@Article{info:doi/10.2196/60676, author="Lockwood, G. Kimberly and Kulkarni, R. Priya and Branch, H. OraLee and Graham, A. Sarah", title="Cardiac Self-Efficacy Improvement in a Digital Heart Health Program: Secondary Analysis From a Feasibility and Acceptability Pilot Study", journal="JMIR Form Res", year="2025", month="Apr", day="24", volume="9", pages="e60676", keywords="digital health", keywords="self-efficacy", keywords="behavior change", keywords="prevention", keywords="cardiovascular health", keywords="digital heart health", keywords="lifestyle", keywords="heart health", keywords="health coaching", keywords="mobile phone", abstract="Background: Lifestyle modification programs play a critical role in preventing and managing cardiovascular disease (CVD). A key aim of many programs is improving patients' self-efficacy. In-person lifestyle modification programs can enhance self-efficacy in managing CVD risk, also known as cardiac self-efficacy (CSE). However, such programs are typically staffing and resource intensive. Digital lifestyle modification programs may offer a scalable and accessible way to improve CSE, but this has not been shown in prior research. Objective: This study examined changes in CSE among individuals using a digital lifestyle modification program for cardiovascular health. Evaluation of improvement in CSE was a secondary goal of a feasibility and acceptability pilot study of a digital program for Heart Health. Methods: Participants were individuals with elevated risk for CVD who enrolled in a 90-day pilot study that involved mobile app--based, artificial intelligence--powered health coaching and educational lessons focused on behaviors that promote cardiovascular health. Participants completed the 9-item CSE Scale at baseline and in month 2. Changes in confidence in participants' ability to manage their cardiovascular health were assessed. Results: The sample included 273 (n=207, 61.2\% female; mean age 59.3, SD 10.1 years) participants who submitted a complete CSE Scale at baseline and in month 2. The total CSE Scale score increased by 12.9\% (P<.001) from baseline to month 2. Additionally, there were significant increases in mean score on each of the 9 individual CSE Scale items (all P<.001), with the largest increases in confidence ``in knowing when to call or visit the doctor for your heart disease'' (17\% increase; P<.001), ``in knowing how much physical activity is good for you'' (16.3\% increase; P<.001), and ``that you can get regular aerobic exercise'' (19\% increase; P<.001). Conclusions: The present analyses indicate that participants in a digital lifestyle modification program for cardiovascular health showed significant improvements in CSE within 2 months. This work adds to the growing literature examining ways to improve health-related self-efficacy and scalable access to programs for prevention and management of CVD. ", doi="10.2196/60676", url="https://formative.jmir.org/2025/1/e60676" } @Article{info:doi/10.2196/71676, author="Pack, Allison and Bailey, C. Stacy and O'Conor, Rachel and Velazquez, Evelyn and Wismer, Guisselle and Yeh, Fangyu and Curtis, M. Laura and Alcantara, Kenya and Wolf, S. Michael", title="A Portal-Based Intervention (PATTERN) Designed to Support Medication Use Among Older Adults: Feasibility and Acceptability Study", journal="JMIR Form Res", year="2025", month="Apr", day="24", volume="9", pages="e71676", keywords="older adults", keywords="multiple chronic conditions", keywords="polypharmacy", keywords="primary care", keywords="medication adherence", keywords="patient portal", abstract="Background: Poor medication adherence among older adults with multiple chronic conditions and polypharmacy is a public health concern stemming from distinct challenges. Prior interventions have largely used a one-size-fits-all approach or resource-intensive approaches inappropriate for busy primary care clinics. Objective: To address this, Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) was adapted from prior work. PATTERN is a portal-based intervention for monitoring self-reported medication adherence challenges among older adults in primary care. This study sought to implement and evaluate PATTERN's feasibility and acceptability. Methods: We conducted a patient randomized study with a posttest design. Primary care physicians at the participating health center were informed of the study, and approval was obtained to contact their patients. Patient eligibility included being aged 60 years or older, having prescription medications for ?8 chronic conditions, and an upcoming visit with a physician who had provided approval. Potentially eligible patients were identified using an electronic health record query, and a research coordinator phoned them to confirm eligibility, assess interest, obtain consent, and conduct enrollment. Randomization occurred following enrollment. Those randomized to PATTERN received a medication adherence assessment in their patient portal accounts several days ahead of their visit. The assessment identified whether a patient was