E\u003Cfigcaption\u003E\u003Cspan class=\"typcn typcn-clipboard\"\u003E\u003C\u002Fspan\u003ETable 2.\n Job satisfaction items.\u003C\u002Ffigcaption\u003E\u003Ctable width=\"614\" border=\"0\" cellpadding=\"7\" cellspacing=\"0\" rules=\"groups\" frame=\"hsides\"\u003E\u003Ccol width=\"40\" span=\"1\"\u003E\u003Ccol width=\"546\" span=\"1\"\u003E\u003Cthead\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003ENo.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EItem\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Fthead\u003E\u003Ctbody\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E\u003Cbr\u003E\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIn general, I am satisfied with...\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E1\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…my work situation.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…the advanced and professional training.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E3\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…the work climate.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E4\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…the communication.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E5\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…the operational procedures.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E6\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…the quality of care.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E7\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…the leadership of my supervisor.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E8\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E…the neurological hospital as employer.\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Ftbody\u003E\u003C\u002Ftable\u003E\u003C\u002Fdiv\u003E\u003Ch4\u003EStatistical Analysis\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003ETo assess the internal consistencies of the scales, we calculated Cronbach alpha values and conducted an exploratory factor analysis for the reflection scale. For testing hypothesis 1, we conducted a contrast analysis [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref51\" rel=\"footnote\"\u003E51\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. The second time of measurement (2012) in the Stroke Unit ward was tested against the three other conditions (Stroke Unit 2010; other wards 2010 and 2012). For conducting the contrast analysis, we treated the 2 (2010 vs 2012) × 2 (Stroke Unit vs other wards) factors as a 1 × 4 design. The hypothesis that there was a higher level of reflection in the Stroke Unit in 2012 than in all other conditions (A>B=C=D) is represented in the focal contrast with the coefficients 3 -1 -1 -1. We also conducted an analysis of single items using \u003Ci\u003Et\u003C\u002Fi\u003E tests. For testing hypothesis 2, we calculated Pearson product-moment correlations for both the complete scales and for single items. Statistical analyses were conducted using IBM SPSS Statistics 20.\u003C\u002Fp\u003E\u003Ch4\u003EEthical Considerations\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EData collection was approved by the hospital’s works council and the data protection officer. Participants signed a consent form that was also approved by the works council and the data protection officer.\u003C\u002Fp\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"Results\" data-label=\"Results\"\u003EResults\u003C\u002Fh3\u003E\u003Ch4\u003EInternal Consistency and Factor Analysis\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EThe complete reflection scale had an internal consistency of alpha=.84. To further explore the structure of the scale, a factor analysis was conducted extracting two factors, using a Varimax rotation. The two factors explained 56% of the variance that emerged (factor 1: 37%, factor 2: 19%). After rotation, all items had factor loadings of at least .50 on one of the two factors and not more than .40 on the respective other factor. The first factor was labeled \u003Ci\u003Ecollaborative reflection\u003C\u002Fi\u003E and the second factor labeled \u003Ci\u003Eindividual reflection\u003C\u002Fi\u003E. The collaborative reflection subscale consisted of 7 items (items 2, 4-8, and 10 in \u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#table1\" rel=\"footnote\"\u003ETable 1\u003C\u002Fa\u003E\u003C\u002Fspan\u003E) and had an internal consistency of alpha=.85. The corrected item-total correlations of these items are presented in \u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#table3\" rel=\"footnote\"\u003ETable 3\u003C\u002Fa\u003E\u003C\u002Fspan\u003E. The individual reflection subscale consisted of 3 items (items 1, 3, and 9 in \u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#table1\" rel=\"footnote\"\u003ETable 1\u003C\u002Fa\u003E\u003C\u002Fspan\u003E) and had only an internal consistency of alpha=.59. Therefore, we had to exclude this subscale from further analyses. The internal consistency of the job satisfaction scale was alpha=.89.\u003C\u002Fp\u003E\u003Cdiv class=\"figure-table\"\u003E\u003Cfigcaption\u003E\u003Cspan class=\"typcn typcn-clipboard\"\u003E\u003C\u002Fspan\u003ETable 3.\n Corrected item-total correlations of the collaborative reflection items.\u003C\u002Ffigcaption\u003E\u003Ctable width=\"800\" border=\"0\" cellpadding=\"7\" cellspacing=\"0\" rules=\"groups\" frame=\"hsides\"\u003E\u003Ccol width=\"400\" span=\"1\"\u003E\u003Ccol width=\"150\" span=\"1\"\u003E\u003Cthead\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EItem\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003ECorrected item-total correlations\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Fthead\u003E\u003Ctbody\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EI am provided with enough time to reflect upon my experiences at work.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.38\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe discuss on a regular basis if we work successfully together as a team.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.66\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIf things do not work out as they should, we try as a team to find the reason.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.68\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe as a team think about how we can learn from past experiences.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.75\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with colleagues how I could improve myself.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.59\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with my supervisor how I could improve myself.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.64\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIn our organization we are encouraged to reflect upon our experiences at work.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.62\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Ftbody\u003E\u003C\u002Ftable\u003E\u003C\u002Fdiv\u003E\u003Ch4\u003EReflection\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003ETo test whether there was more reflection in the Stroke Unit in 2012 compared to 2010 and to the other wards (hypothesis 1), we conducted a contrast analysis with collaborative reflection as a dependent variable. To check whether there was systematic variance besides the variance of the focal contrast, we computed additional orthogonal contrasts. If the hypothesis of the focal contrast was correct, only the focal contrast but not the residual contrasts should be significant.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003ERegarding collaborative reflection, the hypothesis was supported by the data. There was a significant effect of the focal contrast: \u003Ci\u003EF\u003C\u002Fi\u003E\u003Csub\u003E(1, 327)\u003C\u002Fsub\u003E=3.97, \u003Ci\u003EP\u003C\u002Fi\u003E=.047, eta squared=.01. But there was no effect of the associated orthogonal effects: \u003Ci\u003EF\u003C\u002Fi\u003E\u003Csub\u003E(1, 327)\u003C\u002Fsub\u003E=1.90, \u003Ci\u003EP\u003C\u002Fi\u003E=.17. So the contrast analysis shows that collaborative reflection increased in the Stroke Unit from 2010 (mean 2.84, SD 0.72) to 2012 (mean 3.06, SD 0.63) but not in the other wards (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68).