%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60676 %T Cardiac Self-Efficacy Improvement in a Digital Heart Health Program: Secondary Analysis From a Feasibility and Acceptability Pilot Study %A Lockwood,Kimberly G %A Kulkarni,Priya R %A Branch,OraLee H %A Graham,Sarah A %K digital health %K self-efficacy %K behavior change %K prevention %K cardiovascular health %K digital heart health %K lifestyle %K heart health %K health coaching %K mobile phone %D 2025 %7 24.4.2025 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/60676 %U https://formative.jmir.org/2025/1/e60676 %U https://doi.org/10.2196/60676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e71676 %T A Portal-Based Intervention (PATTERN) Designed to Support Medication Use Among Older Adults: Feasibility and Acceptability Study %A Pack,Allison %A Bailey,Stacy C %A O'Conor,Rachel %A Velazquez,Evelyn %A Wismer,Guisselle %A Yeh,Fangyu %A Curtis,Laura M %A Alcantara,Kenya %A Wolf,Michael S %K older adults %K multiple chronic conditions %K polypharmacy %K primary care %K medication adherence %K patient portal %D 2025 %7 24.4.2025 %9 %J JMIR Form Res %G English %X 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 %R 10.2196/71676 %U https://formative.jmir.org/2025/1/e71676 %U https://doi.org/10.2196/71676 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e71867 %T 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 %A Kendall,Ashley D %A Pela,Emily %A Amonica,Danielle %A Jaworski,Erin %A Floyd,Brenikki %A , %+ Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois Chicago, 818 S. Wolcott Ave., SRH 6th Floor, Chicago, IL, 60612, United States, 1 3123551836, akendall@uic.edu %K mobile app %K mHealth %K digital mental health %K meditation %K mindfulness %K juvenile legal system %K officers %K workplace %K ecological momentary assessment (EMA) %K emotion regulation %D 2025 %7 24.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X 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 %R 10.2196/71867 %U https://www.researchprotocols.org/2025/1/e71867 %U https://doi.org/10.2196/71867 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 6 %N %P e70463 %T Decentralized Biobanking Apps for Patient Tracking of Biospecimen Research: Real-World Usability and Feasibility Study %A Sanchez,William %A Dewan,Ananya %A Budd,Eve %A Eifler,M %A Miller,Robert C %A Kahn,Jeffery %A Macis,Mario %A Gross,Marielle %+ Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave., Baltimore, PA, 17225, United States, 1 8135416103, mariellesophiagross@gmail.com %K patient empowerment %K biobanking %K biospecimens %K transparency %K community engagement %K nonfungible tokens %K NFTs %K blockchain technology %K decentralized biobanking %K pilot studies %K technical feasibility %K biowallet %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Bioinform Biotech %G English %X 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. %M 40208659 %R 10.2196/70463 %U https://bioinform.jmir.org/2025/1/e70463 %U https://doi.org/10.2196/70463 %U http://www.ncbi.nlm.nih.gov/pubmed/40208659 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e42406 %T Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study %A Kola,Lola %A Fatodu,Tobi %A Kola,Manasseh %A Olayemi,Bisola A %A Adefolarin,Adeyinka O %A Dania,Simpa %A Kumar,Manasi %A Ben-Zeev,Dror %+ WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 3017 G.P.O, Ibadan, 23401, Nigeria, 234 (2) 2411768, lola_kola2004@yahoo.com %K adolescent perinatal depression %K primary care %K mHealth app %K user centered design %K smartphone %K human-centered design %K HCD %K depression %K postpartum %K perinatal %K postnatal %K teenage %K adolescent %K youth %K low-middle-income countries %K LMIC %K middle income %K adoption %K acceptability %K mobile health %K mHealth %K mobile app %K women’s health %K mental health %K depressive %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 40203299 %R 10.2196/42406 %U https://formative.jmir.org/2025/1/e42406 %U https://doi.org/10.2196/42406 %U http://www.ncbi.nlm.nih.gov/pubmed/40203299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67782 %T AI-Enhanced Virtual Reality Self-Talk for Psychological Counseling: Formative Qualitative Study %A Zisquit,‪Moreah %A Shoa,Alon %A Oliva,Ramon %A Perry,Stav %A Spanlang,Bernhard %A Brunstein Klomek,Anat %A Slater,Mel %A Friedman,Doron %+ Baruch Ivcher School of Psychology, Reichman University, Baruch Ivcher School of Psychology, Ha'universita 8, Herzliya, Israel, 972 523091406, Zisquit.moreah@post.runi.ac.il %K virtual human %K large language model %K virtual reality %K self-talk %K psychotherapy %K artificial intelligence %K AI %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 40173447 %R 10.2196/67782 %U https://formative.jmir.org/2025/1/e67782 %U https://doi.org/10.2196/67782 %U http://www.ncbi.nlm.nih.gov/pubmed/40173447 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e58837 %T 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 %A Flo,Gayle L %A Alzate Aguirre,Mateo %A Gochanour,Benjamin R %A Hynes,Kristin J %A Scott,Christopher G %A Fink,Angela L %A M Arruda-Olson,Adelaide %K coronary disease %K follow-up studies %K lipids %K myocardial infarction %K statins %D 2025 %7 28.3.2025 %9 %J JMIR Cardio %G English %X 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. %R 10.2196/58837 %U https://cardio.jmir.org/2025/1/e58837 %U https://doi.org/10.2196/58837 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59527 %T Patients’ and Health Care Professionals’ Expectations of Virtual Therapeutic Agents in Outpatient Aftercare: Qualitative Survey Study %A Immel,Diana %A Hilpert,Bernhard %A Schwarz,Patricia %A Hein,Andreas %A Gebhard,Patrick %A Barton,Simon %A Hurlemann,René %+ Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Hermann-Ehlers-Str. 7, Oldenburg, 26160, Germany, 49 441961517, diana.immel@uni-oldenburg.de %K socially interactive agent %K e-mental health %K mental illness %K mental disorder %K depression %K major depressive disorder %K suicide prevention %K suicidal ideation %K outpatient aftercare %K artificial intelligence %K virtual therapeutic assistant %K public health %K digital technology %K digital intervention %K digital health care %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 40138692 %R 10.2196/59527 %U https://formative.jmir.org/2025/1/e59527 %U https://doi.org/10.2196/59527 %U http://www.ncbi.nlm.nih.gov/pubmed/40138692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63704 %T Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study %A Rookes,Tasmin Alanna %A Batla,Amit %A Armstrong,Megan %A Ambler,Gareth %A Walters,Kate %A Schrag,Anette %K Parkinson disease %K feasibility %K remote monitoring %K Parkinson %K acceptability %K reliability %K wearable devices %K wearable %K self-management %K quantitative assessments %K quantitative %K qualitative %K monitoring %K patient %D 2025 %7 25.3.2025 %9 %J JMIR Form Res %G English %X 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 %R 10.2196/63704 %U https://formative.jmir.org/2025/1/e63704 %U https://doi.org/10.2196/63704 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67293 %T 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 %A Whittemore,Robin %A Jeon,Sangchoon %A Akyirem,Samuel %A Chen,Helen N C %A Lipson,Joanna %A Minchala,Maritza %A Wagner,Julie %+ School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, United States, 1 860 420 9623, robin.whittemore@yale.edu %K patient portal %K mobile phone %K diabetes %K community health center %K adults %K diabetic %K DM %K diabetes mellitus %K Type 2 diabetes %K T2D %K community health centers %K CHCs %K pilot study %K feasibility %K self-management %K glycemic control %K patient portals %K social determinants of health %K primary outcome %K digital health %K digital health literacy %K health technology %K health technologies %K psychosocial %K efficacy %D 2025 %7 25.3.2025 %9 Original Paper %J JMIR Form Res %G English %X 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% 0) and 20.7% (12/58) mostly switched (defined as a reduction in CPD>75% and EC use>0) in week 12. Conclusions: EMA is a suitable method to collect recall-based smoking-related data. Though results from mixed effect modeling and RR comparisons were similar using EMA or survey data, EMA provides unique advantages, namely greater granularity in the time and the capability to detect switching patterns in near real time. These findings provide the feasibility of using EMA in developing smoking cessation interventions in future tobacco harm reduction research. Trial Registration: ClinicalTrials.gov NCT04465318; https://clinicaltrials.gov/study/NCT04465318 International Registered Report Identifier (IRRID): RR2-10.1186/s13722-021-00284-0 %R 10.2196/66709 %U https://formative.jmir.org/2025/1/e66709 %U https://doi.org/10.2196/66709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63095 %T Digital Translation Platform (Translatly) to Overcome Communication Barriers in Clinical Care: Pilot Study %A Olsavszky,Victor %A Bazari,Mutaz %A Dai,Taieb Ben %A Olsavszky,Ana %A Finkelmeier,Fabian %A Friedrich-Rust,Mireen %A Zeuzem,Stefan %A Herrmann,Eva %A Leipe,Jan %A Michael,Florian Alexander %A Westernhagen,Hans von %A Ballo,Olivier %+ Department of Dermatology, Venereology and Allergy, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 2280, victor.olsavszky@medma.uni-heidelberg.de %K language barriers %K health care communication %K medical app %K real-time translation %K medical translation %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Language barriers in health care can lead to misdiagnosis, inappropriate treatment, and increased medical errors. Efforts to mitigate these include using interpreters and translation tools, but these measures often fall short, particularly when cultural nuances are overlooked. Consequently, medical professionals may have to rely on their staff or patients’ relatives for interpretation, compromising the quality of care. Objective: This formative pilot study aims to assess the feasibility of Translatly, a digital translation platform, in clinical practice. Specifically, the study focuses on evaluating (1) how health care professionals overcome language barriers and their acceptance of an on-demand video telephony platform, (2) the feasibility of the platform during medical consultations, and (3) identifying potential challenges for future development. Methods: The study included ethnographic interviews with health care professionals and an observational pilot to assess the use of the Translatly platform in clinical practice. Translatly was developed to make real-time translation easy and accessible on both Android and iOS devices. The system’s backend architecture uses Java-based services hosted on DigitalOcean. The app securely exchanges data between mobile devices and servers, with user information and call records stored in a MySQL database. An admin panel helps manage the system, and Firebase integration enables fast push notifications to ensure that health care professionals can connect with translators whenever they need to. The platform was piloted in a German university hospital with 170 volunteer nonprofessional translators, mainly medical students, supporting translation in over 20 languages, including Farsi, Dari, and Arabic. Results: Ethnographic research conducted by interviewing health care professionals in Frankfurt am Main and other German cities revealed that current practices for overcoming language barriers often rely on family members or digital tools such as Google Translate, raising concerns about accuracy and emotional distress. Respondents preferred an on-demand translation service staffed by medically experienced translators, such as medical students, who understand medical terminology and can empathize with patients. The observational pilot study recorded 39 requests for translation services, 16 (41%) of which were successfully completed. The translations covered 6 different languages and were carried out by a team of 10 translators. Most requests came from departments such as infectious diseases (5/16, 31%) and emergency (4/16, 25%). Challenges were identified around translator availability, with 23 (59%) total requests (N=39) going unanswered, which was further evidenced by user feedback. Conclusions: This pilot study demonstrates the feasibility of the Translatly platform in real-world health care settings. It shows the potential to improve communication and patient outcomes by addressing language barriers. Despite its potential, challenges such as translator availability highlight the need for further development. %M 39451122 %R 10.2196/63095 %U https://formative.jmir.org/2025/1/e63095 %U https://doi.org/10.2196/63095 %U http://www.ncbi.nlm.nih.gov/pubmed/39451122 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64565 %T Testing and Iterative Improvement of the CEN ISO/TS 82304-2 Health App Quality Assessment: Pilot Interrater Reliability Study %A Frey,Anna-Lena %A Matei,Diana %A Phillips,Ben %A McCabe,Adam %A Fuller,Rachel %A Laibarra,Begoña %A Alonso,Laura %A de la Hoz,Victor %A Pratdepadua Bufill,Carme %A Llebot Casajuana,Berta %A D'Avenio,Giuseppe %A Sottile,Pier Angelo %A Rocchi,Laura Melania %A Errera,Matteo %A Laaissaoui,Yasmine %A Cardinal,Michael %A Kok,Menno %A Hoogendoorn,Petra %+ National eHealth Living Lab, Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands, 31 654341785, a.p.y.hoogendoorn@lumc.nl %K health apps %K mobile health %K digital health %K quality evaluation %K assessment framework %K interrater reliability %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: With the increasing use of health apps and ongoing concerns regarding their safety, effectiveness, and data privacy, numerous health app quality assessment frameworks have emerged. However, assessment initiatives experience difficulties scaling, and there is currently no comprehensive, consistent, internationally recognized assessment framework. Therefore, health apps often need to undergo several quality evaluations to enter different markets, leading to duplication of work. The CEN ISO/TS 82304‑2 health app assessment seeks to address this issue, aiming to provide an internationally accepted quality evaluation through a network of assessment organizations located in different countries. Objective: This study aimed to develop and evolve the draft CEN ISO/TS 82304-2 assessment handbook and developer guidance by testing them across organizations in several countries. Methods: Assessment organizations from 5 countries were engaged to evaluate 24 health apps using the evolving CEN ISO/TS 82304-2 assessment across 3 evaluation rounds. The information submitted by a given health app developer was evaluated by 2 assessment organizations, and interrater reliability was examined. In addition, app developers and assessors were asked to report how much time they spent on information collation or evaluation and to rate the clarity of the developer guidance or assessor handbook, respectively. The collected data were used to iteratively improve the handbook and guidance between rounds. Results: The interrater reliability between assessment organizations improved from round 1 to round 2 and stayed relatively stable between rounds 2 and 3, with 80% (55/69) of assessment questions demonstrating moderate or better (Gwet AC1>0.41) agreement in round 3. The median time required by developers to prepare the assessment information was 8 hours and 59 minutes (IQR 5.7-27.1 hours) in round 3, whereas assessors reported a median evaluation time of 8 hours and 46 minutes (IQR 7.1-11.0 hours). The draft guidance and handbook were generally perceived as clear, with a median round-3 clarity rating of 1.73 (IQR 1.64-1.90) for developers and 1.78 (IQR 1.71-1.89) for assessors (0=“very unclear”, 1=“somewhat unclear”, and 2=“completely clear”). Conclusions: To our knowledge, this is the first study to examine the consistency of health app evaluations across organizations located in different countries. Given that the CEN ISO/TS 82304-2 guidance and handbook are still under development, the interrater reliability findings observed at this early stage are promising, and this study provided valuable information for further refinement of the assessment. This study marks an important first step toward establishing the CEN ISO/TS 82304-2 assessment as a consistent, cross-national health app evaluation. It is envisioned that the assessment will ultimately help avoid duplication of work, prevent inequities by facilitating access to smaller markets for developers, and build trust among users, thereby increasing the adoption of high-quality health apps. %M 40063936 %R 10.2196/64565 %U https://formative.jmir.org/2025/1/e64565 %U https://doi.org/10.2196/64565 %U http://www.ncbi.nlm.nih.gov/pubmed/40063936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67406 %T Development and Implementation of Strong Foundations, a Digitally Delivered Fall Prevention Program: Usability and Feasibility Pilot Exercise Cohort Study %A Moran,Ryan %A Wing,David %A Davey,Hope %A Barkai,Hava %A Nichols,Jeanne %K digital health %K fall prevention %K fall risk %K older adults %K geriatrics %K system usability scale %K Strong Foundations %K feasibility %K public health %K user acceptance %K exercise %K usability %K digital technology %K mobile phone %D 2025 %7 28.2.2025 %9 %J JMIR Form Res %G English %X Background: Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility. Objective: This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance. Methods: The “Strong Foundations” program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention’s (CDC’s) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021. Results: A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9% and 24%, respectively; by week 12, 64% (23/36) of participants improved in the timed up and go and 91% (32/35) improved the chair stands. Conclusion: There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk. %R 10.2196/67406 %U https://formative.jmir.org/2025/1/e67406 %U https://doi.org/10.2196/67406 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66681 %T Effect on Response Rates of Adding a QR Code to Patient Consent Forms for Qualitative Research in Patients With Cancer: Pilot Randomized Controlled Trial %A Wyse,Rebecca %A Forbes,Erin %A Norton,Grace %A Viana Da Silva,Priscilla %A Fakes,Kristy %A Johnston,Sally Ann %A Smith,Stephen R %A Zucca,Alison %+ School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia, 61 02 40420272, rebecca.wyse@health.nsw.gov.au %K QR code %K qualitative research %K cancer %K randomized controlled trial %K RCT %K patient recruitment %K consent forms %K response rates %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The successful conduct of health and medical research is largely dependent on participant recruitment. Effective, yet inexpensive methods of increasing response rates for all types of research are required. QR codes are now commonplace, and despite having been extensively used to recruit study participants, a search of the literature failed to reveal any randomized trial investigating the effect of adding a QR code on qualitative research response rates. Objective: This study aimed to collect data on rates of response, consent, and decline among patients with cancer, and the average time taken to respond following randomization to receive either a QR code or no QR code on the patient consent form for a qualitative research study. Methods: This was a pilot randomized controlled trial (RCT) embedded within a qualitative research study. In total, 40 eligible patients received a recruitment pack for the qualitative study, which included an information statement, a consent form, and an addressed, stamped envelope to return their consent form. Patients were randomized 1:1 to the control (standard recruitment pack only) or intervention group (standard recruitment pack including modified consent form with a QR code). Results: In total, 27 out of 40 patients (age: mean 63.0, SD 14.8 years; 45% female) responded to the consent form. A lower proportion of the QR code group (60%) responded (odd ratio [OR] 0.57, 95% CI 0.14-2.37; P=.44), compared to 75% of the standard recruitment group. However, a higher proportion of the QR group (35%) consented (OR 1.84, 95% CI 0.41-8.29; P=.43), compared to the standard recruitment group (20%). A lower proportion of the QR group (25%) declined (OR 0.34, 95% CI 0.09-1.38; P=.13) relative to the standard recruitment group (55%). The mean response time of the QR code group was 16 days (rate ratio [RR] 0.79, 95% CI 0.47-1.35; P=.39) compared to 19 days for the standard recruitment group. None of the age-adjusted analyses were statistically significant. Conclusions: This underpowered pilot study did not find any evidence that offering an option to respond through a QR code on a patient consent form for a qualitative study increased the overall patient response rate (combined rate of consent and decline). However, there was a nonsignificant trend, indicating that more patients who received the QR code consented compared to those who did not receive the QR code. This study provides useful preliminary data on the potential impact of QR codes on patient response rates to invitations to participate in qualitative research and can be used to inform fully powered RCTs. Trial Registration: OSF Registries 10.17605/OSF.IO/PJ25X; https://doi.org/10.17605/OSF.IO/PJ25X %M 39983108 %R 10.2196/66681 %U https://formative.jmir.org/2025/1/e66681 %U https://doi.org/10.2196/66681 %U http://www.ncbi.nlm.nih.gov/pubmed/39983108 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e51939 %T Assessing the Feasibility and Utility of Patient-Specific 3D Advanced Visualization Modeling in Cerebrovascular Disease: Retrospective Analysis and Prospective Survey Pilot Study %A Sarkar,Korak %A Bhimarasetty,Vishal %A Rahim,Abdul %A Curtis,Colin %A Hughes,Kimberly %+ Department of Academics, Ochsner BioDesign Lab, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA, 70119, United States, 1 504 894 2799, korak.sarkar.md@gmail.com %K cerebrovascular disease %K advanced visualization %K 3D modeling %K cerebrovascular %K intracerebral arteriovenous malformations %K artery %K vein %K vessel %K medical extended reality %K 3D printing %K medical simulation %K virtual reality %K augmented reality %K usability %K survey %K stroke %K brain %K cerebral %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence, clinical burden, and health care costs (>US $100 billion) associated with cerebrovascular disease (CVD) will increase significantly as the US population grows and ages over the next 25 years. Existing 2D imaging modalities have inherent limitations in visualizing complex CVD, which may be mitigated with the use of patient-specific 3D advanced visualization (AV) technologies. There remain gaps in knowledge, however, regarding how and with what impact these technologies are being used in CVD. Objective: The aim of this study was to characterize the clinical attributes and reported utility associated with the use of 3D AV modeling in CVDs, specifically intracerebral arteriovenous malformations. Methods: This pilot study employs a combination of retrospective analysis and prospective surveys to describe the utilization and utility of patient-specific AV models at a single high-volume certified comprehensive stroke center. Results: From July 2017 to February 2023, 25 AV models were created for 4 different clinicians. The average patient age was 37.4 years; 44% (11/25) of the patients were African Americans, 52% (13/25) were on public insurance, and 56% (14/25) were associated with a neurovascular procedure. In this study, 18 clinicians with diverse experience responded to AV model surveys, with a 92.2% (166/180) completion rate. There was an average reported utility of 8.0 on a 0-10 scale, with higher scores reflecting increased utility. Compared to 2D viewing, AV models allowed staff to appreciate novel abnormal anatomy, and therefore, they would have changed their therapeutic approach in 45% (23/51) of the cases. Conclusions: AV models were used in complex CVDs associated with young, publicly insured individuals requiring resource-intensive interventions. There was strong and diverse clinician engagement with overall report of substantial utility of AV models. Staff clinicians frequently reported novel anatomical and therapeutic insights based on AV models compared to traditional 2D viewing. This study establishes the infrastructure for future larger randomized studies that can be repeated for CVDs or other disease states and incorporate assessments of other AV modalities such as 3D printing and medical extended reality. %M 39983107 %R 10.2196/51939 %U https://formative.jmir.org/2025/1/e51939 %U https://doi.org/10.2196/51939 %U http://www.ncbi.nlm.nih.gov/pubmed/39983107 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65302 %T Digital Solution to Support Medication Adherence and Self-Management in Patients with Cancer (SAMSON): Pilot Randomized Controlled Trial %A Dang,Thu Ha %A Wickramasinghe,Nilmini %A Jayaraman,Prem Prakash %A Burbury,Kate %A Alexander,Marliese %A Whitechurch,Ashley %A Dyer,Mitchell %A Quinn,Stephen %A Forkan,Abdur Rahim Mohammad %A Schofield,Penelope %+ Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Melbourne, 3122, Australia, 61 422703347, thuhadang@swin.edu.au %K home-based cancer treatment %K smartphone app %K oral chemotherapy %K patient safety %K SAMSON %K mobile phone %K digital solution %K medication adherence %K self-management %K cancer %K randomized controlled trial %K RCT %K pilot study %K oncology %K mobile health %K mHealth %K quality of life %K eHealth %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication nonadherence is a serious problem in cancer, potentially impacts patients’ health outcomes and health care costs. Although technology-based medication adherence (MA) interventions have emerged, evidence supporting their quality and effectiveness remains limited. Objective: This study tested the acceptability, feasibility, and potential effects of Safety and Adherence to Medications and Self-care Advice in Oncology (SAMSON), a digital solution designed to support MA and self-management in cancer. Methods: A 12-week, 2-arm, unblinded, pragmatic pilot randomized controlled trial was conducted. Adults with hematological malignancies who started oral cancer medicines within the last 12 months were recruited from a metropolitan specialized hospital and randomized 1:1 to SAMSON or control (usual care). The SAMSON solution included a smartphone app with tailored alerts and real-time self-care advice, a web-based dashboard for health care professionals (HCPs) to monitor patients’ adherence and symptoms, and motivational interviewing (MI) teleconsultations delivered by oncology nurses and pharmacists at baseline and weeks 1, 4, 8, and 12. Primary outcomes were the patients’ acceptance of SAMSON, measured by the Unified Theory of Acceptance and Use of Technology at 12 weeks, and study feasibility, measured by predefined rates of recruitment, randomization, retention, intervention adherence, and outcome assessment completion. Secondary outcomes were comparison of MA and clinical self-assessments through online questionnaires, including adherence, toxicity self-management, anxiety and depression symptoms, and quality of life, measured at baseline and 12 weeks between the 2 arms. Data retrieved from the SAMSON app (Swinburne University of Technology) was analysed for task completion. Results: A total of 33 patients (79% of those who were approached) consented to participate in the trial. Of those, 31/33 (94%) completed baseline surveys and were randomized to SAMSON (15/31) and control arms (16/31). Of 31 patients, 28 (90%) completed the 12-week surveys (12 SAMSON and 16 control). Overall, patients rated the SAMSON solution as highly acceptable (13/15, 87% app usage; 14/15, 93% MI teleconsultation delivery). They reported that SAMSON was easy to use (10/12, 83%) and helpful in improving their MA (6/12, 50%). All study HCPs reported the SAMSON solution was helpful in supporting patients’ MA. Patients completed an average of 99 tasks over the 12-week study period (71% of scheduled tasks). Most patients (10/12, 83%) completed all 5 scheduled consultations. All study feasibility measures were higher than the predefined upper thresholds, except the rate of patients’ responses to medication reminders. Conclusions: The results demonstrated that the SAMSON solution is acceptable, usable, and useful for oncology HCPs and patients with cancer. The SAMSON solution is feasible in real-life oncology settings. Our next steps involve refining the SAMSON solution based on participants’ feedback, conducting a large-scale randomized controlled trial to evaluate its clinical and economic effectiveness, and exploring potential commercialization. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000472673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385728 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-079122 %M 39969972 %R 10.2196/65302 %U https://formative.jmir.org/2025/1/e65302 %U https://doi.org/10.2196/65302 %U http://www.ncbi.nlm.nih.gov/pubmed/39969972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62706 %T Acceptance of Unsupervised App-Based Cognitive Assessment in Outpatient Care: An Implementation Study %A Blotenberg,Iris %A Boekholt,Melanie %A Lieberknecht,Nils %A Säring,Paula %A Thyrian,Jochen René %K mild cognitive impairment %K Alzheimer disease %K dementia %K cognition %K computerized assessment %K digital assessment %K digital cognitive biomarkers %K home-based assessment %K digital platform %K mobile phone %D 2025 %7 13.2.2025 %9 %J JMIR Form Res %G English %X Background: The use of unsupervised digital cognitive assessments provides considerable opportunities for early and comprehensive testing for Alzheimer disease, minimizing the demand on time and personnel resources in medical practices. However, the acceptance within health care has yet to be assessed. Objective: In this implementation study, the acceptance of an app-based, repeated cognitive assessment for early symptoms of Alzheimer disease in the outpatient care setting from both physicians’ and patients’ perspectives was examined. Methods: In total, 15 primary care practices participated, where patients with self- or relative-reported memory problems could be prescribed an app (neotivCare app [neotiv GmbH]) for comprehensive cognitive testing. Patients used the app to test their episodic memory function weekly for 12 weeks at home. After the testing period and the final consultation, physicians and patients received questionnaires to assess the app’s acceptance. Results: We received completed questionnaires from physicians for 45 patients. In addition, we received 45 completed questionnaires from the patients themselves. The physicians reported that, for most patients, the app supported their decision-making in the diagnostic process (26/45, 58%). In addition, most physicians found the app’s information dependable (34/45, 76%) and felt more certain in their decisions (38/45, 84%). From the patients’ perspective, a majority felt thoroughly tested (34/45, 76%), and only a few considered the time commitment for the cognitive tests to be too burdensome (7/45, 16%). Furthermore, despite the weekly cognitive testing and the lengthy 12-week testing period, a majority of patients participated in all tests (39/54, 72%). Conclusions: Our results indicate a high level of acceptance by physicians and patients, suggesting significant potential for the implementation of unsupervised digital cognitive assessments into routine health care. In the future, acceptance should be assessed in large-scale studies, with a particular focus on the impact on health care delivery and patient outcomes. %R 10.2196/62706 %U https://formative.jmir.org/2025/1/e62706 %U https://doi.org/10.2196/62706 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66692 %T Use of a Technology-Based Fall Prevention Program With Visual Feedback in the Setting of Early Geriatric Rehabilitation: Controlled and Nonrandomized Study %A Steinmetz,Carolin %A Stenzel,Christina %A Sylvester,Maj %A Glage,Denis %A Linke,Anne %A Sadlonova,Monika %A von Arnim,Christine A F %A Schnieder,Marlena %A Valentová,Miroslava %A Heinemann,Stephanie %K fall prevention %K fall prevention program %K early geriatric rehabilitation %K gerontology %K older adult %K elder %K aging %K digital exercise intervention %K digital activity %K physical exercise %K functional capacity %K new technology %K technology-based %K digital intervention %K feasibility %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: The Otago program (OP) is evidence-based and focuses on fall prevention in older people. The feasibility and usability of a short-term digital program modeled after the principles of the OP in the setting of early geriatric rehabilitation (EGR) are unclear. Objective: This study investigated the feasibility and usability of an additional technology-based fall prevention program (FPP) in the setting of EGR. Methods: We performed a feasibility study in the setting of EGR. A sample of 30 patients (mobility at least by walker; mini-mental status test score >17) was recruited between March and June 2024 and compared with a retrospective cohort (n=30, former EGR patients). All patients in the intervention group (IG) received a supervised, OP-modified FPP thrice/week for 20 minutes using a technology-based platform called “Pixformance.” The device is a digital trainer and enables real-time corrections. The primary end point was the feasibility (given when 80% of the IG participated in 6 trainings within 2 weeks). Secondary outcomes were usability (patients’ and facilitators’ perspective; ≥75%), risk of falls (Berg Balance Scale), mobility (Timed Up and Go Test), functional independence (Functional Independence Measure), and activities of daily living (Barthel Index). Several further exploratory end points were analyzed including anxiety and depression (Four-Item Patient Health Questionnaire; PH-Q4). Data were accessed at entry to EGR and after 2 weeks prior to discharge. To analyze the pre-posttest results, the dependent Student t test and the Wilcoxon test were applied. A mixed ANOVA with repeated measurements was used for statistical analyses of time-, group-, and interaction-related changes. Results: A cohort of 60 patients (mean 80.2, SD 6.1 y; 58% females, 35/60) was analyzed. The main indication for EGR was stroke (9/60, 15%). Patients were recruited into a prospective IG (n=30) and a retrospective control group (n=30). Of the 30 patients in the prospective IG, 11 patients (37%) completed 6 training sessions within 2 weeks. Reasons why participants did not complete 6 training sessions were diagnostic appointments (33%), pain/discomfort (33%), or fatigue (17%). EGR patients rated FPP usability at 84% and facilitators at 65% out of 100%. Pre-posttest analysis of the standard assessments showed a significant interaction in Berg Balance Scale (<.01). In both groups, a significant improvement over time was found in the Timed Up and Go Test (<.01), Barthel Index (<.01), and Functional Independence Measure (<.01). Likewise, in the IG, the PH-Q4 score (.02) improved. Conclusions: While the technology-based FPP in the EGR setting was generally well-accepted by patients, with high usability ratings, its feasibility was limited. Only 37% of participants completed the required additional training sessions. Further studies should test the technology-based FPP as an integrated part of the EGR complex therapy concept. Our findings suggest potential benefits of incorporating technology-based FPPs in EGR, but further refinement is needed to enhance participation and feasibility. %R 10.2196/66692 %U https://formative.jmir.org/2025/1/e66692 %U https://doi.org/10.2196/66692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60275 %T Assessing Dynamic Cognitive Function in the Daily Lives of Youths With and Without Type 1 Diabetes: Usability Study %A Ray,Mary Katherine %A Fleming,Jorie %A Aschenbrenner,Andrew %A Hassenstab,Jason %A Redwine,Brooke %A Burns,Carissa %A Arbelaez,Ana Maria %A Vajravelu,Mary Ellen %A Hershey,Tamara %K ecological momentary assessment %K EMA %K ambulatory %K smartphone %K continuous glucose monitoring %K CGM %K assessment %K daily lives %K youth %K type 1 diabetes %K diabetes %K feasibility study %K pilot study %K glycemic control %K environmental factor %K phone %K acceptability %K young %K cognitive test %K app %K application %K mobile phone %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: Studies have shown a relationship between worse glycemic control and lower cognitive scores in youths with type 1 diabetes (T1D). However, most studies assess long-term glucose control (eg, years-decades) and cognition at a single time point. Understanding this relationship at a higher temporal resolution (eg, minutes-hours) and in naturalistic settings has potential clinical implications. Newer technology (eg, continuous glucose monitoring [CGM] and ecological momentary assessment) provides a unique opportunity to explore the glucose dynamics that influence dynamic cognition; that is, cognitive functions that fluctuate short-term and are influenced by environmental factors. Objective: Before we can assess this relationship, we need to determine the feasibility of measuring cognition in youths in daily life and determine the plausibility of obtaining glucose variation with CGM to be integrated with real-time cognition measures. This study’s purpose was to assess the acceptability of measuring dynamic cognition using a smartphone app and adherence to cognitive testing in daily life in youths with and without T1D. Further, we assessed CGM-derived glucose measures at temporally related timeframes to cognitive testing in naturalistic settings. Methods: Data were obtained from 3 studies including one in-laboratory study and 2 remote studies. For all studies, youths were asked to complete cognitive tests on the Ambulatory Research in Cognition (ARC) smartphone app that measured processing speed, associative memory, and working memory. For the in-laboratory study, youths completed testing 4 times during 1 session. For the remote studies, youths were asked to complete cognitive tests 5 times per day for either 10 or 14 consecutive days in daily life. Youths were asked to rate their impressions of the app. Youths with T1D wore a CGM. Results: 74 youths (n=53 control; n=21 T1D) aged 4‐16 years participated. Youths generally reported liking or understanding the ARC app tasks in a laboratory and remote setting. Youths had high testing adherence in daily life (2350/3080 to 721/900, 76.3%‐80.2%) and none dropped out. The percentage of measurements within each glycemic range taken immediately before the app’s cognitive testing was 3% (28/942) low glucose, 51% (484/942) euglycemia, 23% (221/942) high glucose, and 22% (210/942) very high glucose. In the 2-hour window before each cognitive task, mean glucose was 182.5 (SD 76.2) mg/dL, SD in glucose was 27.1 mg/dL (SD 18.7), and the mean maximum difference between the highest and lowest glucose was 85.5 (SD 53.7) mg/dL. Conclusions: The results suggest that using the ARC smartphone app to assess dynamic cognitive functions in youths with and without T1D is feasible. Further, we showed CGM-derived glycemic variability at temporally associated timeframes of dynamic cognitive assessments. The next steps include using ecological momentary assessment in a fully powered study to determine the relationship between short-term glycemic control and cognition in youths with T1D. %R 10.2196/60275 %U https://formative.jmir.org/2025/1/e60275 %U https://doi.org/10.2196/60275 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57768 %T Evaluating the Knowledge Level, Practice, and Behavioral Change Potential of Care Managers in Pressure Injury Prevention Using a Mobile App Prototyping Model in the Home-Care Setting: Single-Arm, Pre-Post Pilot Study %A Kohta,Masushi %A Takahashi,Mayumi %A Koyanagi,Hiroe %A Sugama,Junko %K behavioral change %K home care %K knowledge %K mobile application %K pressure injury %K mHealth %K mobile health %K apps %K practice %K injury %K prevention %K prototype %K effectiveness %K care manager %K Japan %K Pips-Map %K questionnaire %K wound care %K pilot study %K women %D 2025 %7 7.2.2025 %9 %J JMIR Form Res %G English %X Background: The use of mobile apps to promote knowledge level, practice, and behavioral change potential has become increasingly common. However, studies on apps targeting social welfare employees working in the home-care setting to prevent pressure injury (PI) are lacking. The care manager (CM) plays a key role in connecting the demand and supply of home-care services. PI is more prevalent in the home-care setting, where resources are limited, than in acute settings. Objective: The research hypothesis was that CMs who use a mobile app will have improved general knowledge and heightened practice for PI prevention, compared to that before using the app. This study aimed to assess the effectiveness of a PI prevention support mobile app prototyping model (Pips-Map) in improving the knowledge level, practice, and behavioral change potential of CMs in PI prevention in the home-care setting. Methods: This was conducted between December 2021 and December 2023 as a single-arm, pre-post pilot study including 27 CMs who worked in a Japanese city. Pips-Map was used for 6 months in daily practice, and a self-administered test questionnaire was used to assess participants’ knowledge and practice in PI prevention before or after using Pips-Map. At the end of the posttest, a validated App Behavior Change Scale was used to analyze behavioral change potential. This study followed the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results: In total, 19 participants were analyzed. Out of 55 points, the total mean knowledge score significantly increased from 30.9 (SD 5.9) in the pretest group to 36.1 (SD 5.9) in the posttest group (P=.0003). The number of participants with a total score of >70% (adequate knowledge level) increased from 2 (11%) to 7 (36.8%), but the difference was not statistically significant (P=.07). For the level of practice, out of 21 points, the total score increased from 15.2 (SD 3.1) in the pretest group to 16.2 (SD 3.0) in the posttest group, but no statistically significant differences were observed (P=.16). The behavior change scale revealed that participants positively evaluated the Pips-Map to provide information on PI prevention guidelines but had concerns regarding inadequate usability and financial incentives of Pips-Map. Conclusions: The use of Pips-Map for 6 months in actual practice increased the knowledge level of Japanese CMs in PI prevention, but it did not change the level of practice. Considering the need for updating apps that aim to promote behavioral change, this study identified some limitations of Pips-Map. Thus, revisions must be made to adapt Pips-Map to home-based care needs. Trial Registration: UMIN Clinical Trial Registry UMIN000048904; https://tinyurl.com/5bt6zv7t %R 10.2196/57768 %U https://formative.jmir.org/2025/1/e57768 %U https://doi.org/10.2196/57768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66979 %T Assessing the Impact of a Virtual Reality Cognitive Intervention on Tennis Performance in Junior Tennis Players: Pilot Study %A Anguera,Joaquin A %A Choudhry,Aleem %A Seaman,Michael %A Fedele,Dominick %+ Neuroscape, Department of Neurology and Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, United States, 1 415 702 4322, joaquin.anguera@ucsf.edu %K executive function %K serious games %K cognitive training %K performance enhancement %K athletes %K sport %K pilot study %K VR %K virtual reality %K serious game %K tennis %K adolescents %K teenagers %K youth %K randomized controlled trial %K players %D 2025 %7 7.2.2025 %9 Short Paper %J JMIR Form Res %G English %X Background: There is evidence that cognitive training interventions can positively impact executive functions, and that some studies have demonstrated that athletes typically exhibit greater accuracy and faster response times on select cognitive tasks. While the engagement of executive functions is suggested to be part of high-level sporting activities, it is unclear whether such training approaches could directly benefit athletic performance. Objective: The objective of this study was to evaluate the impact of a combined virtual reality (VR)– and tablet-based cognitive training intervention on adolescent tennis players’ performance. Here, we examined differences in Universal Tennis Rating (UTR) between players who supplemented their regular tennis training with a cognitive training intervention and a group that continued regular tennis training alone. This custom cognitive training program targeted specific cognitive control abilities including attention, working memory, and goal management. Methods: Data were collected from a cohort of tennis players in a randomized controlled trial design led by the dedicated research team. Participants (N=23, age: mean 14.8, SD 2.4 years) from the Czech Lawn Tenis Klub (Prague, Czech Republic) were invited to participate in this study. These individuals were randomized into an intervention + training-as-usual group (n=13) or training-as-usual group (control group; n=10), with the change in UTR score being the primary metric of interest. Results: There was no difference in UTR between the 2 groups at baseline (intervention: mean 8.32, SD 2.7; control: mean 7.60, SD 2.3). Following the treatment period, individuals in the intervention group showed a significant improvement in their UTR (an increase of 0.5; t12=4.88, P<.001) unlike the control group (an increase of 0.02; t9=1.77, P=.12). On comparing the change in UTR (posttraining UTR minus pretraining UTR) attained by each group, we found that the intervention group had a 38% greater improvement in UTR than the control group. An analysis of covariance revealed a significantly greater improvement in UTR for the intervention group than for the control group (F1,20=8.82, P=.008). Conclusions: The present findings suggest that training cognitive abilities through an immersive visual platform may benefit athletic performance, including tennis. Such a result warrants careful consideration, given the known difficulties in evidencing far transfer not only in cognitive studies but also in athletic activities. These preliminary pilot findings suggest that the Mastermind Cognitive Training program may be a viable tool for supplementing athletic training practices, although this result warrants further investigation and replication. However, many questions remain unanswered, and further work is needed to better understand the potential utility and mechanisms underlying potential effects of such a platform. %M 39918854 %R 10.2196/66979 %U https://formative.jmir.org/2025/1/e66979 %U https://doi.org/10.2196/66979 %U http://www.ncbi.nlm.nih.gov/pubmed/39918854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62915 %T Women Empowered to Connect With Addiction Resources and Engage in Evidence-Based Treatment (WE-CARE)—an mHealth Application for the Universal Screening of Alcohol, Substance Use, Depression, and Anxiety: Usability and Feasibility Study %A Isaacs,Krystyna %A Shifflett,Autumn %A Patel,Kajal %A Karpisek,Lacey %A Cui,Yi %A Lawental,Maayan %A Tzilos Wernette,Golfo %A Borsari,Brian %A Chang,Katie %A Ma,Tony %+ Benten Technologies, 9408 Grant Ave, Unit 206, Manassas, VA, 20110, United States, 1 7036625858, krysisaacs@gmail.com %K service linkage %K digital health %K education %K mental health %K substance use disorder %K SUD %K alcohol use disorder %K chatbot %K childbearing women %K women %K alcohol %K substance use %K empowerment %K evidence-based treatment %K usability %K feasibility %K mobile health %K mhealth %K app %K depression %K anxiety %K screening %K e-screening %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Women of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment. Objective: In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age. Methods: We used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app’s usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women’s reactions to the app. Results: A total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as “at-risk” for substance use disorders contacted the free treatment clinic for further evaluation. Conclusions: The mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change. %M 39918861 %R 10.2196/62915 %U https://formative.jmir.org/2025/1/e62915 %U https://doi.org/10.2196/62915 %U http://www.ncbi.nlm.nih.gov/pubmed/39918861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68619 %T Users’ Perspectives of Direct-to-Consumer Telemedicine Services: Survey Study %A Churruca,Kate %A Foo,Darran %A Turner,Andrew %A Crameri,Emily %A Saba,Maree %A Spanos,Samantha %A Vickers,Matthew %A Braithwaite,Jeffrey %A Ellis,Louise A %K telemedicine %K digital health technology %K direct-to-consumer %K digital tools %K telehealth %K consumer experience %D 2025 %7 3.2.2025 %9 %J JMIR Form Res %G English %X Background: Commercially run direct-to-consumer (DTC) telemedicine services are on the rise in countries such as Australia and the United States. These include DTC services that are web-based, largely asynchronous, and offer targeted treatment pathways for specific health issues (eg, weight loss or sexual function). It has been argued that DTC telemedicine improves access to health care and promotes patient empowerment. Despite research examining quality and safety issues, little is known about users’ reasons for accessing DTC telemedicine services or their perceptions of them. Objective: In this study, we aimed to examine the perspectives of Australian users accessing DTC telemedicine services, including the reasons for use, perceived benefits, and concerns, in addition to their usage and interaction with traditional general practice services. Methods: A web-based cross-sectional survey including questions on demographics, published and validated scales, and author-developed closed- and open-response questions was administered via REDCap in 2023 to Australian adults accessing DTC telemedicine services. Results: Among the 151 respondents, most (136/151, 90.1%) had seen a general practitioner (GP) in the previous 12 months and were somewhat or very satisfied (118/136, 86.8%) with the care, just over half found it easy to get an appointment with their GP (76/151, 50.3%), and a quarter found it difficult (38/151, 25.2%). Among the 136 respondents who had seen a GP, more than half either “never” (55/136, 40.4%) or “rarely” (23/136, 16.9%) discussed the information and treatment received from DTC telemedicine service with their GP. The majority of respondents were using a DTC telemedicine service offering prescription skin care (92/151, 60.9%), had received treatment in the previous 6 months (123/151, 81.5%), and had self-initiated care (128/151, 84.8%). The most frequently cited reasons for using DTC telemedicine were related to convenience (97/121, 80.2%) and flexibility (71/121, 58.7%), while approximately a third of the sample selected that it was difficult to see traditional health care provider in their preferred time frame (44/121, 36.4%) and that the use of DTC telemedicine allowed them to gain access to services otherwise unavailable through traditional health care (39/121, 32.2%). Most participants felt “more in control” (106/128, 82.9%) and “in charge” of their health concern (102/130, 78.5%) when using DTC telemedicine services, in addition to having “more correct knowledge” (92/128, 71.9%) and “feeling better informed as a patient” (94/131, 71.8%). “Costs of services” (40/115, 34.8%) and “privacy” (31/115, 27%) were the most frequently reported concerns with using digital health care technologies such as DTC telemedicine. Conclusions: We report that most users perceive DTC telemedicine services as offering ease of access and convenience, and that their use contributes to a greater sense of empowerment over their health. Concerns were related to data privacy and the costs of utilizing the services. Responses suggest that DTC telemedicine may be tapping into a previously unmet need, rather than complementing traditional health care provided by a GP. %R 10.2196/68619 %U https://formative.jmir.org/2025/1/e68619 %U https://doi.org/10.2196/68619 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54392 %T Web-Based Exercise and Nutrition Intervention to Improve Leg Muscle Strength and Physical Functioning in Older Adults: Pre-Post Pilot Study %A Dorhout,Berber Gijsbertha %A Wezenbeek,Nick %A de Groot,Lisette C P G M %A Grootswagers,Pol %K web-based lifestyle intervention %K resistance exercise %K protein intake %K muscle strength %K muscle mass %K older adults %K web-based exercise %K nutrition %K exercise %K resistance training %K sarcopenia %D 2025 %7 30.1.2025 %9 %J JMIR Form Res %G English %X Background: The lifestyle intervention ProMuscle, which combines resistance exercise and an increased protein intake, was effective in improving muscle strength, muscle mass, and physical functioning in older adults. However, due to a growing shortage of health care professionals, the rapidly growing aging population cannot be personally guided in the future. Therefore, Uni2Move, a scalable web-based variant of ProMuscle, was designed to reach larger groups of older adults without putting additional burden on health care professionals. Objective: The current study investigated the effects of a web-based lifestyle intervention on muscle strength, protein intake, and physical functioning in healthy older adults. In addition, we conducted a qualitative study to gather key insights of the participants involved, as little is known about older adults’ perceptions of web-based lifestyle interventions. Methods: A pre-post pilot study was conducted in the Netherlands. In the 24-week intervention, 19 healthy adults aged >55 years were included. They performed resistance training at home twice a week for 24 weeks via web-based workout videos. Videos (45‐60 minutes) were recorded by the fitness trainer and mainly focused on training leg muscles. In addition, older adults were advised on increasing protein intake via two web-based consultations by a dietitian in the first 12 weeks and via an e-learning course in the second 12 weeks. Intervention adherence and acceptance was measured in week 25. The 1 repetition maximum knee extension strength, repeated chair rise test, and protein intake were measured at baseline, week 13, and week 25. Linear mixed models were used to test differences over time. Semistructured interviews were used to gather experiences of participants. Atlas.ti version 22 was used to analyze the interviews. Results: The mean age of participants (n=19) at baseline was 69 (SD 7) years. The 1 repetition maximum knee extension strength and repeated chair rise test improved significantly during the 24-week intervention with a mean difference of 7.0 kg (95% CI 4.8-9.3; P<.001) and −1.2 seconds (95% CI −1.7 to −0.6; P<.001), respectively. Total protein intake per day did not change, whereas protein intake during breakfast had increased significantly after 13 weeks with a mean difference of 6.9 g (95% CI 1.1-12.7; P=.01). Qualitative research revealed that advantages of the program included no need to travel and exercising in their own environment. Disadvantages were the lack of physical interaction and no corrections by the trainer. Conclusions: The results of the web-based exercise and nutrition intervention Uni2Move indicate potential improvements of muscle strength and physical functioning in healthy middle-aged and older adults. Providing such lifestyle interventions on the internet could reach an increased number of older adults, providing the opportunity to contribute to the health and independence of the rapidly growing aging population. %R 10.2196/54392 %U https://formative.jmir.org/2025/1/e54392 %U https://doi.org/10.2196/54392 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67171 %T Engagement With an Internet-Administered, Guided, Low-Intensity Cognitive Behavioral Therapy Intervention for Parents of Children Treated for Cancer: Analysis of Log-Data From the ENGAGE Feasibility Trial %A Reuther,Christina %A von Essen,Louise %A Mustafa,Mudassir Imran %A Saarijärvi,Markus %A Woodford,Joanne %+ CIRCLE - Complex Intervention Research in Health and Care, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds 14B, Uppsala, 75237, Sweden, 46 70 425 07 14, louise-von.essen@uu.se %K childhood cancer survivor %K cognitive behavioral therapy %K engagement %K internet-administered intervention %K log-data %K parents %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Parents of children treated for cancer may experience psychological difficulties including depression, anxiety, and posttraumatic stress. Digital interventions, such as internet-administered cognitive behavioral therapy, offer an accessible and flexible means to support parents. However, engagement with and adherence to digital interventions remain a significant challenge, potentially limiting efficacy. Understanding factors influencing user engagement and adherence is crucial for enhancing the acceptability, feasibility, and efficacy of these interventions. We developed an internet-administered, guided, low-intensity cognitive behavioral therapy (LICBT)–based self-help intervention for parents of children treated for cancer, (EJDeR [internetbaserad självhjälp för föräldrar till barn som avslutat en behandling mot cancer or internet-based self-help for parents of children who have completed cancer treatment]). EJDeR included 2 LICBT techniques—behavioral activation and worry management. Subsequently, we conducted the ENGAGE feasibility trial and EJDeR was found to be acceptable and feasible. However, intervention adherence rates were marginally under progression criteria. Objective: This study aimed to (1) describe user engagement with the EJDeR intervention and examine whether (2) sociodemographic characteristics differed between adherers and nonadherers, (3) depression and anxiety scores differed between adherers and nonadherers at baseline, (4) user engagement differed between adherers and nonadherers, and (5) user engagement differed between fathers and mothers. Methods: We performed a secondary analysis of ENGAGE data, including 71 participants. User engagement data were collected through log-data tracking, for example, communication with e-therapists, homework submissions, log-ins, minutes working with EJDeR, and modules completed. Chi-square tests examined differences between adherers and nonadherers and fathers and mothers concerning categorical data. Independent-samples t tests examined differences regarding continuous variables. Results: Module completion rates were higher among those who worked with behavioral activation as their first LICBT module versus worry management. Of the 20 nonadherers who opened the first LICBT module allocated, 30% (n=6) opened behavioral activation and 70% (n=14) opened worry management. No significant differences in sociodemographic characteristics were found. Nonadherers who opened behavioral activation as the first LICBT module allocated had a significantly higher level of depression symptoms at baseline than adherers. No other differences in depression and anxiety scores between adherers and nonadherers were found. Minutes working with EJDeR, number of log-ins, days using EJDeR, number of written messages sent to e-therapists, number of written messages sent to participants, and total number of homework exercises submitted were significantly higher among adherers than among nonadherers. There were no significant differences between fathers and mothers regarding user engagement variables. Conclusions: Straightforward techniques, such as behavioral activation, may be well-suited for digital delivery, and more complex techniques, such as worry management, may require modifications to improve user engagement. User engagement was measured behaviorally, for example, through log-data tracking, and future research should measure emotional and cognitive components of engagement. Trial Registration: ISRCTN Registry 57233429; https://doi.org/10.1186/ISRCTN57233429 %M 39874575 %R 10.2196/67171 %U https://formative.jmir.org/2025/1/e67171 %U https://doi.org/10.2196/67171 %U http://www.ncbi.nlm.nih.gov/pubmed/39874575 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e62809 %T Effectiveness of a New Device for Hand, Wrist, and Forearm Rehabilitation: Feasibility Randomized Controlled Trial %A Ríos Rincón,Adriana M %A Guptill,Christine %A Liubaoerjijin,Yilina %A Figeys,Mathieu %A Koubasi,Farnaz %A Gregson,Geoffrey %A Miguel Cruz,Antonio %K hand %K upper limb %K motion %K movement %K wrist %K therapeutics %K rehabilitation %K musculoskeletal %K musculoskeletal diseases %K stroke %K wrist fractures %K feasibility studies %K randomized controlled trial %K digital health %K physiotherapy %K physical therapy %K occupational therapy %D 2025 %7 27.1.