@Article{info:doi/10.2196/69548, author="Pearl, L. Rebecca and Saunders, Danielle and Groshon, C. Laurie and Li, Yulin and Shonrock, Abigail and Puhl, M. Rebecca and Driscoll, A. Kimberly and Manavalan, Preeti and Gelfand, M. Joel and Wadden, A. Thomas and Westen, C. Sarah and Montanez-Wiscovich, Marjorie and Lou, Xiang-Yang", title="Feasibility and Acceptability of a Psychological Intervention for Internalized Health-Related Stigma Among Adults With Chronic Health Conditions: Preliminary Investigation", journal="JMIR Form Res", year="2025", month="Jul", day="29", volume="9", pages="e69548", keywords="cancer", keywords="chronic disease", keywords="diabetes", keywords="HIV", keywords="obesity", keywords="pain", keywords="skin disease", keywords="stigma", abstract="Background: Health-related stigma is widely acknowledged as a threat to public health and a barrier to managing chronic health conditions. Internalized stigma is a particularly strong predictor of poor health outcomes across health conditions, yet few evidence-based interventions are available. Peer support and counseling have been investigated as interventions for reducing internalized stigma. Typically, these interventions are developed and tested in disease-specific research, focusing on one health condition in isolation from others. This approach may limit knowledge and dissemination of support for health-related stigma across health conditions. Recent work has highlighted the need for research that breaks down traditional silos by using cross-cutting approaches to understand and reduce stigma. Objective: This study aimed to determine the feasibility and acceptability of a new group-based psychological intervention designed to reduce internalized health-related stigma among adults with different stigmatized chronic physical health conditions. Methods: A group intervention that was initially designed to address internalized weight stigma was adapted to be generalizable to other forms of internalized health-related stigma. This was done with input from Advisory Board members living with different stigmatized chronic health conditions and health professionals who specialized in these conditions. Adults with obesity, diabetes, HIV, skin diseases, chronic pain, or cancers were recruited to attend 12 weekly online group meetings. The average session attendance rate was computed with and without makeup sessions. A treatment acceptability questionnaire was completed at week 12. Primarily for feasibility testing, participants completed pre- and post-treatment questionnaires that assessed internalized health-related stigma and other relevant aspects of mental health and health-related quality of life. At baseline, participants were also asked to report reasons for perceived discrimination. Data collection occurred from December 2023 through April 2024. Results: In total, 10 adults were recruited within approximately 6 weeks, of whom 8 attended at least 1 treatment session and completed post-treatment questionnaires, with a 80\% retention. The average session attendance rate was 95.8\% with makeup sessions and 83.3\% for those without makeup. Treatment acceptability ratings were high, with an overall acceptability rating of approximately 6.5 (SD 0.5) out of 7. Medium to large effect sizes were observed for changes in internalized stigma and some aspects of mental health. Almost all (n=7, 87.5\%) of participants reported experiencing discrimination due to their health conditions, which accompanied a wide range of other reasons for perceived discrimination. Conclusions: Results showed high feasibility and acceptability of a transdiagnostic, online group psychological intervention for internalized health-related stigma delivered to adults with different types of stigmatized chronic physical health conditions. Given the small sample size and limited generalizability, testing in a large efficacy trial is needed to determine intervention benefits. ", doi="10.2196/69548", url="https://formative.jmir.org/2025/1/e69548" } @Article{info:doi/10.2196/68582, author="Marques da Silva, Berto Cibele Cristine and Dal Corso, Simone and Lunardi, Claudia Adriana and Fonseca, Jos{\'e} Alfredo and Rached, Zahi Samia and Athanazio, Abensur Rodrigo and Carvalho, Fernandes Celso Ricardo", title="Effect of Dual Bronchodilation on the Exercise Capacity of Individuals With Non-Cystic Fibrosis Bronchiectasis: Protocol for a Randomized Controlled Double-Blind Crossover Study", journal="JMIR Res Protoc", year="2025", month="Jul", day="28", volume="14", pages="e68582", keywords="bronchiectasis", keywords="bronchodilator agents", keywords="exercise test", keywords="exercise", keywords="non-cystic fibrosis bronchiectasis", keywords="exercise