@Article{info:doi/10.2196/60073, author="Fernandez, Alejandra and Bernal, Savannah and Kim, Lana and Potla, Subodh", title="Using Ecological Momentary Assessment to Assess Family Functioning in Spanish-Speaking Parent and Adolescent Dyads: Daily Questionnaire Study", journal="JMIR Form Res", year="2025", month="Jun", day="11", volume="9", pages="e60073", keywords="adolescence", keywords="ecological momentary assessment", keywords="family functioning", keywords="family function", keywords="feasibility", keywords="acceptability", keywords="adolescent", keywords="family-based", keywords="family-based interventions", keywords="EMA", keywords="community-based", keywords="smartphone", abstract="Background: Family functioning is associated with several adolescent health outcomes, and many family-based interventions (FBIs) exist to improve family functioning. However, most FBIs assess family functioning retrospectively at baseline and post intervention, thereby overlooking the daily fluctuations in family functioning throughout the intervention. Ecological momentary assessment (EMA) is a method involving a high frequency of assessments and has been underused to assess family functioning across parent and adolescent dyads. Further, limited research exists on the use of EMA in bilingual populations. Objective: The purpose of this study was to assess an EMA protocol's feasibility and acceptability and to analyze within-person and between-person variance in family functioning reports in a sample of primarily Spanish-speaking parent and adolescent dyads. Methods: Participants completed a baseline assessment (including demographics and family functioning assessment), a 7-day protocol with a once-daily family assessment questionnaire using an EMA app, and an acceptability questionnaire at the conclusion of the study. Results: We recruited 7 mothers (mean age 37.29, SD 3.82 years) and 8 adolescents (n=7, 88\% females; mean age 11.86, SD 1.07 years) who identified themselves as Hispanic/Latinx. The participants showed overall satisfaction with the EMA protocol. The daily assessments were completed relatively quickly (mean 3 minutes and 16 seconds, SD 11 minutes and 5 seconds) after the prompt notification was received, and the response rate across the daily assessments was 90\% (87/97). The reported family functioning was relatively high across both adolescents (mean 4.57) and parents (mean 4.59). The variance across adolescents (SD 0.459) was larger than that within their individual reports of family functioning (SD 0.122). Alternatively, the variance across parents was smaller (SD 0.132) than that reported among parents' individual reports of family functioning (SD 0.286). Our findings highlight the heterogeneity between adolescent and parent responses. Finally, the visual inspection of data underscored the individualized patterns and reported differences in the family functioning reports across parents and adolescents. Conclusion: Our findings emphasize the value of EMA in studying family (eg, adolescent-caregiver) behaviors. EMA's ability to capture immediate experiences presents a nuanced picture of daily interactions and offers suggestions for practice when using the EMA methodology in populations such as the one included in this study (ie, primarily Spanish-speaking parent-adolescent dyads). ", doi="10.2196/60073", url="https://formative.jmir.org/2025/1/e60073" } @Article{info:doi/10.2196/66187, author="Unzueta Saavedra, Jimena and Deaso, A. Emma and Austin, Margot and Cadavid, Laura and Kraff, Rachel and Knowles, M. Emma E.", title="Smartphone Ecological Momentary Assessment and Wearable Activity Tracking in Pediatric Depression: Cohort Study", journal="JMIR Form Res", year="2025", month="Jun", day="11", volume="9", pages="e66187", keywords="depression", keywords="ecological momentary assessment", keywords="activity", keywords="sleep", keywords="mood", keywords="adolescent", abstract="Background: Adolescent depression is a significant public health concern. The presentation of depressive symptoms varies widely among individuals, fluctuating in intensity over time. Ecological momentary assessment (EMA) offers a unique advantage by enhancing ecological validity and reducing recall bias, allowing for a more accurate and nuanced understanding of major depressive disorder (MDD) symptoms. This methodology provides valuable insights into the fluctuating nature of depression, which could inform more personalized and timely interventions. Objective: This study aims to (1) evaluate the feasibility of collecting smartphone-based EMA data alongside activity and sleep tracking in adolescents with depression; (2) investigate the severity and variability of mood symptoms reported over time; and (3) explore the relationship between mood, activity, and sleep. Methods: Thirty-six participants (23 with MDD, 13 unaffected controls; 75\% [n=27] female, mean age 19.50 y) completed twice-daily EMA check-ins over 2 weeks, complemented by continuous activity and sleep monitoring using FitBit Charge 3 devices. The study examined feasibility, usability of the EMA app, symptom severity and variability, and relationships between mood, activity, and sleep. We applied linear mixed-effects regression to the data to examine relationships between variables. Results: Participants completed a total of 923 unique check-ins (mean check-ins per participant=25.60). Overall compliance rates were high (91.57\%), indicating the approach is highly feasible. MDD participants demonstrated greater symptom severity and variability over time compared with controls ($\beta$=34.48, P<.001). Individuals with MDD exhibited greater diurnal variation ($\beta$=?2.54, P<.001) with worse mood in the morning and worse mood than anxiety scores over time ($\beta$=?6.93, P<.001). Life stress was a significant predictor of more severe EMA scores ($\beta$=24.50, P<.001). MDD cases exhibited more inconsistent sleep patterns ($\beta$=32.14, P<.001), shorter total sleep times ($\beta$=?94.38, P<.001), and a higher frequency of naps ($\beta$=14.05, P<.001). MDD cases took fewer steps per day (mean 5828.64, SD 6188.85) than controls (mean 7088.47, SD 5378.18) over the course of the study, but this difference was not significant (P=.33), and activity levels were not significantly predictive of EMA score (P=.75). Conclusions: This study demonstrates the feasibility of integrating smartphone-based EMA with wearable activity tracking in adolescents with depression. High compliance rates support the practicality of this approach, while EMA data provide valuable insights into the dynamic nature of depressive symptoms, particularly in relation to sleep and life stress. Future studies should validate these findings in larger, more diverse samples. Clinically, EMA and wearable tracking may enhance routine assessments and inform personalized