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Forearm, wrist, and hand impairments affect many individuals and impose a significant economic burden on health care systems. The FEPSim (flexion, extension, pronation, and supination) is designed for hand and wrist rehabilitation. It could become part of the standard care for upper extremity rehabilitation, aiming to improve range of motion, dexterity, and strength during therapeutic activities. However, the FEPSim has not yet been tested in a health care setting, highlighting the need for a trial to assess its effectiveness in upper extremity rehabilitation. Objective: We aim to assess the feasibility of conducting a definitive trial investigating the effectiveness of adding a new device for hand therapy exercises, the FEPSim, to standard care for patients with impairments of the hand, wrist, and forearm. Methods: Thirty-eight patients with impairments of distal upper extremities were randomly assigned either to the intervention group (FEPSim and standard care, n=19) or to the control group (standard care, n=19). Therapeutic activities to increase strength, range of motion, resistance, and dexterity were delivered by treating hand therapists using the FEPSim device for the intervention group. Outcome measures included wrist passive and active range of motion, grip strength, pinch grip force, and the Patient-Rated Wrist Evaluation. Results: The trial retention rate (36/38, 95%) and compliance (control group: 100%; intervention group: 89%) were high. The comparisons of the change-from-baseline between groups revealed that in 63.2% (12/19) of the outcome variables, the change was in favor of the FEPSim, with statistically significant improvements in passive wrist flexion (t34=−0.335, P=.008) and grip strength (t34=−1.841, P=.04). Conclusions: The FEPSim was accepted as part of standard care by therapists and patients at 2 hospitals. The trial design was feasible for hand intervention using the FEPSim device. The FEPSim positively affected grip strength, an objective measure of hand functioning. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 %R 10.2196/62809 %U https://rehab.jmir.org/2025/1/e62809 %U https://doi.org/10.2196/62809 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55932 %T Exploring Web-Based Support for Suicidal Ideation in the Scottish Population: Usability Study %A McClelland,Heather %A O'Connor,Rory C %A Gibson,Laura %A MacIntyre,Donald J %+ School of Health and Wellbeing, University of Glasgow, 90 Byres Road, Clarice Pears Building, Glasgow, G12 8TB, United Kingdom, 44 141 330 3299, heather.mcclelland@glasgow.ac.uk %K suicide prevention %K Scotland %K suicidal thoughts %K digital intervention %K internet %K self-help %K crisis intervention %D 2025 %7 24.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is a global health concern. In the United Kingdom, Scotland has the highest suicide rate. Lived experience and suicide prevention stakeholders in Scotland have identified a key gap in suicide prevention activities: the lack of 24-hour peer-driven web-based support for people who are suicidal. Objective: This usability study aimed to evaluate the feasibility, acceptability, utility, and reach of a suicide prevention website (Surviving Suicidal Thoughts) specifically designed to support residents in Scotland who are experiencing suicidal thoughts themselves or suspect or know someone who is experiencing suicidal thoughts. Intended support was delivered through the provision of personal testimony videos of individuals with lived experience. Methods: A peer-driven website was developed specifically to support residents of Scotland experiencing suicidal thoughts. The website included resources (eg, videos from lived experience and written guidance about how to respond to someone who may be experiencing suicidal thoughts) to help reduce distress, normalize experiences, and challenge distressing thoughts. The website was promoted via leading web-based social media channels and Google Ads. Evaluation of the website was based on website engagement, marketing strategy, and direct web user feedback via a cross-sectional survey. Results: Data were collected for 41 weeks (June 2022 to February 2023) spanning the launch of the website and the conclusion of the second marketing campaign. On average, the website received 99.9 visitors per day. A total of 56% (n=14,439) of visitors were female, ages ranged from younger than 18 years to older than 70 years (commonly between 25 and 34 years) and originated from all regions of Scotland. According to Google Search terms of Scottish residents, of the individuals indicated to be experiencing suicidal thoughts but not looking for help, 5.3% (n=920) engaged with the website compared to 10.5% (n=2898) who were indicated to be looking for help for themselves. Based on participant responses to the evaluation survey (n=101), the website was associated with a significant reduction in suicidal thoughts (P=.03). Reasons for visiting the website varied. Marketing data implied that people were more likely to engage with advertisements, which they felt were more personal, and visitors to the website were more likely to engage with videos, which corresponded to their age. Conclusions: A peer-led website may help residents of Scotland who are experiencing suicidal thoughts. Web-based interventions may have considerable reach in Scotland both in terms of age and geographic area. Engagement with the website was similar to other self-help websites for suicidal ideation; however, more nuanced methods of analyzing website engagement for help-seeking behavior are recommended. Future work would benefit from exploring the effectiveness of this website based on a larger participant sample with website modifications guided by the principles of social learning theory. %M 39854713 %R 10.2196/55932 %U https://formative.jmir.org/2025/1/e55932 %U https://doi.org/10.2196/55932 %U http://www.ncbi.nlm.nih.gov/pubmed/39854713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64427 %T Feasibility, User Acceptance, and Outcomes of Using a Cancer Prehabilitation App for Exercise: Pilot Cohort Study %A Zhang,Fuquan %A Bang,Deepali %A Visperas,Christine Alejandro %A Tun,Mon Hnin %A Tay,San San %K cancer prehabilitation %K mobile app %K technology %K feasibility %K acceptance %K cancer %K prehabilitation %K mHealth %K exercise %K application %K app %K mobile application %K reliability %K smartphone app %K sustainability %K effectiveness %K older patients %K older adults %K elderly %D 2025 %7 20.1.2025 %9 %J JMIR Form Res %G English %X Background: The efficacy of cancer prehabilitation programs is supported by international reviews and meta-analyses. Technology has been deployed in cancer prehabilitation to address challenges such as access or limited resources. This study evaluated the feasibility, user acceptance, safety, and program outcomes of a newly developed mobile app for cancer prehabilitation. The app integrates with Singapore’s existing health care mobile app, Health Buddy, and provides instructional videos for prescribed exercises. Objective: The objectives of this study were to investigate the feasibility, user experience, safety, and outcomes of a mobile app for cancer prehabilitation within a hospital-associated, home-based, multimodal cancer prehabilitation program. Methods: This retrospective study analyzed the records of patients enrolled in the cancer prehabilitation program from September 1, 2022, to March 30, 2023. Patients who participated in the prehabilitation program (n=63) were categorized into 2 groups: those prescribed the app (n=41) and those who were not (n=22). There was further subgroup analysis of those who were prescribed: app users (n=25) versus those who were non-app users (n=16). Demographics, Fried Frailty Phenotype, prehabilitation duration, app use, and functional outcome measures (6-minute walk test [6MWT], 30-second sit-to-stand test [STS], timed up and go test [TUG], and Hospital Anxiety and Depression Scale [HADS]) were collected. Compliance was determined by the completion of prescribed exercises and the accuracy of executing these exercises, with a high compliance rate considered to be at 80% or more. Baseline characteristics and preoperative outcomes were compared between the groups. User satisfaction was assessed through surveys among app users (n=25). Results: Among 63 patients, 41 (65.1%) patients were prescribed the app, of which 22 (34.9%) patients were users. No significant differences in preoperative functional improvements were observed between app users and nonusers (6MWT: P=.60; STS: P=.81; TUG: P=.53; HADS: P=.36), or between those prescribed and not prescribed the app (6MWT: P=.94; STS: P=.26; TUG: P=.39; HADS: P=.62). However, high compliance rates (80%) were observed among app users. Patient satisfaction with the app was high (>90%), with positive feedback on ease of use and technical reliability. Baseline measures revealed significantly lower functional scores and higher mean frailty scores in the nonprescribed group. Conclusions: This preliminary study demonstrates the acceptability, feasibility, and safety of Singapore’s first smartphone app for exercise prescription in cancer prehabilitation. Lower baseline functional outcome measures and a higher mean frailty score in the unprescribed group have implications for the selection process and patient participation. Further studies should include strategies to enhance patients’ readiness for technology, sustainability, and effectiveness in older patients. %R 10.2196/64427 %U https://formative.jmir.org/2025/1/e64427 %U https://doi.org/10.2196/64427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58460 %T Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial %A Leung,May May %A Mateo,Katrina F %A Dublin,Marlo %A Harrison,Laura %A Verdaguer,Sandra %A Wyka,Katarzyna %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, United States, 1 6176363676, maymay.leung@tufts.edu %K childhood obesity %K preadolescents %K racial and ethnic minority populations %K dietary behaviors %K BMI %K digital health %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of .05), with the exception of the first prompt of the day (P=.01 and P<.001). Conclusions: Providing a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants’ mobile devices. International Registered Report Identifier (IRRID): RR2-10.2196/57664 %M 39637378 %R 10.2196/60193 %U https://formative.jmir.org/2024/1/e60193 %U https://doi.org/10.2196/60193 %U http://www.ncbi.nlm.nih.gov/pubmed/39637378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45763 %T Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study %A Huang,Xuan %A Wang,Ying %A Yang,Xixian %A Jiang,Ruo %A Liu,Yicheng %A Wang,Hui %+ Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China, 86 21 24058249, wangh2005@alumni.sjtu.edu.cn %K mobile health technology %K smartphones %K mobile phone %K internet hospital %K China %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries. Objective: This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals. Methods: Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China’s Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021. Results: A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61%), consultations (72/124, 58.06%), and prescriptions (61/124, 49.19%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management (1.56% vs 11.67%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study. Conclusions: Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones. %M 39631758 %R 10.2196/45763 %U https://formative.jmir.org/2024/1/e45763 %U https://doi.org/10.2196/45763 %U http://www.ncbi.nlm.nih.gov/pubmed/39631758 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58682 %T An Image-Recognition Dietary Assessment App for Adolescents With Obesity: Pilot Randomized Controlled Trial %A Oei,Krista %A Choi,Elizabeth EY %A Bar-Dayan,Alisa %A Stinson,Jennifer N %A Palmert,Mark R %A Alfonsi,Jeffrey E %A Hamilton,Jill %+ Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada, 1 4168131500, krista.oei@sickkids.ca %K obesity %K weight management %K dietary assessment %K nutrition %K adolescent %K digital health app %K mHealth %K mobile health %K image recognition %K teens %K weight %K youth %K diet %K dietary %K dietary app %K usability %K feasibility %K pilot randomized controlled trial %K obesity management %K nutritional %K user %K patient engagement %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a period of increased susceptibility to developing obesity-related health issues due to poor eating patterns and increased sedentary behaviors. Recommendations for pediatric obesity management include dietary assessments. However, adolescents often avoid food logging through traditional methods. The use of image-recognition dietary assessment apps in adolescents with obesity is not well studied. Eating for Wellness (E4W) is a mobile app that determines the nutritional content of meals from photos and incorporates nutritional goal setting. Nutritional data can be displayed for health care providers (HCPs) via the Clinician Portal, while the data are presented to the user in a manner that minimizes the focus on calorie counting. Objective: This study aims to evaluate the usability and feasibility of E4W, a mobile health app designed to improve dietary intake in adolescents with obesity attending an obesity clinic, using a phased approach. Methods: The overall study was conducted in 2 phases to refine and evaluate E4W. In Phase 1, usability was tested through 3 iterative cycles of patient interviews. A total of 14 patient participants, aged 12-18 years with a BMI≥97th percentile, were included. Participants performed standardized scenario-based tasks in E4W and provided feedback on the app. Two iterative cycles were conducted for HCPs (n=4). Refinements were made during each cycle based on issues encountered and feedback provided. In Phase 2, a pilot randomized controlled trial of 32 adolescents (16 adolescents enrolled in the experimental group for 1 month, and 16 controls enrolled for 1 month) was completed. Both groups met with their dietitian at baseline, midstudy, and 1 month following their baseline visit to discuss goals and eating patterns. The control group was instructed to take photos of all intake using their default phone camera, without access to E4W, while those in the experimental group received full access to E4W. The primary outcome was the feasibility of implementation. Secondary outcomes examined overall change in dietary intake and achievement of nutritional goals. Results: Usability testing demonstrated that E4W and the Clinician Portal were easy to use, efficient, and well-liked by patients and HCPs. Feasibility testing revealed high patient acceptability scores. However, significant technical challenges were encountered. Although the use of E4W did not significantly impact patient engagement (control: mean 0.9, SD 0.7; experimental: mean 1.7, SD 1.9; P=.14), there were outliers in the experimental group with very high engagement and improved self-reported efficacy. Overall, there was no improvement in dietary intake, although assessment was hindered by poor adherence to traditional methods of food logging. Conclusions: E4W and the Clinician Portal were well-received by patients and HCPs. Further research is warranted and planned to determine if E4W can improve dietary intake and achievement of nutritional goals in adolescents with obesity. Trial Registration: ClinicalTrials.gov NCT05548868; https://clinicaltrials.gov/study/NCT05548868 %M 39621405 %R 10.2196/58682 %U https://formative.jmir.org/2024/1/e58682 %U https://doi.org/10.2196/58682 %U http://www.ncbi.nlm.nih.gov/pubmed/39621405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60670 %T Optimizing Compassion Training in Medical Trainees Using an Adjunct mHealth App: A Preliminary Single-Arm Feasibility and Acceptability Study %A Wooldridge,Jennalee S %A Soriano,Emily C %A Chu,Gage %A Shirazi,Anaheed %A Shapiro,Desiree %A Patterson,Marta %A Kim,Hyun-Chung %A Herbert,Matthew S %+ Mental Health Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, United States, 1 6194978326, m1herbert@health.ucsd.edu %K mobile phone %K compassion %K empathy %K mHealth %K mobile health %K medical student %K medical resident %K mHealth app %K app %K medical trainee %K training %K feasibility %K acceptability %K pilot %K mindfulness %K self-compassion %K smartphone app %K compassion %K applicability %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While structured compassion training programs have shown promise for increasing compassion among medical trainees, a major challenge is applying the concepts and practices taught during the program into the complex, dynamic, time-pressured, and often hectic hospital workplace. Objective: The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary effects of Compassion Coach, a mobile health (mHealth) smartphone app designed to bolster a 6-week mindfulness and self-compassion training program for medical trainees. Methods: In Compassion Coach, notifications to remind, encourage, and measure the perceived impact of informal mindfulness and compassion practices taught during the program were delivered at 7 AM, 12 PM, and 7 PM, respectively, 3 times per week over the course of the training program. The app also contained a library of guided audio formal mindfulness and compassion practices to allow quick and easy access. In this pilot study, we collected data from 29 medical students and residents who downloaded Compassion Coach and completed surveys assessing perceived effectiveness and acceptability. Engagement with the Compassion Coach app was passively tracked through notification response rate and library resource access over time. Results: The average response rate to notifications was 58% (SD 29%; range 12%-98%), with a significant decline over time (P=.009; odds ratio 0.98, 95% CI 0.96-0.99). Across all participants and occasions, the majority agreed the informal practices prompted by Compassion Coach helped them feel grounded and centered (110/150, 73%), improved compassion (29/41, 71%), reduced burnout (106/191, 56%), and improved their mood (133/191, 70%). In total, 16 (55%) of the 29 participants accessed guided audio recordings on average 3 (SD 3.4) times throughout the program. At the posttreatment time point, most participants (13/18, 72%) indicated that Compassion Coach helped them engage in compassion practices in daily life, and half (9/18, 50%) indicated that Compassion Coach helped improve interactions with patients. Conclusions: Overall, preliminary results of Compassion Coach are encouraging and suggest the integration of a smartphone app with an ongoing mindfulness and self-compassion training program may bolster the effects of the program on medical trainees. However, there was variability in engagement with Compassion Coach and perceived helpfulness. Additional research is indicated to optimize this novel mHealth approach and conduct a study powered to formally evaluate effects. %M 39589766 %R 10.2196/60670 %U https://formative.jmir.org/2024/1/e60670 %U https://doi.org/10.2196/60670 %U http://www.ncbi.nlm.nih.gov/pubmed/39589766 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60878 %T Population Characteristics in Justice Health Research Based on PubMed Abstracts From 1963 to 2023: Text Mining Study %A Lukmanjaya,Wilson %A Butler,Tony %A Taflan,Patricia %A Simpson,Paul %A Ginnivan,Natasha %A Buchan,Iain %A Nenadic,Goran %A Karystianis,George %+ School of Population Health, University of New South Wales, Samuels Building, F25, Samuel Terry Ave, Kensington NSW, Sydney, 2052, Australia, 61 2 9385 3136, w.lukmanjaya@unsw.edu.au %K epidemiology %K PubMed %K criminology %K text mining %K justice health %K offending and incarcerated populations %K population characteristics %K open research %K health research %K text mining study %K epidemiological criminology %K public health %K justice systems %K bias %K population %K men %K women %K prison %K prisoner %K researcher %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The field of epidemiological criminology (or justice health research) has emerged in the past decade, studying the intersection between the public health and justice systems. To ensure research efforts are focused and equitable, it is important to reflect on the outputs in this area and address knowledge gaps. Objective: This study aimed to examine the characteristics of populations researched in a large sample of published outputs and identify research gaps and biases. Methods: A rule-based, text mining method was applied to 34,481 PubMed abstracts published from 1963 to 2023 to identify 4 population characteristics (sex, age, offender type, and nationality). Results: We evaluated our method in a random sample of 100 PubMed abstracts. Microprecision was 94.3%, with microrecall at 85.9% and micro–F1-score at 89.9% across the 4 characteristics. Half (n=17,039, 49.4%) of the 34,481 abstracts did not have any characteristic mentions and only 1.3% (n=443) reported sex, age, offender type, and nationality. From the 5170 (14.9%) abstracts that reported age, 3581 (69.3%) mentioned young people (younger than 18 years) and 3037 (58.7%) mentioned adults. Since 1990, studies reporting female-only populations increased, and in 2023, these accounted for almost half (105/216, 48.6%) of the research outputs, as opposed to 33.3% (72/216) for male-only populations. Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest number of abstracts proportional to their incarcerated populations. Offenders with mental illness were the most common group of interest (840/4814, 17.4%), with an increase from 1990 onward. Conclusions: Research reporting on female populations increased, surpassing that involving male individuals, despite female individuals representing 5% of the incarcerated population; this suggests that male prisoners are underresearched. Although calls have been made for the justice health area to focus more on young people, our results showed that among the abstracts reporting age, most mentioned a population aged <18 years, reflecting a rise of youth involvement in the youth justice system. Those convicted of sex offenses and crimes relating to children were not as researched as the existing literature suggests, with a focus instead on populations with mental illness, whose rates rose steadily in the last 30 years. After adjusting for the size of the incarcerated population, Nordic countries have conducted proportionately the most research. Our findings highlight that despite the presence of several research reporting guidelines, justice health abstracts still do not adequately describe the investigated populations. Our study offers new insights in the field of justice health with implications for promoting diversity in the selection of research participants. %M 39576975 %R 10.2196/60878 %U https://formative.jmir.org/2024/1/e60878 %U https://doi.org/10.2196/60878 %U http://www.ncbi.nlm.nih.gov/pubmed/39576975 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e60942 %T Whole-Body Cryotherapy Reduces Systemic Inflammation in Healthy Adults: Pilot Cohort Study %A Chun,Elizabeth %A Joseph,Richard %A Pojednic,Rachele %+ Stanford Lifestyle Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 6178337372, rpojedni@stanford.edu %K cold therapy %K C-reactive protein %K fasting glucose %K HbA1c %K inflammation %K lipid metabolism %K whole-body cryotherapy %K cryotherapy %K retrospective %K reactive protein %K biomarker %K adult %K systemic inflammation %D 2024 %7 22.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Chronically elevated inflammation is implicated in many conditions, including obesity, metabolic syndrome, and cardiovascular disease, and has been associated with increased mortality risk. Whole-body cryotherapy (W-BC) is a promising modality to treat inflammation with demonstrated benefits for clinical subpopulations including those with arthritis, obesity, and type 2 diabetes. However, it is unclear whether the benefit from W-BC extends to healthy individuals prior to chronic disease–related inflammation. In addition, the long-term durability of W-BC effect is unknown. Objective: This study investigates the inflammatory response to W-BC in healthy adults with a biomarker of inflammation, high-sensitivity C-reactive protein (hsCRP), and clinical biomarkers of metabolism including fasting glucose, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), and triglycerides. Methods: Fifteen individuals (n=9 female) participated in frequent recreational W-BC (3 minutes of cold exposure at –110 ℃) over approximately 9 months and had blood draws at baseline plus follow-up visits. Biomarkers were modeled as linear functions of W-BC sessions received in the month prior to blood draw. Results: The mean amount of W-BC received was 6.78 (SD 4.26) times per month with the cumulative total ranging from 13 to 157 W-BC sessions over the course of the study. On average, participants completed 1-2 sessions per week throughout the intervention. The number of W-BC sessions were associated with decreased hsCRP (–0.14 mg/L in hsCRP per W-BC session; P<.01) and with durability of up to 9 months. Increased W-BC was also associated with a downward trend in fasting glucose. This trend failed to reach significance at 1 month (–0.73 mg/dL in fasting glucose per W-BC session; P<.10) but was significant for 2- and 3-month windows (P<.05). HbA1c was increased significantly after 9 months (P<.01); however, the change occurred within normal ranges (difference=0.13% and <5.7%) and was not clinically significant. There was no association between W-BC and LDL cholesterol, HDL cholesterol, or triglycerides (P>.10), although LDL trended lower over the time period examined (P=.07). Conclusions: These results suggest that W-BC beneficially impacts systemic inflammation by lowering hsCRP levels in healthy individuals and may also have some modulating effect on fasting glucose. %M 39576692 %R 10.2196/60942 %U https://www.i-jmr.org/2024/1/e60942 %U https://doi.org/10.2196/60942 %U http://www.ncbi.nlm.nih.gov/pubmed/39576692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60037 %T An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study %A Alnooh,Ghadah %A AlTamimi,Jozaa Z %A Williams,Elizabeth A %A Hawley,Mark S %+ Centre for Assistive Technology and Connected Healthcare, School of Medicine and Population Health, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 1142222000, mark.hawley@sheffield.ac.uk %K hypertension %K blood pressure %K Dietary Approaches to Stop Hypertension %K DASH diet %K self-efficacy %K mobile health %K mHealth %K Saudi Arabia %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals’ and patients’ preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app’s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. %M 39561360 %R 10.2196/60037 %U https://formative.jmir.org/2024/1/e60037 %U https://doi.org/10.2196/60037 %U http://www.ncbi.nlm.nih.gov/pubmed/39561360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62725 %T Assessing Digital Phenotyping for App Recommendations and Sustained Engagement: Cohort Study %A Dwyer,Bridget %A Flathers,Matthew %A Burns,James %A Mikkelson,Jane %A Perlmutter,Elana %A Chen,Kelly %A Ram,Nanik %A Torous,John %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02115, United States, 1 6176676700, jtorous@bidmc.harvard.edu %K engagement %K mental health %K digital phenotype %K pilot study %K phenotyping %K smartphone sensors %K anxiety %K sleep %K fitness %K depression %K qualitative %K app recommendation %K app use %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Low engagement with mental health apps continues to limit their impact. New approaches to help match patients to the right app may increase engagement by ensuring the app they are using is best suited to their mental health needs. Objective: This study aims to pilot how digital phenotyping, using data from smartphone sensors to infer symptom, behavioral, and functional outcomes, could be used to match people to mental health apps and potentially increase engagement Methods: After 1 week of collecting digital phenotyping data with the mindLAMP app (Beth Israel Deaconess Medical Center), participants were randomly assigned to the digital phenotyping arm, receiving feedback and recommendations based on those data to select 1 of 4 predetermined mental health apps (related to mood, anxiety, sleep, and fitness), or the control arm, selecting the same apps but without any feedback or recommendations. All participants used their selected app for 4 weeks with numerous metrics of engagement recorded, including objective screentime measures, self-reported engagement measures, and Digital Working Alliance Inventory scores. Results: A total of 82 participants enrolled in the study; 17 (21%) dropped out of the digital phenotyping arm and 18 (22%) dropped out from the control arm. Across both groups, few participants chose or were recommended the insomnia or fitness app. The majority (39/47, 83%) used a depression or anxiety app. Engagement as measured by objective screen time and Digital Working Alliance Inventory scores were higher in the digital phenotyping arm. There was no correlation between self-reported and objective metrics of app use. Qualitative results highlighted the importance of habit formation in sustained app use. Conclusions: The results suggest that digital phenotyping app recommendation is feasible and may increase engagement. This approach is generalizable to other apps beyond the 4 apps selected for use in this pilot, and practical for real-world use given that the study was conducted without any compensation or external incentives that may have biased results. Advances in digital phenotyping will likely make this method of app recommendation more personalized and thus of even greater interest. %M 39560976 %R 10.2196/62725 %U https://formative.jmir.org/2024/1/e62725 %U https://doi.org/10.2196/62725 %U http://www.ncbi.nlm.nih.gov/pubmed/39560976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60453 %T Exploring the Perspectives of Older Adults on a Digital Brain Health Platform Using Natural Language Processing: Cohort Study %A Ding,Huitong %A Gifford,Katherine %A Shih,Ludy C %A Ho,Kristi %A Rahman,Salman %A Igwe,Akwaugo %A Low,Spencer %A Popp,Zachary %A Searls,Edward %A Li,Zexu %A Madan,Sanskruti %A Burk,Alexa %A Hwang,Phillip H %A Anda-Duran,Ileana De %A Kolachalama,Vijaya B %A Au,Rhoda %A Lin,Honghuang %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 7744554881, honghuang.lin@umassmed.edu %K digital brain health %K older adults %K perspectives %K semistructured interviews %K natural language processing %K mobile phone %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although digital technology represents a growing field aiming to revolutionize early Alzheimer disease risk prediction and monitoring, the perspectives of older adults on an integrated digital brain health platform have not been investigated. Objective: This study aims to understand the perspectives of older adults on a digital brain health platform by conducting semistructured interviews and analyzing their transcriptions by natural language processing. Methods: The study included 28 participants from the Boston University Alzheimer’s Disease Research Center, all of whom engaged with a digital brain health platform over an initial assessment period of 14 days. Semistructured interviews were conducted to collect data on participants’ experiences with the digital brain health platform. The transcripts generated from these interviews were analyzed using natural language processing techniques. The frequency of positive and negative terms was evaluated through word count analysis. A sentiment analysis was used to measure the emotional tone and subjective perceptions of the participants toward the digital platform. Results: Word count analysis revealed a generally positive sentiment toward the digital platform, with “like,” “well,” and “good” being the most frequently mentioned positive terms. However, terms such as “problem” and “hard” indicated certain challenges faced by participants. Sentiment analysis showed a slightly positive attitude with a median polarity score of 0.13 (IQR 0.08-0.15), ranging from –1 (completely negative) to 1 (completely positive), and a median subjectivity score of 0.51 (IQR 0.47-0.53), ranging from 0 (completely objective) to 1 (completely subjective). These results suggested an overall positive attitude among the study cohort. Conclusions: The study highlights the importance of understanding older adults’ attitudes toward digital health platforms amid the comprehensive evolution of the digitalization era. Future research should focus on refining digital solutions to meet the specific needs of older adults, fostering a more personalized approach to brain health. %M 39556805 %R 10.2196/60453 %U https://formative.jmir.org/2024/1/e60453 %U https://doi.org/10.2196/60453 %U http://www.ncbi.nlm.nih.gov/pubmed/39556805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58537 %T Exploring the Qualitative Experiences of Administering and Participating in Remote Research via Telephone Using the Montreal Cognitive Assessment-Blind: Cross-Sectional Study of Older Adults %A Dumassais,Shirley %A Grewal,Karl Singh %A Aubin,Gabrielle %A O'Connell,Megan %A Phillips,Natalie A %A Wittich,Walter %+ École d'Optométrie, Université de Montréal, 3744 Jean Brillant Street, Montréal, QC, H3T 1P1, Canada, 1 514 343 6471, shirley.dumassais@umontreal.ca %K neuropsychological tests %K telemedicine %K social inclusion %K telehealth %K remote %K qualitative %K neuropsychological %K cognitive %K screening %K assessment %K perception %K perspective %K telephone %K cross-sectional %K thematic %K mobile phone %K Montreal Cognitive Assessment %K MoCA %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic caused a drastic shift in the practice of research and clinical services. It has been noted that cognition measured via in-person versus remote methods differ substantially, and it is possible that subjective and experiential differences exist between modalities. Objective: The aim of the study is to explore the perceptions of both researchers and older adult participants on the experience of remotely conducted research using a cognitive screener. Methods: We conducted a thematic analysis of the experience of engaging in remote research from both the participant (n=10) and researcher (n=4) perspectives. The research interaction was framed through teleadministration of the Montreal Cognitive Assessment-Blind (suitable for telephone administration) and administration of a subsequent semistructured debriefing interview. Participant perspectives were garnered during debriefing interviews, while researcher insights were collected via self-reported qualitative field notes completed following each research session. Results: Data aggregated into themes of barriers and facilitators from the lenses of both participants and researchers. Participants noted facilitators including short instrument length, convenience, and presession contact; barriers included the length of the interaction, some tasks being more challenging on the phone, and the potential for participant dishonesty. Research assistants noted several facilitators: instrument length, rapport building, ability to prepare for and record sessions, and comfort with the protocol; barriers were items with too many response options, telephone issues (eg, response delays), and concerns about participant comprehension. Conclusions: These results suggest remote telephone-delivered cognitive screening tools as a feasible and acceptable method of research inquiry. The findings provide a starting point for the inclusion of diverse populations in research to capture underrepresented groups whose input would immensely benefit our understanding of remotely delivered cognitive screening measures. Further, we offer materials (eg, checklists), which can be used in future investigations to promote future inclusive research and increase generalizability. %M 39546346 %R 10.2196/58537 %U https://formative.jmir.org/2024/1/e58537 %U https://doi.org/10.2196/58537 %U http://www.ncbi.nlm.nih.gov/pubmed/39546346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50389 %T Development of an Interprofessional Education Project in Dentistry Based on the Positive Behavior Support Theory: Pilot Curriculum Development and Validation Study %A Pang,MengWei %A Lu,WeiYu %A Huang,Chuling %A Lin,Meixiu %A Ran,Jiangsheng %A Tang,Xiaomei %A Huang,YuanDing %A Yang,Sheng %A Song,Jinlin %+ College of Stomatology, Chongqing Medical University, No. 426, Songshi North Road, Chongqing, 401147, China, 86 13594327961, songjinlin@hospital.cqmu.edu.cn %K innovative interprofessional education %K dentistry %K dental technology %K positive behavior support %K IPE %K positive behavior %K training system %K dental education %K %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective interprofessional education (IPE) can facilitate teamwork between dentists and dental technicians, thereby enabling the efficient provision of high-quality dental care. Objective: This study aimed to design and assess an IPE module named Project 35, which was offered to dental and dental technology students early in their undergraduate training as a precursor to a more comprehensive IPE curriculum in dentistry and dental technology. Methods: Leveraging positive behavior support (PBS) theory, Project 35 was devised as an innovation and entrepreneurship educational training framework. It used project-based learning to cultivate teamwork skills and to promote the professional development of dental and dental technology students. The pilot study was designed to present the IPE module and preliminarily assess its validity. In survey 1, which was conducted immediately after the course, the dental and dental technology students’ self-reported skill acquisition and attitudes were assessed and compared. Survey 2, conducted 1 year after the course, focused on the comparative benefits of Project 35 training for dental technology students versus an untrained group. Results: A total of 66 students, including 36 dental students and 30 dental technology students who had undertaken the training, were recruited. Project 35 training improved teamwork skills for students in both disciplines comparably, and the students recognized the training as highly valuable and effective. The mean values for all items indicating skills improvement of students ranged from 4.13 (SD 0.797) to 4.63 (SD 0.495) for dental students and from 4.13 (SD 0.869) to 4.74 (SD 0.619) for dental technology students. Among the dental technology students, the trained group showed greater independent and innovative approaches and was more optimistic about the future of the profession than the nontrained group (P<.05). Conclusions: Despite the small sample size, the validity of the Project 35 training system was evident, and the success of our pilot study provides a sound basis for the future development of IPE in clinical dental and dental technology education programs. %M 39527801 %R 10.2196/50389 %U https://formative.jmir.org/2024/1/e50389 %U https://doi.org/10.2196/50389 %U http://www.ncbi.nlm.nih.gov/pubmed/39527801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58176 %T Crowdsourcing Adverse Events Associated With Monoclonal Antibodies Targeting Calcitonin Gene–Related Peptide Signaling for Migraine Prevention: Natural Language Processing Analysis of Social Media %A Zhang,Pengfei %A Kamitaki,Brad K %A Do,Thien Phu %+ Department of Neurology, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, United States, 1 7322357729, pz124@rwjms.rutgers.edu %K internet %K patient reported outcome %K headache %K health information %K Reddit %K registry %K monoclonal antibody %K crowdsourcing %K postmarketing %K safety %K surveillance %K migraine %K preventives %K prevention %K self-reported %K calcitonin gene–related peptide %K calcitonin %K therapeutics %K social media %K medication-related %K posts %K propranolol %K topiramate %K erenumab %K fremanezumab %K cross-sectional %K surveys %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical trials demonstrate the efficacy and tolerability of medications targeting calcitonin gene–related peptide (CGRP) signaling for migraine prevention. However, these trials may not accurately reflect the real-world experiences of more diverse and heterogeneous patient populations, who often have higher disease burden and more comorbidities. Therefore, postmarketing safety surveillance is warranted. Regulatory organizations encourage marketing authorization holders to screen digital media for suspected adverse reactions, applying the same requirements as for spontaneous reports. Real-world data from social media platforms constitute a potential venue to capture diverse patient experiences and help detect treatment-related adverse events. However, while social media holds promise for this purpose, its use in pharmacovigilance is still in its early stages. Computational linguistics, which involves the automatic manipulation and quantitative analysis of oral or written language, offers a potential method for exploring this content. Objective: This study aims to characterize adverse events related to monoclonal antibodies targeting CGRP signaling on Reddit, a large online social media forum, by using computational linguistics. Methods: We examined differences in word frequencies from medication-related posts on the Reddit subforum r/Migraine over a 10-year period (2010-2020) using computational linguistics. The study had 2 phases: a validation phase and an application phase. In the validation phase, we compared posts about propranolol and topiramate, as well as posts about each medication against randomly selected posts, to identify known and expected adverse events. In the application phase, we analyzed posts discussing 2 monoclonal antibodies targeting CGRP signaling—erenumab and fremanezumab—to identify potential adverse events for these medications. Results: From 22,467 Reddit r/Migraine posts, we extracted 402 (2%) propranolol posts, 1423 (6.33%) topiramate posts, 468 (2.08%) erenumab posts, and 73 (0.32%) fremanezumab posts. Comparing topiramate against propranolol identified several expected adverse events, for example, “appetite,” “weight,” “taste,” “foggy,” “forgetful,” and “dizziness.” Comparing erenumab against a random selection of terms identified “constipation” as a recurring keyword. Comparing erenumab against fremanezumab identified “constipation,” “depression,” “vomiting,” and “muscle” as keywords. No adverse events were identified for fremanezumab. Conclusions: The validation phase of our study accurately identified common adverse events for oral migraine preventive medications. For example, typical adverse events such as “appetite” and “dizziness” were mentioned in posts about topiramate. When we applied this methodology to monoclonal antibodies targeting CGRP or its receptor—fremanezumab and erenumab, respectively—we found no definite adverse events for fremanezumab. However, notable flagged words for erenumab included “constipation,” “depression,” and “vomiting.” In conclusion, computational linguistics applied to social media may help identify potential adverse events for novel therapeutics. While social media data show promise for pharmacovigilance, further work is needed to improve its reliability and usability. %M 39515814 %R 10.2196/58176 %U https://formative.jmir.org/2024/1/e58176 %U https://doi.org/10.2196/58176 %U http://www.ncbi.nlm.nih.gov/pubmed/39515814 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49708 %T Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys %A Phadnis,Rachael %A Perera,Udara %A Lea,Veronica %A Davlin,Stacy %A Lee,Juliette %A Siesel,Casey %A Abeygunathilaka,Dhanushka %A Wickramasinghe,S C %+ Centers for Disease Control and Prevention Foundation, 600 Peachtree St NE, #1000, Atlanta, GA, 30308, United States, 1 320 248 7430, rachaelphadnis@gmail.com %K pilot study %K mobile phone survey %K survey methodology %K COVID-19 %K data collection %K national survey %K pandemic %K population-based study %K Sri Lanka %K middle-income countries %K low-income countries %K vaccine acceptability %K vaccine %K COVID-19 vaccination %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective: This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods: The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results: In the first survey, n=5001, the overall response rate was 7.5%, with a completion rate of 85.6%. In the second survey, n=1250, the overall response rate was 10.9%, with a completion rate of 61.9%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6%), more than two-thirds avoided public transportation (808/1173, 68.9%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8% vs 61/578, 10.6%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7%). Conclusions: The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country’s response during the COVID-19 pandemic, obviating the need for face-to-face data collection. %M 39514850 %R 10.2196/49708 %U https://formative.jmir.org/2024/1/e49708 %U https://doi.org/10.2196/49708 %U http://www.ncbi.nlm.nih.gov/pubmed/39514850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64674 %T System-Wide, Electronic Health Record–Based Medication Alerts for Appropriate Prescribing of Direct Oral Anticoagulants: Pilot Randomized Controlled Trial %A Smith,Shawna N %A Lanham,Michael S M %A Seagull,F Jacob %A Fabbri,Morris %A Dorsch,Michael P %A Jennings,Kathleen %A Barnes,Geoffrey %+ Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1425 E Ann St, Ann Arbor, MI, 48109, United States, 1 8882871082, gbarnes@umich.edu %K direct oral anticoagulants %K electronic health record %K medication safety %K prescribing errors %K pilot randomized controlled trial %K alert system optimization %K clinical decision support %K EHR %K randomized controlled trial %K RCT %K oral anticoagulants %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While direct oral anticoagulants (DOACs) have improved oral anticoagulation management, inappropriate prescribing remains prevalent and leads to adverse drug events. Antithrombotic stewardship programs seek to enhance DOAC prescribing but require scalable and sustainable strategies. Objective: We present a pilot, prescriber-level randomized controlled trial to assess the effectiveness of electronic health record (EHR)–based medication alerts in a large health system. Methods: The pilot assessed prescriber responses to alerts for initial DOAC prescription errors (apixaban and rivaroxaban). A user-centered, multistage design process informed alert development, emphasizing clear indication, appropriate dosing based on renal function, and drug-drug interactions. Alerts appeared whenever a DOAC was being prescribed in a way that did not follow package label instructions. Clinician responses measured acceptability, accuracy, feasibility, and utilization of the alerts. Results: The study ran from August 1, 2022, through April 30, 2023. Only 1 prescriber requested trial exclusion, demonstrating acceptability. The error rate for false alerts due to incomplete data was 6.6% (16/243). Two scenarios with alert design and/or execution errors occurred but were quickly identified and resolved, underlining the importance of a responsive quality assurance process in EHR-based interventions. Trial feasibility issues related to alert-data capture were identified and resolved. Trial feasibility was also assessed with balanced randomization of prescribers and the inclusion of various alerts across both medications. Assessing utilization, 34.2% (83/243) of the encounters (with 134 prescribers) led to a prescription change. Conclusions: The pilot implementation study demonstrated the acceptability, accuracy, feasibility, and estimates of the utilization of EHR-based medication alerts for DOAC prescriptions and successfully established just-in-time randomization of prescribing clinicians. This pilot study sets the stage for large-scale, randomized implementation evaluations of EHR-based alerts to improve medication safety. Trial Registration: ClinicalTrials.gov NCT05351749; https://clinicaltrials.gov/study/NCT05351749 %M 39514247 %R 10.2196/64674 %U https://formative.jmir.org/2024/1/e64674 %U https://doi.org/10.2196/64674 %U http://www.ncbi.nlm.nih.gov/pubmed/39514247 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64540 %T Preliminary Feasibility of a Novel Mind-Body Program to Prevent Persistent Concussion Symptoms Among Young Adults With Anxiety: Nonrandomized Open Pilot Study %A Becker,Molly Elizabeth %A Stratton Levey,Nadine %A Yeh,Gloria Y %A Giacino,Joseph %A Iverson,Grant %A Silverberg,Noah %A Parker,Robert A %A McKinnon,Ellen %A Siravo,Caitlin %A Shah,Priyanca %A Vranceanu,Ana-Maria %A Greenberg,Jonathan %+ Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 648, Boston, MA, 02114, United States, 1 6176439402, jgreenberg5@mgh.harvard.edu %K concussions %K mind-body %K preventions %K young adults %K feasibility %K persistence %K open pilot %K mind-body program %K preliminary feasibility %K mild traumatic brain injuries %K United States %K adults %K psychological factors %K mind-body interventions %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Concussions are common, particularly among young adults, and often are associated with persistent, debilitating, and hard-to-treat symptoms. Anxiety and concussion symptoms often amplify each other, and growing evidence indicates that anxiety plays a key role in symptoms persistence after concussion. Targeting anxiety early after concussion may be a promising means of helping prevent persistent concussion symptoms in this population. We developed the Toolkit for Optimal Recovery after Concussion (TOR-C), the first mind-body program tailored for young adults with a recent concussion and anxiety, aiming to prevent persistent concussion symptoms. Objective: This study aims to conduct an open pilot of TOR-C to test preliminary feasibility, signal of change in measures, and treatment perceptions. Methods: Five young adults (aged 18-24 years) attended 4 weekly one-on-one live video sessions with a clinician. Participants completed questionnaires measuring treatment targets (ie, pain catastrophizing, mindfulness, fear avoidance, limiting behaviors, and all-or-nothing behaviors) and outcomes (ie, postconcussive symptoms, physical function, anxiety, depression, and pain) at baseline, immediately following the intervention, and 3 months after intervention completion. At the conclusion of the program, participants attended a qualitative interview and provided feedback about the program to help optimize study content and procedures. Results: Feasibility markers were excellent for credibility and expectancy (5/5, 100% of participants scored above the credibility and expectancy scale midpoint), client satisfaction (4/5, 80% of participants scored above the Client Satisfaction Questionnaire midpoint), therapist adherence (97% adherence), acceptability of treatment (5/5, 100% of participants attended 3 or more sessions), adherence to homework (87% home practice completion), and feasibility of assessments (no measures fully missing). The feasibility of recruitment was good (5/7, 71% of eligible participants agreed to participate). There were preliminary signals of improvements from pre-post comparisons in treatment targets (d=0.72-2.20) and outcomes (d=0.41-1.38), which were sustained after 3 months (d=0.38-2.74 and d=0.71-1.63 respectively). Exit interviews indicated overall positive perceptions of skills and highlighted barriers (eg, busyness) and facilitators (eg, accountability) to engagement. Conclusions: TOR-C shows preliminary feasibility, is associated with a signal of improvement in treatment targets and outcomes, and has the potential to support recovery from concussion. The quantitative findings along with the qualitative feedback obtained from the exit interviews will help optimize TOR-C in preparation for an upcoming randomized controlled trial of TOR-C versus an active control condition of health education for concussion recovery. International Registered Report Identifier (IRRID): RR2-10.2196/25746 %M 39514283 %R 10.2196/64540 %U https://formative.jmir.org/2024/1/e64540 %U https://doi.org/10.2196/64540 %U http://www.ncbi.nlm.nih.gov/pubmed/39514283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56437 %T Virtual Coach–Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial %A Reilly,Erin D %A Kelly,Megan M %A Grigorian,Hannah L %A Waring,Molly E %A Quigley,Karen S %A Hogan,Timothy P %A Heapy,Alicia A %A Drebing,Charles E %A Volonte,Matias %A Kathawalla,Ummul-Kiram %A Robins,Hannah E %A Bernice,Katarina %A Bickmore,Timothy %+ Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 4191, erin.reilly@va.gov %K chronic pain %K randomized controlled trial %K usability %K acceptance and commitment therapy %K embodied conversational agent %K veterans %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47%-56%) and a 40% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. Objective: This study aims to evaluate the virtual coach–guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Methods: Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Results: Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). Conclusions: VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain—chronic pain acceptance—after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132 International Registered Report Identifier (IRRID): RR2-10.2196/45887 %M 39514264 %R 10.2196/56437 %U https://formative.jmir.org/2024/1/e56437 %U https://doi.org/10.2196/56437 %U http://www.ncbi.nlm.nih.gov/pubmed/39514264 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53156 %T Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial %A Kershner,Kyle %A Morton,David %A Robison,Justin %A N'dah,Kindia Williams %A Fanning,Jason %+ Department of Health and Exercise Science, Wake Forest University, 1834 Wake Forest Road, Winston-Salem, NC, 27109, United States, 1 3367585042, fanninjt@wfu.edu %K virtual reality %K physical activity %K videoconference %K social connection %K remote meeting %K gerontology %K physical inactivity %K at-home intervention %K descriptive statistics %K eHealth %K comorbidity %K cybersickness %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA. Objective: This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery. Methods: Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from –5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses. Results: None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98% (59/60) and 96% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA. Conclusions: These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed. Trial Registration: ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245 %M 39514256 %R 10.2196/53156 %U https://formative.jmir.org/2024/1/e53156 %U https://doi.org/10.2196/53156 %U http://www.ncbi.nlm.nih.gov/pubmed/39514256 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53444 %T Remote Patient Monitoring and Digital Therapeutics Enhancing the Continuum of Care in Heart Failure: Nonrandomized Pilot Study %A Marier-Tétrault,Emmanuel %A Bebawi,Emmanuel %A Béchard,Stéphanie %A Brouillard,Philippe %A Zuchinali,Priccila %A Remillard,Emilie %A Carrier,Zoé %A Jean-Charles,Loyda %A Nguyen,John Nam Kha %A Lehoux,Pascale %A Pomey,Marie-Pascale %A Ribeiro,Paula A B %A Tournoux,François %+ Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC, H2X 0C1, Canada, 1 514 890 8000, emmanuel.marier-tetrault.chum@ssss.gouv.qc.ca %K heart failure %K remote patient management %K telemonitoring %K digital therapeutics %K digital health %K heart %K therapeutics %K pilot study %K patient care %K medical therapy %K vitals %K weight %K symptoms %K quality of life %K medication optimization %K mobile phone %D 2024 %7 6.