capacity", keywords="thoracoabdominal kinematics", abstract="Background: Bronchodilators (BDs) have been used therapeutically to improve exercise capacity in patients with other chronic respiratory diseases. However, the effect of BDs on the exercise capacity of individuals with non-cystic fibrosis bronchiectasis (NCFB) is poorly understood. Objective: The aim of this study was to evaluate the effects of BDs on exercise capacity and thoracoabdominal kinematics in patients with NCFB. Methods: This crossover randomized controlled trial will involve 45 outpatients with NCFB aged 18 to 59 years. They will be evaluated in 3 visits. On day 1, the maximal exercise capacity (cardiopulmonary exercise test; peak work rate [Wpeak]) will be assessed. On day 2, individuals will be randomized to receive either BD (ipratropium bromide 160 {\textmu}g and fenoterol hydrobromide 400 {\textmu}g) or a placebo and then undergo simultaneous endurance exercise capacity (constant work-rate exercise test) and thoracoabdominal kinematics (optoelectronic plethysmography) assessments. After at least 1-week washout (day 3), the individuals will repeat the same assessments as on day 2 in the reverse order. The time to the limit of tolerance will be obtained in both groups (BD and placebo groups) as the primary outcome. Thoracoabdominal kinematics will be assessed at 3 time points: at rest, during unloaded exercise, and at 75\% Wpeak. The total chest wall and compartmental volumes as well as thoracoabdominal asynchrony will be assessed. The assessors and patients will be blinded to the interventions (BDs or placebo). Data will be compared using 1-sided t tests or Wilcoxon tests and repeated-measures analysis of variance or Friedman tests. Categorical data will be analyzed using the chi-square test or Fisher test. The associations among variables will be analyzed using Pearson or Spearman correlation. The significance level will be set at 5\% (P<.05). Results: The ethics approval was granted in November 2018, and a pilot study was commenced in April 2019 but was interrupted due to the COVID-19 pandemic. The study restarted in April 2022, and data collection is anticipated to continue until November 2025. The publication of the results is anticipated to be in 2025 or 2026. Conclusions: There is no evidence that BDs can improve the exercise capacity of patients with NCFB. This trial will compare the endurance exercise capacity of the same individual with and without dual bronchodilation. If successful, this study will demonstrate that exercise capacity can be improved with the use of BDs in adults with NCFB. Trial Registration: ClinicalTrials.gov NCT05183841; https://clinicaltrials.gov/study/NCT05183841 International Registered Report Identifier (IRRID): DERR1-10.2196/68582 ", doi="10.2196/68582", url="https://www.researchprotocols.org/2025/1/e68582" } @Article{info:doi/10.2196/66379, author="Zimmermann, M. Bettina and Willem, Theresa and Rost, Michael and Matthes, Nina and Buyx, Alena", title="Perceptions of Stigma Among Patients With Hepatitis B in Germany: Cross-Sectional Survey", journal="JMIR Form Res", year="2025", month="Jun", day="13", volume="9", pages="e66379", keywords="infectious diseases", keywords="infection", keywords="contaminate", keywords="septic shock", keywords="hepatitis B", keywords="social stigma", keywords="stigmatize", keywords="discrimination", keywords="prejudice", keywords="social factor", keywords="social disparity", keywords="social inequality", keywords="social inequity", keywords="Germany", abstract="Background: Many studies find associations between hepatitis B and stigma, but studies from the Western European context are lacking. Based on available studies, we hypothesized that younger age, higher education, male gender, higher privacy needs, and non-German mother tongue were positively associated with perceived hepatitis B--related stigma. Objective: This study aims to describe the prevalence of perceived social stigma among patients with hepatitis B in Germany and to assess what factors are associated with perceptions of hepatitis B--related stigma. Methods: Applying the short version of the Berger stigma scale, we surveyed 195 patients with hepatitis B about their perceptions of hepatitis B--related stigma, privacy needs, and demographic variables through a paper-based questionnaire. Venue-based recruitment of adult patients diagnosed with acute or chronic hepatitis B was implemented at 3 clinical centers in Germany. Patients who could not read German were excluded from the study. Results: From the 195 valid questionnaires, 45.1\% (88/195) of participants identified as female, 36.6\% (71/195) had a high school diploma, and 