K4Health
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This Digital Health Resource Library houses three legacy collections previously maintained by the Knowledge for Health (K4Health) Project. K4Health’s work was made possible by the support of the American People through the United States Agency for International Development (USAID) . K4Health was supported from 2008-2019 by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under cooperative agreements with the Johns Hopkins University. K4Health was implemented by the Johns Hopkins Center for Communication Programs (CCP) in collaboration with FHI 360, Management Sciences for Health (MSH), and IntraHealth International. The K4Health Project ended in September 2019.
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Browsing K4Health by Subject "At risk for a particular disease or infection"
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- ItemA 21st century approach to tackling dengue: Crowdsourced surveillance, predictive mapping and tailored communication.(2016-01-06) Lwin, May O; Vijaykumar, Santosh; Fernando, Owen Noel Newton; Cheong, Siew Ann; Rathnayake, Vajira Sampath; Lim, Gentatsu; Theng, Yin-Leng; Chaudhuri, Subhasis; Foo, SchubertThis paper describes a social media system to prevent dengue in Sri Lanka and potentially in the rest of the South and Southeast Asia regions The system integrates three concepts of public health prevention that have thus far been implemented only in silos First the predictive surveillance component uses a computer simulation to forewarn health authorities and the general public about impending disease outbreaks The civic engagement component allows the general public to use social media tools to interact and engage with health authorities by aiding them in surveillance efforts by reporting symptoms mosquito bites and breeding sites using smartphone technologies The health communication component utilizes citizen data gathered from the first two components to disseminate customized health awareness messages to enhance knowledge and increase preventive behaviors among citizens The system known as Mo Buzz will be made available on a host of digital platforms like simple mobile phones smart phones and a website We present challenges and lessons learnt including content validation stakeholder collaborations and applied trans disciplinary research
- ItemAcceptability and factors associated with willingness to receive short messages for improving antiretroviral therapy adherence in China.(2014-05-15) Xiao, Yongkang; Ji, Guoping; Tian, Cuicui; Li, Hui; Biao, Wei; Hu, ZhiThis study aimed to understand the acceptability of short message service SMS as a reminder for improving antiretroviral therapy ART adherence and determine the factors associated with willingness to accept SMS among people living HIV PLH in China A total of 801 adult patients were recruited in a cross sectional survey Factors associated with willingness in unadjusted analyses 0 10 were included in a logistic regression model 88 4 of the participants owned mobile phones 49 6 read every short message and 16 2 read only if the phone number was familiar 79 5 reported daily SMS to remind taking medicine would be helpful and 68 9 were willing to receive them In the final model willingness to accept was positively associated with being young odds ratio OR 0 32 95 confidence interval CI 0 11 0 99 p 0 048 living in the middle or north region OR 2 36 95 CI 1 24 4 50 p 0 009 OR 71 79 95 CI 21 53 239 37 p Under 0 001 respectively having primary or junior or higher education OR 5 80 95 CI 2 13 15 86 p 0 001 OR 3 20 95 CI 1 20 8 58 p 0 021 respectively having serious disease condition of stage OR 10 01 95 CI 2 12 47 30 p 0 004 being a rural resident OR 2 96 95 CI 1 72 5 10 p Under 0 001 having side effect OR 4 74 95 CI 1 24 18 03 p 0 023 and taking a dose two or more hours late in the last 30 days OR 2 45 95 CI 1 26 4 78 p 0 009 SMS as a reminder for improving ART adherence is acceptable The survey results indicate that to be effective messages need to be more acceptable to elderly patients urban residents individuals with earlier stage of HIV disease and individuals not experiencing side effects Nonetheless these results suggest that for a high proportion of PLH in China reminder messages through mobile phones would be useful for increasing compliance with HIV regimens
- ItemAcceptability of delivering and accessing health information through text messaging among community health advisors.