experiencing a medication adherence challenge, and if so, the type (cognitive, psychological, medical, regimen-related, social, or economic). Identified challenges were sent to the patient's primary care physician. Assessment delivery several days ahead of a visit was thought to offer sufficient time for patients to complete it and clinicians to review any challenges. Approximately 2 weeks after visits, the coordinator recontacted participants to conduct posttest interviews. This ensured clinicians had sufficient time to respond to challenges during or after visits. Posttest interviews measured the self-reported use of the portal, demographic and health characteristics, and for those randomized to PATTERN, intervention satisfaction. Self-reported data were captured in REDCap and analyzed descriptively. Electronic health record data were also analyzed descriptively to objectively identify feasibility, that is, whether intervention arm participants completed the PATTERN assessment. Results: We enrolled 64 participants (32 received usual care, and 32 received intervention). Most were female (66\%, 42/64), not Hispanic or Latino (94\%, 60/64), and identified as White (58\%, 37/64). The average (SD) age was 75 (6.8) years. Most participants (80\%) self-reported using the patient portal ?12 times per year. However, electronic health record data revealed that less than half of all participants randomized to PATTERN (47\%, 15/32) completed the medication adherence assessment. Of those who remembered completing it, 60\% (3/5) were very satisfied with the experience and 20\% (1/5) were a little satisfied. Conclusions: PATTERN has the potential for use with older primary care patients experiencing multiple chronic conditions and polypharmacy. Yet, further adaptation is needed to ensure recipients access their patient portal accounts and complete assessments. Trial Registration: ClinicalTrials.Gov NCT05766423; https://clinicaltrials.gov/study/NCT05766423 ", doi="10.2196/71676", url="https://formative.jmir.org/2025/1/e71676" } @Article{info:doi/10.2196/71867, author="Kendall, D. Ashley and Pela, Emily and Amonica, Danielle and Jaworski, Erin and Floyd, Brenikki and ", title="Feasibility Testing a Meditation App for Professionals Working With Youth in the Legal System: Protocol for a Hybrid Type 2 Effectiveness-Implementation Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="24", volume="14", pages="e71867", keywords="mobile app", keywords="mHealth", keywords="digital mental health", keywords="meditation", keywords="mindfulness", keywords="juvenile legal system", keywords="officers", keywords="workplace", keywords="ecological momentary assessment (EMA)", keywords="emotion regulation", abstract="Background: Probation officers and other professionals who work with youth in the legal system often experience high chronic workplace stress, which can contribute over time to elevations in anxiety, depression, and workplace burnout. Emotion dysregulation appears to function as a common mechanism underlying these elevations, and growing evidence suggests it can be improved with mindfulness meditation. Implemented successfully, app-based meditation programs could provide professionals with real-time tools for mitigating the effects of chronic workplace stress. Objective: This paper describes the protocol for a hybrid type 2 effectiveness-implementation pilot randomized controlled trial (RCT) of Bodhi AIM+, a meditation app adapted with and for professionals who work with youth in the legal system. The adaptation process and implementation plan, as well as the pilot RCT design, were guided by theoretically driven implementation science frameworks. The primary outcome of the pilot RCT is app adherence (ie, ongoing app usage per objective analytics data). Methods: The RCT will be fully remote. Officers and other professionals who work with youth in the legal system (N=50) will be individually randomized to use the meditation app or an active control app matched for time and structure. All participants will be asked to follow a 30-day path of brief audio- or video-guided content and invited to use additional app features as desired. In-app analytics will capture the objective usage of each feature. An adaptive engagement design will be employed to engage nonusers of both apps, whereby analytics data indicating nonuse will trigger additional support (eg, text messages promoting engagement). Mental health outcomes and potential moderators and covariates will be self-reported at baseline, posttest, and 6 months. Participants will also complete 1-week bursts of ecological momentary assessment (EMA) at baseline and over the last week of the intervention to capture the mechanistic target (ie, emotion regulation) in real time. All participants will be invited to complete qualitative posttest interviews. Descriptive statistics will be calculated for quantitative data. Qualitative data will be analyzed using a combined deductive-inductive approach. The quantitative and qualitative data will be incorporated into a mixed methods triangulation