56.9\% (111/195) reported a mother tongue other than German. The mean (SD) stigma score throughout the sample was 5.52 (6.02; range 0-24) and the median was 3.50 (IQR=9.75). Regression analysis revealed that non-German mother tongue, individual data privacy needs, and participants' secrecy regarding their hepatitis B diagnosis independently predicted perceived hepatitis B-related stigma. More precisely, the higher the data privacy need and the more secret the hepatitis B diagnosis, the higher the perceived stigma, and perceived stigma was higher for patients with a non-German mother tongue. Age, gender, and education were no predictors of perceived stigma. Conclusions: The surveyed patients with hepatitis B in Germany reported lower levels of hepatitis B--related stigma than found in other studies conducted in Asian countries. The association with non-German mother tongue indicates an important cultural and social component in the perception of stigma. Community-based interventions and the sensibilization of health care professionals might help overcome perceptions of stigma among hepatitis B--affected populations. ", doi="10.2196/66379", url="https://formative.jmir.org/2025/1/e66379" } @Article{info:doi/10.2196/63811, author="Bergquist, H. Sharon and Wang, Danyang and Pearce, Brad and Smith, K. Alicia and Hankus, Allison and Roberts, L. David and Moore, A. Miranda", title="Relationship of Hair Cortisol Concentration With Perceived and Somatic Stress Indices: Cross-Sectional Pilot Study", journal="JMIR Form Res", year="2025", month="Jun", day="11", volume="9", pages="e63811", keywords="hair cortisol concentration", keywords="perceived stress", keywords="somatic stress", keywords="resilience", keywords="physiological stress", abstract="Background: Hair cortisol is an emerging biomarker of chronic stress. However, the psychological and physiological aspects of chronic stress that are reflected in hair cortisol concentration (HCC) have not been fully determined. Since physiological responses to stress do not always align with how stress is perceived, we conducted this study to evaluate whether HCC correlates with neuroendocrine stress indicators or stress perceptions. Objective: This study aimed to evaluate whether subjective (Perceived Stress Scale and Connor-Davidson Resilience Scale) and objective (plasma cortisol/dehydroepiandrosterone-sulfate [DHEA-S] and cortisol/high-sensitivity C-reactive protein) determinants of stress and resilience correlate with HCC. Methods: In this cross-sectional pilot validity study, scatter plots and Spearman correlation coefficients were used to measure the direction and magnitude of the relationship between stress and resilience measures among 51 predominantly male participants. In a subset (n=24), we performed a step-wise regression modeling approach to isolate the association of perceived and somatic stress on hair cortisol. Results: Bivariate correlations showed a weak inverse association of HCC with Perceived Stress Scale (Spearman correlation $\rho$=?0.14, P=.52) and a stronger positive association with somatic neuroendocrine stress indices cortisol/DHEA-S ($\rho$=0.24, P=.25) and cortisol/high-sensitivity C-reactive protein ($\rho$=0.21, P=.35). In linear regression models, HCC showed the strongest association with cortisol/DHEA-S (r2=0.10, P=.13, 1.01$\beta$ 1.01, 95\% CI 0.99?1.01). This relationship remained when age, gender, hair washing frequency, hair dye or bleach use, diabetes mellitus, obesity, cardiovascular disease, anxiety, medication use, and endocrine disorders were considered. Conclusions: Our results do not indicate a statistically significant association (at the P<.05 threshold) between HCC and stress perception or somatic measures of neuroendocrine response. ", doi="10.2196/63811", url="https://formative.jmir.org/2025/1/e63811" } @Article{info:doi/10.2196/62876, author="Loya, Julio and Garcia, O. David and Maldonado, Adriana and Villavicencio, Edgar", title="A Culturally Tailored Physical Activity Intervention for Hispanic Adults Living With Type 2 Diabetes: Pre-Post Pilot Feasibility Study", journal="JMIR Diabetes", year="2025", month="Jun", day="10", volume="10", pages="e62876", keywords="type 2 diabetes", keywords="physical activity", keywords="Hispanic adults", keywords="intervention", keywords="diabetes mellitus", keywords="metabolic disease", keywords="United States", keywords="lifestyle modification", keywords="pilot intervention", keywords="community-engaged", keywords="self-efficacy", abstract="Background: Type 2 diabetes mellitus (T2DM) is a metabolic disease that affects over 38 million adults in the United States, who are disproportionately Hispanic. Objective: This study describes