(2014-08-07) Schoenberger, Yu-Mei; Phillips, Janice; Mohiuddin, Mohammed Omar; McNees, Patrick; Scarinci, IsabelBACKGROUND Communication technologies can play a significant role in decreasing communication inequalities and cancer disparities by promoting cancer control and enhancing population and individual health Studies have shown that technology such as the mobile phone short message service SMS or text messaging can be an effective health communication strategy that influences individuals health related decisions behaviors and outcomes OBJECTIVE The purpose of this study was to explore usage of communication technologies assess the acceptability of mobile technology for delivery and access of health information and identify cancer and health information needs among Deep South Network for Cancer Control trained Community Health Advisors as Research Partners CHARPs METHODS A mixed method design was used and a triangulation protocol was followed to combine quantitative and qualitative data Focus groups 4 focus groups n 37 and self administered surveys n 77 were conducted to determine CHARPs mobile phone and text message usage The objective was to include identification of barriers and facilitators to a mobile phone intervention RESULTS All participants were African American 37 37 100 11 37 89 were women and the mean age was 53 4 SD 13 9 focus groups and 59 9 SD 8 7 survey Nearly all 33 37 89 of focus group participants reported owning a mobile phone Of those 8 33 24 owned a smartphone 22 33 67 had a text messaging plan and 18 33 55 and 11 33 33 received and sent text messages several times a week or day respectively Similar responses were seen among the survey participants with 75 77 97 reporting owning a mobile phone and of those 22 75 30 owned a smartphone 39 75 53 had a text messaging plan and 37 75 50 received and 27 75 37 sent text messages several times a week or day The benefits of a text messaging system mentioned by focus group participants included alternative form of communication quick method for disseminating information and privacy of communication The main barriers reported by both groups to using mobile technology to receive health information were cost and not knowing how to text message Ways to overcome barriers were explored with focus group participants and education was the most proposed solution Majority of CHARPs were in favor of receiving a weekly text message that would provide cancer health information CONCLUSIONS The findings from this study indicate that CHARPs are receptive to receiving text messages focusing on cancer health information and would be likely to engage in mobile health research These findings represent the first step in the development of an interactive mobile health program designed to provide cancer health information and a support network for the Deep South Network Community Health Advisors as Research Partners DSN CHARPs
- ItemThe acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer.(2011-10-11) Cox, Anna; Illsley, Marianne; Knibb, Wendy; Lucas, Caroline; O'Driscoll, Michael; Potter, Claire; Flowerday, Adrian; Faithfull, SaraE technology is increasingly used in oncology to obtain self reported symptom assessment information from patients although its potential to provide a clinical monitoring tool in palliative care is relatively unexplored in the UK This study aimed to evaluate the support provided to lung cancer patients post palliative radiotherapy using a computerized assessment tool and to determine the clinical acceptability of the tool in a palliative care setting However of the 17 clinicians identified as managing patients who met the initial eligibility criteria for the study only one clinician gave approval for their patient to be contacted regarding participation therefore the benefits of this novel technology could not be assessed Thirteen key clinicians from the centres involved in the study were subsequently interviewed They acknowledged potential benefits of incorporating computerized patient assessment from both a patient and practice perspective but emphasized the importance of clinical intuition over standardized assessment Although clinicians were positive about palliative care patients participating in research they felt that this population of patients were normally too old with too rapidly deteriorating a condition to participate in a study using e technology In order to encourage acceptance of e technology within palliative care emphasis is needed on actively promoting the contribution of technologies with the potential to improve patient outcomes and the patient experience
- ItemAcceptability of smartphone application-based HIV prevention among young men who have sex with men.(2014-01-29) Holloway, Ian W; Rice, Eric; Gibbs, Jeremy; Winetrobe, Hailey; Dunlap, Shannon; Rhoades, HarmonyYoung men who have sex with men YMSM are increasingly using mobile smartphone applications apps such as Grindr to meet sex partners A probability sample of 195 Grindr using YMSM in Southern California were administered an anonymous online survey to assess patterns of and motivations for Grindr use in order to inform development and tailoring of smartphone based HIV prevention for YMSM The number one reason for using Grindr 29 was to meet hook ups Among those participants who used both Grindr and online dating sites a statistically significantly greater percentage used online dating sites for hook ups 42 compared to Grindr 30 Seventy percent of YMSM expressed a willingness to participate in a smartphone app based HIV prevention program Development and testing of smartphone apps for HIV prevention delivery has the potential to engage YMSM in HIV prevention programming which can be tailored based on use patterns and motivations for use