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is the primary cause of hospitalization among Canadian patients aged ≥65 years. Care for HF requires regular clinical follow-ups to prevent readmissions and facilitate medical therapy optimization. Multiple barriers lead to therapeutic medical inertia including limited human resources and regional inequities. Remote patient monitoring (RPM) and digital therapeutics (DTx) solutions have been developed to improve HF management, but their adoption remains limited and underexplored. The Continuum project emerged as a collaborative initiative involving a health care center, a software start-up, and an industrial partner. Objective: We aimed to develop and test the feasibility of the Continuum intervention that seamlessly combined an RPM system with a DTx solution for HF within the same software. Methods: A 3-month pre-post pilot study was conducted from October 2020 to June 2021. Patients with HF who owned a smartphone or tablet (having remote patient monitoring [RPM+]), had (1) access to a self-care app where they could enter their vital signs, weight, and HF symptoms and view educational content; (2) daily monitoring of their data by a nurse; and (3) a DTx module with automated HF medication suggestions based on national guidelines, made available to their treating medical team. Bluetooth devices were offered to facilitate data recording. Nurses on RPM monitoring could call patients and arrange appointments with their medical team. Patients without a mobile device or unable to use the app were followed in another group (without remote patient monitoring [RPM–]). Results: In total, 52 patients were enrolled in this study (32 RPM+ and 20 RPM–). Among patients owning a mobile device, only 14% (5/37) could not use the app. In the RPM+ group, 47% (15/32) of the patients used the app for more than 80% (67 days) of the 12-week study period. The use of our digital solution was integrated into the regular nursing workday and only 34 calls had to be made by the nurse during the study period. Only 6% (2/32) of the patients in the RPM+ group experienced at least 1 all-cause hospitalization versus 35% (7/20) of the RPM– ones during the follow-up (6%, 2/32 vs 25%, 5/20 for HF hospitalization) and patients were more likely to have their HF therapy optimized if the DTx solution was available. Quality of life improved in patients compliant with the use of the mobile app (mean score variation +10.6, SD 14.7). Conclusions: This pilot study demonstrated the feasibility of implementing our digital solution, within the specific context of HF. The seamless integration of Continuum into nursing workflow, mobile app accessibility, and adoption by patients, were the 3 main key learning points of this study. Further investigation is required to assess the potential impacts on hospitalizations, drug optimization, and quality of life. Trial Registration: ClinicalTrials.gov NCT05377190; https://clinicaltrials.gov/study/NCT05377190 (pilot study #21.403) %M 39504548 %R 10.2196/53444 %U https://formative.jmir.org/2024/1/e53444 %U https://doi.org/10.2196/53444 %U http://www.ncbi.nlm.nih.gov/pubmed/39504548 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64412 %T Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study %A Hernandez,Belinda %A Shegog,Ross %A Markham,Christine %A Emery,Susan %A Baumler,Elizabeth %A Thormaehlen,Laura %A Andina Teixeira,Rejane %A Rivera,Yanneth %A Pertuit,Olive %A Kanipe,Chelsey %A Witherspoon,Iraina %A Doss,Janis %A Jones,Victor %A Peskin,Melissa %+ Department of Health Promotion and Behavioral Science, The University of Texas Health Science Center at Houston School of Public Health, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, United States, 1 210 276 9021, belinda.hernandez@uth.tmc.edu %K sexual assault prevention %K sexual harassment prevention %K healthy relationships %K military %K technology-based interventions %K intervention mapping %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program’s goal is to increase Airmen’s knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen’s overall well-being and mission readiness. Objective: This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Methods: Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. Results: After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. Conclusions: The findings from this study demonstrate X-CoRe’s effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe’s impact on SH and SA victimization and the long-term impact on associated psychosocial determinants. %M 39471370 %R 10.2196/64412 %U https://formative.jmir.org/2024/1/e64412 %U https://doi.org/10.2196/64412 %U http://www.ncbi.nlm.nih.gov/pubmed/39471370 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56376 %T Cadence-Based Pedometer App With Financial Incentives to Enhance Moderate-to-Vigorous Physical Activity: Development and Single-Arm Feasibility Study %A Hayashi,Kosuke %A Imai,Hiromitsu %A Oikawa,Ichiro %A Ishihara,Yugo %A Wakuda,Hirokazu %A Miura,Iori %A Uenohara,Shingo %A Kuwae,Asuka %A Kai,Megumi %A Furuya,Ken'ichi %A Uemura,Naoto %+ Department of Clinical Pharmacology and Therapeutics, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, 8795593, Japan, 81 975865952, khayashi@oita-u.ac.jp %K physical activity %K behavioral economics %K pedometer %K arm %K cadence %K app %K public health %K walk %K Google Fit %K heart points %K exercise %K mobile phone %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: High levels of physical activity are key to improving health outcomes, yet many people fail to take action. Using pedometers to target steps per day and providing financial incentives is a simple and scalable approach to promoting public health. However, conventional pedometers do not account for “intensity” and “duration,” making it challenging to efficiently increase people’s moderate-to-vigorous physical activity (MVPA), which is expected to improve health outcomes. Based on these rationales, we developed a smartphone app that sets step cadence as a goal (defined as a daily challenge of walking more than 1500 steps in 15 minutes twice a day, which is a heuristic threshold for moderate physical activity) and provides financial incentive when the challenge is met. Objective: This study aimed to evaluate the feasibility of our novel app and explore whether its use can increase users’ daily MVPA. Methods: A single-arm pre-post study evaluated the feasibility and efficacy of the app. A total of 15 participants used app 1 (an app without financial incentives) for the first period (4 weeks) and then switched to app 2 (an app with financial incentives) for the second period (4 weeks). The primary outcome was the difference between the first and second periods in the number of successful challenge attempts per week. Secondary outcomes were differences between the first and second periods in daily steps and distance walked. Exploratory outcomes included the difference between the first and second periods in daily “heart points” as measured by Google Fit, a publicly available app that measures users’ daily MVPA. Results: The number of successful challenge attempts per week increased significantly compared to the first period (5.6 times per week vs 0.7 times per week; P<.001). Although not statistically significant, there was a trend toward an increase in the mean steps per day and distance walked per day (6586 steps per day vs 5950 steps per day; P=.19; and 4.69 km per day vs 3.85 km per day; P=.09, respectively). An exploratory end point examining daily MVPA by “heart points” collected from Google Fit also showed a significant increase compared to the first period (22.7 points per day vs 12.8 points per day; P=.02). Conclusions: Our app using step cadence as a goal and providing financial incentives seemed feasible and could be an effective app to increase users’ daily MVPA. Based on the results of this study, we are motivated to conduct a confirmatory study with a broader and larger number of participants. Trial Registration: UMIN 000050518; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057420 %M 39447165 %R 10.2196/56376 %U https://formative.jmir.org/2024/1/e56376 %U https://doi.org/10.2196/56376 %U http://www.ncbi.nlm.nih.gov/pubmed/39447165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58994 %T Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative %A Kumar,Komal %A Childs,Amber W %A Kohlmeier,Jonathan %A Kroll,Elizabeth %A Zant,Izabella %A Stolzenbach,Stephanie %A Fenkel,Caroline %+ Charlie Health, Inc, 233 E Main St STE 401, Bozeman, MT, 59715, United States, 1 6506226061, komal0719@gmail.com %K measurement-based care %K MBC %K remote %K intensive outpatient program %K IOP %K mental health %K implementation %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. Objective: The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. Methods: A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. Results: The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Conclusions: Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings. %M 39441653 %R 10.2196/58994 %U https://formative.jmir.org/2024/1/e58994 %U https://doi.org/10.2196/58994 %U http://www.ncbi.nlm.nih.gov/pubmed/39441653 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63156 %T Desires and Needs for Quitting Both e-Cigarettes and Cigarettes Among Young Adults: Formative Qualitative Study Informing the Development of a Smartphone Intervention for Dual Tobacco Cessation %A Nguyen,Nhung %A Koester,Kimberly A %A Tran,Christine %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA, 94502, United States, 1 6508889207, Nhung.Nguyen@ucsf.edu %K smoking cessation %K vaping cessation %K mHealth intervention %K mobile health %K e-cigarettes %K cigarettes %K smartphone intervention %K nicotine dependence %K additive adverse health effects %K tobacco cessation %D 2024 %7 22.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation). Objective: This formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming. Methods: Semistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs. Results: Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly “cold turkey.” The priority product for quitting first varied by the individual’s perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement. Conclusions: This study provides important insights into young adults’ experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes. %M 39437386 %R 10.2196/63156 %U https://formative.jmir.org/2024/1/e63156 %U https://doi.org/10.2196/63156 %U http://www.ncbi.nlm.nih.gov/pubmed/39437386 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59246 %T Feasibility and Acceptability of a Self-Guided Digital Family Skills Management Intervention for Children Newly Diagnosed With Type 1 Diabetes: Pilot Randomized Controlled Trial %A Hughes Lansing,Amy %A Cohen,Laura B %A Glaser,Nicole S %A Loomba,Lindsey A %+ Division of Endocrinology, Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Blvd, Suite 384, Sacramento, CA, 95817, United States, 1 916 734 7098, laalbrecht@ucdavis.edu %K type 1 diabetes %K children %K family support %K family dynamics %K web-based intervention %K feasibility %K acceptability %K self-guided %K intervention %K diabetes %K RCT %K randomized controlled trial %K psychosocial %K well-being %K caregiver %K communication %D 2024 %7 21.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D. Objective: We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program. Methods: We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module. Results: A total of 31 (84%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81%) completed some content and 15 (48%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83%) chose to have all sessions delivered at once and 3 (17%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. Conclusions: In this study, we found that a self-guided digital family support intervention initiated at the time of a child’s T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions. Trial Registration: ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912 %M 39432892 %R 10.2196/59246 %U https://formative.jmir.org/2024/1/e59246 %U https://doi.org/10.2196/59246 %U http://www.ncbi.nlm.nih.gov/pubmed/39432892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60171 %T Design of a Temporally Augmented Text Messaging Bot to Improve Adolescents’ Physical Activity and Engagement: Proof-of-Concept Study %A Ortega,Adrian %A Cushing,Christopher C %+ Center for Behavior Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Floor 10, 750 N Lakeshore Dr, Chicago, IL, 60611, United States, 1 8137326019, adrian.ortega@northwestern.edu %K digital intervention %K youth %K exercise %K SMS %K mHealth %K augmented text messaging %K bot %K adolescents %K adolescent %K physical activity %K engagement %K reliability %K physical activity intervention %K digital health %K digital support %K community %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions. Objective: The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents’ moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials. Methods: Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions. Results: The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE. Conclusions: TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants’ rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing. %M 39388222 %R 10.2196/60171 %U https://formative.jmir.org/2024/1/e60171 %U https://doi.org/10.2196/60171 %U http://www.ncbi.nlm.nih.gov/pubmed/39388222 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60387 %T United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study %A Hill,Miranda %A Greene,Meredith %A Johnson,Julene K %A Tan,Judy Y %+ Cancer Research Center for Health Equity, Division of Population Sciences, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, United States, 1 3104231499, judy.tan@cshs.org %K HIV %K AIDS %K mental health %K loneliness %K older adults %K music-based interventions %K technology %K mobile phone %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV. %M 39378071 %R 10.2196/60387 %U https://formative.jmir.org/2024/1/e60387 %U https://doi.org/10.2196/60387 %U http://www.ncbi.nlm.nih.gov/pubmed/39378071 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54751 %T Inclusion of Individuals With Lived Experiences in the Development of a Digital Intervention for Co-Occurring Depression and Cannabis Use: Mixed Methods Investigation %A Collins,Amanda C %A Bhattacharya,Sukanya %A Oh,Jenny Y %A Salzhauer,Abigail %A Taylor,Charles T %A Wolitzky-Taylor,Kate %A Aupperle,Robin L %A Budney,Alan J %A Jacobson,Nicholas C %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Pkwy, Suite 300, Lebanon, NH, 03766, United States, 1 4693210607, amanda.c.collins@dartmouth.edu %K digital intervention %K depression %K cannabis use %K positive affect %K formative research %K app development %D 2024 %7 7.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing interventions for co-occurring depression and cannabis use often do not treat both disorders simultaneously and can result in higher rates of symptom relapse. Traditional in-person interventions are often difficult to obtain due to financial and time limitations, which may further prevent individuals with co-occurring depression and cannabis use from receiving adequate treatment. Digital interventions can increase the scalability and accessibility for these individuals, but few digital interventions exist to treat both disorders simultaneously. Targeting transdiagnostic processes of these disorders with a digital intervention—specifically positive valence system dysfunction—may yield improved access and outcomes. Objective: Recent research has highlighted a need for the inclusion of individuals with lived experiences to assist in the co-design of interventions to enhance scalability and relevance of an intervention. Thus, the purpose of this study is to describe the process of eliciting feedback from individuals with elevated depressed symptoms and cannabis use and co-designing a digital intervention, Amplification of Positivity—Cannabis Use Disorder (AMP-C), focused on improving positive valence system dysfunction in these disorders. Methods: Ten individuals who endorsed moderate to severe depressive symptoms and regular cannabis use (2-3×/week) were recruited online via Meta ads. Using a mixed methods approach, participants completed a 1-hour mixed methods interview over Zoom (Zoom Technologies Inc) where they gave their feedback and suggestions for the development of a mental health app, based on an existing treatment targeting positive valence system dysfunction, for depressive symptoms and cannabis use. The qualitative approach allowed for a broader investigation of participants’ wants and needs regarding the engagement and scalability of AMP-C, and the quantitative approach allowed for specific ratings of intervention components to be potentially included. Results: Participants perceived the 13 different components of AMP-C as overall helpful (mean 3.9-4.4, SD 0.5-1.1) and interesting (mean 4.0-4.9, SD 0.3-1.1) on a scale from 1 (not at all) to 5 (extremely). They gave qualitative feedback for increasing engagement in the app, including adding a social component, using notifications, and being able to track their symptoms and progress over time. Conclusions: This study highlights the importance of including individuals with lived experiences in the development of interventions, including digital interventions. This inclusion resulted in valuable feedback and suggestions for improving the proposed digital intervention targeting the positive valence system, AMP-C, to better match the wants and needs of individuals with depressive symptoms and cannabis use. %M 39374076 %R 10.2196/54751 %U https://formative.jmir.org/2024/1/e54751 %U https://doi.org/10.2196/54751 %U http://www.ncbi.nlm.nih.gov/pubmed/39374076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58110 %T Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study %A Merchant,Reshma Aziz %A Loke,Bernard %A Chan,Yiong Huak %+ Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 +6567795555, mdcram@nus.edu.sg %K falls %K fall prevention %K wearables %K older adult %K community dwelling older adults %K gait %K gait kinetics %K gait analysis %K biomechanics %K sensors %K gerontology %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. Objective: The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. Methods: This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). Results: The participants’ mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Conclusions: Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level. %M 39361400 %R 10.2196/58110 %U https://formative.jmir.org/2024/1/e58110 %U https://doi.org/10.2196/58110 %U http://www.ncbi.nlm.nih.gov/pubmed/39361400 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57801 %T Designing Survey-Based Mobile Interfaces for Rural Patients With Cancer Using Apple’s ResearchKit and CareKit: Usability Study %A Donawa,Alyssa %A Powell,Christian %A Wang,Rong %A Chih,Ming-Yuan %A Patel,Reema %A Zinner,Ralph %A Aronoff-Spencer,Eliah %A Baker,Corey E %+ Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Hughes Aircraft Electrical Engineering Center, 3740 McClintock Ave Suite 100, Los Angeles, CA, 90089, United States, 1 (213) 821 0415, donawa@usc.edu %K usability %K usability testing %K digital literacy %K ehealth literacy %K digital divide %K mobile health %K mHealth %K patients with cancer %K rural health %K distress %K apps %K ehealth adoption %K HealthKit %K CareKit %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to some demographics. In particular, patients who are older or from rural communities represent a large segment of people who are currently underusing mobile health (mHealth) solutions. System usability continues to hinder mHealth adoption among users with nontraditional digital literacy. Objective: This study aims to investigate if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural patients with cancer, with minimal design changes and forgoing the co-design process. Methods: We developed Assuage (Network Reconnaissance Lab) as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of 4 mobile user interfaces (UIs) based on open-source libraries from Apple’s ResearchKit and CareKit. These UIs varied in complexity for reporting distress symptoms. Patients with cancer were recruited at the Markey Cancer Center, and all research procedures were conducted in person. Participants completed the distress assessment using a randomly selected UI in Assuage with little to no assistance. Data were collected on participant age, location, mobile app use, and familiarity with mHealth apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores. Results: We recruited 30 current or postsurgery patients with cancer for this pilot study. Most participants were aged >50 years (24/30, 80%), from rural areas (25/30, 83%), had up to a high school education (19/30, 63%), and were unfamiliar with mHealth apps (21/30, 70%). General mobile app use was split, with 43% (14/30) of the patients not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with UI 3 and UI 4 achieving an SUS score ≥80, meeting the industry standard for good usability of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens. Conclusions: The findings from this study show that most patients with cancer (20/30, 67%) who participated in this study rated the different interfaces of Assuage as above-average usability (SUS score >68). This suggests that Apple’s ResearchKit and CareKit libraries can provide usable UIs for older and rural users with minimal interface alterations. When resources are limited, the design stage can be simplified by omitting the co-design process while preserving suitable usability for users with nontraditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for interface and electronic survey design, specifically how to segment and navigate surveys, present important interface elements, and signal gestural interactions. %M 39326043 %R 10.2196/57801 %U https://formative.jmir.org/2024/1/e57801 %U https://doi.org/10.2196/57801 %U http://www.ncbi.nlm.nih.gov/pubmed/39326043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53314 %T Creation of an Automated and Comprehensive Resident Progress System for Residents and to Save Hours of Faculty Time: Mixed Methods Study %A Perotte,Rimma %A Berns,Alyssa %A Shaker,Lana %A Ophaswongse,Chayapol %A Underwood,Joseph %A Hajicharalambous,Christina %+ Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ, 07601, United States, 1 5519962470, rimma.perotte@hmhn.org %K progress dashboard %K informatics in medical education %K residency learning management system %K residency progress system %K residency education system %K summarization %K administrative burden %K medical education %K resident %K residency %K resident data %K longitudinal %K pilot study %K competency %K dashboards %K dashboard %K faculty %K residents %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It is vital for residents to have a longitudinal view of their educational progression, and it is crucial for the medical education team to have a clear way to track resident progress over time. Current tools for aggregating resident data are difficult to use and do not provide a comprehensive way to evaluate and display resident educational advancement. Objective: This study aims to describe the creation and assessment of a system designed to improve the longitudinal presentation, quality, and synthesis of educational progress for trainees. We created a new system for residency progress management with 3 goals in mind, that are (1) a long-term and centralized location for residency education data, (2) a clear and intuitive interface that is easy to access for both the residents and faculty involved in medical education, and (3) automated data input, transformation, and analysis. We present evaluations regarding whether residents find the system useful, and whether faculty like the system and perceive that it helps them save time with administrative duties. Methods: The system was created using a suite of Google Workspace tools including Forms, Sheets, Gmail, and a collection of Apps Scripts triggered at various times and events. To assess whether the system had an effect on the residents, we surveyed and asked them to self-report on how often they accessed the system and interviewed them as to whether they found it useful. To understand what the faculty thought of the system, we conducted a 14-person focus group and asked the faculty to self-report their time spent preparing for residency progress meetings before and after the system debut. Results: The system went live in February 2022 as a quality improvement project, evolving through multiple iterations of feedback. The authors found that the system was accessed differently by different postgraduate years (PGY), with the most usage reported in the PGY1 class (weekly), and the least amount of usage in the PGY3 class (once or twice). However, all of the residents reported finding the system useful, specifically for aggregating all of their evaluations in the same place. Faculty members felt that the system enabled a more high-quality biannual clinical competency committee meeting and they reported a combined time savings of 8 hours in preparation for each clinical competency committee as a result of reviewing resident data through the system. Conclusions: Our study reports on the creation of an automated, instantaneous, and comprehensive resident progress management system. The system has been shown to be well-liked by both residents and faculty. Younger PGY classes reported more frequent system usage than older PGY classes. Faculty reported that it helped facilitate more meaningful discussion of training progression and reduced the administrative burden by 8 hours per biannual session. %M 39312292 %R 10.2196/53314 %U https://formative.jmir.org/2024/1/e53314 %U https://doi.org/10.2196/53314 %U http://www.ncbi.nlm.nih.gov/pubmed/39312292 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56939 %T Designing a Culturally Relevant Digital Skin Cancer Prevention Intervention for Hispanic Individuals: Qualitative Exploration %A Niu,Zhaomeng %A Rivera,Yonaira M %A Lozada,Carolina %A Hudson,Shawna V %A Penedo,Frank J %A Manne,Sharon L %A Heckman,Carolyn J %+ Department of Health Informatics, Rutgers School of Health Professions, 675 Hoes Lane West, 826F, Piscataway, NJ, 08854, United States, 1 5093393076, zhaomeng.niu@rutgers.edu %K skin cancer %K prevention %K Hispanic %K sun protection %K skin self-examination %K intervention %K qualitative %K interviews %K health care provider %K community leader %K mobile-based %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the past 2 decades, melanoma incidence among Hispanic individuals has risen by 20%. The mortality rate of Hispanic individuals is higher than that for non-Hispanic White individuals. Skin cancer can largely be prevented with regular sun protection, and skin cancer outcomes can be improved through early detection, for example, by skin self-examination. Alarmingly, Hispanic individuals are less aware of the symptoms and harms of skin cancers, tend to have misperceptions regarding the risks and benefits of skin cancer prevention behaviors, and engage in less sun protection behaviors than non-Hispanic White individuals. Objective: This study aimed to use a community-engaged approach and conduct both group and individual interviews among Hispanic individuals and relevant key stakeholders to explore the potential design of a mobile-based skin cancer prevention intervention for Hispanic individuals. Methods: This study used a qualitative design (focus groups and individual interviews). Participants were recruited from local community organizations’ social media, local events, and contact lists (eg, email). Zoom interviews were conducted to examine whether Hispanic individuals would be interested in a mobile-based skin cancer intervention and to explore their preferences and suggestions to inform skin cancer prevention intervention design. Results: Five focus groups (2 in Spanish and 3 in English) among self-identified Hispanic individuals (n=34) and 15 semistructured, in-depth individual interviews among key stakeholders (health care providers and community leaders; eg, dermatologist, nurse practitioner, licensed social worker, and church leader) were conducted. The main themes and subthemes emerging from the group discussions and individual interviews were organized into the following categories: intervention platform, delivery frequency and format, message design, engagement plan, and activities. WhatsApp and Facebook were identified as suitable platforms for the intervention. Messages including short videos, visuals (eg, images and photographs), and simple texts messages were preferred. Recommendations for message design included personalized messages, personal stories and narratives, culturally relevant design (eg, incorporating family values), and community-trusted sources. Potential engagement and retention recommendations were also discussed. Additional details and exemplar quotes of each theme and subtheme are described. Conclusions: This study provides important insights and directions for the design of a mobile, digital skin cancer intervention to modify Hispanic individuals’ sun protection and skin self-examination behaviors to help improve skin cancer outcomes. Insights gathered from community leaders and health care providers provided valuable additions to the community-derived data. Leveraging popular digital platforms among Hispanic individuals such as WhatsApp or Facebook could be a promising approach to skin cancer prevention. Recommendations from the community included the use of concise videos, illustrative images, clear text messages, tailored communications, narratives featuring personal experiences, designs that reflect cultural significance, and information from sources that are trusted by the community, which provided useful strategies for future intervention design among Hispanic individuals. %M 39265165 %R 10.2196/56939 %U https://formative.jmir.org/2024/1/e56939 %U https://doi.org/10.2196/56939 %U http://www.ncbi.nlm.nih.gov/pubmed/39265165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54005 %T Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study %A De la Cruz-Torralva,Kelly %A Escobar-Agreda,Stefan %A Riega López,Pedro %A Amaro,James %A Reategui-Rivera,C Mahony %A Rojas-Mezarina,Leonardo %+ Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av Grau 755, Cercado de Lima, 15001, Peru, 51 619 7000 ext 4650, priegal@unmsm.edu.pe %K telemedicine %K screening %K treatment %K mental health %K suicide %K depression %K anxiety %K alcoholism %K physicians %K rural areas %K Peru %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. Objective: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. Methods: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. Results: Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. Conclusions: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants. %M 39255480 %R 10.2196/54005 %U https://formative.jmir.org/2024/1/e54005 %U https://doi.org/10.2196/54005 %U http://www.ncbi.nlm.nih.gov/pubmed/39255480 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55079 %T Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial %A Bronas,Ulf G %A Marquez,David X %A Fritschi,Cynthia %A Petrarca,Katherine %A Kitsiou,Spyros %A Ajilore,Olu %A Tintle,Nathan %+ School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, United States, 1 2123055756, ub2154@cumc.columbia.edu %K sedentary time %K physical activity %K cognition %K older adults %K Latinos %K mobile phone %D 2024 %7 5.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. Objective: This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. Methods: This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. Results: Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean –35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. Conclusions: An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. Trial Registration: ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5 %M 39235836 %R 10.2196/55079 %U https://www.jmir.org/2024/1/e55079 %U https://doi.org/10.2196/55079 %U http://www.ncbi.nlm.nih.gov/pubmed/39235836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50817 %T A Serious Game for Enhancing Rescue Reasoning Skills in Tactical Combat Casualty Care: Development and Deployment Study %A Zhu,Siyue %A Li,Zenan %A Sun,Ying %A Kong,Linghui %A Yin,Ming %A Yong,Qinge %A Gao,Yuan %+ Department of Nursing, the First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, China, 1 381 054 8731, gaoyuanzd@163.com %K combat casualty care %K simulation training %K medical service support %K virtual reality %K military exercise %K medical education %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Serious games (SGs) have emerged as engaging and instructional digital simulation tools that are increasingly being used for military medical training. SGs are often compared with traditional media in terms of learning outcomes, but it remains unclear which of the 2 options is more efficient and better accepted in the process of knowledge acquisition. Objective: This study aimed to create and test a scenario-based system suitable for enhancing rescue reasoning skills in tactical combat casualty care. Methods: To evaluate the effectiveness of the SGs, a randomized, observational, comparative trial was conducted. A total of 148 members from mobile medical logistics teams were recruited for training. Pre- and posttraining assessments were conducted using 2 different formats: a video-based online course (n=78) and a game simulation (n=70). We designed 3 evaluation instruments based on the first 2 levels of the Kirkpatrick model (reaction and learning) to measure trainees’ satisfaction, knowledge proficiency, and self-confidence. Results: There were 4 elements that made up the learning path for the SGs: microcourses (video-based online courses), self-test, game simulation, and record query. The knowledge test scores in both groups were significantly higher after the intervention (t154=–6.010 and t138=–7.867, respectively; P<.001). For 5 simulation cases, the average operation time was 13.6 (SD 3.3) minutes, and the average case score was 279.0 (SD 57.6) points (from a possible total of 500 points), with a score rate of only 44% (222/500 points) to 67% (336/500 points). The results indicated no significant difference in trainees’ satisfaction between the 2 training methods (P=.04). However, the game simulation method outperformed the video-based online course in terms of learning proficiency (t146=–2.324, P=.02) and self-perception (t146=–5.492, P<.001). Conclusions: Despite the high satisfaction reported by trainees for both training methods, the game simulation approach demonstrated superior efficiency and acceptance in terms of knowledge acquisition, self-perception, and overall performance. The developed SG holds significant potential as an essential assessment tool for evaluating frontline rescue skills and rescue reasoning in mobile medical logistics teams. %M 39133911 %R 10.2196/50817 %U https://formative.jmir.org/2024/1/e50817 %U https://doi.org/10.2196/50817 %U http://www.ncbi.nlm.nih.gov/pubmed/39133911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54599 %T The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial %A Johnson,Joshua K. %A Longhurst,Jason K %A Gevertzman,Michael %A Jefferson,Corey %A Linder,Susan M %A Bethoux,Francois %A Stilphen,Mary %+ Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code M83-13, Cleveland, OH, 44915, United States, 1 2169030621, johnsoj8@ccf.org %K rehabilitation %K physical therapy %K PT %K physiotherapy %K telehealth %K Parkinson disease %K tele-rehabilitation %K telerehabilitation %K TR %K exercise %K physical activity %K exercise therapy %K tele-health %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K Parkinson’s disease %K Parkinson %K Parkinsons %K Parkinsonism %K PD %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non–study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as “good” or “very good” across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 %M 39083792 %R 10.2196/54599 %U https://formative.jmir.org/2024/1/e54599 %U https://doi.org/10.2196/54599 %U http://www.ncbi.nlm.nih.gov/pubmed/39083792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54817 %T Adding Virtual Reality Mindful Exposure Therapy to a Cancer Center’s Tobacco Treatment Offerings: Feasibility and Acceptability Single-Group Pilot Study %A Jackson,Riley Walton %A Cao-Nasalga,Ann %A Chieng,Amy %A Pirkl,Amy %A Jagielo,Annemarie D %A Xu,Cindy %A Goldenhersch,Emilio %A Rosencovich,Nicolas %A Waitman,Cristian %A Prochaska,Judith J %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 650 724 3608, jpro@stanford.edu %K tobacco cessation %K virtual reality %K exposure therapy %K cancer care %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit. Patients charted as using tobacco are contacted by a tobacco treatment specialist and offered cessation services. As a novel addition, this study examined the acceptability of a virtual reality (VR) mindful exposure therapy app for quitting smoking called MindCotine. Objective: The objective of this study was to determine the feasibility and acceptability of offering 6 weeks of MindCotine treatment as a part of Stanford’s Tobacco Treatment Services for patients seen for cancer care. Methods: As part of a single-group pilot study, the MindCotine VR program was offered to English- or Spanish-speaking patients interested in quitting smoking. Given the visual interface, epilepsy was a medical exclusion. Viewed from a smartphone with an attachable VR headset, MindCotine provides a digital environment with audiovisual content guiding mindfulness exercises (eg, breathing techniques, body awareness, and thought recognition), text-based coaching, and cognitive behavioral therapy-based self-reflections for quitting smoking. Interested patients providing informed consent were mailed a MindCotine headset and asked to use the app for 10+ minutes a day. At the end of 6 weeks, participants completed a feedback survey. Results: Of the 357 patients reached by the tobacco treatment specialist, 62 (17.3%) were ineligible, 190 (53.2%) were not interested in tobacco treatment services, and 78 (21.8%) preferred other tobacco treatment services. Among the 105 eligible and interested in assistance with quitting, 27 (25.7%) were interested in MindCotine, of whom 20 completed the informed consent, 9 used the program, and 8 completed their end-of-treatment survey. Participants using MindCotine completed, on average, 13 (SD 20.2) program activities, 19 (SD 26) journal records, and 11 (SD 12.3) coaching engagements. Of the 9 participants who used MindCotine, 4 (44%) reported some dizziness with app use that resolved and 7 (78%) would recommend MindCotine to a friend. In total, 2 participants quit tobacco (22.2% reporting, 10% overall), 2 others reduced their smoking by 50% or more, and 2 quit for 24 hours and then relapsed. Conclusions: In a feasibility and acceptability pilot study of a novel VR tobacco treatment app offered to patients at a cancer center, 4 of 9 (44%) reporting and 4 of 20 (20%) overall substantially reduced or quit using tobacco after 6 weeks and most would recommend the app to others. Further testing on a larger sample is warranted. Trial Registration: ClinicalTrials.gov NCT05220254; https://clinicaltrials.gov/study/NCT05220254 %M 39042439 %R 10.2196/54817 %U https://formative.jmir.org/2024/1/e54817 %U https://doi.org/10.2196/54817 %U http://www.ncbi.nlm.nih.gov/pubmed/39042439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52212 %T Desensitizing Anxiety Through Imperceptible Change: Feasibility Study on a Paradigm for Single-Session Exposure Therapy for Fear of Public Speaking %A Banakou,Domna %A Johnston,Tania %A Beacco,Alejandro %A Senel,Gizem %A Slater,Mel %+ Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Campus de Mundet Edifici CAVE, Passeig de la Vall d'Hebron 171, Barcelona, 08035, Spain, 34 93 403 ext 9618, melslater@ub.edu %K exposure therapy %K virtual reality %K gradual exposure %K fear of public speaking %K anxiety %K change blindness %K public speaking %K desensitization %K anxiety disorder %K feasibility study %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. Objective: This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. Methods: We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. Results: Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. Conclusions: Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients. %M 39037760 %R 10.2196/52212 %U https://formative.jmir.org/2024/1/e52212 %U https://doi.org/10.2196/52212 %U http://www.ncbi.nlm.nih.gov/pubmed/39037760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48600 %T Acceptance of AI in Health Care for Short- and Long-Term Treatments: Pilot Development Study of an Integrated Theoretical Model %A Wichmann,Johannes %A Gesk,Tanja Sophie %A Leyer,Michael %+ Working group Digitalization and Process Management, Department of Business, Philipps-University Marburg, Barfuessertor 2, Marburg, 35037, Germany, 49 64212823712, johannes.wichmann@wiwi.uni-marburg.de %K health information systems %K integrated theoretical model %K artificial intelligence %K health care %K technology acceptance %K long-term treatments %K short-term treatments %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As digital technologies and especially artificial intelligence (AI) become increasingly important in health care, it is essential to determine whether and why potential users intend to use related health information systems (HIS). Several theories exist, but they focus mainly on aspects of health care or information systems, in addition to general psychological theories, and hence provide a small number of variables to explain future behavior. Thus, research that provides a larger number of variables by combining several theories from health care, information systems, and psychology is necessary. Objective: This study aims to investigate the intention to use new HIS for decisions concerning short- and long-term medical treatments using an integrated approach with several variables to explain future behavior. Methods: We developed an integrated theoretical model based on theories from health care, information systems, and psychology that allowed us to analyze the duality approach of adaptive and nonadaptive appraisals and their influence on the intention to use HIS. We applied the integrated theoretical model to the short-term treatment using AI-based HIS for surgery and the long-term treatment of diabetes tracking using survey data with structured equation modeling. To differentiate between certain levels of AI involvement, we used several scenarios that include treatments by physicians only, physicians with AI support, and AI only to understand how individuals perceive the influence of AI. Results: Our results showed that for short- and long-term treatments, the variables perceived threats, fear (disease), perceived efficacy, attitude (HIS), and perceived norms are important to consider when determining the intention to use AI-based HIS. Furthermore, the results revealed that perceived efficacy and attitude (HIS) are the most important variables to determine intention to use for all treatments and scenarios. In contrast, abilities (HIS) were important for short-term treatments only. For our 9 scenarios, adaptive and nonadaptive appraisals were both important to determine intention to use, depending on whether the treatment is known. Furthermore, we determined R² values that varied between 57.9% and 81.7% for our scenarios, which showed that the explanation power of our model is medium to good. Conclusions: We contribute to HIS literature by highlighting the importance of integrating disease- and technology-related factors and by providing an integrated theoretical model. As such, we show how adaptive and nonadaptive appraisals should be arranged to report on medical decisions in the future, especially in the short and long terms. Physicians and HIS developers can use our insights to identify promising rationale for HIS adoption concerning short- and long-term treatments and adapt and develop HIS accordingly. Specifically, HIS developers should ensure that future HIS act in terms of HIS functions, as our study shows that efficient HIS lead to a positive attitude toward the HIS and ultimately to a higher intention to use. %M 39024565 %R 10.2196/48600 %U https://formative.jmir.org/2024/1/e48600 %U https://doi.org/10.2196/48600 %U http://www.ncbi.nlm.nih.gov/pubmed/39024565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47785 %T Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis %A Ortiz,Fernanda %A Grasberger,Juulia %A Ekstrand,Agneta %A Helanterä,Ilkka %A Giunti,Guido %+ Abdominal Center–Nephrology, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00130, Finland, 358 504270795, fernanda.ortiz@hus.fi %K eHealth %K kidney living donor %K informed consent %K telemedicine %K process standardization %K kidney %K donor %K tool %K usability %K psychological impact %K utility %K smartphone %K coping %K surgery %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. Objective: This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. Methods: The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. Results: The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors’ lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users’ ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. Conclusions: Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. Trial Registration: ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-051166 %M 38981119 %R 10.2196/47785 %U https://formative.jmir.org/2024/1/e47785 %U https://doi.org/10.2196/47785 %U http://www.ncbi.nlm.nih.gov/pubmed/38981119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54587 %T Availability of Alcohol on an Online Third-Party Delivery Platform Across London Boroughs, England: Exploratory Cross-Sectional Study %A Sharpe,Casey %A Bhuptani,Saloni %A Jecks,Mike %A Sheron,Nick %A Henn,Clive %A Burton,Robyn %+ Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, United Kingdom, 44 7595 417304, robyn.burton@stir.ac.uk %K alcohol %K availability %K online %K third-party delivery platforms %K England %K cross-sectional study %K exploratory %K licensing %K public health %K policy %D 2024 %7 28.6.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Higher availability of alcohol is associated with higher levels of alcohol consumption and harm. Alcohol is increasingly accessible online, with rapid delivery often offered by a third-party driver. Remote delivery and online availability are important from a public health perspective, but to date, relatively little research has explored the availability of alcohol offered by online platforms. Objective: This cross-sectional exploratory study describes the availability of alcohol on the third-party platform Deliveroo within London, England. Methods: We extracted the number of outlets offering alcohol on Deliveroo for each London borough and converted these into crude rates per 1000 population (18-64 years). Outlets were grouped as outlets exclusively selling alcohol, off-licenses, and premium. We calculated Pearson correlation coefficients to explore the association between borough’s crude rate of outlets per 1000 population and average Indices of Multiple Deprivation (IMD) 2019 scores. We extracted the number of outlets also selling tobacco or e-cigarettes and used non-Deliveroo drivers. We searched addresses of the top 20 outlets delivering to the most boroughs by outlet type (60 total) to determine their associated premise. Results: We identified 4277 total Deliveroo-based outlets offering alcohol across London, including outlets delivering in multiple boroughs. The crude rate of outlets per 1000 population aged 18-64 years was 0.73 and ranged from 0.22 to 2.29 per borough. Most outlets exclusively sold alcohol (3086/4277, 72.2%), followed by off-licenses (770/4277, 18.0%) and premium (421/4277, 9.8%). The majority of outlets exclusively selling alcohol sold tobacco or e-cigarettes (2951/3086, 95.6%) as did off-licenses to a lesser extent (588/770, 76.4%). Most outlets exclusively offering alcohol used drivers not employed by Deliveroo (2887/3086, 93.6%), and the inverse was true for premium outlets (50/421, 11.9%) and off-licenses (73/770, 9.5%). There were 1049 unique outlets, of which 396 (37.8%) were exclusively offering alcohol—these outlets tended to deliver across multiple boroughs unlike off-licenses and premium outlets. Of outlets with confirmed addresses, self-storage units were listed as the associated premise for 85% (17/20) of outlets exclusively offering alcohol, 11% (2/19) of off-licenses, and 12% (2/17) of premium outlets. We found no significant relationship between borough IMD scores and crude rate of outlets per 1000 population overall (P=.87) or by any outlet type: exclusively alcohol (P=.41), off-license (P=.58), and premium (P=.18). Conclusions: London-based Deliveroo outlets offering alcohol are common and are sometimes operating from self-storage units that have policies prohibiting alcohol storage. This and the potential for increased alcohol accessibility online have implications for public health given the relationship between alcohol’s availability and consumption or harm. There is a need to ensure that regulations for delivery are adequate for protecting children and vulnerable adults. The Licensing Act 2003 may require modernization in the digital age. Future research must explore a relationship between online alcohol availability and deprivation. %M 38941596 %R 10.2196/54587 %U https://formative.jmir.org/2024/1/e54587 %U https://doi.org/10.2196/54587 %U http://www.ncbi.nlm.nih.gov/pubmed/38941596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52316 %T Leveraging Social Media to Predict COVID-19–Induced Disruptions to Mental Well-Being Among University Students: Modeling Study %A Das Swain,Vedant %A Ye,Jingjing %A Ramesh,Siva Karthik %A Mondal,Abhirup %A Abowd,Gregory D %A De Choudhury,Munmun %+ Khoury College of Computer Sciences, Northeastern University, #202, West Village Residence Complex H, 440 Huntington Ave, Boston, MA, 02115, United States, 1 (404) 894 2000, vedantswain@gmail.com %K social media %K mental health %K linguistic markers %K digital phenotyping %K COVID-19 %K disaster well-being %K well-being %K machine learning %K temporal trends %K disruption %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Large-scale crisis events such as COVID-19 often have secondary impacts on individuals’ mental well-being. University students are particularly vulnerable to such impacts. Traditional survey-based methods to identify those in need of support do not scale over large populations and they do not provide timely insights. We pursue an alternative approach through social media data and machine learning. Our models aim to complement surveys and provide early, precise, and objective predictions of students disrupted by COVID-19. Objective: This study aims to demonstrate the feasibility of language on private social media as an indicator of crisis-induced disruption to mental well-being. Methods: We modeled 4124 Facebook posts provided by 43 undergraduate students, spanning over 2 years. We extracted temporal trends in the psycholinguistic attributes of their posts and comments. These trends were used as features to predict how COVID-19 disrupted their mental well-being. Results: The social media–enabled model had an F1-score of 0.79, which was a 39% improvement over a model trained on the self-reported mental state of the participant. The features we used showed promise in predicting other mental states such as anxiety, depression, social, isolation, and suicidal behavior (F1-scores varied between 0.85 and 0.93). We also found that selecting the windows of time 7 months after the COVID-19–induced lockdown presented better results, therefore, paving the way for data minimization. Conclusions: We predicted COVID-19–induced disruptions to mental well-being by developing a machine learning model that leveraged language on private social media. The language in these posts described psycholinguistic trends in students’ online behavior. These longitudinal trends helped predict mental well-being disruption better than models trained on correlated mental health questionnaires. Our work inspires further research into the potential applications of early, precise, and automatic warnings for individuals concerned about their mental health in times of crisis. %M 38916951 %R 10.2196/52316 %U https://formative.jmir.org/2024/1/e52316 %U https://doi.org/10.2196/52316 %U http://www.ncbi.nlm.nih.gov/pubmed/38916951 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55283 %T Web-Based Therapist-Guided Mindfulness-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Pilot Randomized Controlled Trial %A Kerry,Camrie %A Mann,Prabhdeep %A Babaei,Nazanin %A Katz,Joel %A Pirbaglou,Meysam %A Ritvo,Paul %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 580 8021, camrie@yorku.ca %K body dysmorphic disorder %K BDD %K dysmorphophobia %K obsessive-compulsive and related disorders %K OCD %K internet-delivered cognitive behavior therapy %K iCBT %K cognitive behavior therapy %K mindfulness-based cognitive therapy %K mindfulness %K eMental health %K randomized controlled trial %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (CBT) and stand-alone mindfulness meditation interventions are gaining empirical support for a wide variety of mental health conditions. In this study, we test the efficacy of web-based therapist-guided mindfulness-based cognitive behavioral therapy (CBT-M) for body dysmorphic disorder (BDD), a psychiatric disorder characterized by preoccupations with perceived defects in appearance. Objective: This study aims to determine whether CBT-M for BDD delivered on the web is feasible and acceptable and whether mindfulness meditation adds to CBT treatment effects for BDD. Methods: In this 8-week, 2-arm, parallel pilot randomized controlled trial, n=28 adults (aged between 18 and 55 years) were randomly allocated to an experimental group (web-based therapist-guided CBT-M) or a control group (web-based therapist-guided CBT). Study retention, accrual, and intervention adherence were assessed, along with self-report measures for BDD, depression, anxiety, and pain intensity taken at baseline and postintervention. Results: This study was feasible to implement and deemed acceptable by participants. After 8 weeks, significant improvements were found on all outcome measures for both treatment groups, and large between-group effect sizes favoring CBT-M were found for BDD symptom severity (d=–0.96), depression (d=–1.06), pain severity (d=–1.12), and pain interference (d=–1.28). However, linear mixed models demonstrated no significant differences between the groups over 8 weeks. Conclusions: The results suggest that mindfulness meditation may add to beneficial web-based CBT treatment effects for BDD. An adequately powered randomized control trial of web-based CBT-M is warranted. Trial Registration: ClinicalTrials.gov NCT05402475, http://clinicaltrials.gov/ct2/show/NCT05402475 %M 38865704 %R 10.2196/55283 %U https://mental.jmir.org/2024/1/e55283 %U https://doi.org/10.2196/55283 %U http://www.ncbi.nlm.nih.gov/pubmed/38865704 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56373 %T An App-Based Physical Activity Intervention in Community-Dwelling Chinese-, Tagalog-, and Vietnamese-Speaking Americans: Single-Arm Intervention Study %A Nguyen,Antony %A Yu,Filmer %A Park,Linda G %A Fukuoka,Yoshimi %A Wong,Ching %A Gildengorin,Ginny %A Nguyen,Tung T %A Tsoh,Janice Y %A Jih,Jane %+ Division of General Internal Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, United States, 1 4158857563, jane.jih@ucsf.edu %K physical activity %K mHealth %K mobile health %K mobile app %K Asian Americans %K physical activity tracker %K mobile phone %K app %K apps %K application %K applications %K app-based %K intervention %K interventions %K community-dwelling %K tracker %K trackers %K pilot study %K feasibility %K acceptability %K cultural %K culturally %K linguistic %K linguistically %K evidence-based %K community-based %K sociodemographic %K lifestyle %K Chinese %K Vietnamese %K Filipino %K adult %K adults %K multicomponent %K multilingual %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app–based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. Objective: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. Methods: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the app’s daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. Results: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. Conclusions: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered. %M 38857065 %R 10.2196/56373 %U https://formative.jmir.org/2024/1/e56373 %U https://doi.org/10.2196/56373 %U http://www.ncbi.nlm.nih.gov/pubmed/38857065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55918 %T Telemedicine With Wearable Technologies in Patients Undergoing Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy (TEL-HEMATO Study): Prospective Noninterventional Single-Center Study %A Hurtado,Lidia %A Gonzalez Concepcion,Melinda %A Flix-Valle,Aida %A Ruiz-Romeo,Marina %A Gonzalez-Rodriguez,Sonia %A Peña,Marta %A Paviglianiti,Annalisa %A Pera Jambrina,Maria Angeles %A Sureda,Anna %A Ochoa-Arnedo,Cristian %A Mussetti,Alberto %+ Clinical Hematology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda de la Granvia de l’Hospitalet, 199, Barcelona, 08908, Spain, 34 622188475, amussetti@iconcologia.net %K hematology %K hematopoietic cell transplantation %K telemedicine %K wearables %K chimeric antigen receptor T %K CART %K wearable %K hematopoietic %K transplantation %K transplant %K pilot study %K hematological %K HCT %K telehealth %K therapy %K device %K quality of life %K digital health %K smartphone %K app %K patient %K teenager %K youth %K noninterventional %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with hematological malignancies receiving hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy are at risk of developing serious clinical complications after discharge. Objective: The aim of the TEL-HEMATO study was to improve our telehealth platform for the follow-up of patients undergoing HCT or CAR T-cell therapy during the first 3 months after discharge with the addition of wearable devices. Methods: Eleven patients who received autologous (n=2) or allogeneic (n=5) HCT or CAR T-cell therapy (n=4) for hematological malignancies were screened from November 2022 to July 2023. Two patients discontinued the study after enrollment. The telehealth platform consisted of the daily collection of vital signs, physical symptoms, and quality of life assessment up to 3 months after hospital discharge. Each patient received a clinically validated smartwatch (ScanWatch) and a digital thermometer, and a dedicated smartphone app was used to collect these data. Daily revision of the data was performed through a web-based platform by a hematologist or a nurse specialized in HCT and CAR T-cell therapy. Results: Vital signs measured through ScanWatch were successfully collected with medium/high adherence: heart rate was recorded in 8/9 (89%) patients, oxygen saturation and daily steps were recorded in 9/9 (100%) patients, and sleeping hours were recorded in 7/9 (78%) patients. However, temperature recorded manually by the patients was associated with lower compliance, which was recorded in 5/9 (55%) patients. Overall, 5/9 (55%) patients reported clinical symptoms in the app. Quality of life assessment was completed by 8/9 (89%) patients at study enrollment, which decreased to 3/9 (33%) at the end of the third month. Usability was considered acceptable through ratings provided on the System Usability Scale. However, technological issues were reported by the patients. Conclusions: While the addition of wearable devices to a telehealth clinical platform could have potentially synergic benefits for HCT and CAR T-cell therapy patient monitoring, noncomplete automation of the platform and the absence of a dedicated telemedicine team still represent major limitations to be overcome. This is especially true in our real-life setting where the target population generally comprises patients of older age with a low digital education level. %M 38833696 %R 10.2196/55918 %U https://formative.jmir.org/2024/1/e55918 %U https://doi.org/10.2196/55918 %U http://www.ncbi.nlm.nih.gov/pubmed/38833696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52921 %T Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians’ and Specialists’ Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study %A Nabelsi,Véronique %A Lévesque-Chouinard,Annabelle %+ Department of Administrative Sciences, Université du Québec en Outaouais, C.P. 1240, Succ. Hull, Gatineau, QC, J8X 3X7, Canada, 1 819 595 3900 ext 1915, veronique.nabelsi@uqo.ca %K eConsult %K electronic consultation %K digital health solutions %K primary care providers %K specialists %K United Theory of Acceptance and Use of Technology %K UTAUT %K Task-Technology Fit %K TTF %K technology acceptance %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients’ medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs’, specialists’, and patients’ satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs’ and specialists’ acceptance of eConsult services in Quebec, Canada, and worldwide. Objective: This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. Methods: A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. Results: Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. Conclusions: This study provides a better understanding of the factors influencing PCPs’ and specialists’ intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users’ need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service. %M 38814689 %R 10.2196/52921 %U https://formative.jmir.org/2024/1/e52921 %U https://doi.org/10.2196/52921 %U http://www.ncbi.nlm.nih.gov/pubmed/38814689 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51546 %T Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study %A Mizuno,Emi %A Ogasawara,Takayuki %A Mukaino,Masahiko %A Yamaguchi,Masumi %A Tsukada,Shingo %A Sonoda,Shigeru %A Otaka,Yohei %+ Department of Rehabilitation Medicine, Hokkaido University Hospital, Kita14, Nishi5, Kita-ku, Sapporo, 0608648, Japan, 81 117066066, masahikovn@gmail.com %K activity monitoring %K smart clothing system %K stroke %K unseen %K monitoring %K recovery %K physical condition %K deconditioning %K muscle wasting %K wearable technology %K wearable %K activity level %K rehabilitation %K physical therapy %K heart rate %K ADL %K activities of daily living %K training %K older people %K mobile phone %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. Objective: This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. Methods: In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients’ daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. Results: A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=–0.41, P=.21) or 4 weeks post admission (ρ=–0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=–0.82, P=.002) and 4 weeks post admission (ρ=–0.73, P=.01). Conclusions: Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings. %M 38809596 %R 10.2196/51546 %U https://formative.jmir.org/2024/1/e51546 %U https://doi.org/10.2196/51546 %U http://www.ncbi.nlm.nih.gov/pubmed/38809596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51977 %T Web Application to Enable Online Social Interactions in a Parkinson Disease Risk Cohort: Feasibility Study and Social Network Analysis %A Li,Xiancheng %A Gill,Aneet %A Panzarasa,Pietro %A Bestwick,Jonathan %A Schrag,Anette %A Noyce,Alastair %A De Simoni,Anna %+ Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, United Kingdom, 44 2078822520, a.desimoni@qmul.ac.uk %K pilot studies %K network analysis %K Parkinson disease %K risk factors %K risk %K risk cohort %K social interaction %K development %K neurodegenerative disease %K neurodegenerative %K United Kingdom %K feasibility %K design %K pilot %K engagement %K users %K online forum %K online network %K online %K regression analysis %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is evidence that social interaction has an inverse association with the development of neurodegenerative diseases. PREDICT-Parkinson Disease (PREDICT-PD) is an online UK cohort study that stratifies participants for risk of future Parkinson disease (PD). Objective: This study aims to explore the methodological approach and feasibility of assessing the digital social characteristics of people at risk of developing PD and their social capital within the PREDICT-PD platform, making hypotheses about the relationship between web-based social engagement and potential predictive risk indicators of PD. Methods: A web-based application was built to enable social interaction through the PREDICT-PD portal. Feedback from existing members of the cohort was sought and informed the design of the pilot. Dedicated staff used weekly engagement activities, consisting of PD-related research, facts, and queries, to stimulate discussion. Data were collected by the hosting platform. We examined the pattern of connections generated over time through the cumulative number of posts and replies and ego networks using social network analysis. We used network metrics to describe the bonding, bridging, and linking of social capital among participants on the platform. Relevant demographic data and Parkinson risk scores (expressed as an odd 1:x) were analyzed using descriptive statistics. Regression analysis was conducted to estimate the relationship between risk scores (after log transformation) and network measures. Results: Overall, 219 participants took part in a 4-month pilot forum embedded in the study website. In it, 200 people (n=80, 40% male and n=113, 57% female) connected in a large group, where most pairs of users could reach one another either directly or indirectly through other users. A total of 59% (20/34) of discussions were spontaneously started by participants. Participation was asynchronous, with some individuals acting as “brokers” between groups of discussions. As more participants joined the forum and connected to one another through online posts, distinct groups of connected users started to emerge. This pilot showed that a forum application within the cohort web platform was feasible and acceptable and fostered digital social interaction. Matching participants’ web-based social engagement with previously collected data at individual level in the PREDICT-PD study was feasible, showing potential for future analyses correlating online network characteristics with the risk of PD over time, as well as testing digital social engagement as an intervention to modify the risk of developing neurodegenerative diseases. Conclusions: The results from the pilot suggest that an online forum can serve as an intervention to enhance social connectedness and investigate whether patterns of online engagement can impact the risk of developing PD through long-term follow-up. This highlights the potential of leveraging online platforms to study the role of social capital in moderating PD risk and underscores the feasibility of such approaches in future research or interventions. %M 38788211 %R 10.2196/51977 %U https://formative.jmir.org/2024/1/e51977 %U https://doi.org/10.2196/51977 %U http://www.ncbi.nlm.nih.gov/pubmed/38788211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50446 %T Evaluating a New Digital App–Based Program for Heart Health: Feasibility and Acceptability Pilot Study %A Lockwood,Kimberly G %A Kulkarni,Priya R %A Paruthi,Jason %A Buch,Lauren S %A Chaffard,Mathieu %A Schitter,Eva C %A Branch,OraLee H %A Graham,Sarah A %+ Lark Health, 809 Cuesta Dr, Suite B #1033, Mountain View, CA, 94040, United States, 1 5033801340, kimberly.lockwood@lark.com %K digital health %K cardiovascular disease %K artificial intelligence %K AI %K acceptability and feasibility %K pilot study %K lifestyle coaching %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)–powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. Objective: This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. Methods: This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. Results: On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). Conclusions: The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample. %M 38787598 %R 10.2196/50446 %U https://formative.jmir.org/2024/1/e50446 %U https://doi.org/10.2196/50446 %U http://www.ncbi.nlm.nih.gov/pubmed/38787598 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52389 %T Adapting a Dutch Web-Based Intervention to Support Family Caregivers of People With Dementia in the UK Context: Accelerated Experience-Based Co-Design %A Scheibl,Fiona %A Boots,Lizzy %A Eley,Ruth %A Fox,Christopher %A Gracey,Fergus %A Harrison Dening,Karen %A Oyebode,Jan %A Penhale,Bridget %A Poland,Fiona %A Ridel,Gemma %A West,Juniper %A Cross,Jane L %+ Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 (0) 1603593315, J.Cross@uea.ac.uk %K adaptation %K caregivers %K dementia %K intervention %K web-based resources %K United Kingdom %K co-design %K web-based intervention %K support %K carer %K caregiver %K family carer %K community-based %K services %K dementia %K web-based support %K staff %K self-help, web-based %D 2024 %7 22.