\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EIn order to provide more information regarding their construct validity [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref52\" rel=\"footnote\"\u003E52\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], we also considered the particular items of the scale and compared the data of the Stroke Unit in 2012 with the combined other conditions on item level. Results are presented in \u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#table4\" rel=\"footnote\"\u003ETable 4\u003C\u002Fa\u003E\u003C\u002Fspan\u003E. For five of the seven collaborative reflection items, we found significantly higher means for the Stroke Unit in 2012 compared to the other conditions.\u003C\u002Fp\u003E\u003Cdiv class=\"figure-table\"\u003E\u003Cfigcaption\u003E\u003Cspan class=\"typcn typcn-clipboard\"\u003E\u003C\u002Fspan\u003ETable 4.\n Collaborative reflection items: means, standard deviations, \u003Ci\u003Et\u003C\u002Fi\u003E, and \u003Ci\u003EP\u003C\u002Fi\u003E values.\u003C\u002Ffigcaption\u003E\u003Ctable width=\"1000\" border=\"0\" cellpadding=\"7\" cellspacing=\"0\" rules=\"groups\" frame=\"hsides\"\u003E\u003Ccol width=\"180\" span=\"1\"\u003E\u003Ccol width=\"120\" span=\"1\"\u003E\u003Ccol width=\"110\" span=\"1\"\u003E\u003Ccol width=\"65\" span=\"1\"\u003E\u003Ccol width=\"70\" span=\"1\"\u003E\u003Cthead\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EItem\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EStroke Unit 2012, mean (SD)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EOther conditions, mean (SD)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E\u003Ci\u003Et\u003C\u002Fi\u003E (df)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E\u003Ci\u003EP\u003C\u002Fi\u003E (one-tailed)\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Fthead\u003E\u003Ctbody\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EI am provided with enough time to reflect upon my experiences at work.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.81 (0.91)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.38 (0.79)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.14 (323)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.02\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe discuss on a regular basis if we work successfully together as a team.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E3.35 (0.70)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.53 (0.99)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E4.59 (19.65)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E<.001\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIf things do not work out as they should, we try as a team to find the reason.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E3.41 (0.71)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.96 (0.93)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.00 (328)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.02\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe as a team think about how we can learn from past experiences.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E3.35 (0.61)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.90 (0.91)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.00 (329)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.02\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with colleagues how I could improve myself.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E3.00 (0.87)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.98 (0.93)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E0.08 (326)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.47\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with my supervisor how I could improve myself.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.88 (1.17)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.37 (1.03)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E1.98 (326)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.03\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIn our organization we are encouraged to reflect upon our experiences at work.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.65 (1.00)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E2.50 (0.91)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E0.67 (322)\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.25\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Ftbody\u003E\u003C\u002Ftable\u003E\u003C\u002Fdiv\u003E\u003Ch4\u003EJob Satisfaction\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EIn order to test hypothesis 2, we computed a Pearson product-moment correlation to analyze the relationship between collaborative reflection and job satisfaction measurements. As expected, the collaborative reflection scale was positively correlated to the job satisfaction scale (\u003Ci\u003Er\u003C\u002Fi\u003E=.61, \u003Ci\u003EP\u003C\u002Fi\u003E<.001).\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EAnalogous to the presentation of the reflection results, we considered the single items of the collaborative reflection scale in order to provide more information regarding their construct validity. For this purpose, we computed Pearson product-moment correlations for job satisfaction with the individual items of the collaborative reflection scale. As shown in \u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#table5\" rel=\"footnote\"\u003ETable 5\u003C\u002Fa\u003E\u003C\u002Fspan\u003E, all items of the collaborative reflection scale were positively correlated to job satisfaction (all \u003Ci\u003EP\u003C\u002Fi\u003Es<.001).\u003C\u002Fp\u003E\u003Cdiv class=\"figure-table\"\u003E\u003Cfigcaption\u003E\u003Cspan class=\"typcn typcn-clipboard\"\u003E\u003C\u002Fspan\u003ETable 5.\n Significant correlations of the collaborative reflection items with job satisfaction.\u003C\u002Ffigcaption\u003E\u003Ctable width=\"612\" border=\"0\" cellpadding=\"7\" cellspacing=\"0\" rules=\"groups\" frame=\"hsides\"\u003E\u003Ccol width=\"503\" span=\"1\"\u003E\u003Ccol width=\"81\" span=\"1\"\u003E\u003Cthead\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EItem\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E\u003Ci\u003Er\u003C\u002Fi\u003E\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Fthead\u003E\u003Ctbody\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EI am provided with enough time to reflect upon my experiences at work.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.43\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe discuss on a regular basis if we work successfully together as a team.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.38\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIf things do not work out as they should, we try as a team to find the reason.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.49\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWe as a team think about how we can learn from past experiences.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.45\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with colleagues how I could improve.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.37\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EWhen I think I did not do a good job, I discuss with my supervisor how I could improve.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.42\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr valign=\"top\"\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003EIn our organization we are encouraged to reflect upon our experiences at work.