- ItemAchieving HIV risk reduction through HealthMpowerment.org, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men.(2015-01-16) Muessig, Kathryn E; Baltierra, Nina B; Pike, Emily C; Legrand, Sara; Hightow-Weidman, Lisa BYoung Black men who have sex with men and transgender women who have sex with men YBMSM TW are at disproportionate risk for HIV and other sexually transmitted infections HIV STI HealthMpowerment org HMP is a mobile phone optimised online intervention that utilises behaviour change and gaming theories to reduce risky sexual behaviours and build community among HIV positive and negative YBMSM TW The intervention is user driven provides social support and utilises a point reward system A four week pilot trial was conducted with a diverse group of 15 YBMSM TW During exit interviews participants described how HMP components led to behaviour changes such as asking partners sexual history increased condom use and HIV STI testing The user driven structure interactivity and rewards appeared to facilitate sustained user engagement and the mobile platform provided relevant information in real time Participants described the reward elements of exceeding their previous scores and earning points toward prizes as highly motivating HMP showed promise for being able to deliver a sufficient intervention dose and we found a trend toward higher dose received and more advanced stages of behaviour change In this pilot trial HMP was well accepted and demonstrates promise for translating virtual intervention engagement into actual behaviour change to reduce HIV risk behaviours
- ItemActors and intentions in the development process of a mobile phone platform for self-management of hypertension.(2014-06-24) Ranerup, Agneta; Hallberg, IngerAim The aim of this study was to enhance the knowledge regarding actors and intentions in the development process of a mobile phone platform for self management of hypertension Methods Our research approach was a 14 month longitudinal real time ethnography method of description and analysis Data were collected through focus groups with patients and providers patient interviews and design meetings with researchers and experts The analysis was informed by the concepts of actors and inscriptions in actor network theory ANT Results Our study showed that laypersons scientific actors as well as technology itself might influence development processes of support for self management of hypertension The intentions were inscribed into the technology design as well as the models of learning and treatment Conclusions The study highlighted important aspects of how actors and intentions feature in the development of the mobile phone platform to support self management of hypertension The study indicated the multifacetedness of the participating actors including the prominent role of technology The concrete results of such processes included questions in the self report system learning and treatment models
- ItemAn adaptive physical activity intervention for overweight adults: a randomized controlled trial.(2013-12-18) Adams, Marc A; Sallis, James F; Norman, Gregory J; Hovell, Melbourne F; Hekler, Eric B; Perata, ElyseBACKGROUND Physical activity PA interventions typically include components or doses that are static across participants Adaptive interventions are dynamic components or doses change in response to short term variations in participant s performance Emerging theory and technologies make adaptive goal setting and feedback interventions feasible OBJECTIVE To test an adaptive intervention for PA based on Operant and Behavior Economic principles and a percentile based algorithm The adaptive intervention was hypothesized to result in greater increases in steps per day than the static intervention METHODS Participants N 20 were randomized to one of two 6 month treatments 1 static intervention SI or 2 adaptive intervention AI Inactive overweight adults 85 women M 36 9 9 2 years 35 non white in both groups received a pedometer email and text message communication brief health information and biweekly motivational prompts The AI group received daily step goals that adjusted up and down based on the percentile rank algorithm and micro incentives for goal attainment This algorithm adjusted goals based on a moving window an approach that responded to each individual s performance and ensured goals were always challenging but within participants abilities The SI group received a static 10 000 steps day goal with incentives linked to uploading the pedometer s data RESULTS A random effects repeated measures model accounted for 180 repeated measures and autocorrelation After adjusting for covariates the treatment phase showed greater steps day relative to the baseline phase pUnder 001 and a group by study phase interaction was observed p 017 The SI group increased by 1 598 steps day on average between baseline and treatment while the AI group increased by 2 728 steps day on average between baseline and treatment a significant between group difference of 1 130 steps day Cohen s d 74 CONCLUSIONS The adaptive intervention outperformed the static intervention for increasing PA The adaptive goal and feedback algorithm is a behavior change technology that could be incorporated into mHealth technologies and scaled to reach large populations TRIAL REGISTRATION ClinicalTrials gov NCT01793064