interventions by capturing symptom variability and external influences in real time. ", doi="10.2196/66187", url="https://formative.jmir.org/2025/1/e66187" } @Article{info:doi/10.2196/66131, author="Lew, Tovan and Dubale, M. Natnaiel and Doose, Erik and Adenuga, Alex and Bates, E. Holly and West, L. Sarah", title="Impacts of the Mindfulness Meditation Mobile App Calm on Undergraduate Students' Sleep and Emotional State: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="Jun", day="11", volume="9", pages="e66131", keywords="mindfulness", keywords="mobile apps", keywords="students", keywords="mHealth", keywords="sleep", keywords="emotional state", keywords="pilot study", keywords="depression", keywords="anxiety", keywords="stress", keywords="university", keywords="mobile phone", keywords="mobile health", abstract="Background: Undergraduate students frequently experience negative emotional states and sleep quality, which is believed to have worsened following the COVID-19 pandemic. Objective: This study piloted the use of a popular mobile mindfulness app (Calm) as a potential intervention to improve state depression, anxiety, stress, and sleep quality in undergraduate students attending a Canadian university, following the COVID-19 pandemic. Methods: Undergraduate students were randomly assigned to a control or treatment group and completed a series of 3 questionnaires to evaluate baseline state emotional health (Depression Anxiety Stress Scale 42-Item Version [DASS-42], Perceived Stress Scale 10-Item Version [PSS-10], and Pittsburgh Sleep Quality Index). Treatment group participants were instructed to engage with the fully-automated Calm app's sleep section for 30 days: 20 minutes daily, 5 days a week, along with an additional 30 minutes of interaction with other app sections each week, resulting in a goal of 130 minutes per week. The control participants were instructed to continue with everyday life and refrain from the use of mindfulness-based apps for 30 days. Following the 30-day treatment period, all participants repeated the 3 questionnaires. The impact of the treatment on all outcomes was examined using linear mixed model analyses. Independent samples t tests were used to determine if psychosocial health or sleep scores differed between baseline and follow-up and if differences in such scores were present between the groups. Results: A total of 80 students met the inclusion criteria and were randomly assigned to the control (n=40) or treatment (n=40) group. One control participant was lost to follow-up and 3 treatment participants discontinued engaging with the Calm app. Both control (n=39) and treatment (n=37) groups began with similar demographic, emotional state, and sleep characteristics. Treatment participants engaged with the Calm app's sleep section for an average of 234 minutes per week; however, 54\% (20/37) met the minimum prescribed interaction time across all 4 weeks. Following the 30-day treatment period, compared to the control group, the treatment group's state anxiety (mean 14, SD 7.4 vs mean 12, SD 7.8; P=.002), state stress (DASS-42: mean 20, SD 8.8 vs mean 15, SD 8.5; P<.001; PSS-10: mean 22, SD 5.9 vs mean 19, SD 5.9; P=.02), and sleep quality (mean 7.7, SD 2.7 vs mean 6.4, SD 3.5; P<.001) improved. Posttreatment, state stress and perceived stress severity was lower in the treatment versus control group (DASS-42: P=.02; PSS-10: P=.03, respectively). Conclusions: These pilot findings indicate that a mindfulness app may be an effective tool for reducing state anxiety and stress, as well as enhancing sleep quality among undergraduate university students. A larger, randomized controlled trial should confirm these findings. ", doi="10.2196/66131", url="https://formative.jmir.org/2025/1/e66131" } @Article{info:doi/10.2196/64051, author="Ruggiero, Laurie and Quinn, Lauretta and Castillo, Amparo and Monahan, Colleen and Boughton Price, Leticia and Hernandez, Wandy", title="Community Health Worker Diabetes Prevention Awareness Training in an Immersive Virtual World Environment: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2025", month="Jun", day="10", volume="9", pages="e64051", keywords="diabetes prevention", keywords="virtual world", keywords="community health workers", keywords="African American", keywords="training", keywords="community health worker", keywords="pilot study", keywords="obesity", keywords="community awareness", keywords="remote training", keywords="mixed-methods", keywords="acceptability", keywords="feasibility", abstract="Background: The burden of diabetes and obesity are greater for some racial-ethnic minority groups in the United States, including non-Hispanic blacks, underscoring the importance of raising community awareness of diabetes prevention. Community health workers (CHWs) play a critical role in extending our reach into communities to raise awareness of diabetes prevention. Systematic training and support are central to their work. Remote approaches have been helpful in delivering training to overcome common participation barriers. One remote approach, immersive 3D virtual worlds (VW) offer a unique approach to providing remote training incorporating engaging interactive contextual learning opportunities. Objective: This study aimed to implement and evaluate an internet-based 3D VW model to remotely deliver an adapted CHW training program on diabetes prevention awareness for racial-ethnic minority communities. Methods: A sequential mixed methods design, including a pre-post pilot and explanatory phase, examined the feasibility, acceptability, and impact of the VW training. Female CHWs who self-identified as African American or Black or African Ancestry, between 21?65 years of age, fluent in English, and with risk factors for diabetes were recruited. CHW input was gathered to adapt a Centers for Disease Control and Prevention's CHW diabetes prevention awareness training and the VW environment for this study. The final adapted training was standardized for delivery over 10 weeks. Quantitative and qualitative data were collected to examine acceptability, feasibility, and impact of the training model. Primary quantitative pre-post outcomes included training content knowledge and confidence; and secondary behavioral outcomes included motivation for lifestyle change and eating habits. Focus group feedback was collected on acceptability and feasibility during the explanatory phase. Quantitative descriptive and qualitative thematic analysis approaches were used to examine the acceptability, feasibility, and impact of the VW training model. Results: A total of 26 CHWs initiated the study and 22 completed the postassessment. The majority of participants reported that their expectations were met across all sessions and content topics. Participants generally reported satisfaction with the information provided (20/22, 91\% rated very good-excellent) and high levels of interactivity in the training (17/22, 77\% rated very good-excellent). Results of the posttraining acceptability and feasibility quantitative survey and qualitative feedback were generally positive. Mean pre-post values improved across all quantitative outcomes for the VW training group (eg, 92\% [11/12] improved in knowledge; 62\% [8/13]?77\% [10/13] improved across eating habits measures). Explanatory focus group findings were generally positive, highlighting satisfaction with the overall training, its interactivity, and content. The main constructive feedback was related to providing more training and support in using the avatar. Conclusions: Findings on the acceptability, feasibility, and preliminary impact of the VW training model are promising and support continued use, development, and research on this approach. Trial Registration: ClinicalTrials.gov NCT04161846; https://clinicaltrials.gov/study/NCT04161846 ", doi="10.2196/64051", url="https://formative.jmir.org/2025/1/e64051" } @Article{info:doi/10.2196/66053, author="Mariscal, Angel Miguel and Garcia, Celeste and Zavala, Lily and Ramirez, Magaly", title="Culturally Adapted STAR-Caregivers Virtual Training and Follow-Up for Latino Caregivers of People Living With Dementia: Single-Arm Pre-Post Mixed Methods Study", journal="JMIR Aging", year="2025", month="Jun", day="10", volume="8", pages="e66053", keywords="dementia", keywords="gerontology", keywords="geriatric", keywords="older person", keywords="aging", keywords="Latina", keywords="Latino", keywords="caregiver", keywords="symptom management", keywords="digital technology", keywords="digital intervention", keywords="digital health application", keywords="pilot study", abstract="Background: Latino caregivers are at an increased risk of negative health outcomes due to the responsibilities of caring for someone with dementia. Although interventions exist to address caregiver burden, they often do not meet the cultural needs of Latino caregivers. Objective: This study aimed to pilot test the cultural adaptation of the STAR-Caregivers Virtual Training and Follow-Up (STAR-VTF) intervention. The intervention is an evidence-based training program designed to teach family caregivers strategies to manage behavioral and psychological symptoms of dementia (BPSD). Our research team has conducted past studies to identify and perform culturally relevant adaptations to the training modules of STAR-VTF, and this study aimed to pilot these culturally adapted modules with a sample of Latino caregivers. Methods: Data on feasibility, usability, and acceptability were collected from a pilot test in which Latino caregivers (n=16) used the training modules of the STAR-VTF intervention over a 7-week period. Participants completed usability surveys following the completion of each module, and acceptability was assessed through semistructured interviews (n=14) postintervention. Preliminary outcome measures were also collected, and a descriptive analysis was conducted. The primary outcomes were the Revised Memory and Behavior Problem Checklist (RMBPC) and the Preparedness for Caregiving Scale. Results: The pilot study results suggest that it is feasible to deliver the culturally adapted STAR-VTF intervention to Latino caregivers, with 94\% (15/16) of participants maintaining enrollment through intervention completion. The intervention's usability was found to be ``good'' based on an average System Usability Score of 76.7 out of 100 across all training modules. Caregivers were generally satisfied with the training modules. In addition, preliminary outcome results demonstrated a trend of decreased BPSD pre- versus postintervention (RMBPC subscale score: 28.24 to 21.34). Findings also demonstrated decreased caregiver reaction to BPSD pre- versus postintervention (RMBPC subscale score: 40.40 to 37.21) and increased caregiver preparedness based on pre- and postintervention (Preparedness Caregiving Scale score: 1.98 to 2.43). Conclusions: The pilot study demonstrated that the culturally adapted STAR-VTF intervention is feasible and perceived as easy to use by a small sample of Latino caregivers. We aim to refine the cultural adaptations of the STAR-VTF intervention further based on feedback from study participants. Future studies are necessary to test the efficacy of the intervention and support the broad dissemination of the culturally adapted intervention. ", doi="10.2196/66053", url="https://aging.jmir.org/2025/1/e66053" } @Article{info:doi/10.2196/59776, author="Severance, Tyler and Olbara, Gilbert and Njuguna, Festus and Kipng'etich, Martha and Lang'at, Sandra and Kugo, Maureen and Lemmen, Jesse and Treff, Marjorie and Loehrer, Patrick and Vik, Terry", title="Piloting the Extension for Community Healthcare Outcomes (ECHO) Pediatric Oncology Telehealth Education Program in Western Kenya: Implementation Study", journal="JMIR Form Res", year="2025", month="Jun", day="3", volume="9", pages="e59776", keywords="pediatric cancer", keywords="global health", keywords="education", keywords="Extension for Community Healthcare Outcomes", keywords="project ECHO", keywords="pediatric oncology extension", keywords="pediatric", keywords="oncology", keywords="health care", keywords="outcome", keywords="telehealth", keywords="children", keywords="cancer", keywords="diagnosis", keywords="epidemiology", keywords="telementoring", keywords="technical assistance", keywords="virtual platform", keywords="effectiveness", keywords="equitable access", keywords="early diagnosis", keywords="collaboration", keywords="training", keywords="medical education", keywords="remote education", keywords="online education", keywords="low-middle income country", keywords="LMIC", keywords="community health care outcomes", abstract="Background: Childhood cancer has an annual incidence of 150?160 cases per million children worldwide but remains vastly underdiagnosed in low- to middle-income countries such as those in Sub-Saharan Africa. The Moi Teaching and Referral Hospital (MTRH) serves a population of 25 million people, including 10 million children. The average number of pediatric cancer diagnoses was 216 cases annually in 2017?2019, which was well below the anticipated 1500 cases based on epidemiology data. The remaining 75\%?80\% of pediatric cancer cases remain undiagnosed, and these patients are not likely to survive. Prior outreach and needs assessments demonstrated a lack of medical knowledge related to pediatric cancer as a primary barrier to improved referrals, diagnoses, and ultimately, cure. Objective: This study aimed to address disparities in medical knowledge contributing to low diagnostic rates of cancer in children. We implemented Project ECHO (Extension for Community Healthcare Outcomes)---a validated virtual guided practice and telementoring