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Around 700,000 family caregivers provide unpaid care for 900,000 people living with dementia in the United Kingdom. Few family caregivers receive support for their own psychological needs and funding for community respite services has declined. These trends are seen across Europe as demographic and budgetary pressures have intensified due to public spending cuts arising from the 2008 financial crisis and the COVID-19 pandemic. The World Health Organization has prioritized the need to expand the provision of support for caregivers and families of people with dementia by 2025. Web-based interventions have the potential for development as they require modest investment and can be accessed by family caregivers at home. Further cost benefits can be realized by adapting existing interventions with demonstrated effectiveness for new contexts. This paper reports initial findings from the CareCoach study, which is adapting Partner in Balance (PiB), a web-based coaching intervention developed in the Netherlands, for family caregivers in the United Kingdom. Objective: This study aims to work with unpaid family caregivers and staff in adapting the Dutch web-based support tool PiB to improve its acceptability and usability for use in the United Kingdom. Methods: Accelerated Experience-Based Co-Design (AEBCD) was used with caregivers, staff, and core stakeholders. Interviews, workshops, and stakeholder consultations were conducted. Data were analyzed iteratively. Recommendations for the redesign of PiB for use across the United Kingdom were adjudicated by the study Adaptation Working Party. Results: Sixteen caregivers and 17 staff took part in interviews. Thirteen caregivers and 17 staff took part in workshops. Most (n=26) participants were White, female, and retired. All except 4 caregivers (2 male and 2 female) found the PiB’s offer of web-based self-help learning acceptable. Caregivers identified complexity and lack of inclusivity in some wording and video resources as problematic. The staff took a stronger perspective on the lack of inclusivity in PiB video resources. Staff and caregivers coproduced new inclusive wording and recommended creating new videos to adapt PiB for the UK context. Conclusions: AEBCD methods facilitated the engagement of caregivers and staff and advanced the adaptation of the PiB complex intervention. An important addition to the AEBCD method in this process was the work of an Adaptation Working Party, which adjudicated and agreed to new wording where this could not be established in consultation with caregivers and staff. Trial Registration: ISRCTN Registry ISRCTN12540555; https://doi.org/10.1186/ISRCTN12540555 %M 38776139 %R 10.2196/52389 %U https://formative.jmir.org/2024/1/e52389 %U https://doi.org/10.2196/52389 %U http://www.ncbi.nlm.nih.gov/pubmed/38776139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53206 %T Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study %A Bozorgmehr,Arezoo %A Thiem,Simon-Konstantin %A Wild,Dorothea %A Reinsdorff,Melanie %A Vollmar,Horst Christian %A Kappernagel,Annika %A Schloessler,Kathrin %A Weissbach,Sabine %A Pentzek,Michael %A Dehnen,Dorothea %A Drexler,Julia %A Mueller,Beate Sigrid %A Pilic,Larisa %A Lehmann,Lion %A Loescher,Susanne %A Hohmann,Elena Darinka %A Frank,Friederike %A Ates,Gülay %A Kersten,Susanne %A Mortsiefer,Achim %A Aretz,Benjamin %A Weltermann,Birgitta %+ Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus1, Bonn, 53127, Germany, 49 228 287 10173, arezoo.bozorgmehr@ukbonn.de %K primary care %K general practice research network %K physicians %K feasibility study %K IT infrastructure %K usability %K FallAkte %K FallAkte Plus system %K mixed methods usability study %K North Rhine-Westphalian general practice research network %K NRW-GPRN %K Germany %K German %K universities %K survey %K questionnaire %K participants %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. Objective: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany’s largest state. Methods: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. Results: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system’s emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. Conclusions: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI. %M 38767942 %R 10.2196/53206 %U https://formative.jmir.org/2024/1/e53206 %U https://doi.org/10.2196/53206 %U http://www.ncbi.nlm.nih.gov/pubmed/38767942 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55731 %T The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study %A Kepper,Maura %A Walsh-Bailey,Callie %A Miller,Zoe M %A Zhao,Min %A Zucker,Kianna %A Gacad,Angeline %A Herrick,Cynthia %A White,Neil H %A Brownson,Ross C %A Foraker,Randi E %+ Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr, St. Louis, MO, 63130, United States, 1 3149350142, kepperm@wustl.edu %K digital health %K obesity %K clinical care %K adolescents %K physical activity %K diet %K clinical trial %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. Objective: The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. Methods: A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children’s hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. Results: PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Conclusions: Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. Trial Registration: ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193 %M 38758581 %R 10.2196/55731 %U https://formative.jmir.org/2024/1/e55731 %U https://doi.org/10.2196/55731 %U http://www.ncbi.nlm.nih.gov/pubmed/38758581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56198 %T An Internet-Based Intervention to Increase the Ability of Lesbian, Gay, and Bisexual People to Cope With Adverse Events: Single-Group Feasibility Study %A Isbășoiu,Andreea Bogdana %A Sava,Florin Alin %A Larsen,Torill M B %A Anderssen,Norman %A Rotaru,Tudor-Stefan %A Rusu,Andrei %A Sălăgean,Nastasia %A Tulbure,Bogdan Tudor %+ Department of Psychology, West University of Timisoara, 4 Vasile Parvan Bvd., Timisoara, 300223, Romania, 40 256592270, florin.sava@e-uvt.ro %K acceptance and commitment therapy %K anxiety %K depression %K PTSD %K LGBTQ+ %K online interventions %K transdiagnostic %K prevention %D 2024 %7 15.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at higher risk of mental health problems due to widespread hetero- and cisnormativity, including negative public attitudes toward the LGBTQ+ community. In addition to combating social exclusion at the societal level, strengthening the coping abilities of young LGBTQ+ people is an important goal. Objective: In this transdiagnostic feasibility study, we tested a 6-week internet intervention program designed to increase the ability of nonclinical LGBTQ+ participants to cope with adverse events in their daily lives. The program was based on acceptance and commitment therapy principles. Methods: The program consists of 6 web-based modules and low-intensity assistance for homework provided by a single care provider asynchronously. The design was a single-group assignment of 15 self-identified LGB community members who agreed to participate in an open trial with a single group (pre- and postintervention design). Results: Before starting the program, participants found the intervention credible and expressed high satisfaction at the end of the intervention. Treatment adherence, operationalized by the percentage of completed homework assignments (32/36, 88%) was also high. When we compared participants’ pre- and postintervention scores, we found a significant decrease in clinical symptoms of depression (Cohen d=0.44, 90% CI 0.09-0.80), social phobia (d=0.39, 90% CI 0.07-0.72), and posttraumatic stress disorder (d=0.30, 90% CI 0.04-0.55). There was also a significant improvement in the level of self-acceptance and behavioral effectiveness (d=0.64, 90% CI 0.28-0.99) and a significant decrease in the tendency to avoid negative internal experiences (d=0.38, 90% CI 0.09-0.66). The level of general anxiety disorder (P=.11; d=0.29, 90% CI –0.10 to 0.68) and alcohol consumption (P=.35; d=–0.06, 90% CI –0.31 to 0.19) were the only 2 outcomes for which the results were not statistically significant. Conclusions: The proposed web-based acceptance and commitment therapy program, designed to help LGBTQ+ participants better manage emotional difficulties and become more resilient, represents a promising therapeutic tool. The program could be further tested with more participants to ensure its efficacy and effectiveness. Trial Registration: ClinicalTrials.gov NCT05514964; https://clinicaltrials.gov/study/NCT05514964 %M 38749024 %R 10.2196/56198 %U https://formative.jmir.org/2024/1/e56198 %U https://doi.org/10.2196/56198 %U http://www.ncbi.nlm.nih.gov/pubmed/38749024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56138 %T An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study %A Tourrette,Cédric %A Tostain,Jean-Baptiste %A Kozub,Eva %A Badreddine,Maha %A James,Julia %A Noraz,Aurore %A De Choudens,Charlotte %A Moulis,Lionel %A Duflos,Claire %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, Montpellier University, INSERM, Campus Sante, IURC, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France, 33 684014834, francois.carbonnel@umontpellier.fr %K planetary health %K One Health %K medical education %K environmental health %K education %K e-learning %K general practitioner %K pilot study %K climate change %K training %K environmental %K e-learning module %K behavior change %K ecosystem %K questionnaire %K behavior %K self-assessment %K e-learning intervention %K environment %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ≥65 years will increase by 1540%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-Nîmes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. Objective: The objective of this study was to assess the impact of the e-learning module on participants’ knowledge and behavior change. Methods: This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. Results: A total of 95 participants completed the pre- and posttest questionnaires (response rate 55%). The mean scores for participants’ pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). Conclusions: The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice. %M 38743463 %R 10.2196/56138 %U https://formative.jmir.org/2024/1/e56138 %U https://doi.org/10.2196/56138 %U http://www.ncbi.nlm.nih.gov/pubmed/38743463 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56005 %T Training Family Medicine Residents in Dermoscopy Using an e-Learning Course: Pilot Interventional Study %A Friche,Pauline %A Moulis,Lionel %A Du Thanh,Aurélie %A Dereure,Olivier %A Duflos,Claire %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, Unité Mixte de Recherche, Unité d'accueil 11, University of Montpellier, Institut national de la santé et de la recherche médicale, Camps ADV, IURC, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France, 33 684014834, Francois.carbonnel@umontpellier.fr %K dermoscopy %K dermatoscope %K dermatoscopes %K dermatological %K skin %K training %K GP %K family practitioner %K family practitioners %K family physician %K family physicians %K general practice %K family medicine %K primary health care %K internship and residency %K education %K e-learning %K eLearning %K dermatology %K resident %K residency %K intern %K interns %K internship %K internships %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Skin cancers are the most common group of cancers diagnosed worldwide. Aging and sun exposure increase their risk. The decline in the number of dermatologists is pushing the issue of dermatological screening back onto family doctors. Dermoscopy is an easy-to-use tool that increases the sensitivity of melanoma diagnosis by 60% to 90%, but its use is limited due to lack of training. The characteristics of “ideal” dermoscopy training have yet to be established. We created a Moodle (Moodle HQ)-based e-learning course to train family medicine residents in dermoscopy. Objective: This study aimed to evaluate the evolution of dermoscopy knowledge among family doctors immediately and 1 and 3 months after e-learning training. Methods: We conducted a prospective interventional study between April and November 2020 to evaluate an educational program intended for family medicine residents at the University of Montpellier-Nîmes, France. They were asked to complete an e-learning course consisting of 2 modules, with an assessment quiz repeated at 1 (M1) and 3 months (M3). The course was based on a 2-step algorithm, a method of dermoscopic analysis of pigmented skin lesions that is internationally accepted. The objectives of modules 1 and 2 were to differentiate melanocytic lesions from nonmelanocytic lesions and to precisely identify skin lesions by looking for dermoscopic morphological criteria specific to each lesion. Each module consisted of 15 questions with immediate feedback after each question. Results: In total, 134 residents were included, and 66.4% (n=89) and 47% (n=63) of trainees fully participated in the evaluation of module 1 and module 2, respectively. This study showed a significant score improvement 3 months after the training course in 92.1% (n=82) of participants for module 1 and 87.3% (n=55) of participants for module 2 (P<.001). The majority of the participants expressed satisfaction (n=48, 90.6%) with the training course, and 96.3% (n=51) planned to use a dermatoscope in their future practice. Regarding final scores, the only variable that was statistically significant was the resident’s initial scores (P=.003) for module 1. No measured variable was found to be associated with retention (midtraining or final evaluation) for module 2. Residents who had completed at least 1 dermatology rotation during medical school had significantly higher initial scores in module 1 at M0 (P=.03). Residents who reported having completed at least 1 dermatology rotation during their family medicine training had a statistically significant higher score at M1 for module 1 and M3 for module 2 (P=.01 and P=.001). Conclusions: The integration of an e-learning training course in dermoscopy into the curriculum of FM residents results in a significant improvement in their diagnosis skills and meets their expectations. Developing a program combining an e-learning course and face-to-face training for residents is likely to result in more frequent and effective dermoscopy use by family doctors. %M 38739910 %R 10.2196/56005 %U https://formative.jmir.org/2024/1/e56005 %U https://doi.org/10.2196/56005 %U http://www.ncbi.nlm.nih.gov/pubmed/38739910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41573 %T A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study %A Noori,Sofia %A Khasnavis,Siddharth %A DeCroce-Movson,Eliza %A Blay-Tofey,Morkeh %A Vitiello,Evan %+ Department of Psychiatry, University of North Carolina School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27514, United States, 1 9194450221, evan.vitiello@gmail.com %K digital psychiatry %K digital mental health %K didactic curriculum %K residency training %K psychiatry residency %K training classes %K trainee response %K residency curriculum %K trainee feedback %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. Objective: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Methods: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Results: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03), assessment of a patient’s digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed “somewhat comfortable” on any of the above measures. Conclusions: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum. %M 38739423 %R 10.2196/41573 %U https://formative.jmir.org/2024/1/e41573 %U https://doi.org/10.2196/41573 %U http://www.ncbi.nlm.nih.gov/pubmed/38739423 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56130 %T The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study %A Tostain,Jean-Baptiste %A Mathieu,Marina %A Oude Engberink,Agnès %A Clary,Bernard %A Amouyal,Michel %A Lognos,Béatrice %A Demoly,Pascal %A Annesi-Maesano,Isabella %A Ninot,Grégory %A Molinari,Nicolas %A Richard,Arnaud %A Badreddine,Maha %A Duflos,Claire %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Campus Sante, IURC, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34095, France, 33 684014834, francois.carbonnel@umontpellier.fr %K environmental health %K medical education %K One Health %K environment %K environmental %K eLearning %K e-learning %K remote %K learning %K online learning %K primary care %K satisfaction %K awareness %K behavioral %K behavior change %K questionnaire %K survey %K course %K educational %K teaching %K GP %K general practice %K general practitioner %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. Objective: This study assessed the impact of the e-learning component of the PCEH course on participants’ satisfaction, knowledge, and behavior changes toward EH. Methods: This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants’ satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients’ health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. Results: A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant’s health and by 26% for patients’ health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). Conclusions: The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs. %M 38722679 %R 10.2196/56130 %U https://formative.jmir.org/2024/1/e56130 %U https://doi.org/10.2196/56130 %U http://www.ncbi.nlm.nih.gov/pubmed/38722679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53192 %T Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study %A Au-Yeung,Wan-Tai M %A Liu,Yan %A Hanna,Remonda %A Gothard,Sarah %A Rodrigues,Nathaniel %A Leon Guerrero,Cierra %A Beattie,Zachary %A Kaye,Jeffrey %+ Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode: UHN13, Portland, OR, 97239, United States, 1 503 494 6695, auyeungm@ohsu.edu %K neuropsychiatric symptoms %K mild cognitive impairment %K dementia %K unobtrusive monitoring %K digital biomarkers %K environmental precipitants %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. Objective: We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. Methods: The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants’ digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. Results: At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants’ severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. Conclusions: This study is a step toward more frequent assessment of older adults’ behavioral symptoms and holistic in situ monitoring of older adults’ behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms. %M 38717798 %R 10.2196/53192 %U https://formative.jmir.org/2024/1/e53192 %U https://doi.org/10.2196/53192 %U http://www.ncbi.nlm.nih.gov/pubmed/38717798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55917 %T Impact of Electronic Patient-Reported Outcomes on Unplanned Consultations and Hospitalizations in Patients With Cancer Undergoing Systemic Therapy: Results of a Patient-Reported Outcome Study Compared With Matched Retrospective Data %A Trojan,Andreas %A Kühne,Christian %A Kiessling,Michael %A Schumacher,Johannes %A Dröse,Stefan %A Singer,Christian %A Jackisch,Christian %A Thomssen,Christoph %A Kullak-Ublick,Gerd A %+ Oncology, Breast Center Zürichsee, Seestrasse 88, Horgen, 8810, Switzerland, 41 76 34 30 200, trojan@1st.ch %K systemic cancer therapy %K electronic patient-reported outcome %K ePRO %K ePROs %K Consilium Care %K medidux %K unplanned consultation %K hospitalization %K hospitalizations %K hospitalized %K cancer %K oncology %K side effect %K side effects %K adverse %K chemotherapy %K patient reported outcome %K PRO %K PROs %K mobile health %K mHealth %K app %K apps %K application %K applications %K mobile phone %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The evaluation of electronic patient-reported outcomes (ePROs) is increasingly being used in clinical studies of patients with cancer and enables structured and standardized data collection in patients’ everyday lives. So far, few studies or analyses have focused on the medical benefit of ePROs for patients. Objective: The current exploratory analysis aimed to obtain an initial indication of whether the use of the Consilium Care app (recently renamed medidux; mobile Health AG) for structured and regular self-assessment of side effects by ePROs had a recognizable effect on incidences of unplanned consultations and hospitalizations of patients with cancer compared to a control group in a real-world care setting without app use. To analyze this, the incidences of unplanned consultations and hospitalizations of patients with cancer using the Consilium Care app that were recorded by the treating physicians as part of the patient reported outcome (PRO) study were compared retrospectively to corresponding data from a comparable population of patients with cancer collected at 2 Swiss oncology centers during standard-of-care treatment. Methods: Patients with cancer in the PRO study (178 included in this analysis) receiving systemic therapy in a neoadjuvant or noncurative setting performed a self-assessment of side effects via the Consilium Care app over an observational period of 90 days. In this period, unplanned (emergency) consultations and hospitalizations were documented by the participating physicians. The incidence of these events was compared with retrospective data obtained from 2 Swiss tumor centers for a matched cohort of patients with cancer. Results: Both patient groups were comparable in terms of age and gender ratio, as well as the distribution of cancer entities and Joint Committee on Cancer stages. In total, 139 patients from each group were treated with chemotherapy and 39 with other therapies. Looking at all patients, no significant difference in events per patient was found between the Consilium group and the control group (odds ratio 0.742, 90% CI 0.455-1.206). However, a multivariate regression model revealed that the interaction term between the Consilium group and the factor “chemotherapy” was significant at the 5% level (P=.048). This motivated a corresponding subgroup analysis that indicated a relevant reduction of the risk for the intervention group in the subgroup of patients who underwent chemotherapy. The corresponding odds ratio of 0.53, 90% CI 0.288-0.957 is equivalent to a halving of the risk for patients in the Consilium group and suggests a clinically relevant effect that is significant at a 2-sided 10% level (P=.08, Fisher exact test). Conclusions: A comparison of unplanned consultations and hospitalizations from the PRO study with retrospective data from a comparable cohort of patients with cancer suggests a positive effect of regular app-based ePROs for patients receiving chemotherapy. These data are to be verified in the ongoing randomized PRO2 study (registered on ClinicalTrials.gov; NCT05425550). Trial Registration: ClinicalTrials.gov NCT03578731; https://www.clinicaltrials.gov/ct2/show/NCT03578731 International Registered Report Identifier (IRRID): RR2-10.2196/29271 %M 38710048 %R 10.2196/55917 %U https://formative.jmir.org/2024/1/e55917 %U https://doi.org/10.2196/55917 %U http://www.ncbi.nlm.nih.gov/pubmed/38710048 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53550 %T Integrating Virtual Mindfulness-Based Stress Reduction Into Inflammatory Bowel Disease Care: Mixed Methods Feasibility Trial %A Chappell,Kaitlyn Delaney %A Meakins,Diana %A Marsh-Joyal,Melanie %A Bihari,Allison %A Goodman,Karen J %A Le Melledo,Jean-Michel %A Lim,Allen %A Peerani,Farhad %A Kroeker,Karen Ivy %+ Division of Gastroenterology, Department of Medicine, University of Alberta, 130 University Campus NW, Edmonton, AB, T6G 2X8, Canada, 1 780 492 4873, karen.kroeker@ualberta.ca %K inflammatory bowel disease %K psychosocial care %K multidisciplinary care %K quality of care %K quality of life %K mental health %K adult %K adults %K anxiety %K depression %K IBD %K virtual mindfulness %K feasibility trial %K clinic %K health facility %K Canada %K semistructured interview %K psychiatrist %K psychiatrists %K videoconferencing %K effectiveness %K v-MBSR %K coping %K coping strategy %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with inflammatory bowel disease (IBD) experience cycles of aggressive physical symptoms including abdominal pain, diarrhea, and fatigue. These acute symptoms regress and return, and chronic symptoms and complications often linger. The nature of the disease can also cause individuals to experience psychological distress including symptoms of anxiety and depression; however, unlike the physical symptoms of IBD, these psychological symptoms often remain untreated. Objective: This study aims to evaluate the feasibility, acceptability, and effectiveness of virtual mindfulness-based stress reduction (v-MBSR) for adults with IBD. Methods: IBD patients with self-reported anxiety or depression were recruited from clinics in Alberta, Canada to participate in an 8-week v-MSBR intervention. Eligible patients participated in v-MBSR delivered by psychiatrists using a videoconferencing platform. Primary feasibility outcomes included trial uptake, adherence, attendance, and attrition rates. Secondary effectiveness outcomes included measures of anxiety, depression, quality of life (QoL), and mindfulness. Effectiveness data were collected at 3 time points: baseline, at intervention completion, and 6 months after completion. To further assess feasibility and acceptability, participants were invited to participate in a semistructured interview after completing v-MBSR. Results: A total of 16 of the 64 (25%) referred patients agreed to participate in v-MBSR with the most common reason for decline being a lack of time while 7 of the 16 (43.8%) participants completed the program and experienced encouraging effects including decreased anxiety and depression symptoms and increased health-related QoL with both improvements persisting at 6-month follow-up. Participants described improved coping strategies and disease management techniques as benefits of v-MBSR. Conclusions: Patients with IBD were interested in a psychiatrist-led virtual anxiety management intervention, but results demonstrate v-MBSR may be too time intensive for some patients with IBD patients. v-MBSR was acceptable to those who completed the intervention, and improvements to anxiety, depression, and QoL were promising and sustainable. Future studies should attempt to characterize the patients with IBD who may benefit most from interventions like v-MBSR. %M 38709548 %R 10.2196/53550 %U https://formative.jmir.org/2024/1/e53550 %U https://doi.org/10.2196/53550 %U http://www.ncbi.nlm.nih.gov/pubmed/38709548 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54124 %T Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial %A Cunningham,Adam C %A Prentice,Carley %A Peven,Kimberly %A Wickham,Aidan %A Bamford,Ryan %A Radovic,Tara %A Klepchukova,Anna %A Fomina,Maria %A Cunningham,Katja %A Hill,Sarah %A Hantsoo,Liisa %A Payne,Jennifer %A Zhaunova,Liudmila %A Ponzo,Sonia %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 7770032146, l_zhaunova@flo.health %K digital health %K health literacy %K menstrual cycle %K period tracking app %K women’s health %K PMS %K PMDD %K tracking %K app %K application %K tracking app %K tracking application %K menstrual %K women %K efficacy %K general health %K wellbeing %K randomized controlled trial %K awareness %K symptoms %K manage %K management %K premenstrual %K premenstrual syndrome %K premenstrual dysphoric disorder %K reproductive %K reproductive health %K health management %K communication %K pregnancy %K quality of life %K productivity %K education %K functionality %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one’s own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. Objective: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. Methods: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). Results: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=–7.08; t115=–5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=–0.61; t311=–2.73, P=.007), and fear of unplanned pregnancies (D̄=–0.22; t311=–2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=–1.67; t144=–2.49, P=.01). Conclusions: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. Trial Registration: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq %M 38696773 %R 10.2196/54124 %U https://mhealth.jmir.org/2024/1/e54124 %U https://doi.org/10.2196/54124 %U http://www.ncbi.nlm.nih.gov/pubmed/38696773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55402 %T Mi Sleep Coach Mobile App to Address Insomnia Symptoms Among Cancer Survivors: Single-Arm Feasibility Study %A Arring,Noel %A Barton,Debra L %A Lafferty,Carolyn %A Cox,Bryana %A Conroy,Deirdre A %A An,Lawrence %+ College of Nursing, University of Tennessee, 1412 Circle Drive, Room 411, Knoxville, TN, 37966, United States, 1 8659741988, narring@utk.edu %K cognitive behavioral therapy %K insomnia %K mobile health %K breast cancer %K prostate cancer %K colon cancer %K cancer survivor %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Rates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. Objective: This single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. Methods: A 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. Results: In total, 30 participants were enrolled, with 100% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80% (n=24) to 93% (n=28) of the 30 participants. Furthermore, 27 (90%) participants were satisfied with the Mi Sleep Coach app and 28 (93%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P<.001; Cohen d=1.5). At baseline, 25 (83%) participants scored in the moderate (n=19; 15-21) or severe (n=6; 22-28) insomnia range. At week 7, a total of 4 (13%) patients scored in the moderate (n=4) or severe (n=0) range. The number of patients taking prescription sleep medications decreased from 7 (23%) at baseline to 1 (3%; P<.001) at week 7. The number of patients taking over-the-counter sleep medications decreased from 14 (47%) at baseline to 9 (30%; P=.03) at week 7. Conclusions: The Mi Sleep Coach app demonstrated high levels of program adherence and user satisfaction and had large effects on the severity of insomnia among survivors of cancer. The Mi Sleep Coach app is a promising intervention for cancer-related insomnia, and further clinical trials are warranted. If proven to significantly decrease insomnia in survivors of cancer in future randomized controlled clinical trials, this intervention would provide more survivors of cancer with easy access to evidence-based CBT-I treatment. Trial Registration: ClinicalTrials.gov NCT04827459; https://clinicaltrials.gov/study/NCT04827459 %M 38669678 %R 10.2196/55402 %U https://formative.jmir.org/2024/1/e55402 %U https://doi.org/10.2196/55402 %U http://www.ncbi.nlm.nih.gov/pubmed/38669678 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e53212 %T Virtual Reality for Basic Life Support Training in High School Students: Thematic Analysis of Focus Group Interviews %A Min,Hyojin Jennifer %A Andler,Caroline %A Barber,Rebecca Ortiz La Banca %A Chang,Todd P %A Abelairas-Gomez,Cristian %A Knowlin,Laquanda T %A Liu,Deborah R %A Fijačko,Nino %+ Children’s Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, United States, 1 3233614606, hmin@chla.usc.edu %K virtual reality %K mixed reality %K technology %K basic life support %K cardiovascular pulmonary resuscitation %K near-peer mentoring %K education %K high school students %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: High-quality and engaging cardiopulmonary resuscitation (CPR) training of both health care professionals and members of the public is necessary to provide timely and effective CPR to maximize survival and minimize injuries. Virtual reality (VR) is a novel method to enhance CPR engagement and training. However, a near-peer mentoring framework has not been applied in such training to date. Objective: The purpose of this pilot qualitative study was to understand the acceptability and feasibility of using VR technology to introduce basic life support (BLS) to high school students reinforced by near-peer coaching. Methods: Dyads of high school students underwent BLS training in CPR using a VR experience reinforced by the near-peer mentoring model. Focus group interviews were performed following the intervention. The interview sessions were recorded, transcribed verbatim, and subjected to thematic analysis. VR software data were analyzed after five cycles of chest compressions between the two participants. Results: The overwhelming responses from the three dyads of high school students indicated positive acceptance of learning CPR using VR. Analysis of emerging themes revealed three main categories of barriers and facilitators: (1) motivation to learn CPR, (2) CPR learning modality, and (3) coaching CPR content. These themes supported the theoretical framework of an “intention-focused” paradigm leading to acquiring the skills needed to perform CPR and ultimately increasing the chances of a bystander performing CPR. Conclusions: This study highlights the potential for training a unique population to increase bystander effects using novel VR technology coupled with a near-peer mentoring method. Further research is warranted to measure the outcome of the knowledge attained and the intention to perform CPR by high school students who participate in CPR education using VR and a near-peer mentoring method. %R 10.2196/53212 %U https://xr.jmir.org/2024/1/e53212 %U https://doi.org/10.2196/53212 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e51901 %T Preliminary Assessment of an Ambulatory Device Dedicated to Upper Airway Muscle Training in Patients With Sleep Apnea: Proof-of-Concept Study %A Roberge,Patrice %A Ruel,Jean %A Bégin-Drolet,André %A Lemay,Jean %A Gakwaya,Simon %A Masse,Jean-François %A Sériès,Frédéric %+ Mechanical Engineering Department, Université Laval, 1065 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada, 1 418 656 2131 ext 412245, Jean.Ruel@gmc.ulaval.ca %K obstructive sleep apnea/hypopnea syndrome %K OSAHS %K myofunctional therapy %K myotherapy %K oral %K orofacial %K myology %K musculature %K labial %K buccal %K lingual %K speech therapy %K physiotherapy %K physical therapy %K oropharyngeal exercises %K oropharyngeal %K pharyngeal %K pharynx %K hypopnea %K lip %K home-based %K portable device %K devices %K ambulatory %K portable %K monitoring %K apnea %K mouth %K lips %K tongue %K facial %K exercise %K exercises %K myofunctional %K continuous monitoring %K sleep-disordered breathing %K sleep %K breathing %K tongue exercise %K lip exercise %K mHealth %K muscle %K muscles %K muscular %K airway %K sleep apnea %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability. Objective: Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips, tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session. Methods: This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes. Results: Ten participants were enrolled in the study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91% (175/192 sessions). For the tongue exercise, the success rate increased from 66% (211/320 exercises; SD 18%) on the first day to 85% (272/320 exercises; SD 17%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=–0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants’ performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program. Conclusions: The study’s portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation. %M 38875673 %R 10.2196/51901 %U https://biomedeng.jmir.org/2024/1/e51901 %U https://doi.org/10.2196/51901 %U http://www.ncbi.nlm.nih.gov/pubmed/38875673 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49993 %T Lessons From the Field From a Volunteer Telehealth Ambassador Program to Enhance Video Visits Among Low-Income Patients: Qualitative Improvement Study %A Tuot,Delphine S %A Mukherjee,Aarya %A Churape,Amanda %A DeFries,Triveni %A Su,George %A Khoong,Elaine C %A Lyles,Courtney %+ Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 6282068242, Delphine.tuot@ucsf.edu %K digital barriers %K digital support %K digital technologies %K equity %K health care delivery %K safety-net %K telehealth %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to using digital technologies. Objective: This study aimed to increase video visit use in an urban safety-net delivery system. We piloted a telehealth ambassador program, in which volunteers offered technical support to patients with access to digital technologies to convert primary care visits already scheduled as telehealth audio-only visits to telehealth video visits. Methods: We used a descriptive approach to assess the feasibility, efficacy, and acceptability of the pilot telehealth ambassador program. Feasibility was quantified by the percentage of eligible patients who answered calls from telehealth ambassadors. Program efficacy was measured in two ways: (1) the percentage of patients with access to digital technology who interacted with the navigators and were successfully prepared for a telehealth video visit, and (2) the percentage of prepared patients who completed their scheduled video visits. Program acceptability was ascertained by a structured telephone survey. Results: Telehealth ambassadors attempted to contact 776 eligible patients; 43.6% (338/776) were reached by phone, among whom 44.4% (150/338) were provided digital support between March and May 2021. The mean call duration was 8.8 (range 0-35) minutes. Overall, 67.3% (101/150) of patients who received support successfully completed a telehealth video visit with their provider. Among the 188 patients who were contacted but declined video visit digital support, 61% (114/188) provided a reason for their decline; 42% (48/114) did not see added value beyond a telehealth audio-only visit, 20% (23/114) had insufficient internet access, and 27% (31/114) declined learning about a new technology. The acceptability of the telehealth ambassador program was generally favorable, although some patients preferred having in-real-time technology support on the day of their telehealth video visit. Conclusions: This high-touch program reached approximately one-half of eligible patients and helped two-thirds of interested patients with basic video visit capability successfully complete a video visit. Increasing the program’s reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits, partnering with community-based organizations to overcome structural barriers to telehealth use, and offering in-real-time technology support will help increase the program’s efficacy. %M 38619874 %R 10.2196/49993 %U https://formative.jmir.org/2024/1/e49993 %U https://doi.org/10.2196/49993 %U http://www.ncbi.nlm.nih.gov/pubmed/38619874 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53665 %T Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study %A Hebard,Stephen %A Weaver,GracieLee %A Hansen,William B %A Ruppert,Scarlett %+ Department of Public Health Education, University of North Carolina Greensboro, PO BOX 26170, Greensboro, NC, 27402-6170, United States, 1 336 334 5000, gmweaver@uncg.edu %K health care workers %K opioid misuse %K pain management %K prescription opioids %K prevention %K substance abuse %K substance use %K workers %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual’s intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. Objective: This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. Methods: A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. Results: After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (–1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. Conclusions: While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees. %M 38607664 %R 10.2196/53665 %U https://formative.jmir.org/2024/1/e53665 %U https://doi.org/10.2196/53665 %U http://www.ncbi.nlm.nih.gov/pubmed/38607664 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e52443 %T Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study %A Otaka,Eri %A Osawa,Aiko %A Kato,Kenji %A Obayashi,Yota %A Uehara,Shintaro %A Kamiya,Masaki %A Mizuno,Katsuhiro %A Hashide,Shusei %A Kondo,Izumi %K dementia care %K robotics %K emotion %K facial expression %K expression intensity %K long-term care %K sensory modality %K gerontology %K gerontechnology %D 2024 %7 11.4.2024 %9 %J JMIR Aging %G English %X Background: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for “happy,” “sad,” “angry,” “surprised,” “scared,” and “disgusted” were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for “happy” was compared between the different types of robots. Results: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for “happy” was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care. Trial Registration: UMIN Clinical Trials Registry UMIN000046256; https://tinyurl.com/yw37auan %R 10.2196/52443 %U https://aging.jmir.org/2024/1/e52443 %U https://doi.org/10.2196/52443 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53841 %T Acceptability of a Self-Guided Lifestyle Intervention Among Young Men: Mixed Methods Analysis of Pilot Findings %A Reading,Jean Miki %A Crane,Melissa M %A Guan,Justin %A Jackman,Ronston %A Thomson,Maria D %A LaRose,Jessica Gokee %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL, 60611, United States, 1 3125034870, jean.reading@northwestern.edu %K digital health %K gender %K weight loss %K health behaviors %K low touch %K obesity %K obese %K mixed methods analysis %K lifestyle intervention %K young men %K men %K effectiveness %K digital tools %K food intake %K diet %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young men are vastly underrepresented in lifestyle interventions, suggesting a need to develop appealing yet effective interventions for this population. Objective: This study aimed to determine the acceptability of a self-guided lifestyle intervention designed specifically for young men (age: 18-35 years old). Methods: Semistructured interviews and surveys were completed by 14 men following completion of a remotely delivered, 12-week lifestyle intervention. The intervention included 1 virtual group session, digital tools, access to self-paced web- and mobile-based content, and 12 weekly health risk text messages. We quantitatively and qualitatively examined young men’s experiences with the intervention components of a remotely delivered, self-guided lifestyle intervention targeting weight loss. Data were integrated using convergent mixed methods analysis. Results: Men were a mean age of 29.9 (SD 4.9) years with a mean BMI of 31.0 (SD 4.5) kg/m2. The self-guided aspect was not acceptable, and a majority preferred more check-ins. Participants expressed a desire for a social aspect in future lifestyle interventions. All men found the focus on health risks appealing. A majority of men found the study-issued, Bluetooth-enabled scale acceptable. Conclusions: Acceptability of the self-guided lifestyle intervention was perceived as suboptimal by young men. The findings highlight the need to add intervention components that sustain motivation and provide additional social support for young men. Trial Registration: ClinicalTrials.gov NCT04267263; https://www.clinicaltrials.gov/study/NCT04267263 %M 38578686 %R 10.2196/53841 %U https://formative.jmir.org/2024/1/e53841 %U https://doi.org/10.2196/53841 %U http://www.ncbi.nlm.nih.gov/pubmed/38578686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54656 %T Evaluation of an e-Learning Program for Community Pharmacists for Dispensing Emicizumab (Hemlibra) in France: Nationwide Cross-Sectional Study %A Chamouard,Valérie %A Freyssenge,Julie %A Clairaz-Mahiou,Béatrice %A Ferrera Bibas,Felicia %A Fraticelli,Laurie %+ Laboratory P2S (Health Systemic Process), UR 4129, University Claude Bernard Lyon 1, 7-11 rue Guillaume Paradin, Lyon, 69372, France, 33 04 78 78 57 45, laurie.fraticelli@univ-lyon1.fr %K hemophilia %K care pathway %K emicizumab %K Kirkpatrick model %K pharmacy %K survey %K Hemlibra %K France %K e-learning program %K pharmacists %K pharmacist %K hemophilia A %K hospital %K HEMOPHAR %K methodology %K community %K engagement %K pharmaceutical %K rare disease %K digital health %K intervention %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since June 2021, patients with hemophilia A with antifactor VIII inhibitors and those with severe hemophilia A without antifactor VIII inhibitors treated with Hemlibra have had to choose between a community or hospital pharmacy. The French reference center for hemophilia developed the HEMOPHAR e-learning program for community pharmacists for dispensing emicizumab.  Objective: This study aims to evaluate the efficiency and safety of this new care pathway by assessing the HEMOPHAR e-learning program.  Methods: The methodology is based on Kirkpatrick’s model for evaluating the immediate reaction of trained community pharmacists (level 1), their level of acquired knowledge (level 2), and their professional practice after 3 months of dispensation (level 3).  Results: The HEMOPHAR e-learning program reached a large audience, with 67% (337/502) of the eligible community pharmacists following it. The immediate reaction was overall satisfying. High rates of engagement were reported with 63.5% (214/337) to 73.3% (247/337) of completed training modules, along with high rates of success with quizzes of 61.5% (174/337) to 95.7% (244/337). We observed that 83.9% (193/230) of the community pharmacists needed less than 2 attempts to pass the quiz of the module related to professional practice, while the other quizzes required more attempts. Advice on compliance and drug interactions were most frequently provided to patients by the community pharmacists.  Conclusions: This study suggests ways to improve the training of community pharmacists and to optimize coordination with treatment centers. This study also reports on the feasibility of switching to a community pharmacy in a secure pharmaceutical circuit, including in the context of a rare bleeding disease.  Trial Registration: ClinicalTrials.gov NCT05449197; https://clinicaltrials.gov/study/NCT05449197 International Registered Report Identifier (IRRID): RR2-10.2196/43091 %M 38574351 %R 10.2196/54656 %U https://formative.jmir.org/2024/1/e54656 %U https://doi.org/10.2196/54656 %U http://www.ncbi.nlm.nih.gov/pubmed/38574351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54912 %T Behavioral Activation Mobile App to Motivate Smokers to Quit: Feasibility and Pilot Randomized Controlled Trial %A Borrelli,Belinda %A Bartlett,Y Kiera %A Fulford,Daniel %A Frasco,Greg %A Armitage,Christopher J %A Wearden,Alison %+ Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Floor 3, 560 Harrison Ave, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K smoking cessation %K mobile app %K motivation %K depressed mood %K depression %K behavioral activation %K negative affect %K positive affect %K quit smoking %K health behavior change %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavioral activation (BA) is an evidence-based treatment for depression that fosters engagement in values-based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation. Objective: This study determined the feasibility and preliminary efficacy of a mobile app to motivate smokers to quit by using BA and integrating motivational messages to quit smoking. Methods: Adult smokers (N=56; mean age 34.5, SD 9.52 years) who were not ready to quit smoking within 30 days were recruited from advertisements and randomized to either 8 weeks of the BA app (set 2 values-based activities per week+motivational messages+feedback on changes in smoking, mood, and values-based activities) or the control group (no app; received resources for quitting smoking). All participants completed the baseline and end-of-treatment web-based questionnaires. Controls also completed weekly web-based assessments, and BA app participants completed assessments through the app. Results: There were no dropouts and only 2 participants in each condition did not complete the end-of-treatment questionnaire. The results demonstrated that it is feasible to recruit smokers who are unmotivated to quit into a smoking cessation induction trial: 86% (57/66) of eligible participants were randomized (BA app: n=27; control: n=29). Participants reported high levels of satisfaction: 80% (20/25) of participants said they would recommend the BA app, there were moderate-to-high scores on the Mobile App Rating Scale, and 88% (22/25) of participants rated the app 3 stars or higher (out of 5). There were high levels of BA app engagement: 96% (26/27) of participants planned activities, and 67% (18/27) of participants planned 7 or more activities. High engagement was found even among those who were at the highest risk for continued smoking (low motivation to quit, low confidence to quit, and high negative affect). The results provided support for the hypothesized relationships between BA constructs: greater pleasant activity completion was associated with greater positive affect (b=0.37, SE 0.21; 95% CI –0.05 to 0.79; P=.08), and greater positive affect tended to predict fewer cigarettes smoked the next day (b=–0.19, SE 0.10; 95% CI –0.39 to 0.01; P=.06). Additionally, a greater number of activities planned was associated with lower negative affect (b=–0.26, SE 0.15; 95% CI –0.55 to 0.04; P=.09). Overall, 16% (4/25) of BA app participants set a quit date versus 4% (1/27) among controls, and there were promising (but not significant) trends for motivation and confidence to quit. Conclusions: The findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects most important to them, such as mood management. This theory-based intervention has shown some initial support for the underlying theoretical constructs, and further efficacy testing is warranted in a fully powered trial. %M 38573739 %R 10.2196/54912 %U https://formative.jmir.org/2024/1/e54912 %U https://doi.org/10.2196/54912 %U http://www.ncbi.nlm.nih.gov/pubmed/38573739 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48068 %T Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study %A King Jr,Van Lewis %A Siegel,Gregg %A Priesmeyer,Henry Richard %A Siegel,Leslie H %A Potter,Jennifer S %+ Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, 5109 Medical Drive, San Antonio, TX, 78229, United States, 1 210 450 8058, kingvl@uthscsa.edu %K opioid use disorder %K digital health %K behavioral medicine %K KIOS %K mHealth %K substance use disorder %K substance use treatment %K self-management %K opioid misuse %K substance use %K social support %K KIOS app %K KIOS application %K software %K patient-centered %K opioid %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient’s recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. Objective: This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. Methods: We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual’s patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual’s changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. Results: In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. Conclusions: KIOS tracks key clinical variables and generates advice specifically relevant to the patient’s current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse–funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted. %M 38557501 %R 10.2196/48068 %U https://formative.jmir.org/2024/1/e48068 %U https://doi.org/10.2196/48068 %U http://www.ncbi.nlm.nih.gov/pubmed/38557501 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54815 %T eHealth-Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: Protocol for a Pilot Randomized Trial Study %A Creasy,Stephanie L %A Sweet,Sheridan %A Myers,Janet J %A Shumway,Martha %A Tolou-Shams,Marina %A McCaffrey,Nicole %A Dauria,Emily F %+ Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, 130 De Soto St, 6th Floor, Pittsburgh, PA, 15261, United States, 1 4126243136, STC69@pitt.edu %K substance use %K HIV prevention %K carceral system %K intervention development %K young adult %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, the proportion of criminal legal–involved (CLI) adults with a substance use disorder reaches 72%, and ~150,000 persons with HIV pass through a carceral setting annually, which represents 16% of the HIV-infected population nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Young adults represent 41.9% of the adults incarcerated in the United States and have the highest HIV incidence rates nationally. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail; yet, peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people. Objective: This paper describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct. Methods: The three aims of this study are to (1) adapt an existing evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link young adults (18 to 29 years) surveilled by the criminal legal system to substance use and pre-exposure prophylaxis (PrEP) services; (2) refine and test the intervention with criminal legal–involved young adults (CLI-YAs); and (3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YAs (n=24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth-enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (n=10), the navigator (n=1), and system partners (n=4) will assess intervention acceptability and suggestions for improvement. A community of practice, a group of system partners with an interest in working toward solutions to common problems, will inform each phase of the study. Results: The project is currently ongoing. The project was funded in September 2022. Internal review board approval was received on March 21, 2022. The first results from early study aims are expected to be published in 2025. Conclusions: This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YAs. The results will contribute to the development and testing of a future multilevel randomized controlled trial. International Registered Report Identifier (IRRID): DERR1-10.2196/54815 %M 38530335 %R 10.2196/54815 %U https://www.researchprotocols.org/2024/1/e54815 %U https://doi.org/10.2196/54815 %U http://www.ncbi.nlm.nih.gov/pubmed/38530335 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49964 %T Performance of ChatGPT on the India Undergraduate Community Medicine Examination: Cross-Sectional Study %A Gandhi,Aravind P %A Joesph,Felista Karen %A Rajagopal,Vineeth %A Aparnavi,P %A Katkuri,Sushma %A Dayama,Sonal %A Satapathy,Prakasini %A Khatib,Mahalaqua Nazli %A Gaidhane,Shilpa %A Zahiruddin,Quazi Syed %A Behera,Ashish %+ Department of Community Medicine, All India Institute of Medical Sciences, Room 420 Department of Community Medicine, Plot 2, Sector 20, MIHAN, Nagpur, Maharashtra, 441108, India, 91 9585395395, aravindsocialdoc@gmail.com %K artificial intelligence %K ChatGPT %K community medicine %K India %K large language model %K medical education %K digitalization %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical students may increasingly use large language models (LLMs) in their learning. ChatGPT is an LLM at the forefront of this new development in medical education with the capacity to respond to multidisciplinary questions. Objective: The aim of this study was to evaluate the ability of ChatGPT 3.5 to complete the Indian undergraduate medical examination in the subject of community medicine. We further compared ChatGPT scores with the scores obtained by the students. Methods: The study was conducted at a publicly funded medical college in Hyderabad, India. The study was based on the internal assessment examination conducted in January 2023 for students in the Bachelor of Medicine and Bachelor of Surgery Final Year–Part I program; the examination of focus included 40 questions (divided between two papers) from the community medicine subject syllabus. Each paper had three sections with different weightage of marks for each section: section one had two long essay–type questions worth 15 marks each, section two had 8 short essay–type questions worth 5 marks each, and section three had 10 short-answer questions worth 3 marks each. The same questions were administered as prompts to ChatGPT 3.5 and the responses were recorded. Apart from scoring ChatGPT responses, two independent evaluators explored the responses to each question to further analyze their quality with regard to three subdomains: relevancy, coherence, and completeness. Each question was scored in these subdomains on a Likert scale of 1-5. The average of the two evaluators was taken as the subdomain score of the question. The proportion of questions with a score 50% of the maximum score (5) in each subdomain was calculated. Results: ChatGPT 3.5 scored 72.3% on paper 1 and 61% on paper 2. The mean score of the 94 students was 43% on paper 1 and 45% on paper 2. The responses of ChatGPT 3.5 were also rated to be satisfactorily relevant, coherent, and complete for most of the questions (>80%). Conclusions: ChatGPT 3.5 appears to have substantial and sufficient knowledge to understand and answer the Indian medical undergraduate examination in the subject of community medicine. ChatGPT may be introduced to students to enable the self-directed learning of community medicine in pilot mode. However, faculty oversight will be required as ChatGPT is still in the initial stages of development, and thus its potential and reliability of medical content from the Indian context need to be further explored comprehensively. %M 38526538 %R 10.2196/49964 %U https://formative.jmir.org/2024/1/e49964 %U https://doi.org/10.2196/49964 %U http://www.ncbi.nlm.nih.gov/pubmed/38526538 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52482 %T Efficient Machine Reading Comprehension for Health Care Applications: Algorithm Development and Validation of a Context Extraction Approach %A Nguyen,Duy-Anh %A Li,Minyi %A Lambert,Gavin %A Kowalczyk,Ryszard %A McDonald,Rachael %A Vo,Quoc Bao %+ School of Software and Electrical Engineering, Swinburne University of Technology, John St, Hawthorn, 3122, Australia, 61 392148444, anhngd93@gmail.com %K question answering %K machine reading comprehension %K context extraction %K covid19 %K health care %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Extractive methods for machine reading comprehension (MRC) tasks have achieved comparable or better accuracy than human performance on benchmark data sets. However, such models are not as successful when adapted to complex domains such as health care. One of the main reasons is that the context that the MRC model needs to process when operating in a complex domain can be much larger compared with an average open-domain context. This causes the MRC model to make less accurate and slower predictions. A potential solution to this problem is to reduce the input context of the MRC model by extracting only the necessary parts from the original context. Objective: This study aims to develop a method for extracting useful contexts from long articles as an additional component to the question answering task, enabling the MRC model to work more efficiently and accurately. Methods: Existing approaches to context extraction in MRC are based on sentence selection strategies, in which the models are trained to find the sentences containing the answer. We found that using only the sentences containing the answer was insufficient for the MRC model to predict correctly. We conducted a series of empirical studies and observed a strong relationship between the usefulness of the context and the confidence score output of the MRC model. Our investigation showed that a precise input context can boost the prediction correctness of the MRC and greatly reduce inference time. We proposed a method to estimate the utility of each sentence in a context in answering the question and then extract a new, shorter context according to these estimations. We generated a data set to train 2 models for estimating sentence utility, based on which we selected more precise contexts that improved the MRC model’s performance. Results: We demonstrated our approach on the Question Answering Data Set for COVID-19 and Biomedical Semantic Indexing and Question Answering data sets and showed that the approach benefits the downstream MRC model. First, the method substantially reduced the inference time of the entire question answering system by 6 to 7 times. Second, our approach helped the MRC model predict the answer more correctly compared with using the original context (F1-score increased from 0.724 to 0.744 for the Question Answering Data Set for COVID-19 and from 0.651 to 0.704 for the Biomedical Semantic Indexing and Question Answering). We also found a potential problem where extractive transformer MRC models predict poorly despite being given a more precise context in some cases. Conclusions: The proposed context extraction method allows the MRC model to achieve improved prediction correctness and a significantly reduced MRC inference time. This approach works technically with any MRC model and has potential in tasks involving processing long texts. %M 38526545 %R 10.2196/52482 %U https://formative.jmir.org/2024/1/e52482 %U https://doi.org/10.2196/52482 %U http://www.ncbi.nlm.nih.gov/pubmed/38526545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52695 %T Nurse-Led Brief Intervention for Enhancing Safe Sex Practice Among Emerging Adults in Hong Kong Using Instant Messaging: Feasibility Study %A Pak,Sharon Hoi Lam %A Wang,Man Ping %A Teitelman,Anne M %A Wong,Janet Yuen Ha %A Fong,Daniel Yee Tak %A Choi,Edmond Pui Hang %+ School of Nursing and Health Studies, Hong Kong Metropolitan University, 11/F, 1 Sheung Shing Street, Homantin, Kowloon, Hong Kong, China (Hong Kong), 852 39702988, jyhwong@hkmu.edu.hk %K condom use %K emerging adults %K HIV prevention %K IM intervention %K mHealth %K nurse-led intervention %K safer sex practice %K sexual health %K sexually transmitted infections %K text-messaging %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults’ attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice. Objective: The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults. Methods: A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen’s feasibility framework. Results: A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001). Conclusions: The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion. %M 38506897 %R 10.2196/52695 %U https://formative.jmir.org/2024/1/e52695 %U https://doi.org/10.2196/52695 %U http://www.ncbi.nlm.nih.gov/pubmed/38506897 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54500 %T Pharmacy Students’ Attitudes Toward Distance Learning After the COVID-19 Pandemic: Cross-Sectional Study From Saudi Arabia %A Alsahali,Saud %A Almutairi,Salman %A Almutairi,Salem %A Almofadhi,Saleh %A Anaam,Mohammed %A Alshammari,Mohammed %A Abdulsalim,Suhaj %A Almogbel,Yasser %+ Department of Pharmacy Practice, College of Pharmacy, Qassim University, Madinah Road, Unaizah, Qassim, Buraydah, 56219, Saudi Arabia, 966 163011503, s.alsahali@qu.edu.sa %K distance learning %K e-learning %K pharmacy education %K team based learning %K educational experience. %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic learning refers to the use of assistive tools in offline and distance learning environments. It allows students to access learning tools and materials anytime and anywhere. However, distance learning courses depend on several factors that affect the quality of learning, which consequently affect students’ preferences in the settings and tools used to deliver educational materials. Objective: This study aimed to evaluate students’ preferences for continuing distance learning after the pandemic and to assess the distance educational environment after the pandemic. It also aimed to identify the factors affecting distance learning and evaluate students’ preferences regarding modes of communication with instructors. Methods: A web-based survey was used to conduct this cross-sectional study. The target participants of this study were students in the doctor of pharmacy program at Unaizah College of Pharmacy, Qassim, Saudi Arabia. All students enrolled from December 2022 to January 2023 received an invitation with a link to the web-based survey. Results: The survey was completed by 141 students (58 female students and 83 male students). The research results showed that most students (102/141, 72.3%) did not wish to continue distance education for laboratory courses, and 60.3% (85/141) did not wish to continue taking distance team-based learning after the pandemic. Additionally, 83.7% (118/141) of the students indicated that distance courses were simple. More than half of the participants (79/141, 56%) stated that having a camera on during class negatively impacted their learning, and only 29.1% (41/141) of the students stated that nonvisual communication with their fellow students impacted their learning. A large proportion of students (83/141, 58.9%) reported impairment of social engagement on campus, 44% (62/141) in-person interactions during classes, and 73.7% (104/141) were relieved that their classes were not disrupted. Conclusions: Similar to all types of education, distance learning is characterized by advantages and disadvantages, as reported by students. Students felt that the course material was intelligible, and the distance course was uncomplicated. Moreover, they expressed relief that their studies were not disrupted. However, they also reported the loss of face-to-face contact during courses as the most significant drawback of distance learning versus face-to-face learning, followed by a lack of social connection on campus. %M 38488833 %R 10.2196/54500 %U https://formative.jmir.org/2024/1/e54500 %U https://doi.org/10.2196/54500 %U http://www.ncbi.nlm.nih.gov/pubmed/38488833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52442 %T Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study %A Keogh,Alison %A Brennan,Carol %A Johnston,William %A Dickson,Jane %A Leslie,Stephen J %A Burke,David %A Megyesi,Peter %A Caulfield,Brian %+ Insight Centre Data Analytics, University College Dublin, Belfield, Dublin, D04V1W8, Ireland, 353 17167777, Alison.keogh@ucd.ie %K digital health %K heart failure %K cardiology %K self-care %K behavior change %K eHealth %K mHealth %K mobile health %K mobile app %K mobile phone %K elderly %K self-care %K self-management %K digital tools %K digital tool %K human-centered design %K app %K apps %K applications %K wearables %K wearable %K Fitbit %K usability %K adherence %K feasibility %K congestive heart failure %K cardiac failure %K myocardial failure %K heart decompensation %D 2024 %7 1.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people’s acceptance of it in practice. Objective: This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. Methods: A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. Results: Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. Conclusions: The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs. %M 38427410 %R 10.2196/52442 %U https://formative.jmir.org/2024/1/e52442 %U https://doi.org/10.2196/52442 %U http://www.ncbi.nlm.nih.gov/pubmed/38427410 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53659 %T Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial %A Shinno,Seina %A Matsumoto,Kazuki %A Hamatani,Sayo %A Inaba,Yosuke %A Ozawa,Yoshihito %A Kawasaki,Yohei %A Ikai,Tomoki %A Sutoh,Chihiro %A Hayashi,Hiroyuki %A Shimizu,Eiji %+ Division of Clinical Psychology, Kagoshima University Medical and Dental Hospital, 1-35-8 Sakuragaoka, Kagoshima, 8908520, Japan, 81 099 275 5707, k2782199@kadai.jp %K cognitive behavioral therapy %K internet intervention %K panic disorder %K social anxiety %K feasibility trail %K adult %K adults %K anxiety disorder %K internet-based %K e-learning %K Japan %K statistical analyses %K therapist %K therapists %K intervention %K severity %K symptoms %K therapeutic alliance %K mobile phone %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. Objective: The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. Methods: In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire–9, Generalized Anxiety Disorder–7, and Working Alliance Inventory–Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire–9, and Generalized Anxiety Disorder–7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5%, and 2-sided 95% CIs were calculated. Results: Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95% CI –22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95% CI –28.4 to –3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95% CI –50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95% CI –59.7 to –4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67% (n=4) showed treatment response, and 50% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. Conclusions: Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043439 %M 38421717 %R 10.2196/53659 %U https://formative.jmir.org/2024/1/e53659 %U https://doi.org/10.2196/53659 %U http://www.ncbi.nlm.nih.gov/pubmed/38421717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51569 %T Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study %A Agarwal,Anish K %A Gonzales,Rachel %A Scott,Kevin %A Merchant,Raina %+ Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 410 Blockley Hall, Philadelphia, PA, 19104, United States, 1 2157465610, anish.agarwal@pennmedicine.upenn.edu %K digital health %K emergency medicine training %K wearable devices %K burnout %K mobile health %K feasibility %K wearable device %K wearable %K physiologic health data %K nurse %K resident %K emergency department %K acceptability %K well-being %D 2024 %7 22.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. Objective: The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. Methods: This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. Results: Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. Conclusions: This pilot study underscores the potential of wearable devices in monitoring emergency clinicians’ physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce. %M 38386373 %R 10.2196/51569 %U https://formative.jmir.org/2024/1/e51569 %U https://doi.org/10.2196/51569 %U http://www.ncbi.nlm.nih.gov/pubmed/38386373 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49317 %T HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let’s Text!): Pilot Feasibility and Acceptability Study %A Haack,Lauren M %A Armstrong,Courtney C %A Travis,Kate %A Aguilera,Adrian %A Darrow,Sabrina M %+ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 675 18th Street, San Francisco, CA, 94107, United States, 1 415 502 8060, lauren.haack@ucsf.edu %K depression %K adolescents %K evidence-based intervention %K texting %K SMS text message %K cognitive behavioral therapy %K CBT %K group CBT %K shelter-in-place %K COVID-19 %K mobile health %K mHealth %K therapy %K cognitive %K behavior %K web-based therapy %K e-therapy %K youth %K young adults %K mobile phone %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants’ texts. Objective: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system’s impact on adolescents’ group CBT engagement and, ultimately, depression outcomes. Methods: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. Results: All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. Conclusions: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants’ qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research. %M 38373030 %R 10.2196/49317 %U https://mental.jmir.org/2024/1/e49317 %U https://doi.org/10.2196/49317 %U http://www.ncbi.nlm.nih.gov/pubmed/38373030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52164 %T Human-Written vs AI-Generated Texts in Orthopedic Academic Literature: Comparative Qualitative Analysis %A Hakam,Hassan Tarek %A Prill,Robert %A Korte,Lisa %A Lovreković,Bruno %A Ostojić,Marko %A Ramadanov,Nikolai %A Muehlensiepen,Felix %+ Center of Orthopaedics and Trauma Surgery, University Clinic of Brandenburg, Brandenburg Medical School, Hochstr 29, Brandenburg an der Havel, 14770, Germany, 49 03381 411940, hassantarek.hakam@mhb-fontane.de %K artificial intelligence %K AI %K large language model %K LLM %K research %K orthopedic surgery %K sports medicine %K orthopedics %K surgery %K orthopedic %K qualitative study %K medical database %K feedback %K detection %K tool %K scientific integrity %K study design %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As large language models (LLMs) are becoming increasingly integrated into different aspects of health care, questions about the implications for medical academic literature have begun to emerge. Key aspects such as authenticity in academic writing are at stake with artificial intelligence (AI) generating highly linguistically accurate and grammatically sound texts. Objective: The objective of this study is to compare human-written with AI-generated scientific literature in orthopedics and sports medicine. Methods: Five original abstracts were selected from the PubMed database. These abstracts were subsequently rewritten with the assistance of 2 LLMs with different degrees of proficiency. Subsequently, researchers with varying degrees of expertise and with different areas of specialization were asked to rank the abstracts according to linguistic and methodological parameters. Finally, researchers had to classify the articles as AI generated or human written. Results: Neither the researchers nor the AI-detection software could successfully identify the AI-generated texts. Furthermore, the criteria previously suggested in the literature did not correlate with whether the researchers deemed a text to be AI generated or whether they judged the article correctly based on these parameters. Conclusions: The primary finding of this study was that researchers were unable to distinguish between LLM-generated and human-written texts. However, due to the small sample size, it is not possible to generalize the results of this study. As is the case with any tool used in academic research, the potential to cause harm can be mitigated by relying on the transparency and integrity of the researchers. With scientific integrity at stake, further research with a similar study design should be conducted to determine the magnitude of this issue. %M 38363631 %R 10.2196/52164 %U https://formative.jmir.org/2024/1/e52164 %U https://doi.org/10.2196/52164 %U http://www.ncbi.nlm.nih.gov/pubmed/38363631 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48690 %T Sodium Intake Estimation in Hospital Patients Using AI-Based Imaging: Prospective Pilot Study %A Ryu,Jiwon %A Kim,Sejoong %A Lim,Yejee %A Ohn,Jung Hun %A Kim,Sun-wook %A Cho,Jae Ho %A Park,Hee Sun %A Lee,Jongchan %A Kim,Eun Sun %A Kim,Nak-Hyun %A Song,Ji Eun %A Kim,Su Hwan %A Suh,Eui-Chang %A Mukhtorov,Doniyorjon %A Park,Jung Hyun %A Kim,Sung Kweon %A Kim,Hye Won %+ Hospital Medicine Center, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil 82, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 7877638, kimhwhw@gmail.com %K artificial intelligence %K AI %K image-to-text %K smart nutrition %K eHealth %K urine %K validation %K AI image %K food AI %K hospital %K sodium intake %K pilot study %K imaging %K diet %K diet management %K sex %K age %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Measurement of sodium intake in hospitalized patients is critical for their care. In this study, artificial intelligence (AI)–based imaging was performed to determine sodium intake in these patients. Objective: The applicability of a diet management system was evaluated using AI-based imaging to assess the sodium content of diets prescribed for hospitalized patients. Methods: Based on the information on the already investigated nutrients and quantity of food, consumed sodium was analyzed through photographs obtained before and after a meal. We used a hybrid model that first leveraged the capabilities of the You Only Look Once, version 4 (YOLOv4) architecture for the detection of food and dish areas in images. Following this initial detection, 2 distinct approaches were adopted for further classification: a custom ResNet-101 model and a hyperspectral imaging-based technique. These methodologies focused on accurate classification and estimation of the food quantity and sodium amount, respectively. The 24-hour urine sodium (UNa) value was measured as a reference for evaluating the sodium intake. Results: Results were analyzed using complete data from 25 participants out of the total 54 enrolled individuals. The median sodium intake calculated by the AI algorithm (AI-Na) was determined to be 2022.7 mg per day/person (adjusted by administered fluids). A significant correlation was observed between AI-Na and 24-hour UNa, while there was a notable disparity between them. A regression analysis, considering patient characteristics (eg, gender, age, renal function, the use of diuretics, and administered fluids) yielded a formula accounting for the interaction between AI-Na and 24-hour UNa. Consequently, it was concluded that AI-Na holds clinical significance in estimating salt intake for hospitalized patients using images without the need for 24-hour UNa measurements. The degree of correlation between AI-Na and 24-hour UNa was found to vary depending on the use of diuretics. Conclusions: This study highlights the potential of AI-based imaging for determining sodium intake in hospitalized patients. %M 38363594 %R 10.2196/48690 %U https://formative.jmir.org/2024/1/e48690 %U https://doi.org/10.2196/48690 %U http://www.ncbi.nlm.nih.gov/pubmed/38363594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49557 %T Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study %A Hahn,Christine %A Tilstra-Ferrell,Emily %A Salim,Selime %A Goodrum,Nada %A Rheingold,Alyssa %A Gilmore,Amanda K %A Barber,Sara %A Moreland,Angela %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St. MSC 861, Charleston, SC, 29425, United States, 1 8437928209, hahnc@musc.edu %K screening, brief intervention, and referral to treatment %K brief intervention %K intimate partner violence %K sexual assault %K substance use %K alcohol use %K mobile phone %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. Objective: This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. Methods: Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). Results: Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant’s favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. Conclusions: Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA. %M 38358791 %R 10.2196/49557 %U https://formative.jmir.org/2024/1/e49557 %U https://doi.org/10.2196/49557 %U http://www.ncbi.nlm.nih.gov/pubmed/38358791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54600 %T Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study %A van der Horst,Annemieke %A Meijer,Laura %A van Os - Medendorp,Harmieke %A Jukema,Jan S %A Bohlmeijer,Ernst %A Schreurs,Karlein MG %A Kelders,Saskia %+ Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, PO BOX 217, Enschede, 7500 AE, Netherlands, 31 (0)53 489 4470, a.vanderhorst-1@utwente.nl %K pilot feasibility study %K spinal surgery %K digital health intervention %K positive psychology %K acceptance and commitment therapy %K mobile phone %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. Objective: The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). Methods: We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum–Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. Results: A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum–Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients. Conclusions: This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted. %M 38324374 %R 10.2196/54600 %U https://formative.jmir.org/2024/1/e54600 %U https://doi.org/10.2196/54600 %U http://www.ncbi.nlm.nih.gov/pubmed/38324374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51066 %T Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study %A Ronen,Keshet %A Gewali,Anupa %A Dachelet,Kristin %A White,Erica %A Jean-Baptiste,Marimirca %A Evans,Yolanda N %A Unger,Jennifer A %A Tandon,S Darius %A Bhat,Amritha %+ Department of Global Health, University of Washington, 3980 15th Avenue North East, Seattle, WA, 98195, United States, 1 2066854363, keshet@uw.edu %K perinatal depression %K youth %K mHealth %K digital health %K acceptability %K utility %K depression %K pilot study %K pregnancy %K postpartum %K prevention %K cognitive behavioral therapy %K psychoeducation %K mixed methods %K manage %K mood %K mobile phone %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. Objective: We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. Methods: IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. Results: Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. Conclusions: This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study’s small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation. %M 38306159 %R 10.2196/51066 %U https://formative.jmir.org/2024/1/e51066 %U https://doi.org/10.2196/51066 %U http://www.ncbi.nlm.nih.gov/pubmed/38306159 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45910 %T Sleep Patterns of Premedical Undergraduate Students: Pilot Study and Protocol Evaluation %A Rajput,Gargi %A Gao,Andy %A Wu,Tzu-Chun %A Tsai,Ching-Tzu %A Molano,Jennifer %A Wu,Danny T Y %+ Department of Biomedical Informatics, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0840, Cincinnati, OH, 45267, United States, 1 5135586464, wutz@ucmail.uc.edu %K patient-generated health data %K Fitbit wearables %K sleep quality %K premedical college students %K sleep %K sleep hygiene %K student %K colleges %K university %K postsecondary %K higher education %K survey %K sleep pattern %K medical student %K adolescence %K behavior change %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor sleep hygiene persists in college students today, despite its heavy implications on adolescent development and academic performance. Although sleep patterns in undergraduates have been broadly investigated, no study has exclusively assessed the sleep patterns of premedical undergraduate students. A gap also exists in the knowledge of how students perceive their sleep patterns compared to their actual sleep patterns. Objective: This study aims to address 2 research questions: What are the sleep patterns of premedical undergraduate students? Would the proposed study protocol be feasible to examine the perception of sleep quality and promote sleep behavioral changes in premedical undergraduate students? Methods: An anonymous survey was conducted with premedical students in the Medical Science Baccalaureate program at an R1: doctoral university in the Midwest United States to investigate their sleep habits and understand their demographics. The survey consisted of both Pittsburg Sleep Quality Index (PSQI) questionnaire items (1-9) and participant demographic questions. To examine the proposed protocol feasibility, we recruited 5 students from the survey pool for addressing the perception of sleep quality and changes. These participants followed a 2-week protocol wearing Fitbit Inspire 2 watches and underwent preassessments, midassessments, and postassessments. Participants completed daily reflections and semistructured interviews along with PSQI questionnaires during assessments. Results: According to 103 survey responses, premedical students slept an average of 7.1 hours per night. Only a quarter (26/103) of the participants experienced good sleep quality (PSQI<5), although there was no significant difference (P=.11) in the proportions of good (PSQI<5) versus poor sleepers (PSQI≥5) across cohorts. When students perceived no problem at all in their sleep quality, 50% (14/28) of them actually had poor sleep quality. Among the larger proportion of students who perceived sleep quality as only a slight problem, 26% (11/43) of them presented poor sleep quality. High stress levels were associated with poor sleep quality. This study reveals Fitbit as a beneficial tool in raising sleep awareness. Participants highlighted Fitbit elements that aid in comprehension such as being able to visualize their sleep stage breakdown and receive an overview of their sleep pattern by simply looking at their Fitbit sleep scores. In terms of protocol evaluation, participants believed that assessments were conducted within the expected duration, and they did not have a strong opinion about the frequency of survey administration. However, Fitbit was found to provide notable variation daily, leading to missing data. Moreover, the Fitbit app’s feature description was vague and could lead to confusion. Conclusions: Poor sleep quality experienced by unaware premedical students points to a need for raising sleep awareness and developing effective interventions. Future work should refine our study protocol based on lessons learned and health behavior theories and use Fitbit as an informatics solution to promote healthy sleep behaviors. %M 38306175 %R 10.2196/45910 %U https://formative.jmir.org/2024/1/e45910 %U https://doi.org/10.2196/45910 %U http://www.ncbi.nlm.nih.gov/pubmed/38306175 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51770 %T An Initial Validation of Community-Based Air-Conduction Audiometry in Adults With Simulated Hearing Impairment Using a New Web App, DigiBel: Validation Study %A Sienko,Anna %A Thirunavukarasu,Arun James %A Kuzmich,Tanya %A Allen,Louise %+ School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0SP, United Kingdom, 44 1223 336700, as2866@cam.ac.uk %K audiology %K audiometry %K hearing test %K eHealth %K mobile application %K automated audiometry %K hearing loss %K hearing impairment %K web-app %K web-apps %K web-application %K digital health %K hearing %K adult %K adults %K mobile health %K mhealth %K community-based %K home-based %K assistive technology %K screening %K usability %K ears %K ear %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 80% of primary school children in the United States and Europe experience glue ear, which may impair hearing at a critical time for speech acquisition and social development. A web-based app, DigiBel, has been developed primarily to identify individuals with conductive hearing impairment who may benefit from the temporary use of bone-conduction assistive technology in the community. Objective: This preliminary study aims to determine the screening accuracy and usability of DigiBel self-assessed air-conduction (AC) pure tone audiometry in adult volunteers with simulated hearing impairment prior to formal clinical validation. Methods: Healthy adults, each with 1 ear plugged, underwent automated AC pure tone audiometry (reference test) and DigiBel audiometry in quiet community settings. Threshold measurements were compared across 6 tone frequencies and DigiBel test-retest reliability was calculated. The accuracy of DigiBel for detecting more than 20 dB of hearing impairment was assessed. A total of 30 adults (30 unplugged ears and 30 plugged ears) completed both audiometry tests. Results: DigiBel had 100% sensitivity (95% CI 87.23-100) and 72.73% (95% CI 54.48-86.70) specificity in detecting hearing impairment. Threshold mean bias was insignificant except at 4000 and 8000 Hz where a small but significant overestimation of threshold measurement was identified. All 24 participants completing feedback rated the DigiBel test as good or excellent and 21 (88%) participants agreed or strongly agreed that they would be able to do the test at home without help. Conclusions: This study supports the potential use of DigiBel as a screening tool for hearing impairment. The findings will be used to improve the software further prior to undertaking a formal clinical trial of AC and bone-conduction audiometry in individuals with suspected conductive hearing impairment. %M 38271088 %R 10.2196/51770 %U https://formative.jmir.org/2024/1/e51770 %U https://doi.org/10.2196/51770 %U http://www.ncbi.nlm.nih.gov/pubmed/38271088 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48992 %T Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study %A Adams,Leslie B %A Watts,Thomasina %A DeVinney,Aubrey %A Haroz,Emily E %A Thrul,Johannes %A Stephens,Jasmin Brooks %A Campbell,Mia N %A Antoine,Denis %A Lê Cook,Benjamin %A Joe,Sean %A Thorpe Jr,Roland J %+ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, United States, 1 410 955 1906, ladams36@jhu.edu %K Black men %K suicide %K ecological momentary assessment %K feasibility %K acceptability %K mixed methods %K smartphone %K real-time assessment %K suicide prevention %K user experience %K behavior %K implementation %K intervention %K mobile phone %D 2024 %7 22.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. Objective: This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. Methods: We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study’s conclusion. Results: In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. Conclusions: Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. International Registered Report Identifier (IRRID): RR2-10.2196/31241 %M 38252475 %R 10.2196/48992 %U https://formative.jmir.org/2024/1/e48992 %U https://doi.org/10.2196/48992 %U http://www.ncbi.nlm.nih.gov/pubmed/38252475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48960 %T Digital Health Needs and Preferences During Pregnancy and the Postpartum Period: Mixed Methods Study %A Henrich,Natalie %A Brinson,Alison %A Arnold,Alyssa %A Jahnke,Hannah R %+ Maven Clinic, 160 Varick St, New York, NY, 10013, United States, 1 212 457 1790, natalie.henrich@mavenclinic.com %K digital health %K perinatal %K pregnancy %K postpartum %K interviews %K survey %K user needs %K patient centered %K mixed methods %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health is increasingly used to meet the needs of perinatal people, with estimates of pregnancy-related internet use ranging from 90% to 97% of pregnant people. As digital health takes on greater importance during the perinatal period, it is essential that providers and developers of digital health content understand why perinatal people use these resources and the features that enhance their experience. However, gaps remain in understanding the content that is most helpful and how the platforms are navigated. Learning directly from perinatal people about their needs will help ensure alignment between perinatal needs and available content. Objective: This formative study aims to identify the reasons why perinatal people use digital health resources; the features of the digital health platforms that are of greatest importance to them; and how these differ by perinatal stage (pregnancy vs post partum), mental health conditions, parity, and demographics (race and ethnicity). Methods: This mixed methods study used interviews; surveys; and secondary data on demographic, health, and pregnancy characteristics to identify the digital health needs and preferences of pregnant and postpartum people who used the Maven digital health platform in the United States during their pregnancy or postpartum period. The interviews informed the content of the surveys and provided additional insights and examples for interpreting the survey results. The surveys were used to collect data from a sample of Maven users, and the results were linked to the secondary data set. The interviews were thematically analyzed, and survey data were analyzed using descriptive statistics and stratified by parity, race, and mental health status. Results: Overall, 13 people were interviewed (including n=4, 31% pilot interviews), and 147 pregnancy and 110 postpartum survey respondents completed the surveys and had linkable secondary data. Top reasons for using digital health resources during pregnancy were to (1) know what is normal or typical during pregnancy, (2) have access to a health care provider when needed, and (3) know how the baby is developing. Top reasons for postpartum use were to (1) help with breastfeeding, (2) know what normal baby development is, and (3) help with the baby’s health issues. Top platform features during pregnancy and the postpartum period were (1) credible and trustworthy information and providers, (2) nonjudgmental information and support, and (3) no cost to the user. In general, more reasons for using digital resources were identified as extremely important during pregnancy compared with post partum. The results showed minor variations across strata. Conclusions: This formative research found minor differences in digital resource needs and preferences across user characteristics among perinatal people in the United States. Future work should examine whether there are variations in interests within topics by user characteristics, which may provide additional opportunities to better meet user needs. %M 38214971 %R 10.2196/48960 %U https://formative.jmir.org/2024/1/e48960 %U https://doi.org/10.2196/48960 %U http://www.ncbi.nlm.nih.gov/pubmed/38214971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46402 %T Acceptance of Medical Artificial Intelligence in Skin Cancer Screening: Choice-Based Conjoint Survey %A Jagemann,Inga %A Wensing,Ole %A Stegemann,Manuel %A Hirschfeld,Gerrit %+ School of Business, University of Applied Sciences and Arts Bielefeld, Interaktion 1, Bielefeld, 33619, Germany, 49 521106 ext 70508, inga.jagemann@hsbi.de %K artificial intelligence %K skin cancer screening %K choice experiment %K melanoma %K conjoint analysis, technology acceptance %K adoption %K technology use %K dermatology %K skin cancer %K oncology %K screening %K choice based %K trust %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is great interest in using artificial intelligence (AI) to screen for skin cancer. This is fueled by a rising incidence of skin cancer and an increasing scarcity of trained dermatologists. AI systems capable of identifying melanoma could save lives, enable immediate access to screenings, and reduce unnecessary care and health care costs. While such AI-based systems are useful from a public health perspective, past research has shown that individual patients are very hesitant about being examined by an AI system. Objective: The aim of this study was two-fold: (1) to determine the relative importance of the provider (in-person physician, physician via teledermatology, AI, personalized AI), costs of screening (free, 10€, 25€, 40€; 1€=US $1.09), and waiting time (immediate, 1 day, 1 week, 4 weeks) as attributes contributing to patients’ choices of a particular mode of skin cancer screening; and (2) to investigate whether sociodemographic characteristics, especially age, were systematically related to participants’ individual choices. Methods: A choice-based conjoint analysis was used to examine the acceptance of medical AI for a skin cancer screening from the patient’s perspective. Participants responded to 12 choice sets, each containing three screening variants, where each variant was described through the attributes of provider, costs, and waiting time. Furthermore, the impacts of sociodemographic characteristics (age, gender, income, job status, and educational background) on the choices were assessed. Results: Among the 383 clicks on the survey link, a total of 126 (32.9%) respondents completed the online survey. The conjoint analysis showed that the three attributes had more or less equal importance in contributing to the participants’ choices, with provider being the most important attribute. Inspecting the individual part-worths of conjoint attributes showed that treatment by a physician was the most preferred modality, followed by electronic consultation with a physician and personalized AI; the lowest scores were found for the three AI levels. Concerning the relationship between sociodemographic characteristics and relative importance, only age showed a significant positive association to the importance of the attribute provider (r=0.21, P=.02), in which younger participants put less importance on the provider than older participants. All other correlations were not significant. Conclusions: This study adds to the growing body of research using choice-based experiments to investigate the acceptance of AI in health contexts. Future studies are needed to explore the reasons why AI is accepted or rejected and whether sociodemographic characteristics are associated with this decision. %M 38214959 %R 10.2196/46402 %U https://formative.jmir.org/2024/1/e46402 %U https://doi.org/10.2196/46402 %U http://www.ncbi.nlm.nih.gov/pubmed/38214959 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46284 %T Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study %A Gill,Roopan %A Ogilvie,Gina %A Norman,Wendy V %A Fitzsimmons,Brian %A Maher,Ciana %A Renner,Regina %+ Department of Obstetrics and Gynecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto, ON, M5G1E2, Canada, 1 4169782216, roopan.gill@gmail.com %K mobile health %K mHealth %K digital health %K abortion %K human-centered design %K sexual and reproductive health %K qualitative research %K mixed methods %D 2024 %7 9.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. Objective: This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. Methods: People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women’s and Children’s Research Ethics Board. Results: Overall, 62 participants were recruited (average age 30 y); 40% (25/62) of the participants completed the exit surveys, and 24% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80%, with a click rate of 36%. Conclusions: This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion. %M 38194252 %R 10.2196/46284 %U https://formative.jmir.org/2024/1/e46284 %U https://doi.org/10.2196/46284 %U http://www.ncbi.nlm.nih.gov/pubmed/38194252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48402 %T The Effects of a Parent-Focused Social Media Intervention on Child Sun Safety: Pilot and Feasibility Study %A Manne,Sharon %A Wu,Yelena %A Buller,David %A Heckman,Carolyn %A Devine,Katie %A Frederick,Sara %A Solleder,Justin %A Schaefer,Alexis %A Lu,Shou-En %+ Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 120 Albany Street Tower II, New Brunswick, NJ, 08901, United States, 1 7323577978, mannesl@cinj.rutgers.edu %K health behavior %K health promotion and prevention %K parenting %K prevention science %K parents %K parent %K Facebook %K social media %K sun %K prevention %K skin %K dermatology %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle childhood (ages 8-12 years) is a critical period for forming behavioral habits and reducing the risk for the development of skin cancer later in life. During this time, children develop more autonomy and spend more unsupervised time away from their parents. Professional agencies recommend that all children engage in regular sun protection behaviors and avoid the sun during peak daytime hours. Unfortunately, in middle childhood, child sun protection often declines and UV radiation exposure increases. Effective parenting involves balancing ways to encourage the child’s increasing independence while providing practical assistance to ensure sun protection is implemented. Objective: The goal was to evaluate the feasibility, acceptability, and preliminary effects of Sun Safe Families, a Facebook group intervention for parents of children between 8 and 12 years of age. Methods: The team developed Facebook messages targeting parent knowledge, normative influences, sun safety barriers, planning and goal setting, confidence in implementing sun safety, communication, forming habits, and managing sun safety in risky situations. A total of 92 parents were enrolled, and the groups ran for 6 weeks. Feasibility was measured by enrollment and retention rates. Acceptability was measured by engagement in the Facebook groups. Satisfaction was assessed by a treatment evaluation. At pre- and post-intervention, parents completed measures of child sun protection, UV radiation exposure, sunburn, sun safety knowledge, child risk, barriers, sun protection self-efficacy, planning, sun safe habits, norms for child sun safety, and communication about sun safety. Results: Enrollment (64.3%, 92/143) and retention (94.6%, 87/92) were good. On average, participants viewed 67.6% (56.8/84) of posts, “liked” 16.4% (13.77/84) of posts, commented on 14.8% (12.43/84) of posts, and voted on 46% (6.4/14) of polls. Satisfaction was excellent. From pre- to post-intervention, there were significant increases in child sun protection, sun exposure, and sunburn (P<.01; moderate effect sizes), as well as statistically significant increases in planning and self-efficacy (P<.05) and family norms and parent communication (P<.01). Conclusions: This study demonstrated high survey retention, acceptability, and satisfaction with the intervention. There were promising preliminary effects on child sun protection behaviors and parent sun protection attitudes and communication with their child. Replication with a larger sample size and a comparison condition is warranted. %M 38064250 %R 10.2196/48402 %U https://formative.jmir.org/2023/1/e48402 %U https://doi.org/10.2196/48402 %U http://www.ncbi.nlm.nih.gov/pubmed/38064250 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50324 %T Sadness-Based Approach-Avoidance Modification Training for Subjective Stress in Adults: Pilot Randomized Controlled Trial %A Rupp,Lydia Helene %A Keinert,Marie %A Böhme,Stephanie %A Schindler-Gmelch,Lena %A Eskofier,Bjoern %A Schuller,Björn %A Berking,Matthias %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nägelsbachstr. 25a, Erlangen, 91052, Germany, 49 91318567560, lydia.rupp@fau.de %K stress %K emotion %K eHealth %K approach-avoidance %K mental health %K somatic health %K chronic stress %K intervention %K stress-related illness %K app-based %K stress management %K belief %K training %K mobile phone %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs. Objective: We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention. Methods: We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions. Results: The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=−0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition. Conclusions: The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials. Trial Registration: German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007 %M 38032725 %R 10.2196/50324 %U https://formative.jmir.org/2023/1/e50324 %U https://doi.org/10.2196/50324 %U http://www.ncbi.nlm.nih.gov/pubmed/38032725 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e49135 %T Using Mobile Ecological Momentary Assessment to Understand Consumption and Context Around Online Food Delivery Use: Pilot Feasibility and Acceptability Study %A Jia,Si Si %A Allman-Farinelli,Margaret %A Roy,Rajshri %A Phongsavan,Philayrath %A Hyun,Karice %A Gibson,Alice Anne %A Partridge,Stephanie Ruth %+ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown NSW 2006, Sydney, 2006, Australia, 61 2 8627 1697, sisi.jia@sydney.edu.au %K ecological momentary assessment %K mobile applications %K mobile apps %K feasibility studies %K online food delivery %K smartphone %K young adult %K adolescent %K food environment %K consumer behavior %K mobile phone %D 2023 %7 29.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile ecological momentary assessment (EMA) is a powerful tool for collecting real-time and contextual data from individuals. As our reliance on online technologies to increase convenience accelerates, the way we access food is changing. Online food delivery (OFD) services may further encourage unhealthy food consumption habits, given the high availability of energy-dense, nutrient-poor foods. We used EMA to understand the real-time effects of OFD on individuals’ food choices and consumption behaviors. Objective: The primary aims of this pilot study were to assess the feasibility and acceptability of using EMA in young users of OFD and compare 2 different EMA sampling methods. The secondary aims were to gather data on OFD events and their context and examine any correlations between demographics, lifestyle chronic disease risk factors, and OFD use. Methods: This study used EMA methods via a mobile app (mEMASense, ilumivu Inc). Existing users of OFD services aged 16 to 35 years in Australia who had access to a smartphone were recruited. Participants were randomly assigned to 1 of 2 groups: signal-contingent or event-contingent. The signal-contingent group was monitored over 3 days between 7 AM and 10 PM. They received 5 prompts each day to complete EMA surveys via the smartphone app. In contrast, the event-contingent group was monitored over 7 days and was asked to self-report any instance of OFD. Results: A total of 102 participants were analyzed, with 53 participants in the signal-contingent group and 49 participants in the event-contingent group. Compliance rates, indicating the feasibility of signal-contingent and event-contingent protocols, were similar at 72.5% (574/792) and 73.2% (251/343), respectively. Feedback from the participants suggested that the EMA app was not easy to use, which affected their acceptability of the study. Participants in the event-contingent group were 3.53 (95% CI 1.52-8.17) times more likely to have had an OFD event captured during the study. Pizza (23/124, 18.5%) and fried chicken (18/124, 14.5%) comprised a bulk of the 124 OFD orders captured. Most orders were placed at home (98/124, 79%) for 1 person (68/124, 54.8%). Age (incidence rate ratio 0.95, 95% CI 0.91-0.99; P=.03) and dependents (incidence rate ratio 2.01, 95% CI 1.16-3.49; P=.01) were significantly associated with the number of OFD events in a week after adjusting for gender, socioeconomic status, diet quality score, and perceived stress levels. Conclusions: This pilot study showed that EMA using an event-contingent sampling approach may be a better method to capture OFD events and context than signal-contingent sampling. The compliance rates showed that both sampling methods were feasible and acceptable. Although the findings from this study have gathered some insight on the consumption and context of OFD in young people, further studies are required to develop targeted interventions. %M 38019563 %R 10.2196/49135 %U https://mhealth.jmir.org/2023/1/e49135 %U https://doi.org/10.2196/49135 %U http://www.ncbi.nlm.nih.gov/pubmed/38019563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46253 %T Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study %A Demetry,Youstina %A Wasteson,Elisabet %A Lindegaard,Tomas %A Abuleil,Amjad %A Geranmayeh,Anahita %A Andersson,Gerhard %A Shahnavaz,Shervin %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Norra stationsgatan 69, Stockholm, Sweden, 46 739522332, youstina.demetry@ki.se %K internet-based interventions %K cultural adaptation %K Arabic %K youth %K depression %K anxiety %K refugees %K mental health %K Arabic-speaking youth %K mental disorder %K psychological intervention %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. Objective: This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. Methods: A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. Results: The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. Conclusions: The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation. %M 37999955 %R 10.2196/46253 %U https://formative.jmir.org/2023/1/e46253 %U https://doi.org/10.2196/46253 %U http://www.ncbi.nlm.nih.gov/pubmed/37999955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52336 %T Investigating the Feasibility, Acceptability, and Appropriation of a Socially Assistive Robot Among Minority Youth at Risk of Self-Harm: Results of 2 Mixed Methods Pilot Studies %A Williams,A Jess %A Townsend,Ellen %A Naeche,Nkem %A Chapman-Nisar,Amelia %A Hollis,Chris %A Slovak,Petr %A , %+ Department of Informatics, King's College London, 30 Aldwych, Bush House, Strand Campus, London, WC2B 4BG, United Kingdom, 44 020 7848 1988, amy_jess.williams@kcl.ac.uk %K digital intervention %K self-harm %K young people %K emotion regulation %K experience sampling %K interviews %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Minority youth are at an increased risk of experiencing self-harmful thoughts and behaviors. However, there is limited evidence of successful interventions to support young people in the moment of their distress. Digital interventions are considered a potential solution for providing in-the-moment support for those at risk of adverse mental health and self-harm. Objective: These pilot studies aim to investigate the feasibility and acceptability of a new in situ intervention tool, Purrble, among two broad groups of minority youth: (1) lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) youth and (2) racial and ethnic minority youth. Purrble was designed to support in-situ emotion regulation (ER) support when individuals are facing emotionally challenging situations. Methods: This study consisted of 2 mixed methods pilot studies that followed the same mixed methods design, including 3 weeks of daily and weekly surveys and optional follow-up interviews. Inclusion criteria were (1) aged between 16 and 25 years, (2) part of a minority group, (3) had experiences of self-harmful thoughts or behaviors or elevated symptoms of depression or anxiety, and (4) living in the United Kingdom at the time of the study. The primary outcomes were (1) the feasibility of Purrble as an intervention among pilot samples (analyzed by consent rate, retention rate, adherence to surveys, and engagement with the device) and (2) the acceptability and appropriation of Purrble across pilot studies as a tool to support ER in situ (thematically analyzed qualitative open-ended questions and interview data). The secondary outcomes were descriptive pilot data concerning the mental health outcomes in each sample. Results: In total, 21 LGBTQ+ young people participated in pilot study 1, with 86% (n=18) completing the baseline and 3 weeks of daily surveys. These young people maintained engagement with Purrble across deployment, across which period there was a decrease in self-harmful thoughts and anxiety symptoms. A total of 19 ethnic and racial minority youths participated in pilot study 2, and 84% (n=16) completed the study. Although pilot study 2 participants also maintained engagement with Purrble across deployment, this was to a lesser degree than participants of pilot study 1, and perceived mental health outcomes did not indicate potential change associated with the device. The thematic analysis indicated three superordinate themes: (1) stopping the self-harm cycle, (2) adopting ER strategies, and (3) stages of change. Conclusions: These were the first pilot studies of a novel intervention that aimed to provide in situ ER support for young people at risk of self-harm. Both quantitative and qualitative findings indicate that young people found Purrble to be a feasible and acceptable intervention, as they effectively incorporated the device into their ER practices. These engagements with Purrble were described as interrupting the cycle of self-harmful ideation and behavior. %M 37991838 %R 10.2196/52336 %U https://formative.jmir.org/2023/1/e52336 %U https://doi.org/10.2196/52336 %U http://www.ncbi.nlm.nih.gov/pubmed/37991838 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51541 %T Improving Patient Health Literacy During Telehealth Visits Through Remote Teach-Back Methods Training for Family Medicine Residents: Pilot 2-Arm Cluster, Nonrandomized Controlled Trial %A Barksdale,Shanikque %A Stark Taylor,Shannon %A Criss,Shaniece %A Kemper,Karen %A Friedman,Daniela B. %A Thompson,Wanda %A Donelle,Lorie %A MacGilvray,Phyllis %A Natafgi,Nabil %+ Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery Bldg. Suite 349, Columbia, SC, 29208, United States, 1 803 777 8133, nnatafgi@mailbox.sc.edu %K digital health %K family medicine %K health literacy %K medical residents %K patient engagement %K patient-centered %K residency program %K teach-back %K telehealth %K telemedicine %K virtual care %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients’ understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. Objective: We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. Methods: We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop’s videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. Results: Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents’ confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. Conclusions: This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers’ concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers’ ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform. %M 37971799 %R 10.2196/51541 %U https://formative.jmir.org/2023/1/e51541 %U https://doi.org/10.2196/51541 %U http://www.ncbi.nlm.nih.gov/pubmed/37971799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51752 %T Use of Social Media for Health Advocacy for Digital Communities: Descriptive Study %A Ezeilo,Chidimma Ogechukwu %A Leon,Nicholas %A Jajodia,Anushka %A Han,Hae-Ra %+ Johns Hopkins University School of Nursing, 525 N Wolfe Street, Baltimore, MD, 21205, United States, 1 4106142669, hhan3@jhu.edu %K social media %K health advocacy %K community health %K Twitter %K health communication %K health promotion %K communication %K communications %K advocacy %K tweet %K tweets %K nurse %K nurses %K nursing %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been a growth surge in the use of social media among individuals today. The widespread adoption of these platforms, coupled with their engaging features, presents a unique opportunity for the dissemination of health advocacy information. Social media is known as a powerful tool used to share health policy and advocacy efforts and disseminate health information to digital community members and networks. Yet, there is still a gap in the full exploitation of this powerful instrument, among health care professionals, for health advocacy campaigns. Objective: This paper aims to describe the process of mobilizing social media platforms such as Twitter (rebranded to X Corp in 2023) for health advocacy of the digital community. Additionally, it aims to share the lessons and insights gained during this digital health advocacy engagement process. Methods: We performed a comprehensive review of Twitter analytical data to examine the impact of our social media posts. We then consolidated these analytic reports with our meeting logs to describe our systematic, iterative, and collaborative design process to implement social media efforts and generate key lessons learned. Results: Our review of monthly Twitter analytical reports and regular team meeting logs revealed several themes for successful and less successful practices in relation to our social media–based health advocacy efforts. The successful practices noted by the team included using personable, picture-based tweets; using a series of posts on a particular topic rather than an isolated post; leveraging team members’ and partners’ collaborations in shared posts; incorporating hashtags in tweets; using a balanced mix of texts and graphics in posts; using inclusive (nondestigmatizing) languages in tweeted posts; and use of polls to share tweets. Among the many lessons learned, we also experienced limitations including a lack of comprehensive statistics on Twitter usage for health care–related purposes such as health advocacy and limits in collating the estimates of the actual impact made on the intended digital community members by our posts. Conclusions: Twitter has been successfully used in promoting health advocacy content, and the social media team aims to explore other social media platforms that have a wider reach than Twitter. We will continue making necessary adjustments in strategies, techniques, and styles to engage the audience as we expand onto new platforms like Instagram and TikTok for health advocacy promotions. %M 37962914 %R 10.2196/51752 %U https://formative.jmir.org/2023/1/e51752 %U https://doi.org/10.2196/51752 %U http://www.ncbi.nlm.nih.gov/pubmed/37962914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47977 %T Use of Peer-Led Web-Based Platforms for Peer-Assisted Learning Among Canadian Anesthesia Residents and Fellows: Cross-Sectional Study %A Li,Casey %A Salman,Maria %A Esmail,Tariq %A Matava,Clyde %+ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada, 1 4168137445, clyde.matava@sickkids.ca %K medical education %K anesthesia %K residents %K fellowship %K social media %K peer led %K peer assisted learning %K anesthesiology %K mobile device usage %K health care %K medical trainee %K perception %K mobile app %K digital health %D 2023 %7 13.