the development and implementation of Salud Paso por Paso, a culturally tailored and linguistically appropriate intervention to increase engagement in physical activity (PA) for Hispanic adults living with T2DM. Methods: Participants were enrolled in a 6-week pre-post pilot test of a culturally tailored intervention that included sessions covering different aspects of PA and T2DM. Participants were recruited at a local free clinic. Nonparametric paired-sample Wilcoxon signed-rank tests were used to examine differences between pre- and postintervention measures. Results: Twenty-one participants were recruited, and 19 (90.5\%) completed the intervention. Participants significantly increased average hours spent in moderate PA, by 3.16 hours (from 4.73, SD 3.79 minutes to 9.63, SD 6.39 minutes; Z=?3.52; P<.001), average steps per week (from 23,006.38, SD 14,357.13 steps to 43,000.81, SD 30,237.17 steps; Z=?2.79; P=.005), and minutes per week of PA (from 105.94, SD 72.23 minutes to 224.19, SD 167.85 minutes; Z=?3.36; P<.001). Conclusions: Developing effective culturally tailored interventions that can ameliorate the deleterious effects of T2DM in Hispanic adults is an important strategy to promote health equity. The Salud Paso por Paso intervention is an effective way to promote PA in Hispanic adults living with T2DM. ", doi="10.2196/62876", url="https://diabetes.jmir.org/2025/1/e62876" } @Article{info:doi/10.2196/69138, author="Li, Xintong and Dreisbach, Caitlin and Gustafson, M. Carolina and Murali, Patel Komal and Koleck, A. Theresa", title="Prevalence of Multiple Chronic Conditions Among Adults in the All of Us Research Program: Exploratory Analysis", journal="JMIR Form Res", year="2025", month="May", day="12", volume="9", pages="e69138", keywords="electronic health records", keywords="multiple chronic conditions", keywords="prevalence", keywords="secondary data analysis", keywords="United States", keywords="All of Us", abstract="Background: The growing prevalence of multiple chronic conditions (MCC) has significant impacts on health care systems and quality of life. Understanding the prevalence of MCC throughout adulthood offers valuable insights into the evolving burden of chronic diseases and provides strategies for more effective health care outcomes. Objective: This study estimated the prevalence and combinations of MCC among adult participants enrolled in the All of Us (AoU) Research Program, especially studying the variations across age categories. Methods: We conducted an exploratory analysis using electronic health record (EHR) data from adult participants (N=242,828) in the version 7 Controlled Tier AoU Research Program data release. Data analysis was conducted using Python in a Jupyter notebook environment within the AoU Researcher Workbench. Descriptive statistics included condition frequencies, the number of chronic conditions per participant, and prevalence according to age categories. The presence of a chronic condition was determined by documentation of one or more ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes for the respective condition. Age categories were established and aligned with diagnosis dates and stages of adulthood (early adulthood: 18-39 years; middle adulthood: 40-49 years; late middle adulthood: 50-64 years; late adulthood: 65-74 years; advanced old age: 75-89 years). Results: Our findings demonstrated that approximately 76\% (n=183,753) of AoU participants were diagnosed with MCC, with over 40\% (n=98,885) having 6 or more conditions and prevalence increasing with age (from 33.78\% in early adulthood to 68.04\% in advanced old age). The most frequently occurring MCC combinations varied by age category. Participants aged 18-39 years primarily presented mental health--related MCC combinations (eg, anxiety and depressive disorders; n=845), whereas those aged 40-64 years frequently had combinations of physical conditions such as fibromyalgia, chronic pain, fatigue, and arthritis (204 in middle adulthood and 457 in late middle adulthood). In late adulthood and advanced old age, hyperlipidemia and hypertension were the most commonly occurring MCC combinations (n=200 and n=59, respectively). Conclusions: We report notable prevalence of MCC throughout adulthood and variability in MCC combinations by age category in AoU participants. The significant prevalence of MCC underscores a considerable public health challenge, revealed by distinct condition combinations that shift across different life stages. Early adulthood is characterized predominantly by mental health conditions, transitioning to cardiometabolic and physical health conditions in middle, late, and advanced ages. These findings highlight the need