model---to connect multidisciplinary specialists at MTRH with staff in medically underserved communities in western Kenya for training, technical assistance, and mentorship. Methods: Sessions were freely available on Zoom twice monthly and featured an expert-led didactic topic followed by a learner-led, case-based discussion. The discussion used dialogue education to promote learning and engagement among participants, with mentorship from the expert team. Information on ECHO participation was tracked, and electronic surveys were sent to the participants at the end of the pilot year. The ECHO program was run in parallel with the pediatric oncology cancer registry to monitor trends in diagnostic rates within the referral region. Results: The ECHO program launched successfully in January 2020 with a curriculum focused on pediatric oncology for health care providers. A total of 22 sessions were conducted, with an average of 23 learners per session. A total of 148 participants attended at least one session, with the majority (n=80, 54.1\%) attending multiple sessions. The year-end analysis in January 2021 demonstrated that 286 new pediatric patients were diagnosed with cancer at MTRH, representing a 33\% increase over the 3-year average. Conclusions: The Project ECHO platform created a dynamic virtual platform to continue to engage stakeholders across western Kenya. The implementation of this telehealth education platform in Kenya represents an effective model for increasing the recognition and earlier referral of childhood cancer in low- to middle-income countries. ", doi="10.2196/59776", url="https://formative.jmir.org/2025/1/e59776" } @Article{info:doi/10.2196/67964, author="Borelli, L. Jessica and Wang, Yuning and Li, Haofei Frances and Russo, N. Lyric and Tironi, Marta and Yamashita, Ken and Zhou, Elayne and Lai, Jocelyn and Nguyen, Brenda and Azimi, Iman and Marcotullio, Christopher and Labbaf, Sina and Jafarlou, Salar and Dutt, Nikil and Rahmani, Amir", title="Detection of Depressive Symptoms in College Students Using Multimodal Passive Sensing Data and Light Gradient Boosting Machine: Longitudinal Pilot Study", journal="JMIR Form Res", year="2025", month="Jun", day="3", volume="9", pages="e67964", keywords="depression", keywords="college students", keywords="emerging adulthood", keywords="machine learning", keywords="passive sensing", abstract="Background: Depression is the top contributor to global disability. Early detection of depression and depressive symptoms enables timely intervention and reduces their physical and social consequences. Prevalence estimates of depression approach 30\% among college students. Passive, device-based sensing further enables detection of depressive symptoms at a low burden to the individual. Objective: We leveraged an ensemble machine learning method (light gradient boosting machine) to detect depressive symptoms entirely through passive sensing. Methods: A diverse sample of undergraduate students (N=28; mean age 19.96, SD 1.23 y; 15/28, 54\% women; 13/28, 46\% Latine; 10/28, 36\% Asian; 4/28, 14\% non-Latine White; 11/28, 4\% other) participated in an intensive longitudinal study. Participants wore 2 devices (an Oura ring for sleep and physiology data, and a Samsung smartwatch for physiology and movement data) and installed the AWARE software on their mobile devices, which collects passive sensing data such as screen time. Participants were derived from a randomized controlled trial of a positive psychology mobile health intervention. They completed a self-report measure of depressive symptoms administered weekly over a 19- to 22-week period. Results: The light gradient boosting machine model achieved an F1-score of 0.744 and a Cohen $\kappa$ coefficient of 0.474, indicating moderate agreement between the predicted labels and the ground truth. The most predictive features of depressive symptoms were sleep quality and missed mobile interactions. Conclusions: Findings suggest that data collected from passive sensing devices may provide real-time, low-cost insight into the detection of depressive symptoms in college students and may present an opportunity for future prevention and perhaps intervention. ", doi="10.2196/67964", url="https://formative.jmir.org/2025/1/e67964" } @Article{info:doi/10.2196/66549, author="Morgan, Jennifer and Cahill, Jennifer and Ritchie, Christine and Zhang, Lingling and Gazarian, Priscilla", title="Methods of Piloting an Abstraction Tool to Describe Family Engagement in the Hospital Setting: Retrospective Chart Review", journal="JMIR Form Res", year="2025", month="Jun", day="3", volume="9", pages="e66549", keywords="retrospective chart review", keywords="medical record review", keywords="patient family centered care", keywords="care transitions", keywords="family-centered care", keywords="medical record", keywords="family engagement", keywords="patient care", keywords="abstraction tool", keywords="hospital setting", keywords="electronic medical record", keywords="EMR", keywords="data extraction", keywords="decision-making", abstract="Background: Family engagement in hospitals is crucial for improving outcomes and ensuring holistic, patient-centered care. However, there is limited understanding of how providers document family engagement in electronic medical records (EMR) and how factors such as race and health disparities influence engagement practices. The absence of standardized EMR templates complicates tracking engagement and assessing its impact on patient outcomes. Retrospective chart review (RCR) is an effective method for investigating clinical practice and how family engagement is documented, using both structured and unstructured data from patient records. Despite its potential, gaps remain in the literature regarding distinctions between the prepilot and pilot phases in RCR studies. Objective: This article describes the prepiloting and piloting stages in the development of an abstraction tool for an RCR study, highlighting how these phases refined the tool for extracting family engagement data from the EMRs. Methods: A cohort of 2032 medical records was selected using the Research Patient Database Registry and EMRs. Initially, a draft tool was tested during the prepilot phase to assess its stability. To optimize diversity, the sample was then stratified by race. The modified tool was subsequently piloted on a subset of the sample. Results: The prepilot phase tested the tool on 9 records. In the pilot phase, the tool was applied to 39 records, representing approximately 10\% of the sample. After the prepiloting and piloting phases, 293 of the 405 patient records were deemed eligible for inclusion. More than three-quarters of patients had documentation of presence and communication; whereas, only about one-third had documentation of shared decision-making involving families. Conclusions: The prepilot phase helped standardize the abstraction tool, align it with the EMRs, and address potential biases. The pilot phase provided insights into data availability and highlighted areas for refinement before finalizing the tool for the remaining records. Together, these phases ensured the tool's effectiveness for use in large-scale RCR studies. ", doi="10.2196/66549", url="https://formative.jmir.org/2025/1/e66549" } @Article{info:doi/10.2196/66388, author="Oscarsson, Martin and Hammarb{\"a}ck, Sandra and Blom Wiberg, Karolina and Rozental, Alexander and Ginsberg, Ylva and Carlbring, Per and Andersson, Gerhard and J{\"o}nsson, Fredrik", title="Web-Based Stress Management for Working Adults With Attention-Deficit/Hyperactivity Disorder (ADHD): Single-Arm, Open Pilot Trial", journal="JMIR Form Res", year="2025", month="May", day="29", volume="9", pages="e66388", keywords="attention deficit disorder with hyperactivity", keywords="cognitive behavioral therapy", keywords="quality of life", keywords="pilot projects", keywords="internet-based intervention", abstract="Background: National and international guidelines advocate for a multimodal approach to treating adult attention-deficit/hyperactivity disorder (ADHD), combining pharmacotherapy with psychological interventions. While recent reviews support cognitive behavioral therapy (CBT) as a viable treatment for ADHD in adults, evidence remains limited. Another challenge is the availability of psychological interventions, with stimulants remaining the primary treatment choice for adults with ADHD. One promising approach to increasing access to psychological interventions is the dissemination of internet-delivered CBT. Objective: This study evaluated the feasibility, acceptability, and effects of a guided web-based stress management program specifically designed for working adults with ADHD. The intervention aimed to enhance quality of life by addressing stress, exhaustion, anxiety, and depression, commonly experienced by this population. Methods: Thirty-six participants took part in a single-arm open trial, with assessments before, during, and after the intervention. The intervention consisted of 12 modules based on CBT principles, focusing on executive functioning, stress management, and emotion regulation, with clinician support on demand. Primary and secondary outcomes included quality of life (Adult ADHD Quality of Life Scale [AAQoL]), perceived stress (Perceived Stress Scale [PSS-10]), exhaustion (Karolinska Exhaustion Disorder Scale [KEDS]), anxiety (Generalized Anxiety Disorder 7-item Scale [GAD-7]), depression (Patient Health Questionnaire [PHQ-9]), and ADHD symptoms (the World Health Organization Adult ADHD Self-Report Scale [ASRS]). Results: Results indicated a statistically and clinically significant improvement in quality of life (Cohen d=0.84), and a reduction in ADHD symptoms (d=0.98), as well as statistically significant reductions in perceived stress (d=0.83), exhaustion (d=1.12), anxiety (d=1.70), and depression (d=1.25). Improvements were sustained at a 12-week follow-up. A clinically significant improvement in quality of life was observed in 36\% (13/36) of participants. Participants reported high satisfaction with the program and the guidance. Adherence was high, with an overall assessment response rate of 84\%, a mean of 78\% of modules opened, and no explicit dropouts. Twelve of the 36 participants reported negative effects. Qualitative content analysis of participants' written feedback revealed positive experiences and suggestions for improvement. Conclusions: This study suggests promise for web-delivered interventions tailored to the needs of adults with ADHD, pending further research and development in controlled studies. Trial Registration: OSF Registries osf.io/u2cdj; https://osf.io/u2cdj ", doi="10.2196/66388", url="https://formative.jmir.org/2025/1/e66388" } @Article{info:doi/10.2196/65489, author="Zlatar, Z. Zvinka and Greenwood-Hickman, Anne Mikael and Lujan, Martinez Lazaro N. and Cooper, Julie and Florez-Acevedo, Stefani and Marquez, X. David and Aceves, Gutierrez Rosa and Vargas, Paula Andrea and Rosenberg, E. Dori", title="Feasibility and Cultural Adaptation of a Community-Engaged Physical Activity Intervention for Hispanic Older Adults: Pilot Study", journal="JMIR Form Res", year="2025", month="May", day="27", volume="9", pages="e65489", keywords="lifestyle", keywords="dementia risk reduction", keywords="brain health", keywords="sedentary", keywords="exercise", abstract="Background: The adult Hispanic population of the United States faces an increased risk of dementia compared to non-Hispanic White adults. Physical activity (PA) can help reduce dementia risk, but culturally adapted interventions for Hispanic populations are lacking. Culturally adapted interventions are needed to increase uptake and adherence to brain health promotion strategies in the Hispanic community. Objective: The De Pie y a Movernos intervention aims to reduce barriers to participation in clinical research by culturally adapting a remotely based PA intervention for middle-aged and older Hispanic adults and establish its feasibility and acceptability through a pre-post pilot study. Findings from the cultural adaptation process will inform a stage II PA randomized controlled trial. Methods: The adaptation process followed Barrera and Castro's 2006 cultural adaptation framework and included a literature review, translation of intervention materials, review by a Hispanic-comprised community advisory board and bilingual staff, and a pre-post pilot study (N=10) with subsequent focus groups to refine the intervention. The pilot intervention included the use of Fitbit activity trackers and 2 individualized goal-setting calls with a health coach over a period of 3 weeks. Feasibility and acceptability were assessed using both quantitative methods and qualitative focus groups. Primary quantitative outcomes included enrollment, recruitment, and completion rates, as well as acceptability (predetermined satisfaction survey scores ?3). Focus groups were thematically coded to identify themes for participants' opinions about several aspects of the intervention and explore key barriers and facilitators to PA engagement to improve the planned stage II trial. Results: Ten Hispanic adults (age: mean 62.7, SD 5.3 years; education: mean 11.8, SD 3.8 years; n=9, 90\% female; n=9, 90\% Spanish-speaking) participated in the pre-post pilot, with a 100\% completion rate, 50\% enrollment rate, and a recruitment rate of 5 participants per month. Acceptability was high (mean score 4.6, SD 0.3; range 1?5). Qualitative analyses indicated that participants had high satisfaction with the intervention. They expressed a preference for adding group-based activities and increased interaction with study staff. Key barriers to PA