design, allowing for the evaluation of app adherence and other implementation outcomes as well as related barriers and facilitators to implementation. Results: Enrollment into the trial started in December 2024 and is currently underway. Study results are anticipated to be available in 2026. Conclusions: Completion of this pilot trial will inform a future, fully powered RCT to formally evaluate the effectiveness and implementation of Bodhi AIM+. Its use of implementation science methods, coupled with digital technology, positions the present study not only to help make meditation tools available to an important workforce at scale but also to inform broader efforts at implementing and evaluating health apps within workplace settings. Trial Registration: ClincialTrials.gov NCT06555172; https://clinicaltrials.gov/study/NCT06555172 International Registered Report Identifier (IRRID): DERR1-10.2196/71867 ", doi="10.2196/71867", url="https://www.researchprotocols.org/2025/1/e71867" } @Article{info:doi/10.2196/70463, author="Sanchez, William and Dewan, Ananya and Budd, Eve and Eifler, M. and Miller, C. Robert and Kahn, Jeffery and Macis, Mario and Gross, Marielle", title="Decentralized Biobanking Apps for Patient Tracking of Biospecimen Research: Real-World Usability and Feasibility Study", journal="JMIR Bioinform Biotech", year="2025", month="Apr", day="10", volume="6", pages="e70463", keywords="patient empowerment", keywords="biobanking", keywords="biospecimens", keywords="transparency", keywords="community engagement", keywords="nonfungible tokens", keywords="NFTs", keywords="blockchain technology", keywords="decentralized biobanking", keywords="pilot studies", keywords="technical feasibility", keywords="biowallet", abstract="Background: Biobank privacy policies strip patient identifiers from donated specimens, undermining transparency, utility, and value for patients, scientists, and society. We are advancing decentralized biobanking apps that reconnect patients with biospecimens and facilitate engagement through a privacy-preserving nonfungible token (NFT) digital twin framework. The decentralized biobanking platform was first piloted for breast cancer biobank members. Objective: This study aimed to demonstrate the technical feasibility of (1) patient-friendly biobanking apps, (2) integration with institutional biobanks, and (3) establishing the foundation of an NFT digital twin framework for decentralized biobanking. Methods: We designed, developed, and deployed a decentralized biobanking mobile app for a feasibility pilot from 2021 to 2023 in the setting of a breast cancer biobank at a National Cancer Institute comprehensive cancer center. The Flutter app was integrated with the biobank's laboratory information management systems via an institutional review board--approved mechanism leveraging authorized, secure devices and anonymous ID codes and complemented with a nontransferable ERC-721 NFT representing the soul-bound connection between an individual and their specimens. Biowallet NFTs were held within a custodial wallet, whereas the user experiences simulated token-gated access to personalized feedback about collection and use of individual and collective deidentified specimens. Quantified app user journeys and NFT deployment data demonstrate technical feasibility complemented with design workshop feedback. Results: The decentralized biobanking app incorporated key features: ``biobank'' (learn about biobanking), ``biowallet'' (track personal biospecimens), ``labs'' (follow research), and ``profile'' (share data and preferences). In total, 405 pilot participants downloaded the app, including 361 (89.1\%) biobank members. A total of 4 central user journeys were captured. First, all app users were oriented to the ?60,000-biospecimen collection, and 37.8\% (153/405) completed research profiles, collectively enhancing annotations for 760 unused specimens. NFTs were minted for 94.6\% (140/148) of app users with specimens at an average cost of US \$4.51 (SD US \$2.54; range US \$1.84-\$11.23) per token, projected to US \$17,769.40 (SD US \$159.52; range US \$7265.62-\$44,229.27) for the biobank population. In total, 89.3\% (125/140) of the users successfully claimed NFTs during the pilot, thereby tracking 1812 personal specimens, including 202 (11.2\%) distributed under 42 unique research protocols. Participants embraced the opportunity for direct feedback, community engagement, and potential health benefits, although user onboarding requires further refinement. Conclusions: Decentralized biobanking apps demonstrate technical feasibility for empowering patients to track donated biospecimens via integration with institutional biobank infrastructure. Our pilot reveals potential to accelerate biomedical research through patient engagement; however, further development is needed to optimize the accessibility, efficiency, and scalability of platform design and blockchain elements, as well as a robust incentive and governance structure for decentralized