\u003C\u002Ftd\u003E\u003Ctd rowspan=\"1\" colspan=\"1\"\u003E.58\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Ftbody\u003E\u003C\u002Ftable\u003E\u003C\u002Fdiv\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"Discussion\" data-label=\"Discussion\"\u003EDiscussion\u003C\u002Fh3\u003E\u003Ch4\u003EMain Findings\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EThe first goal of this study was to test whether the introduction of apps that support reflection would affect hospital staff’s actual reflection behavior at the workplace. We found an increase in collaborative reflection for those hospital employees who had the opportunity to use the apps. With regard to the contents of the reflection items, our findings illustrate which aspects of reflection the apps were particularly able to support. The apps facilitated the conjoint aspects of reflection. In 2012, participants in the Stroke Unit indicated to a higher degree that they discuss on a regular basis their work as a team. They also stated an increased effort to collaboratively learn from past experiences and to find reasons if something did not work out as it was intended. App users also indicated they increased communication with their supervisors. These are aspects that were explicitly addressed by the apps, since they aimed directly at collaborative reflection. The Talk Reflection app, for instance, was designed with the ambition of fostering collaborative reflection. DocTrain was not only designed for individual reflection but also for reflecting with a mentor. Finally, CLinIC simulated colleagues in the game and allowed for collaborative reflection as an opportunity to improve performance.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EAs expected, there was a positive relationship between reflection behavior and job satisfaction, indicating that higher levels of collaborative reflection processes go along with enhanced job satisfaction among participants in the hospital. This further supports the findings of other authors regarding a relationship between informal learning and job satisfaction as introduced above. The content of our collaborative reflection scale suggests that being provided with sufficient time to reflect, reflecting collaboratively in a team, and discussing work with a supervisor go along with a higher level of job satisfaction.\u003C\u002Fp\u003E\u003Ch4\u003ELimitations and Future Work\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EA limitation of this study is that there were three different reflection apps. Thus, it is not possible to say whether it was the co-actions of all the apps or only a particular app with certain features that led to the increase in reflection. The DocTrain app, for instance, mainly captures data for reflection. CLinIC provides users with additional experiences in a virtual world where they can test different reactions to a situation without doing any harm. But even a single app might itself foster reflection in diverse ways. In the case of the Talk Reflection app, for example, it could be that just writing down their problems helps users to think about them in a different way. But it could also be that the comments of their colleagues help them to acquire new insights. Future studies with single specific reflection apps should be designed to shed light on these questions.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EAnother issue is the topic of collaborative reflection. All apps aimed at fostering collaborative reflection. And in fact, participants in the experimental condition indicated that there was more reflection in the team after the introduction of the apps. However, it remains unclear whether this increase in reflective activity was directly affected by the apps, or whether it just happened that people started to talk about the experiences they had using the apps, or a combination of both. Our data do not ultimately indicate how often and in which way participants used the apps during their everyday work. Future studies should be designed in a way that allows capturing pertinent data about usage. In addition, we did not entirely evaluate the extent to which each individual item of the collaborative reflection scale represented typical reflection behavior from the perspective of the participants. Further research using qualitative methods should assess the representativeness of these items with respect to collaborative reflection.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EAnother limitation of the study is the character of the analysis of the relationship between reflection and job satisfaction. As the relationship could only be shown here correlatively, future research should study this relationship in more detail in order to find out under which conditions reflection apps increase general job satisfaction. Finally, it might be worthwhile for future research to examine the connection between app-induced reflection and other socio-emotional experiences of health care professionals over and above job satisfaction.\u003C\u002Fp\u003E\u003Ch4\u003EConclusions\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EThe current study shows that collaborative technology is relevant for health care professionals [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref53\" rel=\"footnote\"\u003E53\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] and that apps that support reflection have an impact on the collaborative reflection behavior of hospital staff. App designers should therefore have a special eye on the issue of collaborative reflection. Developers should also keep in mind that apps might preferably be used by the whole team of a hospital unit. In order to accommodate this preference, developers should consider the different occupation groups in their app design in order to facilitate multidisciplinary collaboration. Reflection apps should provide opportunities for simple and self-evident interactions with colleagues.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EWe also found that collaborative reflection is related to the job satisfaction of hospital staff, further indicating the high relevance of reflection for health care professionals. This provides an additional reason for designers of medical apps to look into this topic. Reflection apps seem to have strong potential in various respects. They may not only facilitate users’ cognitive processes, such as improving their ways of learning and working. Apps that foster reflection also seem to have the potential to support health care professionals on a socio-emotional level.\u003C\u002Fp\u003E\u003C\u002Farticle\u003E\u003Cp\u003E\u003Ch4 class=\"h4-border-top\"\u003EAcknowledgments\u003C\u002Fh4\u003E\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EThis study was funded by a grant of the European Commission (grant number: 257617). For their important contributions to the development of the apps that were applied in this study, we would like to thank: Michael Prilla, Martin Degeling, Kada Benadjemia, and Jan Nierhoff (Information and Technology Management at the Institute for Applied Work Science, Ruhr University of Bochum, Germany); Lars Müller and Andreas Übelhör (FZI Research Center for Information Technologies, Karlsruhe, Germany); and the team of imaginary srl (Milan, Italy).\u003C\u002Fp\u003E\u003Ch4 class=\"h4-border-top\"\u003EConflicts of Interest\u003C\u002Fh4\u003E\u003Cp\u003E\u003Cp class=\"abstract-paragraph\"\u003ENone declared.\u003C\u002Fp\u003E\u003C\u002Fp\u003E\u003Cdiv class=\"footnotes\"\u003E\u003Ch4 id=\"References\" class=\"h4-border-top navigation-heading\" data-label=\"References\"\u003EReferences\u003C\u002Fh4\u003E\u003Col\u003E\u003Cli\u003E\u003Cspan id=\"ref1\"\u003EAronson L, Niehaus B, Lindow J, Robertson PA, O'Sullivan PS. Development and pilot testing of a reflective learning guide for medical education. Med Teach 2011;33(10):e515-e521. [\u003Ca target=\"_blank\" href=\"https:\u002F\u002Fdx.doi.org\u002F10.3109\u002F0142159X.2011.599894\"\u003ECrossRef\u003C\u002Fa\u003E] [\u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fentrez\u002Fquery.fcgi?cmd=Retrieve&db=PubMed&list_uids=21942487&dopt=Abstract\" target=\"_blank\"\u003EMedline\u003C\u002Fa\u003E]\u003C\u002Fspan\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Cspan id=\"ref2\"\u003EABIM Foundation. American Board of Internal Medicine, ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002;136(3):243-246. 