included lack of awareness about the benefits of PA, low self-efficacy, time constraints, health conditions, and weather, while facilitators included awareness of PA's cognitive benefits, social support from family or friends, accountability, enjoyable activities, self-efficacy, and Fitbit use. Insights from participants and community advisory board recommendations led to modifications for the larger trial, such as incorporating group-based elements for those who want them and adding an option for teleconference coaching calls. Conclusions: The cultural adaptation process was essential in refining the intervention to align with the preferences of older Hispanic adults, which resulted in a feasible and acceptable intervention. Findings will inform a planned stage II randomized controlled trial aimed at promoting PA and reducing dementia risk in older Hispanic adults. ", doi="10.2196/65489", url="https://formative.jmir.org/2025/1/e65489" } @Article{info:doi/10.2196/71285, author="Eidenmueller, Katharina and Hoffmann, Sabine and Kammler-S{\"u}cker, Kornelius and Wenger, Leonard and Mazza, Massimiliano and M{\"u}hle, Christiane and Stenger, Manuel and Meixner, Gerrit and Kiefer, Falk and Lenz, Bernd", title="Reactivity to Smoking Cues in a Social Context: Virtual Reality Experiment", journal="JMIR Form Res", year="2025", month="May", day="26", volume="9", pages="e71285", keywords="virtual reality", keywords="smoking", keywords="cue reactivity", keywords="craving", keywords="social context", abstract="Background: Social contextual factors influence the onset and maintenance of substance abuse. Virtual reality (VR) provides a standardized method to present social stimuli and is increasingly used in addiction research. Objective: This study examines the influence of a smoking versus a nonsmoking agent in VR on craving in nicotine-dependent male participants. Our primary hypothesis was that the interaction with a smoking agent is associated with increased craving compared to a nonsmoking agent. We expected higher craving in the presence of an agent regardless of the agent's smoking status. Methods: Using a head-mounted display (Oculus Rift), 50 nicotine-dependent smokers were exposed to four VR conditions on a virtual marketplace: first without an agent, second and third with an agent who either smoked or did not smoke in randomized order, and fourth without an agent as a follow-up condition. Before the follow-up condition, participants smoked a cigarette. Craving was assessed with the Questionnaire of Smoking Urges and a visual analog scale within VR and after each session. We also examined anxiety and agitation (visual analog scale), immersion and presence with the igroup Presence Questionnaire, and salivary cortisol levels. Results: Results showed no significant difference in the participants' craving, anxiety, or agitation between the smoking and nonsmoking agent conditions. However, craving, anxiety, and agitation increased from the marketplace without an interacting agent to the conditions with an interacting agent, and decreased after smoking a cigarette. Immersion was low in all conditions and decreased over time. Salivary cortisol levels were highest at baseline and decreased over the course of the experiment. Conclusions: These findings suggest that the presence of an agent (as a contextual factor) may override the specific influence of proximal stimuli (burning cigarette). The low immersion highlights the challenges in developing effective VR environments for cue exposure. Trial Registration: Deutsches Register Klinischer Studien DRKS00025746; https://drks.de/search/de/trial/DRKS00025746 ", doi="10.2196/71285", url="https://formative.jmir.org/2025/1/e71285" } @Article{info:doi/10.2196/66073, author="Weber, Ashley and Bakas, Tamilyn and Oudat, Qutaibah and Parikh, A. Nehal and Lambert, Joshua and Tubbs-Cooley, L. Heather and Rice, Jared and Voos, Kristin and Rota, Matthew and Kaplan, C. Heather", title="An Internet-Based and Mobile Family Management Intervention for Mothers of Very Preterm Infants Hospitalized in the Neonatal Intensive Care Unit (the Preemie Progress Program): Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="May", day="21", volume="9", pages="e66073", keywords="neonatal intensive care units", keywords="preterm infant", keywords="family nursing", keywords="parents", keywords="self-management", keywords="family integrated care", abstract="Background: Flexible approaches to parenting training interventions in the neonatal intensive care unit (NICU), including family integrated care (FICare) models, are urgently needed across the globe. Many FICare trials inadvertently exclude parents with low resources who cannot commit to daily infant care (eg, 4-8 hours/day). Preemie Progress (PP) is a fully automated, video-based training program that allows parents to choose when and where they learn, without requiring parent bedside presence. Objective: This study aims to examine the feasibility of recruitment, retention, fidelity, and changes in outcomes during a pilot randomized controlled trial of PP, a video-based intervention aimed at training mothers of very preterm infants in evidence-based family management skills in the NICU. Methods: Mothers of infants born between 25 weeks and 0 days to 31 weeks and 6 days of gestation were enrolled in an NICU in the Midwestern United States. Electronic surveys were sent to collect maternal outcomes (Patient-Reported Outcomes Measurement Information System [PROMIS] 8a depression and anxiety scales) at baseline (T1), 14 days (T2) and 28 days (T3) after T1, and 30 days after NICU discharge (T4). Infant electronic health records were extracted to collect infant (ie, weight gain velocity at 36 weeks and receipt of mother's milk) and health care outcomes (ie, NICU length of stay as well as readmissions and emergency department visits within 30 days of discharge). Results: Of 123 eligible mothers, 64 (52\%) were randomly assigned to 1 of 2 arms (PP: n=33, 52\%; attention control [AC]: n=31, 48\%). Loss to follow-up was 30\% (10/33) in the PP arm and 13\% (4/31) in the AC arm. PP mothers watched a mean 17.8 (SD 18.9) of 49 videos. PP retention was linked to higher fidelity. PP mothers showed trends toward greater reductions in anxiety 30 days after discharge (mean ?7.54, SD 1.93; 95\% CI ?11.32 to ?3.76) compared to AC mothers (mean ?4.67, SD 1.59; 95\% CI ?7.80 to ?1.55). PP infants trended toward greater receipt of exclusively mother's milk 28 days after baseline (PP: 14/26, 54\%; AC: 10/28, 36\%) and decreased NICU stay (PP: 57.2 days; AC: 68.3 days) but higher readmissions (PP: 4/33, 12\%; AC: 2/31, 6\%). Conclusions: We were able to recruit a diverse sample of mothers from a range of socioeconomic backgrounds, including mothers experiencing barriers to bedside presence. Recruitment goals were met. PP showed