biobanking. ", doi="10.2196/70463", url="https://bioinform.jmir.org/2025/1/e70463", url="http://www.ncbi.nlm.nih.gov/pubmed/40208659" } @Article{info:doi/10.2196/42406, author="Kola, Lola and Fatodu, Tobi and Kola, Manasseh and Olayemi, A. Bisola and Adefolarin, O. Adeyinka and Dania, Simpa and Kumar, Manasi and Ben-Zeev, Dror", title="Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study", journal="JMIR Form Res", year="2025", month="Apr", day="9", volume="9", pages="e42406", keywords="adolescent perinatal depression", keywords="primary care", keywords="mHealth app", keywords="user centered design", keywords="smartphone", keywords="human-centered design", keywords="HCD", keywords="depression", keywords="postpartum", keywords="perinatal", keywords="postnatal", keywords="teenage", keywords="adolescent", keywords="youth", keywords="low-middle-income countries", keywords="LMIC", keywords="middle income", keywords="adoption", keywords="acceptability", keywords="mobile health", keywords="mHealth", keywords="mobile app", keywords="women's health", keywords="mental health", keywords="depressive", abstract="Background: Mobile health (mHealth), the use of mobile technology in health care, is increasingly being used for mental health service delivery even in low- and middle-income countries to scale up treatment, and a variety of evidence supports their potential in different populations. Objective: This study aims to use the Social Cognitive Theory (SCT) as a lens to explain knowledge of mHealth use for mental health care, personal behavioral capabilities, and the external social contexts that can impact the adoption of an mHealth app for depression care among perinatal adolescents in Nigeria. Methods: At the preliminary stage of a user-centered design (UCD), 4 focus group discussions were conducted among 39 participants: 19 perinatal adolescents with a history of depression and 20 primary care providers. Guided by the SCT, a popular model used for predicting and explaining health behaviors, we documented participants' knowledge of mHealth use for health purposes, advantages, and challenges to the adoption of an mHealth app by young mothers, and approaches to mitigate challenges. Data collection and analysis was an iterative process until saturation of all topic areas was reached. Results: The mean age for young mothers was 17.3 (SD 0.9) years and 48 (SD 5.8) years for care providers. Mistrust from relatives on mobile phone use for therapeutic purposes, avoidance of clinic appointments, and sharing of application contents with friends were some challenges to adoption identified in the study population. Supportive personal factors and expressions of self-efficacy on mobile app use were found to be insufficient for adoption. This is because there are social complications and disapprovals that come along with getting pregnant at a young age. Adequate engagement of parents, guardians, and partners on mHealth solutions by care providers was identified as necessary to the uptake of digital tools for mental health care in this population. Conclusions: The SCT guided the interpretations of the study findings. Young mothers expressed excitement at the use of mHealth technology to manage perinatal depression. Real-life challenges, however, need to be attended to for successful implementation of such interventions. Communications between care providers and patients' relatives on the therapeutic use of mHealth are vital to the success of a mHealth mental health management plan for depression in young mothers in Nigeria. ", doi="10.2196/42406", url="https://formative.jmir.org/2025/1/e42406" } @Article{info:doi/10.2196/67782, author="Zisquit, ?Moreah and Shoa, Alon and Oliva, Ramon and Perry, Stav and Spanlang, Bernhard and Brunstein Klomek, Anat and Slater, Mel and Friedman, Doron", title="AI-Enhanced Virtual Reality Self-Talk for Psychological Counseling: Formative Qualitative Study", journal="JMIR Form Res", year="2025", month="Apr", day="2", volume="9", pages="e67782", keywords="virtual human", keywords="large language model", keywords="virtual reality", keywords="self-talk", keywords="psychotherapy", keywords="artificial intelligence", keywords="AI", abstract="Background: Access to mental health services continues to pose a global challenge, with current services often unable to meet the growing demand. This has sparked interest in conversational artificial intelligence (AI) agents as potential solutions. Despite this, the development of a reliable virtual therapist remains challenging, and the feasibility of AI fulfilling this sensitive role is still uncertain. One promising approach involves using AI agents for psychological self-talk, particularly within virtual reality (VR) environments. Self-talk in VR allows externalizing self-conversation by enabling individuals to embody avatars representing themselves as both patient and counselor, thus enhancing cognitive flexibility and problem-solving abilities. However, participants sometimes experience difficulties progressing in sessions, which is where AI could offer guidance and support. Objective: This formative study aims