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[\u003Ca target=\"_blank\" href=\"https:\u002F\u002Fdx.doi.org\u002F10.1111\u002Fmedu.12198\"\u003ECrossRef\u003C\u002Fa\u003E] [\u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fentrez\u002Fquery.fcgi?cmd=Retrieve&db=PubMed&list_uids=23746157&dopt=Abstract\" target=\"_blank\"\u003EMedline\u003C\u002Fa\u003E]\u003C\u002Fspan\u003E\u003C\u002Fli\u003E\u003C\u002Fol\u003E\u003C\u002Fdiv\u003E\u003Cp style=\"font-style: italic\"\u003EEdited by G Eysenbach; submitted 21.10.13; peer-reviewed by A Miner, R Grad; comments to author 09.01.14; revised version received 25.01.14; accepted 19.02.14; published 17.03.14\u003C\u002Fp\u003E\u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115002955531\" id=\"Copyright\" target=\"_blank\" class=\"navigation-heading h4 d-block\" aria-label=\"Copyright - what is a Creative Commons License?\" data-label=\"Copyright\"\u003ECopyright \u003Cspan class=\"fas fa-question-circle\"\u003E\u003C\u002Fspan\u003E\u003C\u002Fa\u003E\u003Cp class=\"article-copyright\"\u003E©Bettina Renner, Joachim Kimmerle, Dominik Cavael, Volker Ziegler, Lisa Reinmann, Ulrike Cress. Originally published in the Journal of Medical Internet Research (http:\u002F\u002Fwww.jmir.org), 17.03.2014. \u003C\u002Fp\u003E\u003Csmall class=\"article-license\"\u003E\u003Cp class=\"abstract-paragraph\"\u003EThis is an open-access article distributed under the terms of the Creative Commons Attribution License (http:\u002F\u002Fcreativecommons.org\u002Flicenses\u002Fby\u002F2.0\u002F), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http:\u002F\u002Fwww.jmir.org\u002F, as well as this copyright and license information must be included.\u003C\u002Fp\u003E\u003C\u002Fsmall\u003E\u003Cbr\u003E\u003C\u002Fsection\u003E\u003C\u002Farticle\u003E\u003C\u002Fsection\u003E\u003C\u002Fsection\u003E\u003C\u002Fmain\u003E\n"}],fetch:{},error:a,state:{host:a,environment:c,journalPath:j,keys:{},domains:{},screensize:"desktop",defaultCookieScriptId:"aa022ba6-b337-11ef-b288-3fb59f57942d",accessibility:{filter:"none","font-weight":"inherit","font-size":.625,"text-align":"initial"},announcements:{data:[{announcement_id:552,title:"Webinar - Bibsam Open Science Spotlight: Exploring Exergames and Active Microbreaks for Health",description_short:"\u003Cp\u003EJoin us on \u003Cstrong\u003E24 March 2025 at 3:00PM CEST\u003C\u002Fstrong\u003E for a webinar on how exergames—digital games requiring physical activity—can help break up sedentary behavior and improve both psychological and physiological health outcomes.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbr\u003E\u003C\u002Fp\u003E",date_posted:"2025-03-12T17:36:04.000Z",journal_id:b},{announcement_id:546,title:"Webinar: Live Review: Innovating Peer Review Through Open Collaboration",description_short:"\u003Cp\u003E\u003Cspan style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; white-space-collapse: preserve; background-color: transparent; font-size: 11pt; font-family: "IBM Plex Sans", sans-serif; color: rgb(0, 0, 0); vertical-align: baseline;\"\u003EJoin JMIR Publications and PREreview for a discussion on \u003C\u002Fspan\u003E\u003Ca href=\"https:\u002F\u002Fprereview.org\u002Flive-reviews\" style=\"text-decoration-line: none;\"\u003E\u003Cspan style=\"font-size: 11pt; font-family: "IBM Plex Sans", sans-serif; color: rgb(0, 0, 0); background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space-collapse: preserve;\"\u003ELive Reviews\u003C\u002Fspan\u003E\u003C\u002Fa\u003E\u003Cspan style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; white-space-collapse: preserve; background-color: transparent; font-size: 11pt; font-family: "IBM Plex Sans", sans-serif; color: rgb(0, 0, 0); vertical-align: baseline;\"\u003E—an innovative, community-driven approach to peer review. This webinar will explore how Live Reviews bring authors, reviewers, and facilitators together in real time to improve the transparency, rigor, and inclusivity of the review process.\u003C\u002Fspan\u003E\u003C\u002Fp\u003E",date_posted:"2025-02-18T18:13:16.000Z",journal_id:b},{announcement_id:540,title:"JMIR Publications Announces New CEO",description_short:"\u003Cp\u003EJMIR Publications, the leading open access publisher in digital health and open science, announced today that Sean Jeong has been appointed as its new chief executive officer (CEO), effective January 23, 2025.\u003C\u002Fp\u003E",date_posted:"2025-02-03T10:00:43.000Z",journal_id:b},{announcement_id:525,title:"JMIR Publications Integrates With Web of Science to Recognize Peer Reviewers",description_short:"\u003Cp\u003EJMIR Publications, a leading open access publisher of academic journals, is pleased to announce a new partnership with the Web of Science Reviewer Recognition Service (Web of Science RRS) to provide official recognition for the critical contributions of its peer reviewers.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbr\u003E\u003C\u002Fp\u003E",date_posted:"2024-11-14T16:33:25.000Z",journal_id:b},{announcement_id:517,title:"Webinar Announcement: Navigating Academic Promotion - Key Strategies for Junior Faculty Success",description_short:"\u003Cp\u003EJoin us for an insightful webinar inspired by the article “Advice for Junior Faculty Regarding Academic Promotion.” This session is designed to provide junior faculty with practical strategies to navigate the academic promotion process smoothly and effectively. Whether you're just beginning your academic journey or aiming for your next promotion, this webinar offers valuable advice from both senior and junior faculty members.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbr\u003E\u003C\u002Fp\u003E",date_posted:"2024-10-22T15:09:34.000Z",journal_id:b},{announcement_id:512,title:"JMIR Publications CEO and Executive Editor Gunther Eysenbach Achieves #1 Ranking as Most Cited Researcher in Medical Informatics for Fifth Consecutive Year",description_short:"\u003Cp\u003EJMIR Publications is proud to announce that Gunther Eysenbach, founder, CEO and executive editor, has once again been named the #1 most cited researcher in the subfield of medical informatics by Stanford\u002FElsevier’s Top 2% Scientists rankings\u003C\u002Fp\u003E",date_posted:"2024-10-11T17:08:49.000Z",journal_id:b},{announcement_id:509,title:"Call for Papers: Theme Issue: The Emergence of Medical Futures Studies",description_short:"\u003Cp\u003E\u003Cstrong\u003EThe \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E is pleased to announce a call for papers for the theme issue The Emergence of Medical Futures Studies. This is the first ever call for papers on this topic.\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E",date_posted:"2024-10-08T12:00:52.000Z",journal_id:b},{announcement_id:493,title:"JMIR Publications + PREreview Live Review: Thursday, July 18- 12 pm ET",description_short:"\u003Cp\u003EJMIR Publications and PREreview are pleased to announce our next Preprint Live Review on Thursday, July 18\u003C\u002Fp\u003E",date_posted:"2024-07-04T13:05:37.000Z",journal_id:b},{announcement_id:476,title:"Journal of Medical Internet Research Receives a Journal Impact Factor of 5.8",description_short:"\u003Cp\u003EJMIR Publications announced today that its flagship journal, the \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E, reported a Journal Impact Factor (JIF) of 5.8 as published in the 2024 Journal Citation Report (JCR) from Clarivate.