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Peer-assisted learning (PAL) using peer-led web-based platforms (PWPs), including social media, can be a highly effective method of supporting medical trainees. PWPs, such as mobile apps for sharing anesthesia resources and social media groups or discussion forums pertaining to anesthesia training, may play a role in facilitating anesthesia trainee-led web-based education. However, there have been many challenges facing anesthesia trainees when it comes to incorporating PWPs, especially social media and mobile apps for PAL. Objective: The primary objective of this survey was to assess the proportion of trainees that use social media and mobile apps. The secondary objective was to identify the trainees’ perceptions on the use of social media and mobile apps for educational purposes, including PAL. Methods: This cross-sectional study was conducted through a survey administered via email at a single large academic center. The survey tool collected data between 2016 and 2017 on the following: demographic data (year of study, field of specialty), use of technology and web-based resources for medicine, use of social media platforms for anesthesia or training, benefits and barriers to future uses of social media for training, and ideas for trainee-led websites. Descriptive statistics were reported. Results: In total, 80 anesthesia trainees (51 residents and 29 fellows) responded to the survey (response rate of 33% of out 240 trainees contacted). All trainees reported having a mobile device that most (n=61, 76%) reported using multiple times a day to access medical resources. The highest perceived benefits of PWPs according to residents were that the most valuable information was available on-demand (n=27, 53%), they saved time (n=27, 53%), and they improved their overall learning experience within anesthesia (n=24, 47%). In comparison, fellows thought that PWPs were beneficial because they provided multiple perspectives of a single topic (n=13, 45%) and served as an additional platform to discuss ideas with peers (n=13, 45%). The most popular platforms used by both residents and fellows were Facebook (residents: n=44, 86%; fellows: n=26, 90%) followed by LinkedIn (residents: n=21, 42%; fellows: n=9, 29%). Even though most anesthesia trainees used social media for personal reasons, only 26% (n=21) reported having used resident- or fellow-driven PWP resources. Examples of PWPs that trainees used included anesthesia groups and a resident Dropbox resource folder. Conclusions: There was generally an acceptance for using PWPs for PAL as they provided various benefits for trainees at all levels of learning. PWPs have the potential to garner an increased sense of community and sharing within learning experiences throughout all levels of training. The information gained from this survey will help inform the basis for developing an anesthesia trainee-led e-learning platform. %M 37955954 %R 10.2196/47977 %U https://formative.jmir.org/2023/1/e47977 %U https://doi.org/10.2196/47977 %U http://www.ncbi.nlm.nih.gov/pubmed/37955954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49459 %T Strengths and Weaknesses of ChatGPT Models for Scientific Writing About Medical Vitamin B12: Mixed Methods Study %A Abuyaman,Omar %+ Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, FAMS Bldg, 2nd fl, Zarqa, 13133, Jordan, 962 781074280, o.abuyaman@gmail.com %K AI %K ChatGPT %K GPT-4 %K GPT-3.5 %K vitamin B12 %K artificial intelligence %K language editing %K wide range information %K AI solutions %K scientific content %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: ChatGPT is a large language model developed by OpenAI designed to generate human-like responses to prompts. Objective: This study aims to evaluate the ability of GPT-4 to generate scientific content and assist in scientific writing using medical vitamin B12 as the topic. Furthermore, the study will compare the performance of GPT-4 to its predecessor, GPT-3.5. Methods: The study examined responses from GPT-4 and GPT-3.5 to vitamin B12–related prompts, focusing on their quality and characteristics and comparing them to established scientific literature. Results: The results indicated that GPT-4 can potentially streamline scientific writing through its ability to edit language and write abstracts, keywords, and abbreviation lists. However, significant limitations of ChatGPT were revealed, including its inability to identify and address bias, inability to include recent information, lack of transparency, and inclusion of inaccurate information. Additionally, it cannot check for plagiarism or provide proper references. The accuracy of GPT-4’s answers was found to be superior to GPT-3.5. Conclusions: ChatGPT can be considered a helpful assistant in the writing process but not a replacement for a scientist’s expertise. Researchers must remain aware of its limitations and use it appropriately. The improvements in consecutive ChatGPT versions suggest the possibility of overcoming some present limitations in the near future. %M 37948100 %R 10.2196/49459 %U https://formative.jmir.org/2023/1/e49459 %U https://doi.org/10.2196/49459 %U http://www.ncbi.nlm.nih.gov/pubmed/37948100 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50833 %T An eHealth Prevention Program for Substance Use, Sexual Assault, and Sexual Risk Behaviors for Adolescents in Primary Care: Pilot Feasibility Randomized Controlled Trial of Teen Well Check %A Gilmore,Amanda K %A Fortson,Kennicia %A Mullican,K Nicole %A García-Ramírez,Grisel %A Hutchins,Anna %A Bartlett,Alyssa M %A Gooding,Holly C %A Wallis,Elizabeth %A Levy,Sharon %A Ruggiero,Kenneth J %A Kaysen,Debra %A Danielson,Carla Kmett %A Platner,Robert %A Hartman,April %A Self-Brown,Shannon %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302, United States, agilmore12@gsu.edu %K prevention %K adolescents %K eHealth %K drug use %K sexual assault %K sexual health %D 2023 %7 2.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. Objective: Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. Methods: Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. Results: We recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). Conclusions: These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. Trial Registration: ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434 %M 37917146 %R 10.2196/50833 %U https://formative.jmir.org/2023/1/e50833 %U https://doi.org/10.2196/50833 %U http://www.ncbi.nlm.nih.gov/pubmed/37917146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e30443 %T Reducing Dental Anxiety in Children Using a Mobile Health App: Usability and User Experience Study %A del Carmen,María del Carmen %A Cagigas-Muñiz,Daniel %A García-Robles,Rocío %A Oprescu,Andreea Madalina %+ Universidad de Sevilla, Avda. Reina Mercedes s/n, Sevilla, 41012, Spain, 34 954554324, mcromerot@us.es %K dentistry %K dental anxiety %K children %K mobile %K app %K usability %K user experience %K human-centered design %K mobile health %K mHealth %K digital health %K mobile application %K application development %D 2023 %7 27.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Dentistry interventions cause common anxiety and fear problems in children (6-11 years), and according to scientific evidence, this causes a decrease in their quality of life. Therapies mediated by IT-based tools have been shown to positively influence children’s mood based on distraction as well as relaxing activities, but there is no evidence of their use to reduce dental anxiety in children. Objective: The aim of this study was to answer the following research question: Does our new children-centered codesign methodology contribute to achieving a usable mobile-based product with a highly scored user experience? Methods: A mobile health app was developed to reduce dental anxiety in children using rapid application development following the usage-centered design methodology. Structured interviews were conducted to test the usability and user experience of the app prototype among 40 children (n=20, 50%, boys and n=20, 50%, girls; age 6-11 years) using a children-adapted questionnaire and the 7-point Single Ease Question rating scale. The Smiley Faces Program—Revised questionnaire was used to assess the level of dental anxiety in participants. Results: There were no significant differences between girls and boys. The task completion rate was 95% (n=19) for children aged 6-8 years (group 1) and 100% (n=20) for children aged 9-11 years (group 2). Group 1 found watching the relaxing video (task C) to be the easiest, followed by playing a video minigame (task B) and watching the narrative (task A). Group 2 found task C to be the easiest, followed by task A and then task B. The average time spent on the different types of tasks was similar in both age groups. Most of the children in both age groups were happy with the app and found it funny. All children thought that having the app in the waiting room during a dental visit would be useful. Conclusions: The findings confirmed that the app is usable and provides an excellent user experience. Our children-adapted methodology contributes to achieving usable mobile-based products for children with a highly scored user experience. %M 37889521 %R 10.2196/30443 %U https://formative.jmir.org/2023/1/e30443 %U https://doi.org/10.2196/30443 %U http://www.ncbi.nlm.nih.gov/pubmed/37889521 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48515 %T A Mobile App to Assist the Mentors of African American Young Men Who Have Sex With Men: Usability Study %A Kaufman,Michelle R %A Wright,Kate %A Eschliman,Evan L %A Levine,Deborah %A Simon,Jeannette %+ Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, United States, 1 410 955 2313, michellekaufman@jhu.edu %K mentoring %K youth %K mobile app %K men who have sex with men %K MSM %K HIV prevention %K healthy relationships %K African American %D 2023 %7 27.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in general and even less on the role that mentors may play in promoting healthy outcomes in sexual and gender minority youth. African American young men who have sex with men (YMSM) are more likely to reside in communities with limited access to formalized mentorship programs and may benefit from naturally occurring mentoring relationships that address health outcomes, specifically related to HIV. Objective: This study is a usability test of a mobile app designed for the mentors of African American YMSM to increase mentors’ knowledge of and confidence in talking about HIV prevention and related topics with mentees. Methods: Following consent, eligible and naturally occurring mentoring pairs involving African American YMSM in Baltimore; Philadelphia; and Washington, District of Columbia, tested the app, UrbanMentorHub, for usability. Participants downloaded the app and used it for 1 month, completed pre- and postintervention surveys, and participated in a follow-up focus group discussion. Participants’ sociodemographic characteristics and HIV- and mentorship-related measures were characterized using descriptive statistics. Wilcoxon signed rank tests were used to test for pre- and postintervention differences in knowledge, confidence, and outcome expectancy measures. Focus group discussions were audio recorded and transcribed. Transcripts were thematically coded and analyzed to identify ways that UrbanMentorHub could be improved in the mentoring context. Results: Nine mentorship pairs participated in this usability study (N=18). Mentors obtained high scores on knowledge, confidence, outcome expectancies, skills, and intentions related to HIV and mentoring. No pre- or postintervention changes were observed in these measures. Mentors reported usually initiating conversations around HIV testing and pre-exposure prophylaxis; mentees and mentors equally initiated conversations on sexual practices and same-sex relationships. Mentors reported sexual practices as the most frequently discussed topic in the past month and pre-exposure prophylaxis being the least discussed. Mentees reported high comfort with HIV-related conversations. No pre- or postintervention change was observed regarding HIV knowledge. Most mentees reported having discussed most HIV-related topics with their mentor in the past month. Mentor feedback on the app was mostly neutral, although they reported positive perceptions of the idea of the app, indicating the potential for addressing a need in their communities. Mentors suggested ways to improve the app content and design elements. Conclusions: Although there was no observed statistical change in measured outcomes, and qualitative feedback was overall neutral, the results of this usability study can inform future work to design and promote interventions and resources that support mentoring relationships for African American YMSM. %M 37889552 %R 10.2196/48515 %U https://formative.jmir.org/2023/1/e48515 %U https://doi.org/10.2196/48515 %U http://www.ncbi.nlm.nih.gov/pubmed/37889552 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49009 %T An Implementation Pilot of Web-Based Self-Training Programs on Sexual Dysfunctions in the Dutch Public Sexual Health Setting: Mixed Methods Study %A Zimbile,Filippo %A Beek,Titia %A David,Silke %A Crutzen,Rik %+ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3720BA, Netherlands, 31 0651953096, filippo.zimbile@rivm.nl %K implementation pilot digital health %K e-sexual health %K sexual dysfunctions %K self-care %K public health %K sexual issue %K barrier %K sexual health %K intervention %K young adult %K young %K sexual problem %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based sexual health interventions may be more acceptable to people compared with face-to-face support, given the stigma and embarrassment often associated with sexual problems. The Dutch public sexual health clinics (SHCs) conducted an implementation pilot with 4 web-based self-training programs on sexual dysfunctions (WSTPs) for young people. In addition to a basic sexuality program, the WSTPs focused on the following complaints: pain during intercourse, premature ejaculation, and no sex drive. Objective: This study aims to gain insight into the potential reach of the freely offered WSTPs; use, acceptance, evaluation, and perceived impact of the WSTPs by young people; and evaluation and acceptance of the WSTPs by nurses of the SHCs. Methods: A quantitative baseline measurement (BM) and a follow-up measurement (FM) were conducted among the users. In addition, qualitative data were gathered through video interviews with a sample of respondents of the FM and nurses of the SHCs to gain more in-depth insights into their assessment of the WSTPs. Participants were recruited via social media, posters, and referrals by nurses of the SHCs. Quantitative data were analyzed using descriptive statistics. Independent 2-tailed t tests and one-way independent ANOVAs were used to compare the scores between subgroups based on background characteristics. Dependent 2-tailed t tests were used to assess the possible changes between BM and FM. The interviews were analyzed using a thematic analysis. Results: A total of 1028 young people (aged 16-24 y) completed the BM, 666 started with 1 of the WSTPs, and 104 participants completed the FM. In addition, 8 users and 8 nurses were interviewed. Of the participants who completed the BM, 87.74% (902/1028) experienced moderate (411/1028, 39.98%) to high (491/1028, 47.76%) severity of complaints, of which 20.43% (210/1028) had had them for >1 year and 27.82% (286/1028) even for ≥2 years, and 38.91% (400/1028) were dissatisfied with their sex lives. Only 8.75% (90/1028) had sought professional help in the past 2 years. At FM, users rated satisfaction with their sex life more positively than they did at BM, and they experienced less discomfort from their complaints. The overall rating was positive, with a mean report grade of 7.3 (SD 1.45; on a 10-point scale). Anonymity, clear information and explanation, and practical exercises are indicated as strengths of the WSTPs, leading to more understanding and normalization. Nurses appreciate the high quality of information and accessibility of the WSTPs. They consider them as a valuable addition to the consultation hours. Conclusions: WSTPs can reach a large number of young people with sexual problems who are less likely to seek professional help. This can result in an improved understanding of their issues, a decrease in complaints, and reduced barriers to communicating with a partner or professional. %M 37883172 %R 10.2196/49009 %U https://formative.jmir.org/2023/1/e49009 %U https://doi.org/10.2196/49009 %U http://www.ncbi.nlm.nih.gov/pubmed/37883172 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46008 %T Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study %A Prior,Katrina %A Salemink,Elske %A Piggott,Monique %A Manning,Victoria %A Wiers,Reinout W %A Teachman,Bethany A %A Teesson,Maree %A Baillie,Andrew J %A Mahoney,Alison %A McLellan,Lauren %A Newton,Nicola C %A Stapinski,Lexine A %+ Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 286279032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K young adult %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. Objective: This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (“Re-Train Your Brain”) when delivered in conjunction with treatment as usual (TAU). Methods: The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. Results: Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. Conclusions: Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): RR2-10.2196/28667 %M 37878363 %R 10.2196/46008 %U https://formative.jmir.org/2023/1/e46008 %U https://doi.org/10.2196/46008 %U http://www.ncbi.nlm.nih.gov/pubmed/37878363 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48758 %T Digital Training Program for Line Managers (Managing Minds at Work): Protocol for a Feasibility Pilot Cluster Randomized Controlled Trial %A Thomson,Louise %A Hassard,Juliet %A Frost,Alexandra %A Bartle,Craig %A Yarker,Joanna %A Munir,Fehmidah %A Kneller,Richard %A Marwaha,Steven %A Daly,Guy %A Russell,Sean %A Meyer,Caroline %A Vaughan,Benjamin %A Newman,Kristina %A Blake,Holly %+ School of Medicine, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, United Kingdom, 44 1157484314, louise.thomson@nottingham.ac.uk %K acceptability %K anxiety %K burnout %K cluster randomised control trial %K depression %K digital training %K feasibility %K intervention %K intervention %K managers %K mental health %K stress %K usability %K work %K workplace %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers’ understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers’ knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work. Objective: The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers. Methods: We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors. Results: Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023. Conclusions: The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials. Trial Registration: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019 International Registered Report Identifier (IRRID): DERR1-10.2196/48758 %M 37874612 %R 10.2196/48758 %U https://www.researchprotocols.org/2023/1/e48758 %U https://doi.org/10.2196/48758 %U http://www.ncbi.nlm.nih.gov/pubmed/37874612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47151 %T A Trauma-Informed, Geospatially Aware, Just-in-Time Adaptive mHealth Intervention to Support Effective Coping Skills Among People Living With HIV in New Orleans: Development and Protocol for a Pilot Randomized Controlled Trial %A Skeen,Simone J %A Tokarz,Stephanie %A Gasik,Rayna E %A Solano,Chelsea McGettigan %A Smith,Ethan A %A Sagoe,Momi Binaifer %A Hudson,Lauryn V %A Steele,Kara %A Theall,Katherine P %A Clum,Gretchen A %+ Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, 22nd Fl, New Orleans, LA, 70112, United States, 1 504 988 1847, sskeen@tulane.edu %K mobile health %K mHealth %K HIV %K traumatic stress %K posttraumatic growth %K coping %K geospatial %K just-in-time adaptive intervention %K JITAI %K just-in-time %K posttraumatic %K medication adherence %K mental well-being %K viral suppression %K coping %K development %K design %K acceptability %K feasibility %K mobile phone %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2020, Greater New Orleans, Louisiana, was home to 7048 people living with HIV—1083 per 100,000 residents, 2.85 times the US national rate. With Louisiana routinely ranked last in indexes of health equity, violent crime rates in Orleans Parish quintupling national averages, and in-care New Orleans people living with HIV surviving twice the US average of adverse childhood experiences, accessible, trauma-focused, evidence-based interventions (EBIs) for violence-affected people living with HIV are urgently needed. Objective: To meet this need, we adapted Living in the Face of Trauma, a well-established EBI tailored for people living with HIV, into NOLA GEM, a just-in-time adaptive mobile health (mHealth) intervention. This study aimed to culturally tailor and refine the NOLA GEM app and assess its acceptability; feasibility; and preliminary efficacy on care engagement, medication adherence, viral suppression, and mental well-being among in-care people living with HIV in Greater New Orleans. Methods: The development of NOLA GEM entailed identifying real-time tailoring variables via a geographic ecological momentary assessment (GEMA) study (n=49; aim 1) and place-based and user-centered tailoring, responsive to the unique cultural contexts of HIV survivorship in New Orleans, via formative interviews (n=12; aim 2). The iOS- and Android-enabled NOLA GEM app leverages twice-daily GEMA prompts to offer just-in-time, in-app recommendations for effective coping skills practice and app-delivered Living in the Face of Trauma session content. For aim 3, the pilot trial will enroll an analytic sample of 60 New Orleans people living with HIV individually randomized to parallel NOLA GEM (intervention) or GEMA-alone (control) arms at a 1:1 allocation for a 21-day period. Acceptability and feasibility will be assessed via enrollment, attrition, active daily use through paradata metrics, and prevalidated usability measures. At the postassessment time point, primary end points will be assessed via a range of well-validated, domain-specific scales. Care engagement and viral suppression will be assessed via past missed appointments and self-reported viral load at 30 and 90 days, respectively, and through well-demonstrated adherence self-efficacy measures. Results: Aims 1 and 2 have been achieved, NOLA GEM is in Beta, and all aim-3 methods have been reviewed and approved by the institutional review board of Tulane University. Recruitment was launched in July 2023, with a target date for follow-up assessment completion in December 2023. Conclusions: By leveraging user-centered development and embracing principles that elevate the lived expertise of New Orleans people living with HIV, mHealth-adapted EBIs can reflect community wisdom on posttraumatic resilience. Sustainable adoption of the NOLA GEM app and a promising early efficacy profile will support the feasibility of a future fully powered clinical trial and potential translation to new underserved settings in service of holistic survivorship and well-being of people living with HIV. Trial Registration: ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/ct2/show/NCT05784714 International Registered Report Identifier (IRRID): PRR1-10.2196/47151 %M 37874637 %R 10.2196/47151 %U https://www.researchprotocols.org/2023/1/e47151 %U https://doi.org/10.2196/47151 %U http://www.ncbi.nlm.nih.gov/pubmed/37874637 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e50116 %T A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study %A Morgan,Jessica Kelley %A Rawlins,Caitlin R %A Walther,Steven K %A Harvey,Andrew %A O'Donnell,Annmarie %A Greene,Marla %A Schmidt,Troy G %+ Continuous Precision Medicine, 800 Park Offices Drive, Suite 3718, Research Triangle Park, NC, 27709-3547, United States, 1 9196185405, jmorgan@cpmed.io %K mobile app %K pain management %K opioids %K older adults %K veterans %K mobile phone %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Prescription opioid misuse risk is disproportionate among veterans; military veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse is costly in terms of morbidity, mortality, and humanitarian and economic burden and costs the Civilian Health and Medical Program of the Department of Veterans Affairs more than US $1.13 billion annually. Preventing opioid misuse at the time of prescription is a critical component in the response to the opioid crisis. The CPMRx mobile app has been shown to decrease the odds of opioid misuse during the postoperative period. Objective: The overarching purpose of this feasibility pilot study was to explore whether deploying a mobile app (CPMRx) to track postoperative pain and medication use is feasible in a Department of Veterans Affairs medical center. In support of this goal, we had four complementary specific aims: (1) determine the technological and logistical feasibility of the mobile app, (2) assess the acceptability of the mobile app to participants, (3) measure demand for and engagement with the mobile app, and (4) explore the potential use of the mobile app to patients and providers. Methods: Participants (N=10) were veterans undergoing total knee arthroplasty within the Veterans Health Administration provided with the CPMRx app to self-manage their pain during their 7-day at-home recovery following surgery. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile app for patients that includes a behavioral health intervention and a clinical decision support tool for health care providers that provides feedback about pain and medication use trends. Patients filled out paper questionnaires regarding acceptability at their postoperative follow-up appointment. Results: Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the app was 4.9 of 5 (5=“very little”), and the average rating for ease of use was 4.4 of 5 (5=“very easy”). Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well with a mean number of mobile app entries of 34.1 (SD 20.1) during the postoperative period. There were no reported technological or logistical issues with the mobile app. Participants took an average of 25.13 (SD 14.37) opioid tablets to manage their postoperative pain. Conclusions: Results of this study revealed that the use of a mobile app for pain and medication management during postoperative recovery was both feasible and acceptable in older veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential use of the mobile app to provide actionable insights to clinicians if adopted more widely. %M 37851497 %R 10.2196/50116 %U https://periop.jmir.org/2023/1/e50116 %U https://doi.org/10.2196/50116 %U http://www.ncbi.nlm.nih.gov/pubmed/37851497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50030 %T The Effects of Exercise on Synaptic Plasticity in Individuals With Mild Cognitive Impairment: Protocol for a Pilot Intervention Study %A Ramdeo,Karishma R %A Fahnestock,Margaret %A Gibala,Martin %A Selvaganapathy,Ponnambalam Ravi %A Lee,Justin %A Nelson,Aimee Jennifer %+ Department of Kinesiology, McMaster University, 1280 Main Street W, Hamilton, ON, L8S4L8, Canada, 1 905 525 9140, nelsonaj@mcmaster.ca %K mild cognitive impairment %K exercise %K brain-derived neurotrophic factor %K cognition %K brain plasticity %K repetitive transcranial magnetic stimulation %K transcranial magnetic stimulation %K magnetic stimulation %K aging %K interval training %K intermittent theta-burst stimulation %K repetitive transcranial magnetic stimulation %K ageing %K gerontology %K geriatric %K cognitive %K physical activity %K fitness %K neurology %K neuroscience %K synapse %K synaptic %K plasticity %K brain %K neurotrophic %K hormone %K hormones %K endocrinology %D 2023 %7 18.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mild cognitive impairment (MCI) is a syndrome preceding more severe impairment characterized by dementia. MCI affects an estimated 15% to 20% of people older than 65 years. Nonpharmacological interventions including exercise are recommended as part of overall MCI management based on the positive effects of exercise on cognitive performance. Interval training involves brief intermittent bouts of exercise interspersed with short recovery periods. This type of exercise promotes cognitive improvement and can be performed in individuals with MCI. Synaptic plasticity can be assessed in vivo by the neurophysiological response to repetitive transcranial magnetic stimulation (rTMS). A method to assess synaptic plasticity uses an intermittent theta burst stimulation (iTBS), which is a patterned form of rTMS. Individuals with MCI have decreased responses to iTBS, reflecting reduced synaptic plasticity. It is unknown whether interval training causes changes in synaptic plasticity in individuals living with MCI. Objective: This research will determine whether interval training performed using a cycle ergometer enhances synaptic plasticity in individuals with MCI. The three aims are to (1) quantify synaptic plasticity after interval training performed at a self-determined intensity in individuals with MCI; (2) determine whether changes in synaptic plasticity correlate with changes in serum brain-derived neurotrophic factor, osteocalcin, and cognition; and (3) assess participant compliance to the exercise schedule. Methods: 24 individuals diagnosed with MCI will be recruited for assignment to 1 of the 2 equally sized groups: exercise and no exercise. The exercise group will perform exercise 3 times per week for 4 weeks. Synaptic plasticity will be measured before and following the 4-week intervention. At these time points, synaptic plasticity will be measured as the response to single-pulse TMS, reflected as the percent change in the average amplitude of 20 motor-evoked potentials before and after an iTBS rTMS protocol, which is used to induce synaptic plasticity. In addition, individuals will complete a battery of cognitive assessments and provide a blood sample from the antecubital vein to determine serum brain-derived neurotrophic factor and osteocalcin. Results: The study began in September 2023. Conclusions: The proposed research is the first to assess whether synaptic plasticity is enhanced after exercise training in individuals with MCI. If exercise does indeed modify synaptic plasticity, this will create a new avenue by which we can study and manipulate neural plasticity in these individuals. Trial Registration: ClinicalTrials.gov NCT05663918; https://clinicaltrials.gov/study/NCT05663918 International Registered Report Identifier (IRRID): PRR1-10.2196/50030 %M 37851488 %R 10.2196/50030 %U https://www.researchprotocols.org/2023/1/e50030 %U https://doi.org/10.2196/50030 %U http://www.ncbi.nlm.nih.gov/pubmed/37851488 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47267 %T Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing %A Andrews,Nicole Emma %A Ireland,David %A Vijayakumar,Pranavie %A Burvill,Lyza %A Hay,Elizabeth %A Westerman,Daria %A Rose,Tanya %A Schlumpf,Mikaela %A Strong,Jenny %A Claus,Andrew %+ RECOVER Injury Research Centre, The University of Queensland, Level 7, Surgical Treatment and Rehabilitation Service (STARS), 296 Herston Rd, Herston, 4029, Australia, 61 418762617, n.andrews@uq.edu.au %K chronic pain %K education %K neurophysiology %K neuroscience %K conversation agent %K chatbot %K age %K young adult %K adolescence %K adolescent %K pain %K patient education %K usability %K acceptability %K mobile health %K mHealth %K mobile app %K health app %K youth %K mobile phone %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. Objective: This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. Methods: Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. Results: Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores’ speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores’ speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores’ speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). Conclusions: This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone. %M 37801342 %R 10.2196/47267 %U https://formative.jmir.org/2023/1/e47267 %U https://doi.org/10.2196/47267 %U http://www.ncbi.nlm.nih.gov/pubmed/37801342 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49998 %T The Appa Health App for Youth Mental Health: Development and Usability Study %A Giovanelli,Alison %A Sanchez Karver,Tahilin %A Roundfield,Katrina D %A Woodruff,Sean %A Wierzba,Catherine %A Wolny,J %A Kaufman,Michelle R %+ Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA, 94143, United States, 1 8054050772, alison.giovanelli@ucsf.edu %K digital mental health %K youth mentoring %K cognitive behavioral therapy %K teenager %K adolescent %K mobile phone %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. Objective: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa’s 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. Methods: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers’ characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Results: Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Conclusions: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program. %M 37792468 %R 10.2196/49998 %U https://formative.jmir.org/2023/1/e49998 %U https://doi.org/10.2196/49998 %U http://www.ncbi.nlm.nih.gov/pubmed/37792468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51055 %T Preferences for and Experiences of an HIV-Prevention Mobile App Designed for Transmasculine People: Pilot Feasibility Trial and Qualitative Investigation %A Jones,Jeb %A Butler,Gareth %A Woody,Meaghan %A Castel,Amanda D %A Kulie,Paige %A Sheets,Martha %A Scheim,Ayden I %A Reisner,Sari L %A Valencia,Rachel %A Wang,Minglun %A Stekler,Joanne D %A Sullivan,Patrick S %A Stephenson,Rob %+ Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K transmasculine %K HIV %K mHealth %K preference %K prevention %K mobile app %K transgender %K STI %K meta-analyses %K app-based intervention %K cisgender %K sexual health %K sexual risk behavior %K smartphone %D 2023 %7 21.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Transmasculine people are at risk for HIV; yet few HIV prevention interventions have been developed for this population. We adapted an existing HIV prevention smartphone app for cisgender men who have sex with men to meet the sexual health needs of transmasculine people. Objective: This study aims to assess the acceptability of the adapted app, Transpire, among transmasculine people living in Atlanta, Georgia, and Washington, DC, via in-depth interviews of participants in a pilot feasibility trial. Methods: Participants used the Transpire app for 3 months as part of a pilot study of the app. Eligible participants were aged 18-34 years. There were no eligibility criteria with respect to race and ethnicity, and most participants were non-Hispanic White. At the end of the follow-up, participants were invited to participate in web-based in-depth interviews to discuss their experiences using the app and feedback on design and content. Interviews were transcribed and coded using a constant comparative approach. Three main themes were identified: sexual behavior, app experiences and feedback, and pre-exposure prophylaxis. Results: Overall, participants found the app acceptable and thought that it would be a useful tool for themselves and their peers. Participants reported appreciating having a comprehensive information source available to them on their phones and reported learning more about HIV, sexually transmitted infections, and pre-exposure prophylaxis via the app. They also reported appreciating the inclusive language that was used throughout the app. Although the app included some resources on mental health and substance use, participants reported that they would have appreciated more resources and information in these areas as well as more comprehensive information about other health concerns, including hormone therapy. Representative quotes are presented for each of the identified themes. Conclusions: There is a desire to have greater access to reliable sexual health information among transmasculine people. Mobile apps like Transpire are an acceptable intervention to increase access to this information and other resources. More evidence is needed, however, from more racially and ethnically diverse samples of transmasculine people. %M 37733430 %R 10.2196/51055 %U https://formative.jmir.org/2023/1/e51055 %U https://doi.org/10.2196/51055 %U http://www.ncbi.nlm.nih.gov/pubmed/37733430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45693 %T Using Continuous Passive Assessment Technology to Describe Health and Behavior Patterns Preceding and Following a Cancer Diagnosis in Older Adults: Proof-of-Concept Case Series Study %A Wu,Chao-Yi %A Tibbitts,Deanne %A Beattie,Zachary %A Dodge,Hiroko %A Shannon,Jackilen %A Kaye,Jeffrey %A Winters-Stone,Kerri %+ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 10-003C, Charlestown, MA, 02129, United States, 1 617 724 2428, chwu3@mgh.harvard.edu %K sensor %K quality of life %K physical activity %K medication %K monitoring %K function %K mobile phone %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Describing changes in health and behavior that precede and follow a sentinel health event, such as a cancer diagnosis, is challenging because of the lack of longitudinal, objective measurements that are collected frequently enough to capture varying trajectories of change leading up to and following the event. A continuous passive assessment system that continuously monitors older adults’ physical activity, weight, medication-taking behavior, pain, health events, and mood could enable the identification of more specific health and behavior patterns leading up to a cancer diagnosis and whether and how patterns change thereafter. Objective: In this study, we conducted a proof-of-concept retrospective analysis, in which we identified new cancer diagnoses in older adults and compared trajectories of change in health and behaviors before and after cancer diagnosis. Methods: Participants were 10 older adults (mean age 71.8, SD 4.9 years; 3/10, 30% female) with various self-reported cancer types from a larger prospective cohort study of older adults. A technology-agnostic assessment platform using multiple devices provided continuous data on daily physical activity via wearable sensors (actigraphy); weight via a Wi-Fi–enabled digital scale; daily medication-taking behavior using electronic Bluetooth-enabled pillboxes; and weekly pain, health events, and mood with online, self-report surveys. Results: Longitudinal linear mixed-effects models revealed significant differences in the pre- and postcancer trajectories of step counts (P<.001), step count variability (P=.004), weight (P<.001), pain severity (P<.001), hospitalization or emergency room visits (P=.03), days away from home overnight (P=.01), and the number of pillbox door openings (P<.001). Over the year preceding a cancer diagnosis, there were gradual reductions in step counts and weight and gradual increases in pain severity, step count variability, hospitalization or emergency room visits, and days away from home overnight compared with 1 year after the cancer diagnosis. Across the year after the cancer diagnosis, there was a gradual increase in the number of pillbox door openings compared with 1 year before the cancer diagnosis. There was no significant trajectory change from the pre– to post–cancer diagnosis period in terms of low mood (P=.60) and loneliness (P=.22). Conclusions: A home-based, technology-agnostic, and multidomain assessment platform could provide a unique approach to monitoring different types of behavior and health markers in parallel before and after a life-changing health event. Continuous passive monitoring that is ecologically valid, less prone to bias, and limits participant burden could greatly enhance research that aims to improve early detection efforts, clinical care, and outcomes for people with cancer. %M 37561574 %R 10.2196/45693 %U https://formative.jmir.org/2023/1/e45693 %U https://doi.org/10.2196/45693 %U http://www.ncbi.nlm.nih.gov/pubmed/37561574 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45541 %T Usability and Satisfaction Testing of Game-Based Learning Avatar-Navigated Mobile (GLAm), an App for Cervical Cancer Screening: Mixed Methods Study %A Wanberg,Lindsey J %A Kim,Angela %A Vogel,Rachel I %A Sadak,Karim Thomas %A Teoh,Deanna %+ Division of Gynecologic Oncology, Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE, MMC 395, Minneapolis, MN, 55455, United States, 1 612 625 6503, dkteoh@umn.edu %K cancer screening %K cervical cancer screening %K cervical cancer %K Game-based Learning Avatar-navigated mobile %K health care app %K mixed methods study %K mobile health %K mobile technology %K Pap test %K usability testing %K young adult health care %D 2023 %7 8.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Barriers to cervical cancer screening in young adults include a lack of knowledge and negative perceptions of testing. Evidence shows that mobile technology reduces these barriers; thus, we developed a web app, Game-based Learning Avatar-navigated mobile (GLAm), to educate and motivate cervical cancer screening using the Fogg Behavioral Model as a theoretic guide. Users create avatars to navigate the app, answer short quizzes with education about cervical cancer and screening, watch videos of the screening process, and earn digital trophies. Objective: We tested ease of use, usefulness, and satisfaction with the GLAm app among young adults. Methods: This mixed methods study comprised a qualitative think-aloud play interview session and a quantitative survey study. Participants were cervical cancer screening–eligible US residents aged 21 to 29 years recruited through social media. Qualitative study participants explored the app in a think-aloud play session conducted through videoconference. Data were analyzed using directed content analysis to identify themes of ease of use, usefulness, and content satisfaction. Qualitative study participants and additional participants then used the app independently for 1 week and completed a web-based survey (the quantitative study). Ease of use, usefulness, and satisfaction were assessed using the validated Technology Acceptance Model and Computer System Usability Questionnaire adapted to use of an app. Mean (SD) scores (range 1-7) are presented. Results: A total of 23 individuals participated in one or both study components. The mean age was 25.6 years. A majority were cisgender women (21/23, 91%) and White (18/23, 78%), and 83% (19/23) had at least some secondary education. Nine participants completed the think-aloud play session. Direct content analysis showed desire for content that is concise, eases anxiety around screenings, and uses game features (avatars and rewards). Twenty-three individuals completed the quantitative survey study. Mean scores showed the app was perceived to be easy to use (mean score 6.17, SD 0.27) and moderately useful to increase cervical cancer screening knowledge and uptake (mean score 4.94, SD 0.27). Participants were highly satisfied with the app (mean score 6.21, SD 1.20). Conclusions: Survey results showed participants were satisfied with the app format and found it easy to use. The app was perceived to be moderately useful to inform and motivate cervical cancer screening; notably, the screening reminder function was not tested in this study. Qualitative study results demonstrated the app’s ability to ease anxiety about screening through demonstration of the screening process, and brevity of app components was favored. Interpretation of results is limited by the predominantly cisgender, White, and educated study population; additional testing in populations which historically have lower cervical cancer screening uptake is needed. A modified version of the app is undergoing efficacy testing in a randomized clinical trial. %M 37552527 %R 10.2196/45541 %U https://formative.jmir.org/2023/1/e45541 %U https://doi.org/10.2196/45541 %U http://www.ncbi.nlm.nih.gov/pubmed/37552527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47516 %T Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study %A Hallgren,Kevin A %A Duncan,Mark H %A Iles-Shih,Matthew D %A Cohn,Eliza B %A McCabe,Connor J %A Chang,Yanni M %A Saxon,Andrew J %+ Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, 1959 NE Pacific St., Seattle, WA, 98195, United States, 1 206 616 2906, khallgre@uw.edu %K contingency management %K methamphetamine use disorder %K mobile health %K mHealth %K mobile phone %D 2023 %7 6.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, methamphetamine-related overdoses have tripled from 2015 to 2020 and continue to rise. However, efficacious treatments such as contingency management (CM) are often unavailable in health systems. Objective: We conducted a single-arm pilot study to evaluate the feasibility, engagement, and usability of a fully remotely delivered mobile health CM program offered to adult outpatients who used methamphetamine and were receiving health care within a large university health system. Methods: Participants were referred by primary care or behavioral health clinicians between September 2021 and July 2022. Eligibility criteria screening was conducted by telephone and included self-reported methamphetamine use on ≥5 out of the past 30 days and a goal of reducing or abstaining from methamphetamine use. Eligible participants who agreed to take part then completed an initial welcome phase that included 2 videoconference calls to register for and learn about the CM program and 2 “practice” saliva-based substance tests prompted by a smartphone app. Participants who completed these welcome phase activities could then receive the remotely delivered CM intervention for 12 consecutive weeks. The intervention included approximately 24 randomly scheduled smartphone alerts requesting a video recording of themselves taking a saliva-based substance test to verify recent methamphetamine abstinence, 12 weekly calls with a CM guide, 35 self-paced cognitive behavioral therapy modules, and multiple surveys. Financial incentives were disbursed via reloadable debit cards. An intervention usability questionnaire was completed at the midpoint. Results: Overall, 37 patients completed telephone screenings, with 28 (76%) meeting the eligibility criteria and consenting to participate. Most participants who completed a baseline questionnaire (21/24, 88%) self-reported symptoms consistent with severe methamphetamine use disorder, and most had other co-occurring non-methamphetamine substance use disorders (22/28, 79%) and co-occurring mental health disorders (25/28, 89%) according to existing electronic health records. Overall, 54% (15/28) of participants successfully completed the welcome phase and were able to receive the CM intervention. Among these participants, engagement with substance testing, calls with CM guides, and cognitive behavioral therapy modules varied. Rates of verified methamphetamine abstinence in substance testing were generally low but varied considerably across participants. Participants reported positive opinions about the intervention’s ease of use and satisfaction with the intervention. Conclusions: Fully remote CM can be feasibly delivered within health care settings lacking existing CM programs. Although remote delivery may help reduce barriers to treatment access, many patients who use methamphetamine may struggle to engage with initial onboarding. High rates of co-occurring psychiatric conditions in the patient population may also contribute to uptake and engagement challenges. Future efforts could leverage greater human-to-human connection, more streamlined onboarding procedures, larger incentives, longer durations, and the incentivization of non–abstinence-based recovery goals to increase uptake and engagement with fully remote mobile health–based CM. %M 37410529 %R 10.2196/47516 %U https://formative.jmir.org/2023/1/e47516 %U https://doi.org/10.2196/47516 %U http://www.ncbi.nlm.nih.gov/pubmed/37410529 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43304 %T Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study %A Suzuki,Joji %A Loguidice,Frank %A Prostko,Sara %A Szpak,Veronica %A Sharma,Samata %A Vercollone,Lisa %A Garner,Carol %A Ahern,David %+ Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Rd, Room 4168, Boston, MA, 02474, United States, 1 6174557981, jsuzuki2@bwh.harvard.edu %K alcohol use disorder %K inpatient detoxification %K peer recovery coach %K smartphone app %K alcohol %K substance use %K substance abuse %K drinking %K recovery %K peer support %K detox %K coaching %K health app %K mobile health %K mHealth %K mobile app %K care coordination %K digitally %K detoxification %K Lifeguard %K peer recovery %K inpatient alcohol %D 2023 %7 5.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches—individuals with the lived experience of recovery who obtain training to be coaches—are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition. Objective: We aimed to evaluate the feasibility of using an existing care coordination app (Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. Methods: This study was conducted on an American Society of Addiction Medicine–Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up. Results: All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing addiction treatment during the follow-up. The participants who engaged with the coach post discharge, compared to those who did not, were significantly more likely to link with treatment (83% vs 0%, χ2=6.67, P=.01). Conclusions: The results demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving postdischarge outcomes. Trial Registration: ClinicalTrials.gov NCT05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544 %M 37405844 %R 10.2196/43304 %U https://formative.jmir.org/2023/1/e43304 %U https://doi.org/10.2196/43304 %U http://www.ncbi.nlm.nih.gov/pubmed/37405844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46062 %T Understanding Users’ Experiences of a Novel Web-Based Cognitive Behavioral Therapy Platform for Depression and Anxiety: Qualitative Interviews From Pilot Trial Participants %A Shkel,Jane %A Green,Gavin %A Le,Stacey %A Kaveladze,Benjamin %A Marcotte,Veronique %A Rushton,Kevin %A Nguyen,Theresa %A Schueller,Stephen M %+ Department of Psychological Science, University of California, Irvine, 4341 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 949 824 3850, s.schueller@uci.edu %K anxiety %K depression %K cognitive behavioral therapy %K clinical trial %K intervention %K qualitative research %K digital mental health intervention %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) can help bridge the gap between the demand for mental health care and availability of treatment resources. The affordances of DMHIs have been proposed to overcome barriers to care such as accessibility, cost, and stigma. Despite these proposals, most evaluations of the DMHI focus on clinical effectiveness, with less consideration of users’ perspectives and experiences. Objective: We conducted a pilot randomized controlled trial of “Overcoming Thoughts,” a web-based platform that uses cognitive and behavioral principles to address depression and anxiety. The “Overcoming Thoughts” platform included 2 brief interventions—cognitive restructuring and behavioral experimentation. Users accessed either a version that included asynchronous interactions with other users (“crowdsourced” platform) or a completely self-guided version (control condition). We aimed to understand the users’ perspectives and experiences by conducting a subset of interviews during the follow-up period of the trial. Methods: We used purposive sampling to select a subset of trial participants based on group assignment (treatment and control) and symptom improvement (those who improved and those who did not on primary outcomes). We conducted semistructured interviews with 23 participants during the follow-up period that addressed acceptability, usability, and impact. We conducted a thematic analysis of the interviews until saturation was reached. Results: A total of 8 major themes were identified: possible opportunities to expand the platform; improvements in mental health because of using the platform; increased self-reflection skills; platform being more helpful for certain situations or domains; implementation of skills into users’ lives, even without direct platform use; increased coping skills because of using the platform; repetitiveness of platform exercises; and use pattern. Although no differences in themes were found among groups based on improvement status (all P values >.05, ranging from .12 to .86), there were 4 themes that differed based on conditions (P values from .01 to .046): helpfulness of self-reflection supported by an exercise summary (greater in control); aiding in slowing thoughts and feeling calmer (greater in control); overcoming patterns of avoidance (greater in control); and repetitiveness of content (greater in the intervention). Conclusions: We identified the different benefits that users perceived from a novel DMHI and opportunities to improve the platform. Interestingly, we did not note any differences in themes between those who improved and those who did not, but we did find some differences between those who received the control and intervention versions of the platform. Future research should continue to investigate users’ experiences with DMHIs to better understand the complex dynamics of their use and outcomes. %M 37338967 %R 10.2196/46062 %U https://formative.jmir.org/2023/1/e46062 %U https://doi.org/10.2196/46062 %U http://www.ncbi.nlm.nih.gov/pubmed/37338967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45102 %T Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message–Based Assessment Tool: Longitudinal Pilot Study %A Goldhaber,Nicole H %A Chea,Annie %A Hekler,Eric B %A Zhou,Wenjia %A Fergerson,Byron %+ Department of Surgery, School of Medicine, University of California, San Diego Health, 9300 Campus Point Drive, #7220, La Jolla, CA, 92037, United States, 1 310 889 8678, nhgoldhaber@health.ucsd.edu %K physician burnout %K mental health %K text-message assessment %K text %K mobile text %K stress assessment %K text message %K pilot study %K physician %K burnout %K United States %K survey %K trainee %K stress %K engagement %K users %K tracking %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physician burnout is a multibillion-dollar issue in the United States. Despite its prevalence, burnout is difficult to accurately measure. Institutions generally rely on periodic surveys that are subject to recall bias. SMS text message–based surveys or assessments have been used in health care and have the advantage of easy accessibility and high response rates. Objective: In this pilot project, we evaluated the utility of and participant engagement with a simple, longitudinal, and SMS text message–based mental health assessment system for physician-trainees at the study institution. The goal of the SMS text message–based assessment system was to track stress, burnout, empathy, engagement, and work satisfaction levels faced by users in their normal working conditions. Methods: Three SMS text message-based questions per week for 5 weeks were sent to each participant. All data received were deidentified. Additionally, each participant had a deidentified personal web page to follow their scores as well as the aggregated scores of all participants over time. A 13-question optional survey was sent at the conclusion of the study to evaluate the usability of the platform. Descriptive statistics were performed. Results: In all, 81 participants were recruited and answered at least six (mean 14; median 14; range 6-16) questions for a total of 1113 responses. Overall, 10 (17%) out of 59 participants responded “Yes” to having experienced a traumatic experience during the study period. Only 3 participants ever answered being “Not at all satisfied” with their job. The highest number of responses indicating that participants were stressed or burnt out came on day 25 in the 34-day study period. There were mixed levels of concern for the privacy of responses. No substantial correlations were noted between responses and having experienced a traumatic experience during the study period. Furthermore, 12 participants responded to the optional feedback survey, and all either agreed or strongly agreed that the SMS text message–based assessment system was easy to use and the number of texts received was reasonable. None of the 12 respondents indicated that using the SMS text message–based assessment system caused stress. Conclusions: Responses demonstrated that SMS text message–based mental health assessments are potentially useful for recording physician-trainee mental health levels in real time with minimal burden, but further study of SMS text message–based mental health assessments should address limitations such as improving response rates and clarifying participants’ sense of privacy when using the SMS text message–based assessment system. The findings of this pilot study can inform the development of institution-wide tools for assessing physician burnout and protecting physicians from occupational stress. %M 37266985 %R 10.2196/45102 %U https://formative.jmir.org/2023/1/e45102 %U https://doi.org/10.2196/45102 %U http://www.ncbi.nlm.nih.gov/pubmed/37266985 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44806 %T Assessing Health Care Professionals' Mindset in Adopting Telemedicine Post COVID-19: Pilot Questionnaire Study %A Naghdi,Rozhin %A Nguyen,Gianhu %A Vazquez,Cecile Maria %A Antonio,Christian Mark %A Cabrera,Carlos %A Chandra,Austin %A Chok,Jay %+ Keck Graduate Institute, 535 Watson Drive, Claremont, CA, 91711, United States, 1 6268633284, jay_chok@kgi.edu %K digital health %K patient perspective %K creative destruction of medicine %K pilot study %K patient-centered health %K willingness %K delivery model %K questionnaire %K telehealth %K accessibility %K implementation %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Amidst the COVID-19 pandemic, the traditional health care model has evolved toward a more patient-centric model. In relation to this trend, digital health services have seen an acceleration, which may have significant implications for the health care model. Due to the impact of COVID-19 on health care facilities, it is important to explore health professionals’ willingness to adopt a patient-centric digital health delivery model for medicine and health care. Objective: The aim of this study was to pilot a survey that assesses the impact and implementation of telehealth in view of health care providers prior to and post COVID-19. Methods: A total of 26 volunteer health care professionals participated in the pilot study, of which 19/26 (73%) completed the general demographics portion. Among these respondents, 9/26 (35%) completed the entirety of the survey. The questionnaire included questions relating to general demographics, accessibility and benefits, usability, and engagements with telemedicine. Participants were randomly assigned to 1 of the 4 questionnaire designs (A-D) based on their expertise in telehealth. Of the 9 total participants who completed their randomly assigned questionnaire, 1 (11%) was randomly assigned to A, 3 (33%) were randomly assigned to B, 2 (22%) were randomly assigned to C, and 3 (33%) were randomly assigned to D. Results: Responses and data from the study questionnaire were collected from Qualtrics. Microsoft Excel was used for data organization. Due to limited responses and data, no advanced statistical software was implemented. From the 9 participants who completed the entirety of the survey, responses from those with telehealth experience (n=4) showed that telehealth was preferred for follow-ups, lab results, and consultations, and that with telehealth, there was greater flexibility with appointment times and a decrease in the number of patients seen. Among the 4 health care providers with telehealth experience, all of them believed it improved accessibility and reduced physical barriers; health care professionals believed telehealth reduced translational barriers with patients. Among health care professionals without telehealth experience (n=5), 60% (3/5) reported a decrease in appointments for in-office visits post COVID-19 and strongly agreed or agreed that telehealth could influence the quality of care for patients. All 5 participants also reported no general concerns about telehealth prior to the pandemic and agreed that it would provide accessibility for patients. Conclusions: Preliminary findings of our pilot study showed initial support of a dynamical shift within the health care model due to the rise in the use of telehealth services between health care providers and patients but no statistically significant results. Further research and investigation with a larger sample size is warranted to better understand the mindset of health care professionals in adopting telemedicine post COVID-19. %M 37266997 %R 10.2196/44806 %U https://formative.jmir.org/2023/1/e44806 %U https://doi.org/10.2196/44806 %U http://www.ncbi.nlm.nih.gov/pubmed/37266997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45908 %T Pulse-Based Nutrition Education Intervention Among High School Students to Enhance Knowledge, Attitudes, and Practices: Pilot for a Formative Survey Study %A Teshome,Getenesh Berhanu %A Haileslassie,Hiwot Abebe %A Shand,Phyllis %A Lin,Yun %A Lieffers,Jessica R L %A Henry,Carol %+ Applied Human Sciences, University of Prince Edward Island, 550 University Ave, Charlottetown, PE, C1A 4P3, Canada, 1 3067153659, hhaileslassie@upei.ca %K adolescents %K food literacy %K high school %K macronutrients %K micronutrients %K pulses %K dietary pattern %K diet %K eating habits %K nutrition %K students %K school-based interventions %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Promoting pulse consumption in schools could improve students’ healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. Objective: This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. Methods: Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. Results: In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. Conclusions: Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students. %M 37256666 %R 10.2196/45908 %U https://formative.jmir.org/2023/1/e45908 %U https://doi.org/10.2196/45908 %U http://www.ncbi.nlm.nih.gov/pubmed/37256666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43603 %T Black Smokers’ Preferences for Features of a Smoking Cessation App: Qualitative Study %A Enyioha,Chineme %A Loufman,Larissa M %A Grewe,Mary E %A Cené,Crystal W %A Khairat,Saif %A Goldstein,Adam O %A Kistler,Christine E %+ Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC, 27599, United States, 1 9842155048, chineme_enyioha@med.unc.edu %K mobile health apps %K smoking cessation %K Black smokers %K smoking %K mobile health %K intervention %K application %K development %K online research %K interview %K functionality %K social network %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for smoking cessation have grown extensively over the last few years. Although these interventions improve cessation rates, studies of these interventions consistently lack sufficient Black smokers; hence knowledge of features that make mHealth interventions attractive to Black smokers is limited. Identifying features of mHealth interventions for smoking cessation preferred by Black smokers is critical to developing an intervention that they are likely to use. This may in turn address smoking cessation challenges and barriers to care, which may reduce smoking-related disparities that currently exist. Objective: This study aims to identify features of mHealth interventions that appeal to Black smokers using an evidence-based app developed by the National Cancer Institute, QuitGuide, as a reference. Methods: We recruited Black adult smokers from national web-based research panels with a focus on the Southeastern United States. Participants were asked to download and use QuitGuide for at least a week before participation in remote individual interviews. Participants gave their opinions about features of the QuitGuide app and other mHealth apps they may have used in the past and suggestions for future apps. Results: Of the 18 participants, 78% (n=14) were women, with age ranging from 32 to 65 years. Themes within five major areas relevant for developing a future mHealth smoking cessation app emerged from the individual interviews: (1) content needs including health and financial benefits of quitting, testimonials from individuals who were successful in quitting, and strategies for quitting; (2) format needs such as images, ability to interact with and respond to elements within the app, and links to other helpful resources; (3) functionality including tracking of smoking behavior and symptoms, provision of tailored feedback and reminders to users, and an app that allows for personalization of functions; (4) social network, such as connecting with friends and family through the app, connecting with other users on social media, and connecting with a smoking cessation coach or therapist; and (5) the need for inclusivity for Black individuals, which may be accomplished through the inclusion of smoking-related information and health statistics specific for Black individuals, the inclusion of testimonials from Black celebrities who successfully quit, and the inclusion of cultural relevance in messages contained in the app. Conclusions: Certain features of mHealth interventions for smoking cessation were highly preferred by Black smokers based on their use of a preexisting mHealth app, QuitGuide. Some of these preferences are similar to those already identified by the general population, whereas preferences for increasing the inclusivity of the app are more specific to Black smokers. These findings can serve as the groundwork for a large-scale experiment to evaluate preferences with a larger sample size and can be applied in developing mHealth apps that Black smokers may be more likely to use. %M 37252777 %R 10.2196/43603 %U https://formative.jmir.org/2023/1/e43603 %U https://doi.org/10.2196/43603 %U http://www.ncbi.nlm.nih.gov/pubmed/37252777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46659 %T Automated Diet Capture Using Voice Alerts and Speech Recognition on Smartphones: Pilot Usability and Acceptability Study %A Chikwetu,Lucy %A Daily,Shaundra %A Mortazavi,Bobak J %A Dunn,Jessilyn %+ Department of Biomedical Engineering, Duke University, 1427 FCIEMAS, Durham, NC, 27708, United States, 1 9196605131, jessilyn.dunn@duke.edu %K automatic dietary monitoring %K ADM %K food logging %K diet logging %K voice technologies %K voice alert %K speech recognition %K natural language processing %K NLP %D 2023 %7 16.