- ItemAddressing medication nonadherence by mobile phone: development and delivery of tailored messages.(2014-12-03) Gatwood, Justin; Balkrishnan, Rajesh; Erickson, Steven R; An, Lawrence C; Piette, John D; Farris, Karen BBACKGROUND Medication nonadherence remains a significant public health problem and efforts to improve adherence have shown only limited impact The tailoring of messages has become a popular method of developing communication to influence specific health related behaviors but the development and impact of tailored text messages on medication use is poorly understood OBJECTIVES The aim of this paper is to describe an approach to developing theory based tailored messages for delivery via mobile phone to improve medication adherence among patients with diabetes METHODS Kreuter s five step tailoring process was followed to create tailored messages for mobile phone delivery Two focus group sessions using input from 11 people and expert review of message content were used to adapt the survey instrument on which the messages were tailored and edit the developed messages for the target population RESULTS AND CONCLUSIONS Following established tailoring methods a library of 168 theory driven and 128 medication specific tailored messages were developed and formatted for automated delivery to mobile phones Concepts from the Health Belief Model and Self Determination Theory were used to craft the messages and an algorithm was applied to determine the order and timing of messages with the aim of progressively influencing disease and treatment related beliefs driving adherence to diabetes medication The process described may be applied to future investigations aiming to improve medication adherence in patients with diabetes and the effectiveness of the current messages will be tested in a planned analysis
- ItemAdherence to evidence-based guidelines among diabetes self-management apps.(2013-09-27) Breland, Jessica Y; Yeh, Vivian M; Yu, JessicaSmartphone apps can provide real time interactive self management aid to individuals with diabetes It is currently unclear whether existing diabetes self management apps follow evidence based guidelines The purpose of this study was to evaluate the extent to which existing diabetes self management apps address the seven self management behaviors recommended by the American Association of Diabetes Educators the AADE7 The term diabetes identified relevant self management apps via the Apple App Store search engine in March 2012 Ratings were based on app descriptions and downloads Chi square analyses assessed differences in apps based on developer type Apps promoted a median of two AADE7 skills Overall reliability between description and download ratings was good kappa 66 Reliability of individual skills was variable kappa 25 to 91 Most diabetes apps do not conform to evidence based recommendations and future app reviews would benefit from testing app performance Future apps may also benefit from theory based designs
- ItemAdherence to immunosuppressants: how can it be improved in adolescent organ transplant recipients?(2010-09-16) Fredericks, Emily M; Dore-Stites, DawnPURPOSE OF REVIEW Nonadherence among pediatric transplant recipients is prevalent with rates as high as 75 among adolescents These rates are alarming given that adherence behavior has the potential to be modified This review examines evidence from recent studies and position statements to determine the current issues related to improving medication adherence in adolescent transplant recipients RECENT FINDINGS To date there are no empirically validated treatments to promote adherence in pediatric transplant recipients Yet interventions in other chronic illness populations suggest that combined education and behavioral strategies are the most effective in improving medication adherence The use of technology such as the Internet and cellphones provides a promising mechanism for delivering adherence promoting interventions to adolescents Preliminary studies in pediatric solid organ transplant suggest that interventions focused on targeted education and behavioral cues using cellphone text messages are promising strategies for promoting medication adherence SUMMARY Strategies for promoting adherence in adolescent transplant recipients should include developmentally appropriate models and should incorporate health related education motivational strategies and behavioral skills Interventions should be tailored to meet individual needs and should be a collaborative effort between the adolescent family and healthcare providers
- ItemAdolescent methamphetamine use and sexual risk behaviour in secondary school students in Cape Town, South Africa.(2009-04-20) Plüddemann, Andreas; Flisher, Alan J; Mathews, Catherine; Carney, Tara; Lombard, CarlThis study investigated involvement in substance use and sexual activities among adolescents in Cape Town and specifically the associations between methamphetamine use and sexual risk behaviours Data were collected from 15 randomly selected and 15 matched schools in Cape Town via quantitative questionnaires Students used hand held computers PDAs to answer the questions A total of 4605 grade 9 students were sampled Male and female students were almost equally likely to have used methamphetamine at least once 13 versus 12 Students who had used methamphetamine in the past 30 days were significantly more likely to have had vaginal anal or oral sex than students who had never used it to have been pregnant been responsible for a pregnancy and to have been diagnosed with a sexually transmitted infection Logistic regression analysis indicated significant associations between methamphetamine use in the past 12 months and engaging in vaginal and anal sex Drug abuse and sexually transmitted infections STI prevention services should incorporate the link between drugs and STI into their prevention and education strategies especially those aimed at school going adolescents