\u003C\u002Fp\u003E",date_posted:"2024-06-26T16:13:36.000Z",journal_id:b},{announcement_id:475,title:"JMIR Publications Journals Shine in the 2024 Release of Journal Impact Factor by Clarivate",description_short:"\u003Cp\u003EJMIR Publications is pleased to announce the outstanding performance of its scholarly journals in the 2024 release of Journal Citation Reports (JCR) by Clarivate\u003C\u002Fp\u003E",date_posted:"2024-06-24T17:11:56.000Z",journal_id:b}],pagination:{from:b,to:n,total:154,perPage:n,firstPage:b,lastPage:o}},article:{data:{article_id:3040,published_at:"2014-03-17T09:53:36.000Z",submitted_at:ab,section_id:ac,journal_id:b,year:p,issue:"3",volume:q,identifier:"85",url:"\u002F2014\u002F3\u002Fe85",pdf_url:"https:\u002F\u002Fwww.jmir.org\u002F2014\u002F3\u002Fe85\u002FPDF",html_url:"https:\u002F\u002Fwww.jmir.org\u002F2014\u002F3\u002Fe85",xml_url:"https:\u002F\u002Fwww.jmir.org\u002F2014\u002F3\u002Fe85\u002FXML",title:"Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff",public_id:"J Med Internet Res 2014;16(3):e85",thumbnail:"https:\u002F\u002Fasset.jmir.pub\u002Fassets\u002Fedc1a7150087d5665159ca24ffb46786.JPG",doi:"10.2196\u002Fjmir.3040",pmid:24637405,pmcid:"3979169",issue_title:"March",pages:[],transfer:a,authors:[{first_name:"Bettina",last_name:"Renner",degrees:"Dipl Psych",deceased:a,orcid:a,equal_contrib:b,matchedAffiliations:[b]},{first_name:ad,last_name:ae,degrees:af,deceased:a,orcid:a,equal_contrib:b,matchedAffiliations:[b]},{first_name:"Dominik",last_name:"Cavael",degrees:"MA",deceased:a,orcid:a,equal_contrib:r,matchedAffiliations:[e]},{first_name:"Volker",last_name:"Ziegler",degrees:"Dr med",deceased:a,orcid:a,equal_contrib:r,matchedAffiliations:[e]},{first_name:"Lisa",last_name:"Reinmann",degrees:"BA (Hons)",deceased:a,orcid:a,equal_contrib:r,matchedAffiliations:[e]},{first_name:"Ulrike",last_name:"Cress",degrees:"Dr rer soc",deceased:a,orcid:a,equal_contrib:r,matchedAffiliations:[b,s]}],affiliations:[{aff_id:15804,author_id:11121,phone:a,fax:a,corresp_aff:y,aff_type:a,seq:b,article_id:a,institution_line_1:ag,institution_line_2:d,institution_line_3:d,address_line_1:ah,address_line_2:d,city:z,prov_state:a,postal_code:ai,country:t},{aff_id:14316,author_id:11123,phone:a,fax:a,corresp_aff:y,aff_type:a,seq:b,article_id:a,institution_line_1:"Neurological Clinic Bad Neustadt",institution_line_2:d,institution_line_3:d,address_line_1:a,address_line_2:a,city:"Bad Neustadt",prov_state:a,postal_code:a,country:t},{aff_id:15571,author_id:11126,phone:a,fax:a,corresp_aff:y,aff_type:a,seq:e,article_id:a,institution_line_1:"University of Tuebingen",institution_line_2:d,institution_line_3:d,address_line_1:a,address_line_2:a,city:z,prov_state:a,postal_code:a,country:t}],primaryAuthor:{first_name:ad,last_name:ae,email:"j.kimmerle@iwm-kmrc.de",degrees:af,primaryAffiliation:{fax:"49 7071979100",phone:"49 7071979363",country:t,postal_code:ai,prov_state:a,city:z,address_line_1:ah,address_line_2:d,institution_line_1:ag,institution_line_2:d,institution_line_3:d}},abstract:"Background: Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support. Objective: In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff’s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals. Methods: Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167\u002F485) for the first and 40.6% (210\u002F517) for the second measure. Results: Collaborative reflection was increased (P=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (r=.61, P<.001). Conclusions: The findings provide evidence for an effect of the apps on hospital employees’ reflection behavior. Apps that foster reflective learning can increase health care professionals’ reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps. ",keywords:a,date_submitted:ab,title_html:a,sections:[{title:"Mobile Health (mhealth)",section_id:ac,journal_id:b,colour:u,count:3079},{title:"e-Learning and Digital Medical Education",section_id:57,journal_id:b,colour:u,count:754}],preprint:g,articleKD:g,isOldOjphiMigrated:g,isNewsArticle:g}},articles:{recent:[],openReview:[]},articleTypes:{},authentication:{data:a,jwt:a},countries:{data:[]},departments:{data:[]},help:{data:{}},journal:{data:{journal_id:b,title:aj,tag:ak,description:a,path:j,slug:j,seq:b,enabled:b,environment:c,url:al,batch:b,year:am,colour:u,impact:A,order:b,published:an,transfers:a,cite_score:ao,settings:{aboutJournal:"\u003Cp\u003EThe \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E (JMIR) is the pioneer open access eHealth journal, and is the flagship journal of JMIR Publications. It is a leading health services and digital health journal globally in terms of quality\u002Fvisibility \u003Ca href=\"..\u002F..\u002F..\u002F..\u002F..\u002Fannouncements\u002F476\"\u003E(Journal Impact Factor™ 5.8 (Clarivate, 2024))\u003C\u002Fa\u003E, ranking Q1 in both the 'Medical Informatics' and 'Health Care Sciences & Services' categories, and is also the largest journal in the field. The journal is \u003Ca href=\"https:\u002F\u002Fscholar.google.com\u002Fcitations?view_op=top_venues&hl=en&vq=eng_medicalinformatics\" rel=\"noopener\" target=\"_blank\"\u003Eranked #1 on Google Scholar\u003C\u002Fa\u003E in the 'Medical Informatics' discipline. The journal focuses on emerging technologies, medical devices, apps, engineering, telehealth and informatics applications for patient education, prevention, population health and clinical care.\u003C\u002Fp\u003E\r\n\u003Cp\u003EJMIR is indexed in all major literature indices including \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fnlmcatalog\u002F100959882\"\u003ENational Library of Medicine(NLM)\u002FMEDLINE\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fv2.sherpa.ac.uk\u002Fid\u002Fpublisher\u002F2600\"\u003ESherpa\u002FRomeo,\u003C\u002Fa\u003E \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F?term=%22Journal+of+medical+Internet+research%22%5BJournal%5D&sort=\"\u003EPubMed,\u003C\u002Fa\u003E \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Fjournals\u002F224\u002F\"\u003EPMC\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.scopus.com\u002Fsourceid\u002F23709\"\u003EScopus\u003C\u002Fa\u003E, Psycinfo, \u003Ca href=\"https:\u002F\u002Fmjl.clarivate.com\u002Fjournal-profile\"\u003EClarivate (which includes Web of Science (WoS)\u002FESCI\u002FSCIE)\u003C\u002Fa\u003E, EBSCO\u002FEBSCO Essentials, \u003Ca href=\"https:\u002F\u002Fdoaj.org\u002Ftoc\u002F1438-8871?source=%7B%22query%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22terms%22%3A%7B%22index.issn.exact%22%3A%5B%221438-8871%22%5D%7D%7D%5D%7D%7D%2C%22size%22%3A100%2C%22sort%22%3A%5B%7B%22created_date%22%3A%7B%22order%22%3A%22desc%22%7D%7D%5D%2C%22_source%22%3A%7B%7D%2C%22track_total_hits%22%3Atrue%7D\"\u003EDOAJ\u003C\u002Fa\u003E, GoOA and others. The \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E received a CiteScore of \u003Ca href=\"..\u002F..\u002F..\u002F..\u002F..\u002Fannouncements\u002F471\"\u003E14.4\u003C\u002Fa\u003E, placing it in the 95th percentile (#7 of 138) as a Q1 journal in the field of Health Informatics. It is a selective journal complemented by almost \u003Ca href=\"https:\u002F\u002Fjmir.zendesk.com\u002Fhc\u002Fen-us\u002Farticles\u002F115001442707\" target=\"_blank\"\u003E30 specialty JMIR sister journals\u003C\u002Fa\u003E, which have a broader scope, and which together receive over 10,000 submissions a year. \u003C\u002Fp\u003E\r\n\u003Cp\u003EAs an open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as with all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device\u002Ftechnology\u002Fapp reviews). Peer-review reports are \u003Ca href=\"https:\u002F\u002Fjmir.zendesk.com\u002Fhc\u002Fen-us\u002Farticles\u002F115001714547-How-do-I-request-a-manuscript-transfer-to-another-journal-\" target=\"_blank\"\u003Eportable\u003C\u002Fa\u003E across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to a different journal but can simply transfer it between journals. \u003C\u002Fp\u003E\r\n\u003Cp\u003EWe are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as \u003Ca href=\"http:\u002F\u002Fpreprints.jmir.org\"\u003Epreprints\u003C\u002Fa\u003E, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.\u003C\u002Fp\u003E\r\n\u003Cp\u003EAs all JMIR journals, the journal encourages Open Science principles and strongly encourages publication of a protocol before data collection. Authors who have published a protocol in \u003Ca href=\"https:\u002F\u002Fresearchprotocols.org\u002F\"\u003EJMIR Research Protocols\u003C\u002Fa\u003E get a discount of 20% on the Article Processing Fee when publishing a subsequent results paper in any JMIR journal.\u003C\u002Fp\u003E\r\n\u003Cp\u003EBe a widely cited leader in the digital health revolution and \u003Ca href=\"..\u002F..\u002F..\u002F..\u002F..\u002Fauthor\" target=\"_blank\"\u003Esubmit your paper today\u003C\u002Fa\u003E!\u003C\u002Fp\u003E",announcementLink:"https:\u002F\u002Fwww.jmir.org\u002Fannouncements\u002F476",copyrightNotice:d,focusScopeDesc:"\u003Cp\u003EThe \"\u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E\" (JMIR; ISSN 1438-8871, Medline-abbreviation: \u003Cem\u003EJ Med Internet Res\u003C\u002Fem\u003E) \u003Ca href=\"..