for targeted, innovative care modalities and population health initiatives to address the burden of MCC throughout adulthood. ", doi="10.2196/69138", url="https://formative.jmir.org/2025/1/e69138" } @Article{info:doi/10.2196/68355, author="Faccin, Mauro and Geenen, Caspar and Happaerts, Michiel and Ombelet, Sien and Migambi, Patrick and Andr{\'e}, Emmanuel", title="Analyzing Satellite Imagery to Target Tuberculosis Control Interventions in Densely Urbanized Areas of Kigali, Rwanda: Cross-Sectional Pilot Study", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="24", volume="11", pages="e68355", keywords="tuberculosis", keywords="Rwanda", keywords="satellite image", keywords="TB", keywords="PCR testing", keywords="PCR", keywords="questionnaire", keywords="satellite", keywords="active case-finding", keywords="diagnostic", keywords="urban", keywords="Africa", keywords="TB screening", keywords="ACF", keywords="polymerase chain reaction", abstract="Background: Early diagnosis and treatment initiation for tuberculosis (TB) not only improve individual patient outcomes but also reduce circulation within communities. Active case-finding (ACF), a cornerstone of TB control programs, aims to achieve this by targeting symptom screening and laboratory testing for individuals at high risk of infection. However, its efficiency is dependent on the ability to accurately identify such high-risk individuals and communities. The socioeconomic determinants of TB include difficulties in accessing health care and high within-household contact rates. These two determinants are common in the poorest neighborhoods of many sub-Saharan cities, where household crowding and lack of health-care access often coincide with malnutrition and HIV infection, further contributing to the TB burden. Objective: In this study, we propose a new approach to enhance the efficacy of ACF with focused interventions that target subpopulations at high risk. In particular, we focus on densely inhabited urban areas, where the proximity of individuals represents a proxy for poorer neighborhoods with enhanced contact rates. Methods: To this end, we used satellite imagery of the city of Kigali, Rwanda, and computer-vision algorithms to identify areas with a high density of small residential buildings. We subsequently screened 10,423 people living in these areas for TB exposure and symptoms and referred patients with a higher risk score for polymerase chain reaction testing. Results: We found autocorrelation in questionnaire scores for adjacent areas up to 782 meters. We removed the effects of this autocorrelation by aggregating the results based on H3 hexagons with a long diagonal of 1062 meters. Out of 324 people with high questionnaire scores, 202 underwent polymerase chain reaction testing, and 9 people had positive test results. We observed a weak but statistically significant correlation (r=0.28; P=.04) between the mean questionnaire score and the mean urban density of each hexagonal area. Conclusions: Nine previously undiagnosed individuals had positive test results through this screening program. This limited number may be due to low TB incidence in Kigali, Rwanda, during the study period. However, our results suggest that analyzing satellite imagery may allow the identification of urban areas where inhabitants are at higher risk of TB. These findings could be used to efficiently guide targeted ACF interventions. ", doi="10.2196/68355", url="https://publichealth.jmir.org/2025/1/e68355" } @Article{info:doi/10.2196/69113, author="M, Premikha and Goh, Khong Jit and Ng, Qiang Jing and Mutalib, Adeliza and Lim, Yang Huai", title="Impact of Acute Respiratory Infections on Medical Absenteeism Among Military Personnel: Retrospective Cohort Study", journal="JMIR Form Res", year="2025", month="Apr", day="18", volume="9", pages="e69113", keywords="respiratory infections", keywords="military", keywords="epidemiology", keywords="public health", keywords="surveillance", abstract="Background: Acute respiratory infections (ARI) are a significant challenge in military settings due to close communal living, which facilitates the rapid transmission of pathogens. A variety of respiratory pathogens contribute to ARI, each varying in prevalence, severity, and impact on organizational productivity. Understanding and mitigating the impact of ARI is critical for optimizing the health of military personnel and maintaining organizational productivity. Objective: This retrospective study of surveillance data aims to identify pathogens causing ARI among servicemen and determine which pathogens contribute most to medical absenteeism, defined as the combined duration of the issued medical certificate and light duty. Methods: From September 2023 to August 2024, anonymous nasopharyngeal swabs (BioFire FilmArray Respiratory Panel) were collected from Singapore Armed Forces servicemen presenting with ARI symptoms after a doctor's consultation at a local military camp's medical centre. The presence of fever and duration of medical certificate and light duty were self-reported by Singapore Armed Forces servicemen. Results: A total of 1095 nasopharyngeal swabs were collected, of which 608 (55.5\%) tested positive. The most common respiratory pathogen was human rhinovirus/enterovirus (HRV/HEV) in 303 (27.7\%) individuals. The highest proportions of fever were observed in servicemen with influenza (62.8\%, 27/43), SARS-CoV-2 (34.3\%, 12/35), and parainfluenza (31.6\%, 12/38). The odds of patients with influenza that have fever was 5.8 times higher than those of patients infected with HRV/HEV (95\% CI 2.95?11.40, P<.001). The median duration of medical certificate, light duty, and medical absenteeism were 0 (IQR 0), 2 (IQR 2) and 2 (IQR 0) days, respectively. The odds of patients with influenza having a medical certificate with duration ?1 day was 5.34 times higher than those in patients with HRV/HEV (95\% CI 2.63?10.88, P<.001). No significant differences in the duration of medical absenteeism were found between HRV/HEV and other pathogens. Conclusions: Compared to HRV/HEV, influenza infections were significantly associated with longer medical certificate duration. Nonetheless, there were no significant differences in the overall duration of medical absenteeism across pathogens, as servicemen infected with other pathogens were given light duty instead. These findings emphasize the need for pathogen-agnostic ARI measures. While influenza vaccinations are already mandatory for servicemen in local military camps, encouraging additional public health measures (eg, mask-wearing among symptomatic servicemen, COVID-19 vaccinations, therapeutics) can further reduce ARI incidence, minimize the duration of medical absenteeism, and mitigate the impact on organizational productivity. ", doi="10.2196/69113", url="https://formative.jmir.org/2025/1/e69113" } @Article{info:doi/10.2196/58436, author="Glover, Audrey Nicole and Sathar, Farzana and Mokome, Pride and Mathabela, Nkululeko and Taleni, Sipokazi and van Blydenstein, Alexandra Sarah and Mekota, Anna-Maria and Charalambous, Salome and Rachow, Andrea and Ivanova, Olena", title="Improving Health and Well-Being of People With Post--COVID-19 Consequences in South Africa: Situation Analysis and Pilot Intervention Design", journal="JMIR Form Res", year="2025", month="Apr", day="10", volume="9", pages="e58436", keywords="post--COVID-19", keywords="rehabilitation", keywords="support", keywords="quality of life", keywords="group care", keywords="well-being", keywords="South Africa", keywords="COVID-19", keywords="situation analysis", keywords="pilot", keywords="intervention", keywords="context-adapted", keywords="physical health", keywords="mental health", keywords="cross-sectional", keywords="mixed method", keywords="questionnaire", keywords="in-depth", keywords="interviews", keywords="survey", keywords="focus group", keywords="quantitative", keywords="qualitative", keywords="support group", keywords="hospital", keywords="patients", keywords="health care workers", keywords="health worker", abstract="Background: Multisystemic complications post--COVID-19 infection are increasingly described in the literature, yet guidance on the management remains limited. Objectives: This study aimed to assess the needs, preferences, challenges, and existing interventions for individuals with post--COVID-19 symptoms. Based on this, we aimed to develop a context-adapted intervention to improve the overall health and well-being of individuals with post--COVID-19 complications. Methods: We conducted a cross-sectional mixed-methods situation analysis assessing the needs, preferences, challenges, and existing interventions for patients with post--COVID-19 symptoms. We collected data through questionnaires, semistructured in-depth interviews, and focus group discussions (FGDs) from individuals diagnosed with COVID-19 within the previous 18-month period and health care providers who managed patients with COVID-19 in both inpatient and outpatient settings. Quantitative data were summarized using descriptive statistics, qualitative data were transcribed, and deductive analysis focused on suggestions for future interventions. Findings guided the development of a group intervention. Results: We conducted 60 questionnaires, 13 interviews, and 3 FGDs. Questionnaires showed limited knowledge of post--COVID-19 complications at 26.7\% (16/60). Of those who received any