to assess the challenges and advantages of integrating an AI agent into self-talk in VR for psychological counseling, focusing on user experience and the potential role of AI in supporting self-reflection, problem-solving, and positive behavioral change. Methods: We carried out an iterative design and development of a system and protocol integrating large language models (LLMs) within VR self-talk during the first two and a half years. The design process addressed user interface, speech-to-text functionalities, fine-tuning the LLMs, and prompt engineering. Upon completion of the design process, we conducted a 3-month long exploratory qualitative study in which 11 healthy participants completed a session that included identifying a problem they wanted to address, attempting to address this problem using self-talk in VR, and then continuing self-talk in VR but this time with the assistance of an LLM-based virtual human. The sessions were carried out with a trained clinical psychologist and followed by semistructured interviews. We used applied thematic analysis after the interviews to code and develop key themes for the participants that addressed our research objective. Results: In total, 4 themes were identified regarding the quality of advice, the potential advantages of human-AI collaboration in self-help, the believability of the virtual human, and user preferences for avatars in the scenario. The participants rated their desire to engage in additional such sessions at 8.3 out of 10, and more than half of the respondents indicated that they preferred using VR self-talk with AI rather than without it. On average, the usefulness of the session was rated 6.9 (SD 0.54), and the degree to which it helped solve their problem was rated 6.1 (SD 1.58). Participants specifically noted that human-AI collaboration led to improved outcomes and facilitated more positive thought processes, thereby enhancing self-reflection and problem-solving abilities. Conclusions: This exploratory study suggests that the VR self-talk paradigm can be enhanced by LLM-based agents and presents the ways to achieve this, potential pitfalls, and additional insights. ", doi="10.2196/67782", url="https://formative.jmir.org/2025/1/e67782" } @Article{info:doi/10.2196/58837, author="Flo, L. Gayle and Alzate Aguirre, Mateo and Gochanour, R. Benjamin and Hynes, J. Kristin and Scott, G. Christopher and Fink, L. Angela and M Arruda-Olson, Adelaide", title="Pharmacist-Initiated Team-Based Intervention for Optimizing Guideline-Directed Lipid Therapy of Hospitalized Patients With Acute Coronary Syndrome: Pilot Study Using a Stepped-Wedge Cluster Design", journal="JMIR Cardio", year="2025", month="Mar", day="28", volume="9", pages="e58837", keywords="coronary disease", keywords="follow-up studies", keywords="lipids", keywords="myocardial infarction", keywords="statins", abstract="Background: Clinical guidelines recommend high-intensity statin therapy for patients with acute coronary syndrome (ACS). However, high-intensity statins have been underused in this population. Objective: The objective of this study was to evaluate the feasibility of a pharmacist-initiated, team-based intervention for the delivery of individualized, guideline-directed, lipid-lowering therapy for patients with ACS. Methods: Patients admitted with ACS to cardiology hospital services at Mayo Clinic from August 1, 2021, to June 19, 2022, were assigned to a pharmacist-initiated, team-based intervention group or control group using a stepped wedge cluster study design. For the intervention group, pharmacists reviewed electronic health records and provided recommendations for lipid lowering therapy in hospital and at follow-up. In the control group, patients received usual care. Neither care team, nor study team were blinded to study assignments. The primary outcome was the proportion of patients with ACS discharged on high-intensity statins in the intervention group compared to controls. Secondary outcomes were (1) proportion of patients in the intervention group with a specific templated pharmacist intervention note in their electronic health records, (2) frequency of low-density lipoprotein (LDL) measurements in hospital, (3) proportion of patients with information related to lipid follow-up in their discharge summary, and (4) proportion of patients that received LDL monitoring at the outpatient follow-up 4 to 12 weeks post discharge. Results: There were 410 patients included in this study (median age 68, IQR 60-78 years) of whom 285 (69.5\%) were male. Of the 402 patients alive at discharge, 355 (88.3\%) were discharged taking a high-intensity statin, with no significant difference (P=.89) observed between groups. Lipid levels were measured in the hospital for 176/210 (83.8\%) patients in the intervention group and 155/200 (77.5\%) patients in the control group (P=.14). Fifty-four of 205 (26.3\%) intervention patients alive at discharge had lipid-related recommendations in their discharge summary compared to 27/197 (13.7\%) controls (P=.002). Forty-seven of 81 (58\%) patients