\u002F..\u002F2019\u002F12\u002Fe17578\u002F\"\u003E(founded in 1999, now in its 25th year!\u003C\u002Fa\u003E\u003Cspan\u003E)\u003C\u002Fspan\u003E is a leading health informatics and health services\u002Fhealth policy journal (ranking in the first quartile Q1 by Impact Factor in these disciplines) focusing on digital health, data science, health informatics and emerging technologies for health, medicine, and biomedical research. The journal is \u003Ca href=\"https:\u002F\u002Fscholar.google.com\u002Fcitations?view_op=top_venues&hl=en&vq=eng_medicalinformatics\" target=\"_blank\" rel=\"noopener\"\u003Eranked #1 on Google Scholar\u003C\u002Fa\u003E\u003Cspan\u003E in the 'Medical Informatics' discipline. \u003C\u002Fspan\u003E\u003C\u002Fp\u003E\r\n\u003Cp\u003EJMIR was the first open access journal covering health informatics, and the first international scientific peer-reviewed journal on all aspects of research, information and communication in the healthcare field using Internet and Internet-related technologies; a broad field, which is known as \"eHealth\" [see also \u003Ca href=\"..\u002F..\u002F2001\u002F2\u002Fe20\u002F\"\u003EWhat is eHealth\u003C\u002Fa\u003E and \u003Ca href=\"..\u002F..\u002F2001\u002F2\u002Fe22\u002F\"\u003EWhat is eHealth (2)\u003C\u002Fa\u003E], or now also \"\u003Cstrong\u003Edigital health\u003C\u002Fstrong\u003E\", which includes mHealth (mobile health). This field also has significant overlaps with what is called \"consumer health informatics\", health 2.0\u002Fmedicine 2.0, or participatory medicine. This focus makes JMIR unique among other medical or medical informatics journals, which tend to focus on clinical informatics or clinical applications. As eHealth\u002FmHealth is a highly interdisciplinary field we are not only inviting research papers from the medical sciences, but also from the computer, behavioral, social and communication sciences, psychology, library sciences, informatics, human-computer interaction studies, and related fields.\u003C\u002Fp\u003E\r\n\u003Cp\u003EThe term \"Internet\" is used in its broadest sense, so we are also interested in high impact studies and applications of digital medicine, mobile technologies, social media, novel wearable devices and sensors, connected home appliances, domotics etc.\u003C\u002Fp\u003E\r\n\u003Cp\u003EThe journal invites manuscripts that deal with the following topics (\u003Ca href=\"..\u002F..\u002Fthemes\"\u003Ethe main themes\u002Ftopics covered by this journal and sample papers can also be found here\u003C\u002Fa\u003E):\u003C\u002Fp\u003E\r\n\u003Cul\u003E\r\n\u003Cli\u003Enovel digital health approaches, methods, and devices\u003C\u002Fli\u003E\r\n\u003Cli\u003Elarge digital medicine \u002F digital therapeutics trials with clinical impact\u003C\u002Fli\u003E\r\n\u003Cli\u003Edata science, open data\u003C\u002Fli\u003E\r\n\u003Cli\u003Estudies evaluating the impact of Internet\u002Fsocial media use or specific eHealth\u002FmHealth interventions on individual health-related or social outcomes\u003C\u002Fli\u003E\r\n\u003Cli\u003Eevaluations and implementations of innovative mhealth (mobile health) applications, social media apps, ubiquitous computing, or innovative and emerging technologies in health\u003C\u002Fli\u003E\r\n\u003Cli\u003Edescriptions of the design and impact of Internet and mobile applications and websites or social media for consumers\u002Fpatients or medical professionals\u003C\u002Fli\u003E\r\n\u003Cli\u003Euse of the Internet, social media and mhealth in the context of clinical information and communication, including telemedicine\u003C\u002Fli\u003E\r\n\u003Cli\u003Euse of the Internet, social media, and mhealth in medical research and the basic sciences such as molecular biology or chemistry (e.g. bioinformatics, online factual databases)\u003C\u002Fli\u003E\r\n\u003Cli\u003Emedical information management and librarian sciences\u003C\u002Fli\u003E\r\n\u003Cli\u003Ee-learning and knowledge translation, online-courses, social media, web-based and mobile programs for undergraduate and continuing education,\u003C\u002Fli\u003E\r\n\u003Cli\u003EeHealth\u002FmHealth and social media applications for public health and population health technology (disease monitoring, teleprevention, teleepidemiology)\u003C\u002Fli\u003E\r\n\u003Cli\u003Eevidence-based medicine and the Internet and mhealth (e.g. online development or dissemination of clinical guidelines, measuring agreement about management of a given clinical problem among physicians, etc.)\u003C\u002Fli\u003E\r\n\u003Cli\u003Ethe impact of eHealth\u002FmHealth\u002FpHealth\u002FiHealth, social media, the Internet, or health care technologies on public health, the health care system and policy\u003C\u002Fli\u003E\r\n\u003Cli\u003Emethodological aspects of doing Internet\u002Fmhealth\u002Fsocial media research, e.g. methodology of web-based surveys\u003C\u002Fli\u003E\r\n\u003Cli\u003Edesign and validation of novel web-based instruments\u003C\u002Fli\u003E\r\n\u003Cli\u003Eecological momentary assessment, sensors, mobile technologies for gathering and analyzing data in real-time\u003C\u002Fli\u003E\r\n\u003Cli\u003Eanalysis of e-communities, social media communities, or virtual social networks\u003C\u002Fli\u003E\r\n\u003Cli\u003Ecomparisons of effectiveness of health communication and information on the Internet\u002FmHealth\u002Fsocial media compared with other methods of health communication,\u003C\u002Fli\u003E\r\n\u003Cli\u003Eeffects of the Internet\u002Fmhealth\u002Fsocial media and information\u002Fcommunication technology on the patient-physician relationship and impact on public health, e.g. the studies investigating how the patient-physician relationship changes as a result of the new ways of getting medical information\u003C\u002Fli\u003E\r\n\u003Cli\u003Eethical and legal problems as well as cross-border and cross-cultural issues of eHealth\u002FmHealth\u003C\u002Fli\u003E\r\n\u003Cli\u003Esystematic studies examining the quality of medical information available in various online venues\u003C\u002Fli\u003E\r\n\u003Cli\u003Emethods of evaluation, quality assessment and improvement of Internet information or eHealth applications\u003C\u002Fli\u003E\r\n\u003Cli\u003Eproposals for standards in the field of medical publishing on the Internet, including self-regulation issues, policies and guidelines to provide reliable healthcare information\u003C\u002Fli\u003E\r\n\u003Cli\u003Eresults and methodological aspects of Internet-based and social media studies, including medical surveys, psychological tests, quality-of-life studies, gathering and\u002For disseminating epidemiological data, use of the Internet\u002Fmobile apps\u002Fsocial media for clinical studies (e-trials), drug reaction reporting and surveillance systems etc.\u003C\u002Fli\u003E\r\n\u003Cli\u003Eelectronic medical publishing, Open Access publishing, altmetrics, and use of the Internet or social media for scholarly publishing (e.g. collaborative peer review)\u003C\u002Fli\u003E\r\n\u003Cli\u003Einformation needs of patients, consumers and health professionals, including studies evaluating search and retrieval behavior of patients\u003C\u002Fli\u003E\r\n\u003Cli\u003Eweb-based studies, e.g. online psychological experiments\u003C\u002Fli\u003E\r\n\u003Cli\u003Eevaluations of mhealth (mobile) applications, as well as ambient \u002F ubiquitous computing approaches, sensors, domotics, and other cutting edge technologies\u003C\u002Fli\u003E\r\n\u003Cli\u003Epersonal health records, patient portals, consumer health informatics applications\u003C\u002Fli\u003E\r\n\u003Cli\u003Ebehavior change technologies\u003C\u002Fli\u003E\r\n\u003Cli\u003EReviews, viewpoint papers and commentaries touching on the issues and themes listed above are also welcome, but should be grounded in data and\u002For a thorough literature review\u003C\u002Fli\u003E\r\n\u003C\u002Ful\u003E\r\n\u003Cp\u003EIn addition, the Journal will occasionally publish original research, reviews and tutorials on more generic, related topics such as:\u003C\u002Fp\u003E\r\n\u003Cul\u003E\r\n\u003Cli\u003EInternet