promising trends in improving maternal, infant, and health care outcomes. Additional studies are needed to optimize PP and study procedures to improve retention and fidelity. PP has the potential to support parent training outside of traditional FICare models or serve as a complement to structure the parent education pillar of adapted FICare models. Trial Registration: ClinicalTrials.gov NCT04638127; https://www.clinicaltrials.gov/study/NCT04638127 ", doi="10.2196/66073", url="https://formative.jmir.org/2025/1/e66073" } @Article{info:doi/10.2196/72659, author="Yoshihara, Shota and Takahashi, Kayoko and Kawaguchi, Hiroyuki and Harai, Nozomi and Tsuchiya, Kyoichiro", title="Effects of Using a Digital Peer-Supported App on Glycated Hemoglobin Changes Among Patients With Type 2 Diabetes: Prospective Single-Arm Pilot Study", journal="JMIR Form Res", year="2025", month="May", day="20", volume="9", pages="e72659", keywords="diabetes type 2", keywords="T2DM", keywords="self-management", keywords="digital health", keywords="HbA1c", keywords="lifestyle intervention", keywords="digital intervention", keywords="type 2 diabetes mellitus", keywords="glycated hemoglobin", abstract="Background: Controlling glycated hemoglobin (HbA1c) levels can be challenging for patients with type 2 diabetes mellitus (T2DM). Peer support promotes HbA1c control, and a digital peer-supported app designed for group interactions may enable patients with T2DM to encourage one another to achieve better HbA1c outcomes. However, no studies have investigated the use of digital peer-supported apps to control HbA1c levels in patients with T2DM. Objective: This pilot study aimed to explore the effects of a digital peer-supported app on HbA1c control in patients with T2DM. Methods: This prospective single-arm pilot study enrolled patients with T2DM who owned smartphones and visited medical institutions in Japan. During the 3-month intervention, participants used a digital peer-supported app in addition to receiving standard care. This app allowed participants to share activity logs and concerns via a chat function to improve HbA1c levels through mutual engagement and encouragement. The primary outcome was the change in HbA1c levels, measured at health care facilities at baseline and after 3 months. The secondary outcomes were body weight and blood pressure, with the most recent data obtained from hospitals and clinics. Physical activity (?1 hour/day) was assessed at the same time points using a self-reported questionnaire. Results: The study included 21 participants with a median age of 56 (IQR 51?61) years, of which 13 (61.9\%) were female. After using the digital peer-supported app for 3 months, the participants' HbA1c levels significantly decreased from 7.1\% (SD 0.6\%) at baseline to 6.9\% (SD 0.1\%) (P=.04). Similarly, participants' body weight decreased from 70.7 (SD 12.7) kg to 69.9 (SD 12.4) kg (P =.004) through app use. Although blood pressure decreased slightly from 128.2 (SD 12.5) mm Hg to 126.0 (SD 12.9) mm Hg, this change was not statistically significant (P=.20). Additionally, the proportion of participants engaged in ?1 hour of daily physical activity significantly increased from 23.5\% (n=4) to 58.5\% (n=10) (P=.03). Conclusions: In addition to receiving standard clinical care, the use of a digital peer-supported app may significantly lower HbA1c levels in patients with T2DM by promoting healthy behaviors. ", doi="10.2196/72659", url="https://formative.jmir.org/2025/1/e72659" } @Article{info:doi/10.2196/58940, author="Kr{\"o}plin, Juliane and Maier, Leonie and Lenz, Jan-Hendrik and Romeike, Bernd", title="Impact of a ``Digital Health'' Curriculum on Students' Perception About Competence and Relevance of Digital Health Topics for Future Professional Challenges: Prospective Pilot Study", journal="JMIR Form Res", year="2025", month="May", day="12", volume="9", pages="e58940", keywords="education", keywords="gamification", keywords="robotics", keywords="telemedicine", keywords="wearable electronic devices", keywords="artificial intelligence", abstract="Background: The rapid integration of digital technologies in health care has emphasized the need to ensure that medical students are well-equipped with the knowledge and competencies related to digital health. Objective: This study aimed to evaluate the impact of the ``Digital Health'' curriculum at our university on the perceptions of medical students regarding the relevance of digital health topics for their future professions and their self-assessed competence in these areas. Methods: The ``Digital Health'' curriculum was introduced at a German university for 2 consecutive semesters. The perceived relevance of topics for their future careers and their subjective competence were evaluated before and after the curriculum using a Likert scale. Furthermore, the practical gamification-based teaching part of the robotics teaching unit was evaluated. In total, 6 months after completing the last semester, a follow-up analysis was performed with questions on the significance of the completed curriculum for current and future professional challenges regarding digital health and suggestions for improvement for innovative teaching. The study was meticulously planned and supported by an approved ethics vote of the local ethics committee to ensure that all ethical guidelines were adhered to (A 2022-0137). Results: A total of 20 students participated, with 13 (65\%) being women. In particular, data protection and information security were considered the most relevant topics both before and after the curriculum. Significant increases in perceived importance were observed for messenger apps (mean increase of 0.8 [SD 1.2]; P<.01). Regarding self-assessed competence, significant development was observed on almost all topics. The greatest development was observed in robotics (mean increase of 1.8 [SD 1.2]; P<.001), open educational resources (mean increase of 1.7 [SD 1.5]; P<.001), and simulation-training (mean increase of 1.6 [SD 1.3]; P<.001). The gamification-based, robot-related teaching was predominantly rated suitable and very enjoyable for the students. Conclusions: The results highlight the potential to integrate more innovative teaching techniques, such as gamification, augmented reality, virtual reality, and simulation training, into a technologically advanced health care environment. Finally, the overarching importance of artificial intelligence and digital health applications signals the need to further integrate them, given their potential in remote and personalized medicine. ", doi="10.2196/58940", url="https://formative.jmir.org/2025/1/e58940" } @Article{info:doi/10.2196/64477, author="Budge, Lynne Stephanie and Tebbe, Aaron Elliot and Lee, Joonwoo and Dom{\'i}nguez Jr, Sergio and Matsuno, Em and Lindley, Louis", title="The Healing Through