with lipid management recommendations provided in the discharge summary had LDL measured in the follow-up period compared with only 119/321 (37.1\%) patients without these recommendations (P=.001). Of the 402 patients who survived to discharge, 166 (41.3\%) had LDL measured at follow-up; the median LDL level was 63.5 (IQR 49-79) mg/dL, and distributions were similar by group (P=.95). Only 101/166 (60.8\%) patients had follow-up LDL values below the target of 70 mg/dL. Conclusions: During hospitalization, there was no group difference in the primary outcome of high-intensity statin therapy. Feasibility of an effective pharmacist-initiated intervention for improvement of lipid management was demonstrated by entry of recommendations in the discharge summary and related adjustment in outpatient statin therapy. The main opportunity for future improvement in lipid management of patients with ACS is in longitudinal patient follow-up. ", doi="10.2196/58837", url="https://cardio.jmir.org/2025/1/e58837" } @Article{info:doi/10.2196/59527, author="Immel, Diana and Hilpert, Bernhard and Schwarz, Patricia and Hein, Andreas and Gebhard, Patrick and Barton, Simon and Hurlemann, Ren{\'e}", title="Patients' and Health Care Professionals' Expectations of Virtual Therapeutic Agents in Outpatient Aftercare: Qualitative Survey Study", journal="JMIR Form Res", year="2025", month="Mar", day="26", volume="9", pages="e59527", keywords="socially interactive agent", keywords="e-mental health", keywords="mental illness", keywords="mental disorder", keywords="depression", keywords="major depressive disorder", keywords="suicide prevention", keywords="suicidal ideation", keywords="outpatient aftercare", keywords="artificial intelligence", keywords="virtual therapeutic assistant", keywords="public health", keywords="digital technology", keywords="digital intervention", keywords="digital health care", abstract="Background: Depression is a serious mental health condition that can have a profound impact on the individual experiencing the disorder and those providing care. While psychotherapy and medication can be effective, there are gaps in current approaches, particularly in outpatient care. This phase is often associated with a high risk of relapse and readmission, and patients often report a lack of support. Socially interactive agents represent an innovative approach to the provision of assistance. Often powered by artificial intelligence, these virtual agents can interact socially and elicit humanlike emotions. In health care, they are used as virtual therapeutic assistants to fill gaps in outpatient aftercare. Objective: We aimed to explore the expectations of patients with depression and health care professionals by conducting a qualitative survey. Our analysis focused on research questions related to the appearance and role of the assistant, the assistant-patient interaction (time of interaction, skills and abilities of the assistant, and modes of interaction) and the therapist-assistant interaction. Methods: A 2-part qualitative study was conducted to explore the perspectives of the 2 groups (patients and care providers). In the first step, care providers (n=30) were recruited during a regional offline meeting. After a short presentation, they were given a link and were asked to complete a semistructured web-based questionnaire. Next, patients (n=20) were recruited from a clinic and were interviewed in a semistructured face-to-face interview. Results: The survey findings suggested that the assistant should be a multimodal communicator (voice, facial expressions, and gestures) and counteract negative self-evaluation. Most participants preferred a female assistant or wanted the option to choose the gender. In total, 24 (80\%) health care professionals wanted a selectable option, while patients exhibited a marked preference for a female or diverse assistant. Regrading patient-assistant interaction, the assistant was seen as a proactive recipient of information, and the patient as a passive one. Gaps in aftercare could be filled by the unlimited availability of the assistant. However, patients should retain their autonomy to avoid dependency. The monitoring of health status was viewed positively by both groups. A biofeedback function was desired to detect early warning signs of disease. When appropriate to the situation, a sense of humor in the assistant was desirable. The desired skills of the assistant can be summarized as providing structure and emotional support, especially warmth and competence to build trust. Consistency was important for the caregiver to appear authentic. Regarding the assistant--care provider interaction, 3 key areas were identified: objective patient status measurement, emergency suicide prevention, and an information tool and decision support system for health care professionals. Conclusions: Overall, the survey conducted provides innovative guidelines for the development of virtual therapeutic assistants to fill the gaps in patient aftercare. ", doi="10.2196/59527", url="https://formative.jmir.org/2025/1/e59527" } @Article{info:doi/10.2196/63704, author="Rookes, Alanna