rehabilitation for COVID-19 (19/60, 31.7\%), 94.7\% (18/19) found it helpful for their recovery. Just over half (23/41, 56\%) of those who did not receive rehabilitation reported that they would have liked to. The majority viewed rehabilitation as an important adjunct to post--COVID-19 care (56/60, 93.3\%) and that support groups would be helpful (53/60, 88.3\%). Qualitative results highlighted the need for mental health support, structured post--COVID-19 follow-up, and financial aid in post--COVID-19 care. Based on the insights from the situation analysis, the theory of change framework, and existing post--COVID-19 evidence, we designed and conducted a pilot support group and rehabilitation intervention for individuals with post--COVID-19 complications. Our main objective was to assess the change in physical and psychological well-being pre- and postintervention. The intervention included 8 weekly themed group sessions supplemented by home tasks. Effectiveness of the intervention was evaluated by questionnaires pre- and postintervention on post--COVID-19 symptoms, quality of life with the EuroQoL 5-Dimension 5-Level, short Warwick-Edinburgh Mental Wellbeing Scale, and physical function by spirometry and 1-minute sit-to-stand test. We also assessed the feasibility and acceptability of the intervention by questionnaires and semistructured in-depth interviews. The intervention outcome analysis is yet to be conducted. Conclusions: Insights from patients and health care providers on the characteristics of post--COVID-19 complications helped guide the development of a context-adapted intervention program with potential to improve health and well-being post--COVID-19. ", doi="10.2196/58436", url="https://formative.jmir.org/2025/1/e58436" } @Article{info:doi/10.2196/66970, author="Berm{\'u}dez-Mill{\'a}n, Angela and P{\'e}rez-Escamilla, Rafael and Segura-P{\'e}rez, Sofia and Grady, James and Feinn VI, S. Richard and Agresta, Hanako and Kim, Dean and Wagner, Ann Julie", title="The Monthly Cycling of Food Insecurity in Latinas at Risk for Diabetes: Methods, Retention, and Sample Characteristics for a Microlongitudinal Design", journal="JMIR Form Res", year="2025", month="Mar", day="28", volume="9", pages="e66970", keywords="food insecurity", keywords="monthly cycling", keywords="type 2 diabetes risk", keywords="quantitative methods", keywords="Latinas", keywords="endocrinology", keywords="nutrition", keywords="nutrition assistance", keywords="micro-longitudinal design", abstract="Background: Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas. We conducted a microlongitudinal study to examine the relationship of monthly cycling of FI and diabetes risk factors. Objective: This study aimed to determine the quantitative methodology, recruitment and retention strategies, predictors of retention across time, and baseline sample demographics. Methods: Participants were adult Latinas living in Hartford, Connecticut who were recruited through a community agency, invited to participate if they were receiving Supplementary Nutrition Assistance Program (SNAP) benefits, screened positive for FI using the 2-item Hunger Vital Sign Screener, and had elevated risk factors for T2D using the American Diabetes Association risk factor test. Using a microlongitudinal design, we collected data twice per month for 3 months (week 2, which is a period of food budget adequacy; and week 4, which is a period of food budget inadequacy) to determine if the monthly cycling of FI was associated with near-term diabetes risk (fasting glucose, fructosamine, and glycosylated albumin) and long-term risk (BMI, waist circumference, and glycated hemoglobin) markers. We determined whether household food inventory, psychological distress, and binge eating mediated associations. We examined Health Action Process Approach model constructs. To assess the relationship between monthly cycling of FI with diabetes risk markers, we used repeated measures general linear mixed models. To assess the role of mediators, we performed a causal pathway analysis. Results: Participant enrollment was from April 1, 2021 to February 21, 2023. A total of 87 participants completed 420 assessments or a mean of 4.83 (SD 2.02) assessments. About half (47/87, 54\%) of the sample self-identified as Puerto Rican, mean age was 35.1 (SD 5.8) years, with 17.1 (SD 11.6) years in the mainland United States. Just under half (41/87, 47.1\%) spoke Spanish only, 69\% (60/87) had no formal schooling, and 31\% (27/87) had less than eighth grade education. Modal household size was 4 including 2 children; 44.8\% (39/87) were not living with a partner. About half (47/87, 54\%) were unemployed, 63.2\% (55/87) reported a monthly income