- ItemAdolescents' perceptions of a mobile cell phone text messaging-enhanced intervention and development of a mobile cell phone-based HIV prevention intervention.(2011-12-22) Cornelius, Judith B; St Lawrence, Janet S; Howard, Jacquelyn C; Shah, Deval; Poka, Avinash; McDonald, Delilah; White, Ann CPURPOSE This study examined African American adolescents perceptions of a mobile cell phone MCP enhanced intervention and development of an MCP based HIV prevention intervention DESIGN AND METHODS One focus group was conducted with 11 adolescents who participated in the Becoming a Responsible Teen Text Messaging project RESULTS Adolescents said they benefited from the MCP enhanced approach and were receptive to the idea of developing an MCP based intervention PRACTICE IMPLICATIONS Nurses can use the findings of this report as a starting point in examining the development of MCP based sexuality education with parents and adolescents
- ItemAffective instability prior to and after thoughts about self-injury in individuals with and at-risk of psychosis: a mobile phone based study.(2013-07-29) Palmier-Claus, J E; Ainsworth, J; Machin, M; Dunn, G; Barkus, E; Barrowclough, C; Rogers, A; Lewis, S WIt has been proposed that affective instability may be associated with thoughts about self injury The aim of this study was to test the hypotheses that instability in feelings of depression but not anxiety guilt or hostility would predict greater concurrent and subsequent thoughts about self injury Thirty six individuals with psychosis completed questions on touch screen mobile phones at semi random times each day for one week The instability of depression predicted greater concurrent and subsequent levels of thoughts about self injury even when controlling for depression level Conversely self injurious thoughts predicted more stable depression The instability of guilt anxiety and hostility did not significantly predict levels of thoughts about self injury Results indicate that a variable depressive state may trigger the onset of thoughts about self injury which increases the risk of its subsequent recurrence The onset of self injurious thoughts may however have a stabilizing effect on subsequent depression
- ItemAfrica's cellular solution to TB.(2013-01-08) Appiah, Bernard
- ItemAfrican American adolescents and new media: associations with HIV/STI risk behavior and psychosocial variables.(2011-07-13) Whiteley, Laura B; Brown, Larry K; Swenson, Rebecca R; Romer, Daniel; DiClemente, Ralph J P; Salazar, Laura E; Vanable, Peter A; Carey, Michael P; Valois, Robert FOBJECTIVES Cell phones and online media are used frequently but we know little about their use among African American adolescents This study examines the frequency of such use and its relationship to psychosocial variables and STI HIV risk behavior SETTING PARTICIPANTS 1 518 African American aged 13 18 years from 2 Northeast US cities Providence RI Syracuse NY and 2 Southeast US cities Columbia SC Macon GA were assessed from 2008 2009 DESIGN Participants were assessed on frequency of cell phone and Internet use psychological constructs ie depression life satisfaction impulsivity and HIV STI risk behaviors ie history of intercourse sexual sensation seeking attitudes peer sexual risks norms with reliable scales and measures using an audio computer assisted self interview RESULTS Over 90 of African American adolescents used cell phones every day or most days and 60 used social networking sites every day or most days 96 used Myspace Greater frequency of cell phone use was associated with sexual sensation seeking P 000 riskier peer sexual norms P 000 and impulsivity P 016 Greater frequency of Internet use was associated with a history of oral vaginal anal sex OR 1 03 CI 1 0 1 05 and sexual sensation seeking P 000 CONCLUSION These findings suggest that riskier youth are online and using cell phones frequently The Internet and cell phones may be useful platforms for targeted health promotion and prevention efforts with AA adolescents