standards\u003C\u002Fli\u003E\r\n\u003Cli\u003Ecybermetrics\u003C\u002Fli\u003E\r\n\u003Cli\u003Esecurity and confidentiality issues\u003C\u002Fli\u003E\r\n\u003Cli\u003EInternet demographics\u003C\u002Fli\u003E\r\n\u003Cli\u003Esocial impact of the Internet\u003C\u002Fli\u003E\r\n\u003Cli\u003Edigital imaging and multimedia\u003C\u002Fli\u003E\r\n\u003Cli\u003Ehealth care records\u003C\u002Fli\u003E\r\n\u003Cli\u003Ehigh-speed networks\u003C\u002Fli\u003E\r\n\u003Cli\u003Etelecommunication\u003C\u002Fli\u003E\r\n\u003Cli\u003Eelectronic publishing\u003C\u002Fli\u003E\r\n\u003Cli\u003Esoftware development\u003C\u002Fli\u003E\r\n\u003C\u002Ful\u003E\r\n\u003Cp\u003EThe \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E is one of the flagship journals of \u003Ca href=\"https:\u002F\u002Fjmirpublications.com\u002F\"\u003EJMIR Publications\u003C\u002Fa\u003E and is \u003Cem\u003Ehighly selective\u003C\u002Fem\u003E. We are not a megajournal that publishes everything regardless of impact. To ensure a rapid turnaround time, we encourage that authors consider \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115001442707-Which-journal-titles-are-JMIR-Publications-currently-publishing-Journal-Portfolio-\"\u003Eother JMIR journal titles\u003C\u002Fa\u003E as well. While it is possible to transfer submissions from one journal to another before, during or after the review process (based on editorial suggestions), authors can avoid delays in decision-making by submitting to the right journal.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EIn order to be considered for\u003Cem\u003E J Med Internet Res\u003C\u002Fem\u003E, \u003Cstrong\u003Eclinical informatics\u003C\u002Fstrong\u003E papers should have a clear connections to the major themes in this journal of consumer\u002Fpatient empowerment and participatory healthcare, and\u002For evaluate the use of mobile\u002FInternet-based\u002Femerging technologies such as patient portals. Other clinical informatics studies with no relationship to consumer health informatics, or more technical papers are best submitted to \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115001442707-Which-journal-titles-are-JMIR-Publications-currently-publishing-Journal-Portfolio-\"\u003Eother JMIR journal titles\u003C\u002Fa\u003E, such as \u003Ca href=\"http:\u002F\u002Fi-jmr.org\u002F\"\u003EInteractive Journal of Medical Research (i-JMR, a general medical journal with focus on innovation)\u003C\u002Fa\u003E, \u003Ca href=\"http:\u002F\u002Fmhealth.jmir.org\u002F\"\u003EJMIR mHealth and uHealth\u003C\u002Fa\u003E, \u003Ca href=\"http:\u002F\u002Fmedinform.jmir.org\u002F\"\u003EJMIR Medical Informatics\u003C\u002Fa\u003E, or \u003Ca href=\"https:\u002F\u002Fhumanfactors.jmir.org\"\u003EJMIR Human Factors\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003E\u003Cstrong\u003EMachine-learning papers\u003C\u002Fstrong\u003E: Machine learning papers are now mostly published in JMIR Medical Informatics (see e-collection \u003Ca href=\"https:\u002F\u002Fmedinform.jmir.org\u002Fthemes\u002F500-machine-learning\"\u003EMachine Learning\u003C\u002Fa\u003E), JMIR Formative Research or JMIR AI, or another sister journal, unless they have reached clinical maturity and are being used and validated in routine clinical use. Our flagship journal J Med Internet Res no longer publishes ML papers unless 1) they show a direct clinical effect or impact on care, 2) are validated using an independent dataset not used for training, 3) are written in a language that can be understood by a healthcare professional, and provide open source or a publicly available tool that can be used by others to validate or apply the findings. We also request that 4) reporting strictly adheres to the \"\u003Ca href=\"..\u002F..\u002F2016\u002F12\u002Fe323\u002F\"\u003EGuidelines for Developing and Reporting Machine Learning Predictive Models in Biomedical Research\u003C\u002Fa\u003E\". Highly technical papers (with mathematical formulas) are unsuitable for J Med Internet Res or this information needs to be provided in a Multimedia Appendix. \u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003E\u003Cstrong\u003EDigital psychiatry and digital mental health\u003C\u002Fstrong\u003E papers are best suited for \u003Ca href=\"http:\u002F\u002Fmental.jmir.org\u002F\"\u003EJMIR Mental Health\u003C\u002Fa\u003E if they are impactful, otherwise JMIR Formative Research publishes early stage work.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EStudies related to public health informatics and surveillance systems should preferably be submitted to \u003Ca href=\"https:\u002F\u002Fpublichealth.jmir.org\"\u003EJMIR Public Health & Surveillance\u003C\u002Fa\u003E. JPHS is also highly selective.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EPapers with focus on \u003Cstrong\u003Egames in health or gamification aspects of apps\u003C\u002Fstrong\u003E and theoretical issues\u002Fcommentary on gaming are now primarily published in \u002F transferred to \u003Ca href=\"http:\u002F\u002Fgames.jmir.org\u002F\"\u003EJMIR Serious Games\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EStudies evaluating systematically the \u003Cstrong\u003Equality of health information\u003C\u002Fstrong\u003E or present tools for social listening may be best suited for \u003Ca href=\"https:\u002F\u002Finfodemiology.jmir.org\"\u003EJMIR Infodemiology\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003E\u003Cstrong\u003EFormative work such as usability studies, pilot studies, and feasibility studies\u003C\u002Fstrong\u003E are no longer published in our flagship journals and should be submitted to \u003Ca href=\"http:\u002F\u002Fformative.jmir.org\u002F\"\u003EJMIR Formative Research\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EProtocols and proposals can be submitted to \u003Ca href=\"https:\u002F\u002Fwww.researchprotocols.org\u002F\"\u003EJMIR Research Protocols\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp\u003ESubmitted manuscripts are subject to a rigorous \u003Cstrong\u003Ebut speedy peer review \u003C\u002Fstrong\u003Eprocess. We aim for a standard review time of less than 2 months, and a \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115001310127-How-to-fast-track-expedite-a-paper-and-what-are-the-benefits-\"\u003Ereview time of 4 weeks for submission to initial decision for fast-tracked papers\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\r\n\u003Cp\u003EThe \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115004367848-What-does-the-peer-review-process-at-JMIR-journals-look-like-\"\u003Ereview process\u003C\u002Fa\u003E is designed to help authors to improve their manuscripts by giving them constructive comments on how to improve their paper, and to publish only those articles which comply to general quality criteria of a scholarly paper, especially originality, clarity, references to related work and validity of results and conclusions.