Ongoing Psychological Empowerment Telehealth Intervention With Two Spirit, Transgender, and Nonbinary Clients of Color in the United States: Open Clinical Trial Feasibility and Implementation Analysis", journal="JMIR Form Res", year="2025", month="May", day="12", volume="9", pages="e64477", keywords="Black, Indigenous, people of color", keywords="transgender", keywords="nonbinary", keywords="radical healing", keywords="internalized transnegativity", keywords="open clinical trial", keywords="psychotherapeutic", keywords="lack of competence", keywords="cultural", keywords="humility", keywords="psychotherapy", keywords="therapist", keywords="HOPE", keywords="Healing Through Ongoing Psychological Empowerment", keywords="gender identity", keywords="intervention", keywords="content analysis", keywords="treatment", keywords="medication", keywords="mental health", abstract="Background: There is a notable lack of psychotherapeutic services tailored to the needs of Two Spirit, transgender, and nonbinary (2STNB) people of color; research indicates that 2STNB clients who are people of color report a lack of competence and cultural humility on the part of their therapists. Objective: The purpose of this study was to report the feasibility and acceptability of the Healing Through Ongoing Psychological Empowerment (HOPE) teletherapy intervention using deductive content analysis. Methods: We used an open clinical trial design (testing one intervention without a comparison group) to test the feasibility and acceptability of the HOPE intervention. At baseline, 51 clients were enrolled in the open clinical trial, with 49 2STNB clients who are people of color starting and completing the HOPE intervention. Clients were recruited primarily from social media and therapist waitlists. Clients completed up to 15 free face-to-face telehealth psychotherapy sessions that were provided by nine 2STNB therapists who are people of color. Feasibility and acceptability interviews were conducted prior to the intervention, immediately following the intervention, and at 6 months after completing the intervention. Results: The HOPE intervention demonstrated high feasibility and acceptability, specifically regarding data collection, psychometric adequacy, interventionist recruitment or training or retention, delivery of the intervention, acceptability of the intervention to clients, and client engagement with the intervention. Conclusions: These findings propose HOPE as a potentially feasible, culturally specific therapeutic approach for the 2STNB community who are people of color. Future randomized controlled trials comparing HOPE to existing evidence-based treatments are needed. Trial Registration: ClinicalTrials.gov NCT05140174; https://clinicaltrials.gov/study/NCT05140174 ", doi="10.2196/64477", url="https://formative.jmir.org/2025/1/e64477" } @Article{info:doi/10.2196/66186, author="Mazur, Lukasz and Butler, Logan and Mitchell, Cody and Lashani, Shaian and Buchanan, Shawna and Fenison, Christi and Adapa, Karthik and Tan, Xianming and An, Selina and Ra, Jin", title="Effect of Immersive Virtual Reality Teamwork Training on Safety Behaviors During Surgical Cases: Nonrandomized Intervention Versus Controlled Pilot Study", journal="JMIR Med Educ", year="2025", month="May", day="1", volume="11", pages="e66186", keywords="Teamwork Evaluation of Non-Technical Skills", keywords="TENTS", keywords="Team Strategies and Tools to Enhance Performance and Patient Safety", keywords="TeamSTEPPS", keywords="immersive virtual reality", keywords="virtual reality", keywords="VR", keywords="safety behavior", keywords="surgical error", keywords="operating room", keywords="OR", keywords="training intervention", keywords="training", keywords="pilot study", keywords="nontechnical skills", keywords="surgery", keywords="surgical", keywords="patient safety", keywords="medical training", keywords="medical education", abstract="Background: Approximately 4000 preventable surgical errors occur per year in the US operating rooms, many due to suboptimal teamwork and safety behaviors. Such errors can result in temporary or permanent harm to patients, including physical injury, emotional distress, or even death, and can also adversely affect care providers, often referred to as the ``second victim.'' Objective: Given the persistence of adverse events in the operating rooms, the objective of this study was to quantify the effect of an innovative and immersive virtual reality (VR)--based educational intervention on (1) safety behaviors of surgeons in the operating rooms and (2) sense-making regarding the overall training experience. Methods: This mixed methods pre- versus postintervention pilot study was conducted in a large academic medical center with 55 operating rooms. Safety behaviors were observed and quantified using validated Teamwork Evaluation of Non-Technical Skills instrument during surgical cases at baseline (101 observations; 83 surgeons) and postimmersive VR based intervention (postintervention: 24 observations within each group; intervention group [with VR training; 10 surgeons] and control [no VR training; 10 surgeons]). VR intervention included a 45-minute immersive VR-based training incorporating a pre- and postdebriefing based on Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) principles to improve safety behaviors. A 2-tailed, 2-sample t-test with adjustments for multiplicity of the tests was used to test for significance in observable safety behaviors between the groupings. The debriefing data underwent analysis through the phenomenological analysis method to gain insights into how participants interpreted the training. Results: Preintervention, all safety behaviors averaged slightly above ``acceptable'' scores, with an overall average of 2.2 (range 2?2.3; 0?3 scale). The 10 surgeons that underwent our intervention showed statistically significant (P<.05) improvements in 90\% (18/20) of safety behaviors when compared to the 10 surgeons that did not receive the intervention (overall average 2.5, range 2.3?2.7 vs overall average 2.1, range 1.9?2.2). Our qualitative analysis based on 492 quotes from participants suggests that the observed behavioral changes are a result of an immersive experience and sense-making of key TeamSTEPPS training concepts. Conclusions: VR-based immersive training intervention focused on TeamSTEPPS principles seems effective in improving safety behaviors in the operating rooms as quantified via observations using the Teamwork Evaluation of Non-Technical Skills instrument. Further research with larger, more diverse sample sizes is needed to confirm the generalizability of these findings. International Registered Report Identifier (IRRID): RR2-10.2196/40445. ", doi="10.2196/66186", url="https://mededu.jmir.org/2025/1/e66186" } @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\%