- ItemApplication of mobile-technology for disease and treatment monitoring of malaria in the "Better Border Healthcare Programme".(2010-09-09) Meankaew, Pongthep; Kaewkungwal, Jaranit; Khamsiriwatchara, Amnat; Khunthong, Podjadeach; Singhasivanon, Pratap; Satimai, WichaiBACKGROUND The main objective of this study was to assess the effectiveness of integrating the use of cell phones into a routine malaria prevention and control programme to improve the management of malaria cases among an under served population in a border area The module for disease and treatment monitoring of malaria DTMM consisted of case investigation and case follow up for treatment compliance and patients symptoms METHODS The module combining web based and mobile technologies was developed as a proof of concept in an attempt to replace the existing manual paper based activities that malaria staff used in treating and caring for malaria patients in the villages for which they were responsible After a patient was detected and registered onto the system case investigation and treatment details were recorded into the malaria database A follow up schedule was generated and the patient s status was updated when the malaria staff conducted their routine home visits using mobile phones loaded with the follow up application module The module also generated text and graph messages for a summary of malaria cases and basic statistics and automatically fed to predetermined malaria personnel for situation analysis Following standard public health practices access to the patient database was strictly limited to authorized personnel in charge of patient case management RESULTS The DTMM module was developed and implemented at the trial site in late November 2008 and was fully functioning in 2009 The system captured 534 malaria patients in 2009 Compared to paper based data in 2004 2008 the mobile phone based case follow up rates by malaria staff improved significantly The follow up rates for both Thai and migrant patients were about 94 99 on Day 7 Plasmodium falciparum and Day 14 Plasmodium vivax and maintained at 84 93 on Day 90 Adherence to anti malarial drug therapy based on self reporting showed high completion rate for P falciparum infected cases but lower rate for P vivax cases Patients symptoms were captured onto the mobile phone during each follow up visit either during the home visit or at Malaria Clinic most patients had headache muscle pain and fatigue and some had fever within the first follow up day day 7 14 after the first anti malarial drug dose CONCLUSIONS The module was successfully integrated and functioned as part of the malaria prevention and control programme Despite the bias inherent in sensitizing malaria workers to perform active case follow up using the mobile device the study proved for its feasibility and the extent to which community healthcare personnel in the low resource settings could potentially utilize it efficiently to perform routine duties even in remote areas The DTMM has been modified and is currently functioning in seven provinces in a project supported by the WHO and the Bill And Melinda Gates Foundation to contain multi drug resistant malaria on the Thai Cambodian border
- ItemApplication of smartphone cameras for detecting clinically active trachoma.(2012-09-24) Bhosai, Satasuk Joy; Amza, Abdou; Beido, Nassirou; Bailey, Robin L; Keenan, Jeremy David; Gaynor, Bruce D; Lietman, Thomas M
- ItemAre MSM willing to SMS for HIV prevention?(2013-12-27) Khosropour, Christine M; Lake, Jason G; Sullivan, Patrick SText messaging is a potential HIV prevention tool for men who have sex with men MSM specifically young MSM and MSM of color To determine the willingness of MSM to receive text messages as part of an HIV prevention intervention we administered an online survey to MSM recruited from MySpace com which included questions about mobile phone ownership and willingness to participate in a future text message based HIV research study Of participants 85 n 5 378 reported owning a mobile phone and 49 n 2 483 of mobile phone owners reported being willing to receive text messages in a future HIV research study Black and Hispanic men were more willing than White non Hispanic men to receive text messages Men with a college degree were less willing to receive texts than men with a high school level of education and men 22 years old were less likely to be willing to receive texts than those younger than 22 years of age The authors findings demonstrate that willingness to receive text messages as part of an HIV research study is moderate and mirrors patterns of text message use in age and race Variations in willingness should be taken into account when designing and implementing future interventions
- ItemAre prodromes preictal events? A prospective PDA-based study.(2011-06-13) Maiwald, Thomas; Blumberg, Julie; Timmer, Jens; Schulze-Bonhage, AndreasUp to 29 of patients with epilepsy report prodromal sensations more than 30 minutes prior to seizures We developed and implemented an objective methodology to prospectively assess the sensitivity and specificity of these subjective experiences using personal digital assistants PDAs The key property in contrast to paper based diaries is the internal recording of the patient s entering time of prodromes and seizures Of 500 patients with epilepsy interviewed 31 claimed to sense prodromal symptoms at least 30 minutes before seizure onset Eleven of them agreed to participate in a 4 week study to objectively measure their prospective prediction performance In 9 patients returning data the majority of prodrome entries were not followed by seizures or were identified only retrospectively Statistical analysis revealed that no patient could outperform a nonspecific random predictor when predicting seizures based on the occurrence of prodromes and that the group performance matched precisely the expected result for a by chance prediction These results question the predictive value of prodromes and the specificity of their occurrence in the preictal period