Tasmin and Batla, Amit and Armstrong, Megan and Ambler, Gareth and Walters, Kate and Schrag, Anette", title="Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study", journal="JMIR Form Res", year="2025", month="Mar", day="25", volume="9", pages="e63704", keywords="Parkinson disease", keywords="feasibility", keywords="remote monitoring", keywords="Parkinson", keywords="acceptability", keywords="reliability", keywords="wearable devices", keywords="wearable", keywords="self-management", keywords="quantitative assessments", keywords="quantitative", keywords="qualitative", keywords="monitoring", keywords="patient", abstract="Background: Parkinson disease is a progressive neurodegenerative disorder with complex motor and nonmotor symptoms. To assess these, clinical assessments are completed, providing a snapshot of a person's experience. Monitoring Parkinson disease using wearable devices can provide continuous and objective data and capture information on movement patterns in daily life. Objective: The aim of the study is to assess patient acceptability and technical reliability of 2 wearable devices used in clinical trials (ActivInsights and Axivity AX3). Methods: Participants in a feasibility study testing a self-management toolkit (PD-Care) optionally wore a wearable device for 1 week, providing feedback through an open- and closed-question survey conducted over the telephone about the acceptability of wearing the device. The closed questions used a Likert scale from 1 to 5 (with 1=strongly agree and 5=strongly disagree) asking whether (1) the device was comfortable to wear, (2) the device was easy to put on, (3) the device was easy to wear, (4) the device was embarrassing to wear, and (5) if they were happy to wear the device for longer than 7 days. Differences in acceptability between devices were analyzed using Mann-Whitney U tests and Wilcoxon matched pairs signed rank tests. These were followed by open-ended questions asking (1) How did you find wearing the device? (2) How did you find putting the device on? (3) Did you take it off and why? (4) What was your overall impression? (5) Did you prefer the wrist- or trunk-worn device and why (Axivity AX3 only)? Results: A total of 22 of 32 (69\%) participants offered the device agreed to wear it. There were no significant differences in the demographic characteristics between those monitored and those who chose not to be. Acceptance with both devices was generally good. The ActivInsights device was more acceptable than the wrist- and trunk-worn Axivity AX3 devices, as more participants found it to be comfortable (n=15, 100\% vs n=5, 71\%; P=.02 and n=4, 57\%; P=.004, respectively), easy to wear (n=15, 100\% vs n=6, 86\%; P=.048 and n=3, 43\%; P=.004, respectively) and would wear for more than 7 days (n=13, 87\% vs n=4, 57\%; P=.02 and n=1, 14\%; P<.001, respectively). The trunk-worn Axivity AX3 device had the lowest acceptance rates, but there were no statistical differences in acceptability between the wrist- and trunk-worn Axivity AX3 devices (all P>.05). There were issues with battery life and recording errors in 3 of 14 (21\%) Axivity AX3 devices and upload failures in 3 of 15 (20\%) ActivInsights devices. Conclusions: Acceptability of wearables for monitoring Parkinson was satisfactory, especially when wrist-worn, although a few participants experienced difficulties in correct use, and there were some errors with the data upload. Trial Registration: ISRCTN Registry ISRCTN92831552; https://www.isrctn.com/ISRCTN92831552 ", doi="10.2196/63704", url="https://formative.jmir.org/2025/1/e63704" } @Article{info:doi/10.2196/67293, author="Whittemore, Robin and Jeon, Sangchoon and Akyirem, Samuel and Chen, C. Helen N. and Lipson, Joanna and Minchala, Maritza and Wagner, Julie", title="Multilevel Intervention to Increase Patient Portal Use in Adults With Type 2 Diabetes Who Access Health Care at Community Health Centers: Single Arm, Pre-Post Pilot Study", journal="JMIR Form Res", year="2025", month="Mar", day="25", volume="9", pages="e67293", keywords="patient portal", keywords="mobile phone", keywords="diabetes", keywords="community health center", keywords="adults", keywords="diabetic", keywords="DM", keywords="diabetes mellitus", keywords="Type 2 diabetes", keywords="T2D", keywords="community health centers", keywords="CHCs", keywords="pilot study", keywords="feasibility", keywords="self-management", keywords="glycemic control", keywords="patient portals", keywords="social determinants of health", keywords="primary outcome", keywords="digital health", keywords="digital health literacy", keywords="health technology", keywords="health technologies", keywords="psychosocial", keywords="efficacy", abstract="Background: Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs. Methods: A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function. Results: In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77\%) and reported low income (19/22, 86\%< US \$40,000/year), low education (13/22, 59\%