\u003C\u002Fp\u003E",googleAnalyticsId:"UA-186918-1",impactFactor:A,journalDescription:"\u003Cp\u003E\u003Cstrong\u003EThe leading peer-reviewed journal for digital medicine and health and health care in the internet age. \u003C\u002Fstrong\u003E\u003C\u002Fp\u003E",journalInitials:"JMIR",footer:"\u003Cul style=\"display: flex; flex-wrap: wrap; justify-content: center; list-style: none;\"\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Fcrossref.jpg\" alt=\"Crossref Member\" \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Fcope.jpg\" alt=\"Committee on Publication Ethics\" \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Fopen-access.jpg\" alt=\"Open Access\" \u002F\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; 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margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E \u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli\u003E \u003C\u002Fli\u003E\r\n\u003Cli\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E \u003C\u002Fa\u003E\u003C\u002Fli\u003E\r\n\u003C\u002Ful\u003E\r\n\u003Cp\u003E \u003C\u002Fp\u003E\r\n\u003C\u002Fsection\u003E\r\n\u003C\u002Fdiv\u003E",onlineIssn:"1438-8871",searchDescription:"Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet",searchKeywords:"Medical, Medicine, Internet, Research, Journal, ehealth, JMIR, open access publishing, medical research, medical informatics",articlesWidget:{enabled:f,count:v,label:"Recent Articles"},openReviewWidget:{enabled:f,count:v,label:"\u003Ca href=\"https:\u002F\u002Fpreprints.jmir.org\"\u003EPreprints\u003C\u002Fa\u003E Open for Peer-Review"},searchWidget:{enabled:f},partnershipsWidget:{enabled:f},submitButton:{enabled:f,label:"Submit Article"},editorInChief:"\u003Cp\u003EGunther Eysenbach, MD, MPH, FACMI, Founding Editor and Publisher; \u003Cspan\u003EAdjunct Professor, School of Health Information Science, University of Victoria, Canada\u003C\u002Fspan\u003E\u003C\u002Fp\u003E"}}},journals:{data:[{journal_id:b,title:aj,tag:ak,description:a,path:j,slug:j,seq:b,enabled:b,environment:c,url:al,batch:b,year:am,colour:u,impact:A,order:b,published:an,transfers:a,cite_score:ao},{journal_id:w,title:"JMIR Research Protocols",tag:"Ongoing trials, grant proposals, formative research, methods, early results. June 2024 - Journal Impact Factor: 1.4 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"JMIR Res Protoc publishes research protocols, current and ongoing trials, and grant proposals in all areas of medicine (with an initial focus on ehealth\u002Fmhealth). Publish your work in this journal to let others know what you are working on, to facilitate collaboration and\u002For recruitment, to avoid duplication of efforts, to create a citable record of a research design idea, and to aid systematic reviewers in compiling evidence. Research protocols or grant proposals that are funded and have undergone peer-review will receive an expedited review if you upload peer-review reports as supplementary files.",path:"resprot",slug:"researchprotocols",seq:e,enabled:b,environment:c,url:"https:\u002F\u002Fwww.researchprotocols.org",batch:b,year:B,colour:"#837a7a",impact:"1.4",order:o,published:4498,transfers:a,cite_score:"2.4"},{journal_id:C,title:"JMIR Formative Research",tag:"Process evaluations, early results and feasibility\u002Fpilot studies of digital and non-digital interventions. June 2024 - Journal Impact Factor: 2.0 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:d,path:ap,slug:ap,seq:D,enabled:b,environment:c,url:"https:\u002F\u002Fformative.jmir.org",batch:e,year:E,colour:"#605959",impact:"2.0",order:F,published:3332,transfers:a,cite_score:"2.7"},{journal_id:F,title:"JMIR mHealth and uHealth",tag:"Focused on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. June 2024 - Journal Impact Factor: 5.4. Q1 journal in \"Health Care Sciences & Services\" and \"Medical Informatics\" categories. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"JMIR mhealth and uhealth is a new journal focussing on mobile and ubiquitous health technologies, including smartphones, augmented reality (Google Glasses), intelligent domestic devices, implantable devices, and other technologies designed to maintain health and improve life.",path:aq,slug:aq,seq:s,enabled:b,environment:c,url:"https:\u002F\u002Fmhealth.jmir.org",batch:e,year:G,colour:ar,impact:"5.4",order:e,published:2764,transfers:a,cite_score:"12.6"},{journal_id:45,title:"Online Journal of Public Health Informatics",tag:"A leading peer-reviewed, open access journal dedicated to the dissemination of high-quality research and innovation in the field of public health informatics.",description:a,path:as,slug:as,seq:H,enabled:b,environment:c,url:"https:\u002F\u002Fojphi.jmir.org",batch:a,year:at,colour:"#3399FF",impact:d,order:H,published:1723,transfers:a,cite_score:a},{journal_id:I,title:"JMIR Public Health and Surveillance",tag:"A multidisciplinary journal that focuses on the intersection of public health and technology, public health informatics, mass media campaigns, surveillance, participatory epidemiology, and innovation in public health practice and research. June 2024 - Journal Impact Factor: 3.5. Q1 journal in \"Public, Environmental & Occupational Health\" category (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Innovations in Public Health practice and research",path:au,slug:au,seq:J,enabled:b,environment:c,url:"https:\u002F\u002Fpublichealth.jmir.org",batch:b,year:k,colour:"#01538A",impact:K,order:J,published:1713,transfers:a,cite_score:"13.7"},{journal_id:L,title:"JMIR Medical Informatics",tag:"Clinical informatics, decision support for health professionals, electronic health records, and eHealth infrastructures. June 2024 - Journal Impact Factor: 3.1 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Clinical informatics",path:av,slug:av,seq:w,enabled:b,environment:c,url:"https:\u002F\u002Fmedinform.jmir.org",batch:e,year:G,colour:"#82ABB9",impact:"3.1",order:n,published:1474,transfers:a,cite_score:"7.9"},{journal_id:q,title:"JMIR Mental Health",tag:"A journal focused on Internet interventions, technologies, and digital innovations for mental health and behavior change. Official journal of the Society for Digital Psychiatry. June 2024 - Journal Impact Factor: 4.8. Q1 journal in \"Psychiatry\" category. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:d,path:aw,slug:aw,seq:L,enabled:b,environment:c,url:"https:\u002F\u002Fmental.jmir.org",batch:b,year:p,colour:"#45936C",impact:ax,order:M,published:1119,transfers:a,cite_score:"10.8"},{journal_id:J,title:"JMIR Human Factors",tag:"Making health care interventions and technologies usable, safe, and effective. June 2024 - Journal Impact Factor: 2.6 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Usability Studies and Ergonomics",path:ay,slug:ay,seq:az,enabled:b,environment:c,url:"https:\u002F\u002Fhumanfactors.jmir.org",batch:e,year:p,colour:"#008C9E",impact:"2.6",order:aA,published:881,transfers:a,cite_score:"3.4"},{journal_id:o,title:"JMIR Serious Games",tag:"A multidisciplinary journal on gaming and gamification including simulation and immersive virtual reality for health education\u002Fpromotion, teaching, medicine, rehabilitation, and social change. June 2024 - Journal Impact Factor: 3.8. Q1 journal in \"Health Care Sciences & Services\" category. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Serious games for health and social change",path:aB,slug:aB,seq:I,enabled:b,environment:c,url:"https:\u002F\u002Fgames.jmir.org",batch:b,year:G,colour:"#4A5A67",impact:"3.8",order:w,published:673,transfers:a,cite_score:"7.3"},{journal_id:N,title:"JMIR Medical Education",tag:"Technology, innovation and openess in medical education in the information age. June 2024 - Journal Impact Factor: 3.2. Q1 journal in \"Education, Scientific Disciplines\" category. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:d,path:aC,slug:aC,seq:aA,enabled:b,environment:c,url:"https:\u002F\u002Fmededu.jmir.org",batch:e,year:k,colour:"#6678A6",impact:aD,order:I,published:597,transfers:a,cite_score:"6.9"},{journal_id:M,title:"Iproceedings",tag:"Electronic Proceedings, Presentations and Posters of Leading Conferences",description:d,path:aE,slug:aE,seq:F,enabled:b,environment:c,url:"https:\u002F\u002Fwww.iproc.org",batch:e,year:k,colour:"#6F7D80",impact:a,order:O,published:510,transfers:a,cite_score:a},{journal_id:x,title:"JMIR Aging",tag:"Digital health technologies, apps, and informatics for patient education, medicine and nursing, preventative interventions, and clinical care \u002F home care for elderly populations. June 2024 - Journal Impact Factor: 5.0. Q1 journal in \"Geriatrics & Gerontology\", \"Gerontology\" and \"Medical Informatics\" categories. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:d,path:aF,slug:aF,seq:O,enabled:b,environment:c,url:"https:\u002F\u002Faging.jmir.org",batch:e,year:l,colour:"#979bc4",impact:"5.0",order:s,published:477,transfers:a,cite_score:"6.5"},{journal_id:aG,title:"JMIRx Med",tag:aH,description:a,path:aI,slug:aI,seq:P,enabled:b,environment:c,url:"https:\u002F\u002Fxmed.jmir.org",batch:a,year:Q,colour:"#3187df",impact:d,order:q,published:468,transfers:a,cite_score:a},{journal_id:s,title:"Interactive Journal of Medical Research",tag:"A new general medical journal for the 21st centrury, focusing on innovation in health and medical research. 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