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective monitoring of dietary habits is critical for promoting healthy lifestyles and preventing or delaying the onset and progression of diet-related diseases, such as type 2 diabetes. Recent advances in speech recognition technologies and natural language processing present new possibilities for automated diet capture; however, further exploration is necessary to assess the usability and acceptability of such technologies for diet logging. Objective: This study explores the usability and acceptability of speech recognition technologies and natural language processing for automated diet logging. Methods: We designed and developed base2Diet—an iOS smartphone application that prompts users to log their food intake using voice or text. To compare the effectiveness of the 2 diet logging modes, we conducted a 28-day pilot study with 2 arms and 2 phases. A total of 18 participants were included in the study, with 9 participants in each arm (text: n=9, voice: n=9). During phase I of the study, all 18 participants received reminders for breakfast, lunch, and dinner at preselected times. At the beginning of phase II, all participants were given the option to choose 3 times during the day to receive 3 times daily reminders to log their food intake for the remainder of the phase, with the ability to modify the selected times at any point before the end of the study. Results: The total number of distinct diet logging events per participant was 1.7 times higher in the voice arm than in the text arm (P=.03, unpaired t test). Similarly, the total number of active days per participant was 1.5 times higher in the voice arm than in the text arm (P=.04, unpaired t test). Furthermore, the text arm had a higher attrition rate than the voice arm, with only 1 participant dropping out of the study in the voice arm, while 5 participants dropped out in the text arm. Conclusions: The results of this pilot study demonstrate the potential of voice technologies in automated diet capturing using smartphones. Our findings suggest that voice-based diet logging is more effective and better received by users compared to traditional text-based methods, underscoring the need for further research in this area. These insights carry significant implications for the development of more effective and accessible tools for monitoring dietary habits and promoting healthy lifestyle choices. %M 37191989 %R 10.2196/46659 %U https://formative.jmir.org/2023/1/e46659 %U https://doi.org/10.2196/46659 %U http://www.ncbi.nlm.nih.gov/pubmed/37191989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43300 %T A Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Concurrent, Exploratory, Flexible, and Multimethod Feasibility Study %A Zlamal,Jaroslav %A Roth Gjevjon,Edith %A Fossum,Mariann %A Steindal,Simen A %A Nes,Andréa Aparecida Gonçalves %+ Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway, 47 95963522, Jaroslav.Zlamal@ldh.no %K technology %K guidance model %K critical thinking %K feasibility %K nursing %K nursing education %K medical education %K nursing student %K digital intervention %K mobile app %K clinical practice %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. Objective: The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. Methods: This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. Results: Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. Conclusions: The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. International Registered Report Identifier (IRRID): RR2-10.2196/31646 %M 37099377 %R 10.2196/43300 %U https://formative.jmir.org/2023/1/e43300 %U https://doi.org/10.2196/43300 %U http://www.ncbi.nlm.nih.gov/pubmed/37099377 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44503 %T An Avatar-Led Web-Based and SMS Text Message Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: Pilot Randomized Controlled Trial %A Heffner,Jaimee L %A Kelly,Megan M %A Reilly,Erin D %A Reece,Scott G %A Claudio,Tracy %A Serfozo,Edit %A Baker,Kelsey %A Watson,Noreen L %A Karekla,Maria %+ Fred Hutchinson Cancer Center, 1100 Fairview Ave N, M3-B232 PO Box 19024, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K embodied agent %K tobacco cessation %K nicotine dependence %K mobile health %K mHealth %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the declining prevalence of cigarette smoking in the United States, socioeconomically disadvantaged veterans receiving care from the Veterans Health Administration have a high prevalence of smoking. Currently, available treatment options for these veterans focus on tobacco users who are ready to quit and have limited reach. Consequently, there is a great need for accessible, effective smoking cessation interventions for veterans at all levels of readiness to quit smoking. Objective: To address these needs, we developed Vet Flexiquit, a web-based Acceptance and Commitment Therapy program for veterans, and evaluated its acceptability (primary aim), efficacy, and impact on theory-based change processes relative to the National Cancer Institute’s SmokefreeVET program in a pilot randomized controlled trial. Methods: Participants (N=49) were randomized 1:1 to receive either the Vet Flexiquit (n=25) or SmokefreeVET (n=24) web program. Both groups received SMS text messages as part of the intervention for 6 weeks. Both interventions are fully automated and self-guided. Primary outcome data were collected at 3 months after the randomization. Self-reported smoking abstinence was biochemically verified using saliva cotinine. Multivariable logistic regression, negative binomial regression, and linear regression models were used to evaluate the association between the treatment arm and outcomes of interest. Results: Acceptability, as measured by overall treatment satisfaction, was high and similar across treatment arms: 100% (17/17) for Vet Flexiquit and 95% (18/19) for SmokefreeVET. Acceptability, as measured by utilization, was more modest (log-ins: M=3.7 for Vet Flexiquit and M=3.2 for SmokefreeVET). There were no statistically significant differences between treatment arms for any acceptability measures. Similarly, there were no statistically significant differences between treatment arms in the secondary outcomes of smoking cessation or change in Acceptance and Commitment Therapy’s theory-based processes. In open-ended survey responses, some veterans in both treatment arms expressed interest in having support from a professional or peer to enhance their experience, as well as an expanded SMS text messaging program. Conclusions: Both programs had high ratings of acceptability, limited utilization, and a similar impact on cessation and cessation processes. Taken together with the qualitative data suggesting that additional support may enhance participants’ experience of both programs, these preliminary findings suggest that the programs may have similar outcomes among veterans who are looking for a digital cessation treatment option and that integrating provider or peer support and enhancing the SMS text messaging program holds promise as a means of boosting engagement and outcomes for both programs. Trial Registration: ClinicalTrials.gov NCT04502524; https://clinicaltrials.gov/ct2/show/NCT04502524 %M 37058346 %R 10.2196/44503 %U https://formative.jmir.org/2023/1/e44503 %U https://doi.org/10.2196/44503 %U http://www.ncbi.nlm.nih.gov/pubmed/37058346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44756 %T Treating Depression in Adolescents and Young Adults Using Remote Intensive Outpatient Programs: Quality Improvement Assessment %A Evans-Chase,Michelle %A Solomon,Phyllis %A Peralta,Bethany %A Kornmann,Rachel %A Fenkel,Caroline %+ School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, United States, 1 6096023792, meva@upenn.edu %K depression %K IOP %K LGBTQ+ %K mental health %K telehealth %K youth %K young adult %D 2023 %7 11.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week. Objective: The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here. Methods: Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care. Results: Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23%) identified as nongender binary and 60% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference –6.06) were seen in depression between intake and discharge (t967=–24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53%). No significant differences were found across subgroups defined by age (F2,958=0.47; P=.63), gender identity (F7,886=1.20; P=.30), or sexual orientation (F7,872=0.47; P=.86). Conclusions: Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth. %M 37040155 %R 10.2196/44756 %U https://formative.jmir.org/2023/1/e44756 %U https://doi.org/10.2196/44756 %U http://www.ncbi.nlm.nih.gov/pubmed/37040155 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43539 %T Lessons Learned From the Implementation of a Pilot Study on Self-collected Specimen Return by Sexual Minority Men (Project Caboodle!): Qualitative Exploration %A Sallabank,Gregory %A Stephenson,Rob %A Gandhi,Monica %A Merrill,Leland %A Sharma,Akshay %+ Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI, 48109, United States, 1 734 647 0151, akshaydr@umich.edu %K HIV %K sexually transmitted diseases %K preexposure prophylaxis %K self-testing %K sexual and gender minorities %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-collection of specimens at home and their return by mail might help reduce some of the barriers to HIV and bacterial sexually transmitted infection (STI) screening encountered by gay, bisexual, and other men who have sex with men (GBMSM). To evaluate the benefits and challenges of bringing this approach to scale, researchers are increasingly requesting GBMSM to return self-collected specimens as part of web-based sexual health studies. Testing self-collected hair samples for preexposure prophylaxis drug levels may also be a viable option to identify GBMSM who face adherence difficulties and offer them support. Objective: Project Caboodle! sought to evaluate the acceptability and feasibility of self-collecting at home and returning by mail 5 specimens (a finger-stick blood sample, a pharyngeal swab, a rectal swab, a urine specimen, and a hair sample) among 100 sexually active GBMSM in the United States aged between 18 and 34 years. In this manuscript, we aimed to describe the key lessons learned from our study’s implementation and to present recommendations offered by participants to maximize the rates of self-collected specimen return. Methods: Following the specimen self-collection phase, a subset of 25 participants (11 who returned all 5 specimens, 4 who returned between 1 and 4 specimens, and 10 who did not return any specimens) was selected for in-depth interviews conducted via a videoconferencing platform. During the session, a semistructured interview guide was used to discuss the factors influencing decisions regarding returning self-collected specimens for laboratory processing. The transcripts were analyzed using template analysis. Results: University branding of web-based and physical materials instilled a sense of trust in participants and increased their confidence in the test results. Shipping the specimen self-collection box in plain unmarked packaging promoted discretion during transit and on its receipt. Using different colored bags with matching color-coded instructions to self-collect each type of specimen minimized the potential for confusion. Participants recommended including prerecorded instructional videos to supplement the written instructions, providing information on the importance of triple-site bacterial STI testing, and adding a reminder of the types of testing that would and would not be conducted on hair samples. Participants also suggested tailoring the specimen self-collection box to include only the tests that they might be interested in completing at that time, adding real-time videoconferencing to the beginning of the study to introduce the research team, and sending personalized reminders following the delivery of the specimen self-collection box. Conclusions: Our results offer valuable insights into aspects that facilitated participant engagement in self-collected specimen return, as well as areas for potential improvement to maximize return rates. Our findings can help guide the design of future large-scale studies and public health programs for home-based HIV, bacterial STI, and preexposure prophylaxis adherence testing. International Registered Report Identifier (IRRID): RR2-10.2196/13647 %M 37023442 %R 10.2196/43539 %U https://formative.jmir.org/2023/1/e43539 %U https://doi.org/10.2196/43539 %U http://www.ncbi.nlm.nih.gov/pubmed/37023442 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39894 %T Moral Elevation Online Intervention for Veterans Experiencing Distress Related to Posttraumatic Stress Disorder and Moral Injury (MOVED): Pilot Trial of a 4-Week Positive Psychology Web-Based Intervention %A McGuire,Adam P %A Howard,Binh An Nguyen %A Erickson,Thane M %A Creech,Suzannah K %+ VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr #151c, Waco, TX, 76711, United States, 1 254 297 5155, adam.mcguire@va.gov %K moral elevation %K web-based intervention %K pilot study %K veterans %K posttraumatic stress disorder %K PTSD %K moral injury %D 2023 %7 24.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Veterans with posttraumatic stress disorder (PTSD) and moral injury can encounter several barriers to treatment, including limited access to care and low engagement with therapy. Furthermore, most treatment approaches focus on alleviating distress rather than cultivating positive experiences that could facilitate trauma recovery. A potential way to address these issues is through moral elevation: feeling uplifted and inspired by others’ virtuous actions. Objective: This study aimed to examine the feasibility and acceptability of a novel, web-based moral elevation intervention for veterans with PTSD symptoms and moral injury distress (Moral Elevation Online Intervention for Veterans Experiencing Distress Related to PTSD and Moral Injury [MOVED]). This mixed methods study also examined potential changes in PTSD symptoms, moral injury distress, quality of life, and prosocial behavior. Methods: In this pilot trial, 48 participants were randomized to a MOVED or control condition (24 participants per condition). Both conditions included 8 sessions and lasted 1 month. The MOVED intervention and all survey components across both conditions were administered online. Participants completed self-report measures that assessed PTSD symptoms, moral injury distress, quality of life, and prosocial behavior at baseline and follow-up. Veterans in the MOVED condition also completed individual qualitative interviews at follow-up. We coded qualitative responses to interviews and identified emergent themes. Results: Findings suggest the MOVED intervention was largely feasible, with evidence for moderate-to-high levels of participation, engagement, and retention in MOVED sessions. Both quantitative and qualitative results suggest veterans found MOVED to be acceptable and satisfactory at the overall treatment level. Furthermore, participants reported high scores for helpfulness and engagement at the session level. Veterans who completed MOVED reported large within-person decreases in PTSD symptoms (Cohen d=1.44), approximately twice that of veterans in the control condition (Cohen d=0.78). Those in MOVED also reported medium-sized increases in physical (Cohen d=0.71) and psychological domains of quality of life (Cohen d=0.74), compared with no meaningful changes in the control condition. Unexpectedly, MOVED veterans reported no decrease in moral injury distress, whereas veterans in the control condition endorsed a medium-sized decrease in the total score. There were no changes in prosociality for either condition. Qualitative feedback further supported high levels of perceived acceptability and satisfaction and positive treatment outcomes across a range of domains, including behaviors, cognitions, emotions, and social functioning. Veterans also recommended adaptations to enhance engagement and maximize the impact of intervention content. Conclusions: Overall, findings indicate that veterans with PTSD and moral injury distress were interested in an intervention based on exposure to and engagement with experiences of moral elevation. After further research and refinement guided by future trials, veterans may benefit from this novel approach, which may enhance treatment outcomes and increase treatment accessibility for those in need of additional trauma-focused care. %M 36961494 %R 10.2196/39894 %U https://formative.jmir.org/2023/1/e39894 %U https://doi.org/10.2196/39894 %U http://www.ncbi.nlm.nih.gov/pubmed/36961494 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43255 %T Overcoming Language Barriers in Paramedic Care With an App Designed to Improve Communication With Foreign-Language Patients: Nonrandomized Controlled Pilot Study %A Müller,Frank %A Schröder,Dominik %A Noack,Eva Maria %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 55139 68193, evamaria.noack@med.uni-goettingen.de %K app %K emergency medical technicians %K language barriers %K limited language proficiency %K migrant %K paramedic %K prehospital emergency care %K refugee %K translator %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Communication across language barriers is a particular challenge for health care providers. In emergency medical services, interpreters are mostly not available on rescue scenes, which jeopardizes safe and high-quality medical care. In a cocreative process together with paramedics and software designers, we developed a fixed-phrase translation app with 600 phrases and 18 supported languages that supports paramedics when providing care to foreign-language patients. This paper reports on the results of a pilot study to evaluate the app’s effect on paramedic-patient communication. Objective: This study aims to gain insights into the efficacy and feasibility of a multilingual app that helps paramedics to communicate with patients who are not proficient in the local language. Methods: A 3-armed nonrandomized interventional pilot study was conducted in 4 rescue stations in the German Federal State of Lower Saxony: 3 rural areas and 1 in urban environment. The intervention group comprised rescue missions with patients with limited German language proficiency (LGP) with whom the app was used; control group 1 comprised LGP patients without app usage; and control group 2 consisted of rescue missions with German-speaking patients. For each rescue operation with LGP patients, paramedics filled out questionnaires about the communications with patients. From standardized Rescue Service Case Protocols, we extracted information on patient demographics (age and sex), clinical aspects (preliminary diagnosis and Glasgow Coma Scale), and rescue operation characteristics (time spent on emergency scene and additional dispatch of emergency physicians). The primary outcome was the paramedics’ perceived quality of communication with LGP patients. The secondary outcome was the ability to obtain necessary information from patients and the ability to provide important information to patients. A linear regression model was applied to assess the impact of the app on perceived communication, controlling demographic factors, and severity of illness. Results: A total of 22 LGP patients were recruited into the intervention group and 122 into control group 1. The control group 2 included 27,212 German-speaking patients. LGP patients were more than 2 decades younger than German-speaking patients. App usage among LGP patients was associated with higher perceived overall quality of communication (0.7 points on a 5-point Likert scale, P=.03). Applying a linear regression model controlling for age, sex, and Glasgow Coma Scale, the quality of communication was associated with an increase of 0.9 points (95% CI 0.2-1.6, P=.01). Compared to either German-speaking patients or LGP patients, paramedics spent 6-7 minutes longer on an emergency scene when the app was used (P=.24). Conclusions: The use of the app suggests a relevant improvement in communication with patients with limited proficiency in the locally spoken language in paramedic care. The small sample size and the lack of randomization reduce the generalizability of the findings. Trial Registration: German Clinical Trials Register DRKS00016719; https://drks.de/search/de/trial/DRKS00016719 %M 36951895 %R 10.2196/43255 %U https://formative.jmir.org/2023/1/e43255 %U https://doi.org/10.2196/43255 %U http://www.ncbi.nlm.nih.gov/pubmed/36951895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43759 %T Effects of COVID-19 Acute Respiratory Distress Syndrome Intensive Care Unit Survivor Telemedicine Clinic on Patient Readmission, Pain Perception, and Self-Assessed Health Scores: Randomized, Prospective, Single-Center, Exploratory Study %A Balakrishnan,Bathmapriya %A Hamrick,Lucas %A Alam,Ariful %A Thompson,Jesse %+ Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, 64 Medical Center Drive, PO Box 9166, Morgantown, WV, 26505, United States, 1 937 304 8855, p.bala1286@gmail.com %K acute respiratory distress syndrome %K aftercare %K COVID-19 pneumonia %K critical care %K survivor %K telemedicine %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors, leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia ICU patients are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high risk of unanticipated health care utilization postdischarge. This patient group commonly has increased readmission rates, long-term decreased mobility, and poorer outcomes. Most multidisciplinary post-ICU clinics for ICU survivors are in large urban academic medical centers providing in-person consultation. Data are lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors. Objective: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on health care utilization post-hospital discharge. Methods: This randomized, unblinded, single-center, parallel-group, exploratory study was conducted at a rural, academic medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a 6-minute walk test (6MWT), EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of this review and tests. The control group (CG) underwent a telemedicine visit within 6 weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit. Results: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72% (13/18) agreed to pulmonary clinic follow-up, compared with 50% (9/18) of CG participants (P=.31). Unanticipated visits to the emergency department occurred for 11% (2/18) of the SG compared with 6% (1/18) of the CG (>.99). The rate of pain or discomfort was 67% (12/18) in the SG compared with 61% (11/18) in the CG (P=.72). The anxiety or depression rate was 72% (13/18) in the SG versus 61% (11/18; P=.59) in the CG. Participants’ mean self-assessed health rating scores were 73.9 (SD 16.1) in the SG compared with 70.6 (SD 20.9) in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for postdischarge critical illness follow-up in an open-ended questionnaire regarding care. Conclusions: This exploratory study found no statistically significant results in reducing health care utilization postdischarge and health-related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for postdischarge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated postdischarge health care utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors that may show improvement in health care utilization in a larger population. %M 36877802 %R 10.2196/43759 %U https://formative.jmir.org/2023/1/e43759 %U https://doi.org/10.2196/43759 %U http://www.ncbi.nlm.nih.gov/pubmed/36877802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42584 %T Reliability and Validity of the Arabic Version of the Game Experience Questionnaire: Pilot Questionnaire Study %A Rebhi,Mahmoud %A Ben Aissa,Mohamed %A Tannoubi,Amayra %A Saidane,Mouna %A Guelmami,Noomen %A Puce,Luca %A Chen,Wen %A Chalghaf,Nasr %A Azaiez,Fairouz %A Zghibi,Makrem %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, robertobragazzi@gmail.com %K Arab countries %K game experience %K reliability %K scale %K validity %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nowadays, digital gaming occupies a central position in the entertainment industry where it has developed into a cherished kind of entertainment in markets all over the world. In addition, it provides other sectors with various social and economic benefits. The Game Experience Questionnaire (GEQ) is a free, quantitative, and comprehensive self-report measure that was developed to assess the player game experience. Despite having been widely used by many research projects in the past, it has not been adapted into Arabic. Furthermore, several components of the scale proved problematic from a psychometric point of view. Therefore, a modified version of the scale is needed to measure the gaming experience of the Arab population. Objective: The aim of this study was to validate and examine the psychometrics of an adapted Arabic version of the GEQ in Tunisia. Methods: A total of 771 volunteer participants completed an online survey, which included an Arabic version of the GEQ, gaming data, and a sociodemographic questionnaire. Subjects were randomized in order to complete two phases of the study: exploratory and confirmatory. The exploratory data were acquired from 360 respondents whose mean age was 23.89 (SD 2.29) years. Out of 360 respondents, 111 (30.8%) were female and 249 (69.2%) were male. Confirmatory data were obtained from the remaining 411 subjects whose mean age was 21.94 (SD 1.80) years. Out of 411 subjects, 169 (41.1%) were female and 242 (58.9%) were male. Results: After the elimination of two items, the exploratory and the confirmatory factor analyses provided an adequate factor structure of the Arabic version of the GEQ. In addition, the internal consistency coefficients suggested the reliability of the instrument. Significant differences were revealed for three subcomponents: flow by age (η2=0.013, P=.002), gender (η2=0.007, P=.02), and game type (η2=0.03, P<.001). For competence (η2=0.01, P=.03) and immersion (η2=0.02, P=.01), significant differences were highlighted by the type of game. The discriminant and convergent validities of the instrument were supported by calculating the average variance extracted (AVE) and comparing the square roots of the AVE values to the correlation coefficients, respectively. Conclusions: The Arabic adapted version of the GEQ is valid and reliable and can be administered to measure the game experience in Arab countries. %M 36482747 %R 10.2196/42584 %U https://formative.jmir.org/2023/1/e42584 %U https://doi.org/10.2196/42584 %U http://www.ncbi.nlm.nih.gov/pubmed/36482747 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41178 %T Smartphone and Wearable Sensors for the Estimation of Facioscapulohumeral Muscular Dystrophy Disease Severity: Cross-sectional Study %A Zhuparris,Ahnjili %A Maleki,Ghobad %A Koopmans,Ingrid %A Doll,Robert J %A Voet,Nicoline %A Kraaij,Wessel %A Cohen,Adam %A van Brummelen,Emilie %A De Maeyer,Joris H %A Groeneveld,Geert Jan %+ Centre for Human Drug Research (CHDR), Zernikedreef 8, Leiden, 2333 CL, Netherlands, 31 0715246400, ggroeneveld@chdr.nl %K facioscapulohumeral muscular dystrophy %K FSHD %K smartphone %K wearables %K machine learning %K Time Up and Go %K regression %K mobile phone %K neuromuscular disease %K mHealth %K mobile health %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Facioscapulohumeral muscular dystrophy (FSHD) is a progressive neuromuscular disease. Its slow and variable progression makes the development of new treatments highly dependent on validated biomarkers that can quantify disease progression and response to drug interventions. Objective: We aimed to build a tool that estimates FSHD clinical severity based on behavioral features captured using smartphone and remote sensor data. The adoption of remote monitoring tools, such as smartphones and wearables, would provide a novel opportunity for continuous, passive, and objective monitoring of FSHD symptom severity outside the clinic. Methods: In total, 38 genetically confirmed patients with FSHD were enrolled. The FSHD Clinical Score and the Timed Up and Go (TUG) test were used to assess FSHD symptom severity at days 0 and 42. Remote sensor data were collected using an Android smartphone, Withings Steel HR+, Body+, and BPM Connect+ for 6 continuous weeks. We created 2 single-task regression models that estimated the FSHD Clinical Score and TUG separately. Further, we built 1 multitask regression model that estimated the 2 clinical assessments simultaneously. Further, we assessed how an increasingly incremental time window affected the model performance. To do so, we trained the models on an incrementally increasing time window (from day 1 until day 14) and evaluated the predictions of the clinical severity on the remaining 4 weeks of data. Results: The single-task regression models achieved an R2 of 0.57 and 0.59 and a root-mean-square error (RMSE) of 2.09 and 1.66 when estimating FSHD Clinical Score and TUG, respectively. Time spent at a health-related location (such as a gym or hospital) and call duration were features that were predictive of both clinical assessments. The multitask model achieved an R2 of 0.66 and 0.81 and an RMSE of 1.97 and 1.61 for the FSHD Clinical Score and TUG, respectively, and therefore outperformed the single-task models in estimating clinical severity. The 3 most important features selected by the multitask model were light sleep duration, total steps per day, and mean steps per minute. Using an increasing time window (starting from day 1 to day 14) for the FSHD Clinical Score, TUG, and multitask estimation yielded an average R2 of 0.65, 0.79, and 0.76 and an average RMSE of 3.37, 2.05, and 4.37, respectively. Conclusions: We demonstrated that smartphone and remote sensor data could be used to estimate FSHD clinical severity and therefore complement the assessment of FSHD outside the clinic. In addition, our results illustrated that training the models on the first week of data allows for consistent and stable prediction of FSHD symptom severity. Longitudinal follow-up studies should be conducted to further validate the reliability and validity of the multitask model as a tool to monitor disease progression over a longer period. Trial Registration: ClinicalTrials.gov NCT04999735; https://www.clinicaltrials.gov/ct2/show/NCT04999735 %M 36920465 %R 10.2196/41178 %U https://formative.jmir.org/2023/1/e41178 %U https://doi.org/10.2196/41178 %U http://www.ncbi.nlm.nih.gov/pubmed/36920465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45355 %T Predicting Pain in People With Sickle Cell Disease in the Day Hospital Using the Commercial Wearable Apple Watch: Feasibility Study %A Stojancic,Rebecca Sofia %A Subramaniam,Arvind %A Vuong,Caroline %A Utkarsh,Kumar %A Golbasi,Nuran %A Fernandez,Olivia %A Shah,Nirmish %+ Duke Sickle Cell Comprehensive Care Unit, Department of Medicine, Division of Hematology, Duke University Hospital, 40 Duke Medicine Cir, Clinic 2N, Durham, NC, 27710, United States, 1 919 684 0628, rsstojan@ncsu.edu %K sickle cell disease %K vaso-occlusive crises %K mobile health %K consumer wearable %K Apple Watch %K machine learning %K pain %K prediction %K smartwatch %K wearable %K predict %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sickle cell disease (SCD) is a genetic red blood cell disorder associated with severe complications including chronic anemia, stroke, and vaso-occlusive crises (VOCs). VOCs are unpredictable, difficult to treat, and the leading cause of hospitalization. Recent efforts have focused on the use of mobile health technology to develop algorithms to predict pain in people with sickle cell disease. Combining the data collection abilities of a consumer wearable, such as the Apple Watch, and machine learning techniques may help us better understand the pain experience and find trends to predict pain from VOCs. Objective: The aim of this study is to (1) determine the feasibility of using the Apple Watch to predict the pain scores in people with sickle cell disease admitted to the Duke University SCD Day Hospital, referred to as the Day Hospital, and (2) build and evaluate machine learning algorithms to predict the pain scores of VOCs with the Apple Watch. Methods: Following approval of the institutional review board, patients with sickle cell disease, older than 18 years, and admitted to Day Hospital for a VOC between July 2021 and September 2021 were approached to participate in the study. Participants were provided with an Apple Watch Series 3, which is to be worn for the duration of their visit. Data collected from the Apple Watch included heart rate, heart rate variability (calculated), and calories. Pain scores and vital signs were collected from the electronic medical record. Data were analyzed using 3 different machine learning models: multinomial logistic regression, gradient boosting, and random forest, and 2 null models, to assess the accuracy of pain scores. The evaluation metrics considered were accuracy (F1-score), area under the receiving operating characteristic curve, and root-mean-square error (RMSE). Results: We enrolled 20 patients with sickle cell disease, all of whom identified as Black or African American and consisted of 12 (60%) females and 8 (40%) males. There were 14 individuals diagnosed with hemoglobin type SS (70%). The median age of the population was 35.5 (IQR 30-41) years. The median time each individual spent wearing the Apple Watch was 2 hours and 17 minutes and a total of 15,683 data points were collected across the population. All models outperformed the null models, and the best-performing model was the random forest model, which was able to predict the pain scores with an accuracy of 84.5%, and a RMSE of 0.84. Conclusions: The strong performance of the model in all metrics validates feasibility and the ability to use data collected from a noninvasive device, the Apple Watch, to predict the pain scores during VOCs. It is a novel and feasible approach and presents a low-cost method that could benefit clinicians and individuals with sickle cell disease in the treatment of VOCs. %M 36917171 %R 10.2196/45355 %U https://formative.jmir.org/2023/1/e45355 %U https://doi.org/10.2196/45355 %U http://www.ncbi.nlm.nih.gov/pubmed/36917171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41273 %T Acceptability and Feasibility of “Village,” a Digital Communication App for Young People Experiencing Low Mood, Thoughts of Self-harm, and Suicidal Ideation to Obtain Support From Family and Friends: Mixed Methods Pilot Open Trial %A Thabrew,Hiran %A Kumar,Harshali %A Steadman,Evandah %+ Department of Psychological Medicine, The University go Auckland, 20-22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 021402055, h.thabrew@auckland.ac.nz %K youth %K suicide %K self-harm %K depression %K support %K application %K mobile phone %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need. Objective: This paper aimed to evaluate the acceptability and feasibility of “Village,” a communication app co-designed with young people and their family and friends from New Zealand. Methods: A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire–9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version). Results: A total of 26 young people (“users”) were enrolled in the trial, of which 21 recruited friends and family members (“buddies”) and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (P=.007), but nonsignificant changes in suicidal ideation and functioning. The embedded risk detection software was activated on 3 occasions, and no additional support was required for users. Conclusions: During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app. Trial Registration: Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2 %M 36912882 %R 10.2196/41273 %U https://formative.jmir.org/2023/1/e41273 %U https://doi.org/10.2196/41273 %U http://www.ncbi.nlm.nih.gov/pubmed/36912882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42861 %T Effects of a Social Media–Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial %A Sui,Yufang %A Kor,Patrick Pui Kin %A Li,Mengli %A Wang,Jingjing %+ School of Nursing, The Hong Kong Polytechnic University, FG421, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, Hong Kong, 852 2766 5622, patrick.kor@polyu.edu.hk %K mind-body intervention %K acupressure %K mindfulness meditation %K social media %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of frail older adults experience high levels of stress. Mind-body interventions (MBIs) focused on caregiver stress are often limited in teaching approaches, difficult to practice, and costly. A social media–based MBI embedded with mindfulness meditation (MM) and self-administered acupressure (SA) may be effective for family caregivers, offer greater usability, and lead to greater adherence. Objective: The aim of this study was to test the feasibility and preliminary effects of a social media–based MBI embedded with MM and SA on family caregivers of frail older adults and to investigate the preliminary effects of the intervention using a pilot randomized controlled trial. Methods: A 2-arm randomized controlled trial design was adopted. Family caregivers of frail older adults (n=64) were randomized into either the intervention group (n=32), receiving 8 weeks of social media–based MM and SA, or the control group (n=32), receiving brief education on caregiving for people with frailty. The primary outcome (caregiver stress) and secondary outcomes (caregiver burden, sleep quality, and mindfulness awareness and attention) were measured using a web-based survey at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2). Results: The feasibility of the intervention was established with a high attendance rate (87.5%), high usability score (79), and low attrition rate (1.6%). The generalized estimating equation results showed that participants in the intervention group at T1 and T2 experienced a significant improvement in stress reduction (P=.02 and P=.04, respectively), sleep quality (P=.004 and P=.01, respectively), and mindful awareness and attention (P=.006 and P=.02, respectively) compared with the control group. There were no substantial improvements in caregiver burden at T1 and T2 (P=.59 and P=.47, respectively). A focus group session conducted after the intervention had 5 themes: impact on the family caregivers, difficulty in practicing the intervention, the strength of the program, the limitations of the program, and perception of the intervention. Conclusions: The findings support the feasibility and preliminary effects of social media–based MBI embedded with acupressure and MM on reducing stress among family caregivers of frail older people and enhancing sleep quality and mindfulness levels. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100049507; http://www.chictr.org.cn/showproj.aspx?proj=128031 %M 36804167 %R 10.2196/42861 %U https://formative.jmir.org/2023/1/e42861 %U https://doi.org/10.2196/42861 %U http://www.ncbi.nlm.nih.gov/pubmed/36804167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42390 %T Comparing the Feasibility and Acceptability of a Virtual Human, Teletherapy, and an e-Manual in Delivering a Stress Management Intervention to Distressed Adult Women: Pilot Study %A Loveys,Kate %A Antoni,Michael %A Donkin,Liesje %A Sagar,Mark %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599 ext 86756, e.broadbent@auckland.ac.nz %K stress %K cognitive behavioral stress management %K telehealth %K conversational agent %K virtual human %K e-manual %K pilot randomized controlled trial %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual humans (VHs), teletherapy, and self-guided e-manuals may increase the accessibility of psychological interventions. However, there is limited research on how these technologies compare in terms of their feasibility and acceptability in delivering stress management interventions. Objective: We conducted a preliminary comparison of the feasibility and acceptability of a VH, teletherapy, and an e-manual at delivering 1 module of cognitive behavioral stress management (CBSM) to evaluate the feasibility of the trial methodology in preparation for a future randomized controlled trial (RCT). Methods: A pilot RCT was conducted with a parallel, mixed design. A community sample of distressed adult women were randomly allocated to receive 1 session of CBSM involving training in cognitive and behavioral techniques by a VH, teletherapy, or an e-manual plus homework over 2 weeks. Data were collected on the feasibility of the intervention technologies (technical support and homework access), trial methods (recruitment methods, questionnaire completion, and methodological difficulty observations), intervention acceptability (intervention completion, self-report ratings, therapist rapport, and trust), and acceptability of the trial methods (self-report ratings and observations). Qualitative data in the form of written responses to open-ended questions were collected to enrich and clarify the findings on intervention acceptability. Results: Overall, 38 participants’ data were analyzed. A VH (n=12), teletherapy (n=12), and an e-manual (n=14) were found to be feasible and acceptable for delivering 1 session of CBSM to distressed adult women based on the overall quantitative and qualitative findings. Technical difficulties were minimal and did not affect intervention completion, and no significant differences were found between the conditions (P=.31). The methodology was feasible, although improvements were identified for a future trial. All conditions achieved good satisfaction and perceived engagement ratings, and no significant group differences were found (P>.40). Participants had similar willingness to recommend each technology (P=.64). There was a nonsignificant trend toward participants feeling more open to using the VH and e-manual from home than teletherapy (P=.10). Rapport (P<.001) and trust (P=.048) were greater with the human teletherapist than with the VH. The qualitative findings enriched the quantitative results by revealing the unique strengths and limitations of each technology that may have influenced acceptability. Conclusions: A VH, teletherapy, and a self-guided e-manual were found to be feasible and acceptable methods of delivering 1 session of a stress management intervention to a community sample of adult women. The technologies were found to have unique strengths and limitations that may affect which works best for whom and in what circumstances. Future research should test additional CBSM modules for delivery by these technologies and conduct a larger RCT to compare their feasibility, acceptability, and effectiveness when delivering a longer home-based stress management program. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000859987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380114&isReview=true %M 36757790 %R 10.2196/42390 %U https://formative.jmir.org/2023/1/e42390 %U https://doi.org/10.2196/42390 %U http://www.ncbi.nlm.nih.gov/pubmed/36757790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37293 %T A Mobile Health App (ChillTime) Promoting Emotion Regulation in Dual Disorders: Acceptability and Feasibility Pilot Study %A Pennou,Antoine %A Lecomte,Tania %A Potvin,Stéphane %A Riopel,Gabrielle %A Vézina,Camille %A Villeneuve,Marie %A Abdel-Baki,Amal %A Khazaal,Yasser %+ Département de Psychologie, Université de Montréal, 90 Avenue Vincent d’Indy, Bur. C-358, Pavillon Marie-Victorin, succ Centre-Ville, post office box 6128, Montreal, QC, H2C 3J7, Canada, 1 514 343 6274, tania.lecomte@umontreal.ca %K dual disorder %K concomitant disorder %K mental disorder %K mental illness %K satisfaction %K mobile app %K mHealth %K mobile health %K emotion regulation %K distress management %K substance use disorder %K substance use %K emotion %K distress %K mental health %K acceptability %K feasibility %K psychosis %K psychotic %K schizophrenia %K emotional health %K pilot study %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of studies highlight the importance of emotion regulation in the treatment and recovery of individuals with psychosis and concomitant disorders such as substance use disorder (SUD), for whom access to integrated dual-disorder treatments is particularly difficult. In this context, dedicated smartphone apps may be useful tools to provide immediate support to individuals in need. However, few studies to date have focused on the development and assessment of apps aimed at promoting emotional regulation for people with psychosis. Objective: The aim of this study was to evaluate the feasibility, acceptability, and potential clinical impact of a dedicated app (ChillTime) for individuals with psychotic disorders and concurrent SUD. The app design process followed recommendations for reducing cognitive effort on a mobile app. A total of 20 coping strategies regrouped in four categories (behavioral, emotional, cognitive, spiritual) were included in the app. Methods: This open pilot study followed a pre-post design. After the initial assessment, researchers asked participants to use the app as part of their treatment over a 30-day period. Feasibility was determined by the frequency of use of the app and measured using the number of completed strategies. Acceptability was determined by measuring ease of use, ease of learning, satisfaction, and perceived utility at the end of the 30-day study period based on responses to satisfaction questionnaires. Clinical scales measuring emotion regulation, substance use (ie, type of substance, amount taken, and frequency of use), and various psychiatric symptoms were administered at the beginning and end of the 30-day period. Results: A total of 13 participants were recruited from two first-episode psychosis clinics in Montreal, Quebec, Canada. All participants were symptomatically stable, were between 18 and 35 years of age (mostly men; 70% of the sample), and had a schizophrenia spectrum disorder with a comorbid substance use diagnosis. A total of 11 participants completed the study (attrition<20%). Approximately half of the participants used the tool at least 33% of the days (11-21 days). Cognitive and emotion-focused techniques were rated the highest in terms of usefulness and were the most frequently used. The majority of participants gave positive answers about the ease of use and the ease of learning the tool. A nonsignificant association of ChillTime use with negative symptoms and drug use was observed. No other statistically significant changes were observed. Conclusions: The ChillTime app showed good feasibility (approximately half of the participants used the tool at least 33% of the days) and acceptability among people with schizophrenia spectrum disorder and SUD. Trends suggesting a potential impact on certain clinical outcomes will need to be replicated in larger-sample studies before any conclusion can be drawn. %M 36705963 %R 10.2196/37293 %U https://formative.jmir.org/2023/1/e37293 %U https://doi.org/10.2196/37293 %U http://www.ncbi.nlm.nih.gov/pubmed/36705963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42151 %T The Usability of Homelab, a Digital Self-service at a Dutch General Practice, for Diagnostic Tests: Pilot Study With a Questionnaire %A Schnoor,Kyma %A Versluis,Anke %A Chavannes,Niels H %A Talboom-Kamp,Esther P W A %+ Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZA, Netherlands, 31 71526 8433, k.schnoor@lumc.nl %K eHealth %K diagnostic testing %K general practitioner %K general practice %K GP %K referral %K online testing %K diagnostic %K laboratory test %K usability %K digital health %K health care service %K service delivery %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth potentially can make health care more accessible and efficient and help reduce the workload in primary health care. Homelab is an eHealth tool implemented in a general practice environment, and it offers relatively simple laboratory diagnostic tests without the referral of the general practitioner. After logging in this eHealth tool, patients select and order a diagnostic test based on their symptoms. The test results are presented online to the general practitioner and the patient. Objective: This study aims to evaluate the use, usability, and user characteristics of Homelab. Further, it aims to evaluate whether Homelab replaces an appointment with the general practitioner. Methods: Homelab has been implemented since May 2021 as a pilot in a Dutch general practice. The number of requests and the ordered diagnostic packages are monitored. After using Homelab, patients are invited to complete a short questionnaire. The questionnaire contains demographic questions and assesses usability using the System Usability Scale (10 items). In addition, questions about requesting an appointment with the general practitioner without Homelab are included. All data were anonymous. Results: The questionnaire was filled by 74 individual patients. The mean age of the patients was 40.33 (SD 12.11) years, and half of them were females (39/74, 53%). The majority of the patients were highly educated (56/74, 76%) and employed (53/74, 72%). Approximately 81% (60/74) of the patients reported that they would use Homelab again in the future and 66% (49/74) reported that they would have gone to the general practitioner if they had not used Homelab. The usability of Homelab was perceived higher by the younger age group (mean 73.96, SD 14.74) than by the older age group (mean 61.59, SD 14.37). In total, 106 test packages were ordered over 1 year, and the most requested diagnostic package was “Am I still healthy? I want to do my annual health checkup.” Homelab was used the most during the months of the COVID-19 lockdown. Conclusions: The use of Homelab, a digital self-service for ordering diagnostic tests, was monitored in this study, and its usability was perceived as above average. Our findings showed that patients are willing to use Homelab in the future and they would use it most of the time as a replacement for regular consultations. Homelab offers opportunities for more accessible and efficient health care for both the patient and the general practitioner. %M 36701183 %R 10.2196/42151 %U https://formative.jmir.org/2023/1/e42151 %U https://doi.org/10.2196/42151 %U http://www.ncbi.nlm.nih.gov/pubmed/36701183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42266 %T User Engagement and Weight Loss Facilitated by a Mobile App: Retrospective Review of Medical Records %A Valinskas,Sarunas %A Nakrys,Marius %A Aleknavičius,Kasparas %A Jonusas,Justinas %A Lileikienė,Angelė %+ Lithuania Business University of Applied Sciences, Turgaus st 21, Klaipėda, 91249, Lithuania, 370 26311099, justinas.jonusas@kilo.health %K intermittent fasting %K fasting %K weight %K weight loss %K mobile application %K body composition %K mHealth %K mobile health %K diet %K dietary intervention %K weight loss outcome %K adherence %K engagement %K mobile app %K motivation %K intervention outcome %K fasting apps %K dietary interventions %K obesity %K regression analysis %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps. Objective: Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition. Methods: We performed a retrospective analysis of data from 665 users with obesity (BMI≥30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in %), and body muscle (in %) were compared. Results: Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass. Conclusions: We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass. %M 36692936 %R 10.2196/42266 %U https://formative.jmir.org/2023/1/e42266 %U https://doi.org/10.2196/42266 %U http://www.ncbi.nlm.nih.gov/pubmed/36692936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40379 %T Feasibility, Usability and Acceptability of a mHealth Intervention to Reduce Cardiovascular Risk in Rural Hispanic Adults: Descriptive Study %A Rowland,Sheri %A Ramos,Athena K %A Trinidad,Natalia %A Quintero,Sophia %A Johnson Beller,Rebecca %A Struwe,Leeza %A Pozehl,Bunny %+ College of Nursing, University of Nebraska Medical Center, 550 N. 19th Street, Lincoln, NE, 68508-0620, United States, 1 402 472 5959, sheri.rowland@unmc.edu %K mHealth %K health behavior %K self-management %K Hispanic/Latino %K rural %K apps %K feasibility %K acceptability %K participation %K engagement %K wearable device %K tracking %K smartphone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) technology using apps or devices to self-manage health behaviors is an effective strategy to improve lifestyle-related health problems such as hypertension, obesity, and diabetes. However, few studies have tested an mHealth intervention with Hispanic/Latino adults, and no studies were found testing mHealth with rural Hispanic/Latino adults, the fastest-growing population in rural areas. Objective: The purpose of this study was to evaluate the feasibility, usability, and acceptability of an mHealth cardiovascular risk self-management intervention with rural Hispanic/Latino adults. Methods: A descriptive study using quantitative and qualitative methods was used to evaluate the feasibility, usability, and acceptability of delivering a 12-week mHealth self-management intervention to reduce cardiovascular risk with rural Hispanic/Latino adults who were randomized to 1 of 2 groups. Both groups were asked to use MyFitnessPal to self-monitor daily steps, weight, and calories. The intervention group received support to download, initiate, and troubleshoot technology challenges with MyFitnessPal (Under Armour) and a smart scale, while the enhanced usual care group received only a general recommendation to use MyFitnessPal to support healthy behaviors. The usability of MyFitnessPal and the smart scale was measured using an adapted Health Information Technology Usability EvaluationScale (Health-ITUES). Adherence data in the intervention group (daily steps, weight, and calories) were downloaded from MyFitnessPal. Acceptability was evaluated using semistructured interviews in a subsample (n=5) of intervention group participants. Results: A sample of 70 eligible participants (enhanced usual care group n=34; intervention group n=36) were enrolled between May and December 2019. The overall attrition was 28% at 12 weeks and 54% at 24 weeks. mHealth usability in the intervention group increased at each time point (6, 12, and 24 weeks). Adherence to self-monitoring using mHealth in the intervention group after week 1 was 55% for steps, 39% for calories, and 35% for weights; at the end of the 12-week intervention, the adherence to self-monitoring was 31% for steps, 11% for weight, and 8% for calories. Spikes in adherence coincided with scheduled in-person study visits. Structured interviews identified common technology challenges including scale and steps not syncing with the app and the need for additional technology support for those with limited mHealth experience. Conclusions: Recruitment of rural Hispanic/Latino adults into the mHealth study was feasible using provider and participant referrals. The use of MyFitnessPal, the smart scale, and SMS text messages to self-monitor daily steps, weights, and calories was acceptable and feasible if technology support was provided. Future research should evaluate and support participants’ baseline technology skill level, provide training if needed, and use a phone call or SMS text message follow-ups as a strategy to minimize attrition. A wearable device, separate from the smartphone app, is recommended for activity tracking. %M 36563025 %R 10.2196/40379 %U https://formative.jmir.org/2022/12/e40379 %U https://doi.org/10.2196/40379 %U http://www.ncbi.nlm.nih.gov/pubmed/36563025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e41317 %T Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis %A Foster,Marva %A Xiong,Wei %A Quintiliani,Lisa %A Hartmann,Christine W %A Gaehde,Stephan %+ VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, 150 S Huntington Avenue, Boston, MA, 02130, United States, 1 857 203 6671, marva.foster@va.gov %K qualitative research %K heart failure %K self-care %K mobile health %K mobile health technology %K older adults %K elderly %K perceptions %K mhealth intervention %K veteran health %K mHealth technology %K elderly health care %K elderly self-care %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans. Objective: The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF. Methods: Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data. Results: Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language. Conclusions: We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features. %M 36538348 %R 10.2196/41317 %U https://formative.jmir.org/2022/12/e41317 %U https://doi.org/10.2196/41317 %U http://www.ncbi.nlm.nih.gov/pubmed/36538348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38479 %T Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals With Binge Eating: The SenseSupport Withdrawal Design Study %A Juarascio,Adrienne S %A Srivastava,Paakhi %A Presseller,Emily K %A Lin,Mandy %A Patarinski,Anna G G %A Manasse,Stephanie M %A Forman,Evan M %+ Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut St., Philadelphia, PA, 19104, United States, 1 215 553 7154, asj32@drexel.edu %K binge eating %K loss-of-control eating %K continuous glucose monitoring %K mobile phone %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Dietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps owing to difficulty in using treatment skills (eg, regular eating) to reduce dietary restraint during their daily lives. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that uses continuous glucose monitoring to detect periods of dietary restraint, may improve CBT to reduce dietary restraint during treatment by providing real-time interventions. Objective: This study aimed to describe the feasibility, acceptability, and initial evaluation of SenseSupport. We presented feasibility, acceptability, target engagement, and initial treatment outcome data from a small trial using an ABAB (A=continuous glucose monitoring data sharing and JITAIs-Off, B=continuous glucose monitoring data sharing and JITAIs-On) design (in which JITAIs were turned on for 2 weeks and then turned off for 2 weeks throughout the treatment). Methods: Participants (N=30) were individuals with BED or BN engaging in ≥3 episodes of ≥5 hours without eating per week at baseline. Participants received 12 sessions of CBT and wore continuous glucose monitors to detect eating behaviors and inform the delivery of JITAIs. Participants completed 4 assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment. Results: Retention was high (25/30, 83% after treatment). However, the rates of continuous glucose monitoring data collection were low (67.4% of expected glucose data were collected), and therapists and participants reported frequent app-related issues. Participants reported that the SenseSupport system was comfortable, minimally disruptive, and easy to use. The only form of dietary restraint that decreased significantly more rapidly during JITAIs-On periods relative to JITAIs-Off periods was the desire for an empty stomach (t43=1.69; P=.049; Cohen d=0.25). There was also a trend toward greater decrease in overall restraint during JITAs-On periods compared with JITAIs-Off periods, but these results were not statistically significant (t43=1.60; P=.06; Cohen d=0.24). There was no significant difference in change in the frequency of binge eating during JITAIs-On periods compared with JITAIs-Off periods (P=.23). Participants demonstrated clinically significant, large decreases in binge eating (t24=10.36; P<.001; Cohen d=2.07), compensatory behaviors (t24=3.40; P=.001; Cohen d=0.68), and global eating pathology (t24=6.25; P<.001; Cohen d=1.25) from pre- to posttreatment. Conclusions: This study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs to augment CBT for binge-spectrum eating disorders. Despite the lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest that the SenseSupport system warrants additional investigation via future, fully powered clinical trials. Trial Registration: ClinicalTrials.gov NCT04126694; https://clinicaltrials.gov/ct2/show/NCT04126694 %M 36515992 %R 10.2196/38479 %U https://formative.jmir.org/2022/12/e38479 %U https://doi.org/10.2196/38479 %U http://www.ncbi.nlm.nih.gov/pubmed/36515992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e43192 %T Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users’ Perspective and Mixed Methods Study %A Borghouts,Judith %A Eikey,Elizabeth V %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole A %A Zheng,Kai %A Wilson,Lorraine %A Caro,Damaris %A Mukamel,Dana B %A Sorkin,Dara H %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 949 438 1337, eeikey@health.ucsd.edu %K older adults %K mental health %K digital mental health intervention %K human support %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits. Objective: This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety. Methods: A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis. Results: A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others. Conclusions: Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness. %M 36512387 %R 10.2196/43192 %U https://formative.jmir.org/2022/12/e43192 %U https://doi.org/10.2196/43192 %U http://www.ncbi.nlm.nih.gov/pubmed/36512387 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37609 %T Using Social Media to Engage Justice-Involved Young Adults in Digital Health Interventions for Substance Use: Pilot Feasibility Survey Study %A Harrison,Anna %A Folk,Johanna %A Rodriguez,Christopher %A Wallace,Amanda %A Tolou-Shams,Marina %+ Mental Health Service, San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA, 94121, United States, 1 415 221 4810, anna.harrison@ucsf.edu %K substance use %K young adult %K social media %K digital health technology %K mobile phone %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults involved in the justice system have high rates of substance use disorders and low rates of treatment engagement. Most justice-involved young adults are supervised in the community—not incarcerated in jail or prison—where they have ongoing access to substances and experience significant barriers to care. When they do engage in treatment, they tend to have worse outcomes than justice-involved adolescents and older adults. Despite the need to develop targeted treatments, there are unique challenges in recruiting this population into clinical research. Digital health technology offers many novel avenues for recruiting justice-involved young adults into clinical research studies and disseminating substance use disorder treatments to justice-involved young adults. Because the vast majority of young adults regularly use one or more social media platforms, social media may offer a cost-effective and efficient way to achieve these goals. Objective: This study aimed to describe the process and feasibility of using social media platforms (Facebook and Reddit) to recruit justice-involved young adults into clinical research. Justice-involved young adults recruited from these platforms completed a survey assessing the acceptability of digital health interventions to address substance use in this population. Methods: Justice-involved young adults (aged 18-24 years) were recruited through paid advertisements placed on Facebook and Reddit. Participants responded to a web-based survey focused on their substance use, treatment use history, and acceptability of various digital health interventions focused on substance use. Results: A national sample of justice-involved young adults were successfully enrolled and completed the survey (N=131). Participants were racially diverse (8/131, 6.1% American Indian individuals; 27/131, 20.6% Asian individuals; 23/131, 17.6% Black individuals; 26/131, 19.8% Latinx individuals; 8/131, 6.1% Pacific Islander individuals; 49/131, 37.4% White individuals; and 2/131, 1.5% individuals who identified as “other” race and ethnicity). Advertisements were cost-effective (US $0.66 per click on Facebook and US $0.47 per click on Reddit). More than half (72/131, 54.9%) of the participants were on probation or parole in the past year and reported hazardous alcohol (54/131, 51.9%) or drug (66/131, 57.4%) use. Most of the participants (103/131, 78.6%) were not currently participating in substance use treatment. Nearly two-third (82/131, 62.6%) of the participants were willing to participate in one or more hypothetical digital health interventions. Conclusions: Social media is a feasible and cost-effective method for reaching justice-involved young adults to participate in substance use research trials. With limited budgets, researchers can reach a broad audience, many of whom could benefit from treatment but are not currently engaged in care. Proposed digital health interventions focusing on reducing substance use, such as private Facebook groups, SMS text message–based appointment reminders, and coaching, had high acceptability. Future work will build on these findings to develop substance use treatment interventions for this population. %M 36459404 %R 10.2196/37609 %U https://formative.jmir.org/2022/12/e37609 %U https://doi.org/10.2196/37609 %U http://www.ncbi.nlm.nih.gov/pubmed/36459404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42376 %T Remotely Assessing Mechanisms of Behavioral Change in Community Substance Use Disorder Treatment to Facilitate Measurement-Informed Care: Pilot Longitudinal Questionnaire Study %A Hallgren,Kevin A %+ Department of Psychiatry and Behavioral Sciences, University of Washington, University of Washington Medical Center, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 616 2906, khallgre@uw.edu %K addiction %K clinical pilot %K measurement-based care %K mechanisms of change %K mobile health %K mHealth %K mobile phone %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Research shows that improvements in coping strategies, abstinence self-efficacy, craving, and depression are potential mechanisms of behavioral change (MOBC) in treatments for substance use disorders (SUDs). However, little is known about how these insights regarding MOBC can be applied to SUD treatment settings. One way to facilitate MOBC-informed care in frontline settings could be to measure and monitor changes in MOBC throughout treatment using brief, frequent questionnaires that patients complete by using mobile technologies (eg, smartphones). The results derived from these questionnaires could potentially be used for clinical monitoring (ie, measurement-based care) to better understand whether individual patients are experiencing treatment-related improvements on key clinical targets. Objective: This study evaluated whether brief, weekly MOBC questionnaires completed by patients remotely can potentially provide clinically meaningful information about changes in MOBC in the context of real-world, community-based SUD treatment. Methods: A total of 30 patients (14/30, 47% female; 13/30, 43% racial or ethnic minority) in a community SUD treatment clinic participated in a pilot study where they were invited to complete brief, weekly questionnaires that assessed various MOBC, including coping strategies, abstinence self-efficacy, craving, depression, and therapeutic alliance. Questionnaires were typically completed remotely via smartphone for up to 6 months; 618 questionnaires were completed in total. Participants also completed longer, psychometrically validated measures of the same MOBC at baseline and 6-month research appointments. Statistical analyses tested whether brief, weekly, remotely completed MOBC questionnaires exhibited characteristics that would be desirable for real-world longitudinal clinical monitoring, including a tendency to detect within-person changes in MOBC over time; cross-sectional and longitudinal associations with longer, psychometrically validated measures completed at research appointments; and similar patterns of associations with 6-month percentage of days abstinent as longer, psychometrically validated MOBC measures completed at research appointments. Results: The results of this study indicated that the brief, weekly, remotely completed MOBC measures exhibited characteristics that are desirable for clinical monitoring, including a tendency to vary longitudinally (within patients over time) more often than measures of alcohol and drug consumption, generally having medium to large cross-sectional and longitudinal correlations with longer psychometrically validated measures of MOBC completed at research appointments, and generally having similar patterns of association with 6-month percentage of days abstinent from alcohol and drugs as longer psychometrically validated MOBC measures completed at research appointments. Conclusions: The results of this pilot study provide initial evidence that incorporating brief, weekly, and remotely completed MOBC questionnaires into community SUD treatment may be a viable approach for facilitating MOBC-informed care. Such questionnaires can potentially support measurement-based care by providing meaningful information about within-patient changes in clinical domains that are often directly targeted in SUD treatments and predict long-term substance use outcomes. %M 36342773 %R 10.2196/42376 %U https://formative.jmir.org/2022/11/e42376 %U https://doi.org/10.2196/42376 %U http://www.ncbi.nlm.nih.gov/pubmed/36342773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40907 %T Use of a Rapid Qualitative Method to Inform the Development of a Text Messaging Intervention for People With Serious Mental Illness Who Smoke: Formative Research Study %A Nagawa,Catherine S %A Lane,Ian A %A McKay,Colleen E %A Kamberi,Ariana %A Shenette,Lisa L %A Kelly,Megan M %A Davis,Maryann %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 8999, cnagawa@mgh.harvard.edu %K serious mental illness %K mental disorder %K psychiatric disorder %K tobacco use %K smoking cessation %K text messaging %K intervention %K smoking %K mental health %K virtual %K COVID-19 %K pandemic %K symptom %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. Objective: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. Methods: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. Results: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the “interplay between smoking and having a serious mental illness” theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the “social contextual factors of smoking in adults with serious mental illness” theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the “smoking and quitting behaviors similar to the general population” theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. Conclusions: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness. %M 36342765 %R 10.2196/40907 %U https://formative.jmir.org/2022/11/e40907 %U https://doi.org/10.2196/40907 %U http://www.ncbi.nlm.nih.gov/pubmed/36342765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e30327 %T Internet-Based Intervention Compared to Brief Intervention for Smoking Cessation in Brazil: Pilot Study %A Machado,Nathalia Munck %A Gomide,Henrique Pinto %A Bernardino,Heder Soares %A Ronzani,Telmo Mota %+ Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 8163287381, nmachado@kumc.edu %K smoking cessation %K internet-based intervention %K digital intervention %K mobile health %K mHealth %K tobacco %K addiction %K public health %K digital intervention %K substance use %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is still the leading cause of preventable death. Governments and health care providers should make available more accessible resources to help tobacco users stop. Objective: This study describes a pilot longitudinal study that evaluated the efficacy of an internet-based intervention compared to the brief intervention for smoking cessation among Brazilians. Methods: Eligible participants were recruited and randomly allocated to one of the two interventions. Measures were drawn by comparing cessation rates, motivation scores, and sought treatment between groups, assessed 1 and 3 months after the intervention. Inferential analysis was performed to compare the participants’ characteristics, and the intention to treat was calculated. Results: A total of 49 smokers were enrolled in this study (n=25, 51% in the brief intervention group; n=24, 49% in the internet-based intervention group). Mean age was 44.5 (SD 13.3) years; most were male (n=29, 59.2%), had elementary school (n=22, 44.9%), smoked 14.5 cigarettes per day on average (SD 8.6), and had a mean score of 4.65 for nicotine dependence and 5.7 for motivation to quit. Moreover, 35 (71%) participants answered follow-up 1, and 19 (39%) answered follow-up 2. The results showed similar rates of cessation and reduction for both intervention groups. Conclusions: The internet-based intervention was slightly more effective for smoking cessation, while the brief intervention was more effective in reducing the number of cigarettes smoked per day. This difference was small and had no statistical significance even after adjusting for intention-to-treat analysis. These results should be interpreted with caution, especially due to the small sample size. %M 36326817 %R 10.2196/30327 %U https://formative.jmir.org/2022/11/e30327 %U https://doi.org/10.2196/30327 %U http://www.ncbi.nlm.nih.gov/pubmed/36326817 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38460 %T Brief App-Based Cognitive Behavioral Therapy for Anxiety Symptoms in Psychiatric Inpatients: Feasibility Randomized Controlled Trial %A Sharma,Gaurav %A Schlosser,Lisa %A Jones,Brett D M %A Blumberger,Daniel M %A Gratzer,David %A Husain,M Omair %A Mulsant,Benoit H %A Rappaport,Lance %A Stergiopoulos,Vicky %A Husain,Muhammad Ishrat %+ Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada, 1 416 979 6948, mr.sharma@mail.utoronto.ca %K inpatient %K mental health %K mental disorder %K psychiatry %K psychiatric %K smartphone app %K cognitive behavioral therapy %K CBT %K anxiety %K mobile app %K mobile health %K mHealth %K health app %K digital health %K eHealth %K feasibility study %K randomized controlled trial %K RCT %K feasibility %K acceptability %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychiatric inpatients often have limited access to psychotherapeutic education or skills for managing anxiety, a common transdiagnostic concern in severe and acute mental illness. COVID-19–related restrictions further limited access to therapy groups on inpatient psychiatric units. App-based interventions may improve access, but evidence supporting the feasibility of their use, acceptability, and effectiveness in psychiatric inpatient settings is limited. MindShift CBT is a free app based on cognitive behavioral therapy principles with evidence for alleviating anxiety symptoms in the outpatient setting. Objective: We aimed to recruit 24 participants from an acute general psychiatric inpatient ward to a 1-month randomized control study assessing the feasibility and acceptability of providing patients with severe and acute mental illness access to the MindShift CBT app for help with managing anxiety symptoms. Methods: Recruitment, data collection, analysis, and interpretation were completed collaboratively by clinician and peer researchers. Inpatients were randomized to two conditions: treatment as usual (TAU) versus TAU plus use of the MindShift CBT app over 6 days. We collected demographic and quantitative data on acceptability and usability of the intervention. Symptoms of depression, anxiety, and psychological distress were measured in pre- and poststudy surveys for preliminary signals of efficacy. We conducted individual semistructured interviews with participants in the MindShift CBT app group at the end of their trial period, which were interpreted using a standardized protocol for thematic analysis. Results: Over 4 weeks, 33 inpatients were referred to the study, 24 consented to participate, 20 were randomized, and 11 completed the study. Of the 9 randomized participants who did not complete the study, 7 were withdrawn because they were discharged or transferred prior to study completion, with a similar distribution among both conditions. Among the enrolled patients, 65% (13/20) were admitted for a psychotic disorder and no patient was admitted primarily for an anxiety disorder. The average length of stay was 20 days (SD 4.4; range 3-21) and 35% (7/20) of patients were involuntarily admitted to hospital. Small sample sizes limited accurate interpretation of the efficacy data. Themes emerging from qualitative interviews included acceptability and usability of the app, and patient agency associated with voluntary participation in research while admitted to hospital. Conclusions: Our study benefitted from collaboration between peer and clinician researchers. Due to rapid patient turnover in the acute inpatient setting, additional flexibility in recruitment and enrollment is needed to determine the efficacy of using app-based psychotherapy on an acute psychiatric ward. Despite the limited sample size, our study suggests that similar interventions may be feasible and acceptable for acutely unwell inpatients. Further study is needed to compare the efficacy of psychotherapeutic apps with existing standards of care in this setting. Trial Registration: ClinicalTrials.gov NCT04841603; https://clinicaltrials.gov/ct2/show/NCT04841603 %M 36322113 %R 10.2196/38460 %U https://formative.jmir.org/2022/11/e38460 %U https://doi.org/10.2196/38460 %U http://www.ncbi.nlm.nih.gov/pubmed/36322113 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36049 %T Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial %A Lai,Byron %A Vogtle,Laura %A Young,Raven %A Craig,Mary %A Kim,Yumi %A Gowey,Marissa %A Swanson-Kimani,Erin %A Davis,Drew %A Rimmer,James H %+ Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, 5 Dearth, McWane 5601, Birmingham, AL, 35209, United States, 1 205 638 9790 ext 8, blai@uabmc.edu %K exercise %K developmental disability %K cerebral palsy %K telemedicine %K telerehabilitation %K therapy %K mobile phone %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). Objective: The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. Methods: This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children’s Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results: A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children’s Assessment of Participation and Enjoyment Active Physical Recreation–Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants’ adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390 %M 36306154 %R 10.2196/36049 %U https://formative.jmir.org/2022/10/e36049 %U https://doi.org/10.2196/36049 %U http://www.ncbi.nlm.nih.gov/pubmed/36306154 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e34923 %T Mobile App to Enhance Patient Activation and Patient-Provider Communication in Major Depressive Disorder Management: Collaborative, Randomized Controlled Pilot Study %A McCue,Maggie %A Blair,Christopher %A Fehnert,Ben %A King,James %A Cormack,Francesca %A Sarkey,Sara %A Eramo,Anna %A Kabir,Christopher %A Khatib,Rasha %A Kemp,David %+ Takeda Pharmaceuticals USA, Inc, 95 Hayden Ave, Lexington, MA, 02421, United States, 1 224 554 2820, Maggie.McCue@takeda.com %K depression %K major depressive disorder %K depression management %K patient engagement %K patient satisfaction %K mobile app %K patient-reported outcomes %K mobile phone %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). Objective: We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). Methods: In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50%) or usual care alone (20/40, 50%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire–Depression). Results: All 37 patients (app arm: n=18, 49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). Conclusions: Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. Trial Registration: ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213 %M 36301599 %R 10.2196/34923 %U https://formative.jmir.org/2022/10/e34923 %U https://doi.org/10.2196/34923 %U http://www.ncbi.nlm.nih.gov/pubmed/36301599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36782 %T The First Asynchronous Online Evidence-Based Medicine Course for Syrian Health Workforce: Effectiveness and Feasibility Pilot Study %A Kenjrawi,Yazan %A Dashash,Mayssoon %+ Medical Education Program, Syrian Virtual University, Omar Bin Abdulaziz Street, Damascus, Syrian Arab Republic, 963 948379097, yazankenjrawi@gmail.com %K evidence-based medicine %K continuous medical education %K web-based learning %K Syria %K medical graduates %K medical education %K web-based course %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence-based medicine (EBM) is critical for providing the best scientifically proven patient health care, and it is implemented worldwide in order to improve the quality of the delivered health care. However, not all Syrian health professionals are knowledgeable about the importance, methodology, and implementation of EBM. Providing web-based learning courses on EBM might be effective in improving the EBM knowledge of health care professionals. Objective: This study was performed to test the effectiveness and the feasibility of an asynchronous web-based course on EBM in improving the competencies of Syrian health care professionals in terms of EBM. Methods: A web-based course on EBM was developed in Arabic and uploaded onto the Syrian Virtual University platform. An electronic registration form was designed and distributed to medical groups on social media for registration to this web-based course. Both the pretest and posttest had the same 3 sections to measure the impact of this web-based EBM program on the knowledge, skills, and attitudes of the Syrian health care professionals. The posttest had an additional section for measuring the efficacy and ease of use of this program. Student paired 1-tailed t test was used to analyze the differences in the different assessment sections among the participants. Results: Nineteen participants filled the electronic registration form, but 8 participants did not meet the inclusion criteria. Therefore, the pretest was sent to the remaining 11 participants (7 men and 4 women) who graduated from Syrian universities. Ten of them completed the pretest, while 7 of them completed the posttest. The web-based course was found to be effective in improving the participants’ EBM knowledge, skills, and attitudes at P>.05. Further, the web-based EBM course was feasible and easy-to-use. Conclusions: In order for EBM to be implemented in Syria, continuous medical education training programs should be designed for clinical practitioners. Our study shows that asynchronous web-based medical education is an effective and a feasible means for introducing the concept of EBM, improving practitioners’ skills, and promoting the positive attitudes of Syrian clinical practitioners toward EBM. %M 36282556 %R 10.2196/36782 %U https://formative.jmir.org/2022/10/e36782 %U https://doi.org/10.2196/36782 %U http://www.ncbi.nlm.nih.gov/pubmed/36282556 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41410 %T Digital Peer-Supported Self-Management Intervention Codesigned by People With Long COVID: Mixed Methods Proof-of-Concept Study %A Wright,Hayley %A Turner,Andrew %A Ennis,Stuart %A Percy,Carol %A Loftus,Garry %A Clyne,Wendy %A Matouskova,Gabriela %A Martin,Faith %+ Centre for Intelligent Healthcare, Coventry University, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, United Kingdom, 44 02477659509, ab7764@coventry.ac.uk %K long COVID %K self-management %K peer support %K digital intervention %K goal setting %K psychological %K physical %K cognitive %K intervention %K United Kingdom %K UK %K efficacy %K COVID-19 %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are around 1.3 million people in the United Kingdom with the devastating psychological, physical, and cognitive consequences of long COVID (LC). UK guidelines recommend that LC symptoms be managed pragmatically with holistic support for patients’ biopsychosocial needs, including psychological, emotional, and physical health. Self-management strategies, such as pacing, prioritization, and goal setting, are vital for the self-management of many LC symptoms. Objective: This paper describes the codevelopment and initial testing of a digital intervention combining peer support with positive psychology approaches for self-managing the physical, emotional, psychological, and cognitive challenges associated with LC. The objectives of this study were to (1) codesign an intervention with and for people with LC; (2) test the intervention and study methods; (3) measure changes in participant well-being, self-efficacy, fatigue, and loneliness; and (4) understand the types of self-management goals and strategies used by people with LC. Methods: The study used a pre-post, mixed methods, pragmatic, uncontrolled design. Digital intervention content was codeveloped with a lived-experience group to meet the needs uncovered during the intervention development and logic mapping phase. The resulting 8-week digital intervention, Hope Programme for Long COVID, was attended by 47 participants, who completed pre- and postprogram measures of well-being, self-efficacy, fatigue, and loneliness. Goal-setting data were extracted from the digital platform at the end of the intervention. Results: The recruitment rate (n=47, 83.9%) and follow-up rate (n=28, 59.6%) were encouraging. Positive mental well-being (mean difference 6.5, P<.001) and self-efficacy (mean difference 1.1, P=.009) improved from baseline to postcourse. All goals set by participants mapped onto the 5 goal-oriented domains in the taxonomy of everyday self-management strategies (TEDSS). The most frequent type of goals was related to activity strategies, followed by health behavior and internal strategies. Conclusions: The bespoke self-management intervention, Hope Programme for Long COVID, was well attended, and follow-up was encouraging. The sample characteristics largely mirrored those of the wider UK population with LC. Although not powered to detect statistically significant changes, the preliminary data show improvements in self-efficacy and positive mental well-being. Our next trial (ISRCTN: 11868601) will use a nonrandomized waitlist control design to further examine intervention efficacy. %M 36166651 %R 10.2196/41410 %U https://formative.jmir.org/2022/10/e41410 %U https://doi.org/10.2196/41410 %U http://www.ncbi.nlm.nih.gov/pubmed/36166651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35176 %T From Real-world Individuals’ Data to National Health Indicators: Multiphase Pilot Study in Gabon %A Koumamba,Aimé Patrice %A Ngoungou,Edgard Brice %A Engohang-Ndong,Jean %A Ibinga,Euloge %A Ondzigue Mbenga,Raymond %A Diallo,Gayo %+ Centre de recherche sur la santé des populations de Bordeaux, Institut national de la santé et de la recherche médicale 1219, Université de Bordeaux, 146 Rue Léo Saignat 11, Bordeaux, 33076, France, 33 77921571, aime-patrice.koumamba@u-bordeaux.fr %K health data quality %K decision support information system %K low- and middle-income countries %K LMICs %K mobile phone %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Achieving health goals requires informed decision-making supported by transparent, reliable, and relevant health information. This helps decision makers, such as health managers, to better understand the functioning of their health system and improve their ability to respond quickly to health demands. To achieve this, the health system needs to be supported by a digitized decision-making information system. In Sub-Saharan African countries, inadequate digital infrastructure, including limited internet connectivity and insufficient access to appropriate computer software, makes it difficult to collect, process, and analyze data for health statistics. The processing of data is done manually in this case; however, this situation affects the quality of the health statistics produced and compromises the quality of health intervention choices in these countries. Objective: This study aimed to describe the conceptual approach of a data production and dissemination platform model proposed and implemented in Gabon. More precisely, it aimed to present the approach applied for the multidimensional analysis of the data production and dissemination process in the existing information system and present the results of an evaluation of the proposed model implemented in a real context. Methods: The research was carried out in 3 phases. First, a platform was designed and developed based on the examination of the various data production and indicator generation procedures. Then, the platform was implemented in chosen health facilities in Gabon. Finally, a platform evaluation was carried out with actual end users. Results: A total of 14 users with 12 years of average experience in health data management were interviewed. The results show that the use of the proposed model significantly improved the completeness, timeliness, and accuracy of data compared with the traditional system (93% vs 12%, P<.001; 96% vs 18%, P<.001; and 100% vs 18%, P<.001; respectively). Conclusions: The proposed model contributes significantly to the improvement of health data quality in Gabon. %M 36206045 %R 10.2196/35176 %U https://formative.jmir.org/2022/10/e35176 %U https://doi.org/10.2196/35176 %U http://www.ncbi.nlm.nih.gov/pubmed/36206045 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40572 %T Feasibility of Measuring Screen Time, Activity, and Context Among Families With Preschoolers: Intensive Longitudinal Pilot Study %A Parker,Hannah %A Burkart,Sarah %A Reesor-Oyer,Layton %A Smith,Michal T %A Dugger,Roddrick %A von Klinggraeff,Lauren %A Weaver,R Glenn %A Beets,Michael W %A Armstrong,Bridget %+ Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208-3904, United States, 1 803 576 8418, ba12@mailbox.sc.edu %K ecological momentary assessment %K accelerometry %K objective digital media use %K screen time %K sleep %K activity %K preschool %K dyads %K mobile phone %D 2022 %7 29.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital media has made screen time more available across multiple contexts, but our understanding of the ways children and families use digital media has lagged behind the rapid adoption of this technology. Objective: This study evaluated the feasibility of an intensive longitudinal data collection protocol to objectively measure digital media use, physical activity, sleep, sedentary behavior, and socioemotional context among caregiver-child dyads. This paper also describes preliminary convergent validity of ecological momentary assessment (EMA) measures and preliminary agreement between caregiver self-reported phone use and phone use collected from passive mobile sensing. Methods: Caregivers and their preschool-aged child (3-5 years) were recruited to complete a 30-day assessment protocol. Within 30-days, caregivers completed 7 days of EMA to measure child behavior problems and caregiver stress. Caregivers and children wore an Axivity AX3 (Newcastle Upon Tyne) accelerometer to assess physical activity, sedentary behavior, and sleep. Phone use was assessed via passive mobile sensing; we used Chronicle for Android users and screenshots of iOS screen time metrics for iOS users. Participants were invited to complete a second 14-day protocol approximately 3-12 months after their first assessment. We used Pearson correlations to examine preliminary convergent validity between validated questionnaire measures of caregiver psychological functioning, child behavior, and EMA items. Root mean square errors were computed to examine the preliminary agreement between caregiver self-reported phone use and objective phone use. Results: Of 110 consenting participants, 105 completed all protocols (105/110, 95.5% retention rate). Compliance was defined a priori as completing ≥70%-75% of each protocol task. There were high compliance rates for passive mobile sensing for both Android (38/40, 95%) and iOS (64/65, 98%). EMA compliance was high (105/105, 100%), but fewer caregivers and children were compliant with accelerometry (62/99, 63% and 40/100, 40%, respectively). Average daily phone use was 383.4 (SD 157.0) minutes for Android users and 354.7 (SD 137.6) minutes for iOS users. There was poor agreement between objective and caregiver self-reported phone use; root mean square errors were 157.1 and 81.4 for Android and iOS users, respectively. Among families who completed the first assessment, 91 re-enrolled to complete the protocol a second time, approximately 7 months later (91/105, 86.7% retention rate). Conclusions: It is feasible to collect intensive longitudinal data on objective digital media use simultaneously with accelerometry and EMA from an economically and racially diverse sample of families with preschool-aged children. The high compliance and retention of the study sample are encouraging signs that these methods of intensive longitudinal data collection can be completed in a longitudinal cohort study. The lack of agreement between self-reported and objectively measured mobile phone use highlights the need for additional research using objective methods to measure digital media use. International Registered Report Identifier (IRRID): RR2-36240 %M 36173677 %R 10.2196/40572 %U https://formative.jmir.org/2022/9/e40572 %U https://doi.org/10.2196/40572 %U http://www.ncbi.nlm.nih.gov/pubmed/36173677 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37637 %T mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study %A Garcia,David O %A Valdez,Luis A %A Aceves,Benjamin %A Bell,Melanie L %A Rabe,Brooke A %A Villavicencio,Edgar A %A Marrero,David G %A Melton,Forest %A Hooker,Steven P %+ Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 3950 S. Country Club, Suite 330, Tucson, AZ, 85714, United States, 1 520 626 4641, davidogarcia@arizona.edu %K Hispanic %K mobile health %K mHealth %K overweight %K obesity %K weight loss %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested. Objective: This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity. Methods: A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ≥225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants’ weight loss experiences and perspectives on mHealth technologies. Results: Of 18 participants, 16 (89%) completed the 12-week assessments; the overall attrition rate was 11.1%. The mean weight loss at week 12 was −4.7 kg (95% CI 7.1 to −2.4 kg; P<.001). Participants wore the Fitbit 71.58% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale. Conclusions: Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men. Trial Registration: ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521 %M 36129735 %R 10.2196/37637 %U https://formative.jmir.org/2022/9/e37637 %U https://doi.org/10.2196/37637 %U http://www.ncbi.nlm.nih.gov/pubmed/36129735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40703 %T Postoperative Outcomes of a Digital Rehabilitation Program After Total Knee Arthroplasty: Retrospective, Observational Feasibility Study %A Hong,Mindy %A Loeb,Joey %A Yang,Manshu %A Bailey,Jeannie F %+ Hinge Health, Inc., 455 Market Street, Suite 700, San Francisco, CA, 94105, United States, 1 615 498 8308, mindy.hong@hingehealth.com %K total knee arthroplasty %K surgical %K digital intervention %K musculoskeletal %K telemedicine %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Surgery can sometimes be the best solution for chronic musculoskeletal pain, but presurgical preparation and postsurgical rehabilitation are often required to achieve the maximum benefits. A digital musculoskeletal surgical care program was developed to support the population of patients undergoing total knee arthroplasty. Objective: We aimed to demonstrate safety, engagement, and acceptability and explore clinical outcomes, health care use, and satisfaction among participants of a digital musculoskeletal surgical care program who were undergoing total knee arthroplasty. Methods: A retrospective, observational feasibility study comparing digital musculoskeletal surgical care program participants to a comparison group was conducted. The intervention group registered for a digital musculoskeletal surgical care program, which included health coaches, physical therapists, and tailored exercises and educational articles to provide preoperative and postoperative support to patients who had recently undergone total knee arthroplasty. Comparison group members received standard-of-care treatment. Engagement (number of exercise therapy sessions and educational articles accessed per week) and acceptability (Net Promoter Score) were examined among intervention group participants. Descriptive statistics for postoperative outcomes, including safety (postoperative complications), clinical improvement (pain, function, anxiety, and depression), and health care use and experiences (length of hospital stay, surgery satisfaction, and physical therapy adherence), were reported for both groups. Differences among postoperative results were compared by using the independent samples 2-tailed t test or Mann-Whitney test for continuous outcomes and the Fisher exact test or chi-square test for categorical outcomes. Results: Of the 53 participants (intervention group: n=22; comparison group: n=31) who were included in this study, 35 (66%) were female and 25 (47%) were aged from 45 to 60 years. On average, the intervention group completed 23 exercise sessions, read 2.7 educational articles, sent 45.5 texts to their health coaches, and were actively engaged for 6 weeks after their operation. Among 21 participants, 14 (67%) self-reported as promoters on the Net Promoter Score scale. Intervention group members reported fewer postoperative complications (6/22, 27%) than the comparison group (15/31, 48%), and they experienced better outcomes with regard to function (Knee Injury and Osteoarthritis Outcome Score–Physical Function Short Form—intervention group: mean 23.0; comparison group: mean 32.5), depression (Patient Health Questionnaire 2-Item—intervention group: mean 0.4; comparison group: mean 1.6), anxiety (General Anxiety Disorder 2-Item—intervention group: mean 0.6; comparison group: mean 1.5), and impressions of change (Patient Global Impression of Change—intervention group: median 7.0; comparison group: median 6.0). Intervention group participants also reported less health care use, better adherence to their physical therapy exercises, and higher surgery satisfaction. Conclusions: Our digital musculoskeletal surgical care program shows promising levels of engagement and acceptability among those who recently underwent total knee arthroplasty. The surgical care program may also help with improving postsurgical complications and clinical outcomes and lowering health care use. %M 36121690 %R 10.2196/40703 %U https://formative.jmir.org/2022/9/e40703 %U https://doi.org/10.2196/40703 %U http://www.ncbi.nlm.nih.gov/pubmed/36121690 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37838 %T Optimizing Health Coaching for Patients With Type 2 Diabetes Using Machine Learning: Model Development and Validation Study %A Di,Shuang %A Petch,Jeremy %A Gerstein,Hertzel C %A Zhu,Ruoqing %A Sherifali,Diana %+ School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 9055259140 ext 21435, dsherif@mcmaster.ca %K diabetes health coaching %K artificial intelligence %K reinforcement learning %K health coaching %K patient outcome %K diabetes %K community health %K digital intervention %K health outcome %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health coaching is an emerging intervention that has been shown to improve clinical and patient-relevant outcomes for type 2 diabetes. Advances in artificial intelligence may provide an avenue for developing a more personalized, adaptive, and cost-effective approach to diabetes health coaching. Objective: We aim to apply Q-learning, a widely used reinforcement learning algorithm, to a diabetes health-coaching data set to develop a model for recommending an optimal coaching intervention at each decision point that is tailored to a patient’s accumulated history. Methods: In this pilot study, we fit a two-stage reinforcement learning model on 177 patients from the intervention arm of a community-based randomized controlled trial conducted in Canada. The policy produced by the reinforcement learning model can recommend a coaching intervention at each decision point that is tailored to a patient’s accumulated history and is expected to maximize the composite clinical outcome of hemoglobin A1c reduction and quality of life improvement (normalized to [ ​0, 1 ​], with a higher score being better). Our data, models, and source code are publicly available. Results: Among the 177 patients, the coaching intervention recommended by our policy mirrored the observed diabetes health coach’s interventions in 17.5% (n=31) of the patients in stage 1 and 14.1% (n=25) of the patients in stage 2. Where there was agreement in both stages, the average cumulative composite outcome (0.839, 95% CI 0.460-1.220) was better than those for whom the optimal policy agreed with the diabetes health coach in only one stage (0.791, 95% CI 0.747-0.836) or differed in both stages (0.755, 95% CI 0.728-0.781). Additionally, the average cumulative composite outcome predicted for the policy’s recommendations was significantly better than that of the observed diabetes health coach’s recommendations (tn-1=10.040; P<.001). Conclusions: Applying reinforcement learning to diabetes health coaching could allow for both the automation of health coaching and an improvement in health outcomes produced by this type of intervention. %M 36099006 %R 10.2196/37838 %U https://formative.jmir.org/2022/9/e37838 %U https://doi.org/10.2196/37838 %U http://www.ncbi.nlm.nih.gov/pubmed/36099006 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38354 %T Tough Talks Virtual Simulation HIV Disclosure Intervention for Young Men Who Have Sex With Men: Development and Usability Testing %A Hightow-Weidman,Lisa B %A Muessig,Kathryn %A Soberano,Zach %A Rosso,Matthew T %A Currie,Andrew %A Adams Larsen,Margo %A Knudtson,Kelly %A Vecchio,Alyssa %+ Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, United States, 1 919 843 0033, lisa_hightow@med.unc.edu %K HIV %K virtual reality %K status disclosure %K prevention %K young men who have sex with men %K artificial intelligence %K medication adherence %K transmission %K viral load %K men %K sex %K development %K usability %K testing %K virtual simulation %K young men %K United States %K behavior %K social determinants %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV status disclosure is an important decision with barriers specific to young men who have sex with men (YMSM), who have the highest rates of new HIV infections in the United States. Behavioral and social determinants of the difficulty to disclose can include fear of rejection, stigma, loss of financial stability, and lack of communication skills. Once able to disclose, a person may have increased access to social support and improved informed risk reduction conversations and medication adherence. Despite the known challenges and advantages of disclosure, there are few effective tools supporting this behavior. Objective: To address this gap in disclosure interventions, the Tough Talks (TT) app, an mHealth intervention using artificial intelligence (AI)–facilitated role-playing scenarios, was developed for YMSM. This paper reports stages of development of the integrated app and results of the usability testing. Methods: Building on the successful development and testing of a stand-alone interactive dialogue feature in phases 1-3, we conducted additional formative research to further refine and enhance the disclosure scenarios and develop and situate them within the context of a comprehensive intervention app to support disclosure. We assessed the new iteration for acceptability and relevance in a usability study with 8 YMSM with HIV. Participants completed a presurvey, app modules, and a semistructured qualitative interview. Results: TT content and activities were based on social cognitive theory and disclosure process model framework and expanded to a 4-module curriculum. The AI-facilitated scenarios used dialogue from an utterance database developed using language crowdsourced through a comic book contest. In usability testing, YMSM reported high satisfaction with TT, with 98% (31/33) of activities receiving positive ratings. Participants found the AI-facilitated scenarios and activities to be representative and relevant to their lived experiences, although they noted difficulty having nuanced disclosure conversations with the AI. Conclusions: TT was an engaging and practical intervention for self-disclosure among YMSM with HIV. Facilitating informed disclosure decisions has the potential to impact engagement in sexual risk behaviors and HIV care. More information is needed about the ideal environment, technical assistance, and clinical support for an mHealth disclosure intervention. TT is being tested as a scalable intervention in a multisite randomized controlled trial to address outstanding questions on accessibility and effect on viral suppression. Trial Registration: ClinicalTrials.gov NCT03414372; https://clinicaltrials.gov/ct2/show/NCT03414372 %M 36074551 %R 10.2196/38354 %U https://formative.jmir.org/2022/9/e38354 %U https://doi.org/10.2196/38354 %U http://www.ncbi.nlm.nih.gov/pubmed/36074551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39772 %T Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program %A Williams,Kimberly D %A Jurkovitz,Claudine T %A Papas,Mia A %A Muther,Ann Kathryn %A Anderson,Sharon L %A Anderson,Tammy L %+ Institute for Research on Equity and Community Health, ChristianaCare, Avenue North, 4000 Nexus Drive, Suite CE1-300, Wilmington, DE, 19803, United States, 1 302 428 2662, kimwilliams@christianacare.org %K opioid use disorder %K substance use %K drug addiction %K opioid treatment program %K COVID-19 %K telehealth %K telemedicine %K eHealth %K Short Message Service %K SMS %K text messaging %K text message %K opioid use %K opioid %K care management %K patient care management %K health intervention %K telehealth intervention %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD. Objective: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment. Methods: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant’s physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program. Results: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment. Conclusions: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality. %M 35973033 %R 10.2196/39772 %U https://formative.jmir.org/2022/8/e39772 %U https://doi.org/10.2196/39772 %U http://www.ncbi.nlm.nih.gov/pubmed/35973033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35743 %T Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program %A Fioratti,Iuri %A Miyamoto,Gisela Cristiane %A Fandim,Junior Vitorino %A Ribeiro,Camila Pereira Pontes %A Batista,Geovana Domingues %A Freitas,Gabriella Evangelista %A Palomo,Andressa Santos %A Reis,Felipe José Jandré dos %A Costa,Leonardo Oliveira Pena %A Maher,Christopher G %A Saragiotto,Bruno Tirotti %+ Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galero, 448, Tatuapé, São Paulo, 03071-000, Brazil, 55 11 970127143, iurifioratti@gmail.com %K telerehabilitation %K musculoskeletal pain %K implementation science %K feasibility study %K chronic pain %K pain %K pilot study %K eHealth %K exercise %K telehealth %K self-management %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation. Objective: This study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet. Methods: The study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients’ perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed. Results: In total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US $278.30 per patient in the intervention group and US $141.52 per patient in the control group. No adverse events were reported during the intervention period. Conclusions: We found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users’ implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe. Trial Registration: ClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439 %M 35776863 %R 10.2196/35743 %U https://formative.jmir.org/2022/8/e35743 %U https://doi.org/10.2196/35743 %U http://www.ncbi.nlm.nih.gov/pubmed/35776863 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e28626 %T A Smoking Cessation Mobile App for Persons Living With HIV: Preliminary Efficacy and Feasibility Study %A Schnall,Rebecca %A Liu,Jianfang %A Alvarez,Gabriella %A Porras,Tiffany %A Ganzhorn,Sarah %A Boerner,Samantha %A Huang,Ming-Chun %A Trujillo,Paul %A Cioe,Patricia %+ Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, United States, 1 212 342 6886, rb897@columbia.edu %K HIV %K mHealth %K smoking cessation %K intervention %K smoking %K persons with HIV %K pilot %K pilot test %K mobile app %K smartwatch %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of smoking in the United States general population has gradually declined to the lowest rate ever recorded; however, this has not been true for persons with HIV. Objective: We conducted a pilot test to assess the feasibility and efficacy of the Lumme Quit Smoking mobile app and smartwatch combination with sensing capabilities to improve smoking cessation in persons with HIV. Methods: A total of 40 participants were enrolled in the study and randomly assigned 1:1 to the control arm, which received an 8-week supply of nicotine replacement therapy, a 30-minute smoking cessation counseling session, and weekly check-in calls with study staff, or to the intervention arm, which additionally received the Lumme Quit Smoking app and smartwatch. Results: Of the 40 participants enrolled, 37 completed the follow-up study assessments and 16 used the app every day during the 56-day period. During the 6-month recruitment and enrollment period, 122 people were screened for eligibility, with 67.2% (82/122) deemed ineligible. Smoking criteria and incompatible tech were the major reasons for ineligibility. There was no difference in the proportion of 7-day point prevalence abstinence by study arm and no significant decrease in exhaled carbon monoxide for the intervention and control arms separately. However, the average exhaled carbon monoxide decreased over time when analyzing both arms together (P=.02). Conclusions: Results suggest excellent feasibility and acceptability of using a smoking sensor app among this smoking population. The knowledge gained from this research will enable the scientific community, clinicians, and community stakeholders to improve tobacco cessation outcomes for persons with HIV. Trial Registration: ClinicalTrials.gov NCT04808609; https://clinicaltrials.gov/ct2/show/NCT04808609 %M 35980739 %R 10.2196/28626 %U https://formative.jmir.org/2022/8/e28626 %U https://doi.org/10.2196/28626 %U http://www.ncbi.nlm.nih.gov/pubmed/35980739 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34737 %T Predictors of the Acceptance of an Electronic Coach Targeting Self-management of Patients With Type 2 Diabetes: Web-Based Survey %A Harakeh,Zeena %A Van Keulen,Hilde %A Hogenelst,Koen %A Otten,Wilma %A De Hoogh,Iris M %A Van Empelen,Pepijn %+ Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands, 31 6 11615907, zeena.harakeh@tno.nl %K mobile health %K type 2 diabetes %K self-management %K eCoach %K Technology Acceptance Model %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes (T2D) is a lifestyle-related disease whose prevalence increases with age. Diabetes self-management through mobile health (mHealth) apps enables patients with T2D to improve their health. According to the Technology Acceptance Model (TAM), technology acceptance (ie, intended use) is necessary to ensure mHealth can be implemented successfully. Therefore, the specific acceptance requirements of patients with T2D should be considered. Objective: This cross-sectional study aims to examine the extent to which different TAM predictors are associated with the acceptance of a diabetes app including an electronic coach (eCoach; Iris app) among patients with T2D. Methods: Using a web-based survey, data on 92 patients with T2D (mean age 62.76 years, SD 8.29 years) were collected. Acceptance of the Iris app with the TAM predictors (ie, perceived usefulness, perceived ease of use, social influence, perceived self-efficacy, perceived security, prior usage experience, perceived health, and propensity of data/information sharing) was assessed. Further, control variables (ie, gender, age, education, ethnicity, household, BMI, amount of years with diabetes, diabetes-related complaints, and medication use) were assessed. Results: Multiple linear regression analyses showed that acceptance of the Iris app was positively associated with perceived usefulness (β=.57, P<.001), social influence (subjective norm; β=.20, P=.004), and willingness to share data (β=.25, P<.001). In addition, acceptance regarding the Iris app was higher among patients with T2D with overweight (β=.23, P=.01) or obese BMI (β=.21, P=.01). The model explained 75.8% of the variance in the acceptance of the Iris app by patients with T2D. In addition, perceived usefulness of the Iris app was positively related to perceived ease of use (β=.32, P<.001), subjective norm (β=.26, P=.004), perceived control (β=.19, P=.03), willingness to share data (β=.20, P=.01) regarding the Iris app, and perceived security regarding general use of apps/smartphone/internet (β=.15, P=.04). The model explained 58.2% of the variance in patients’ perceived usefulness about the Iris app. Conclusions: Among patients with T2D, the belief that the use of the Iris app is helpful/beneficial, the willingness to share their Iris app data, and others’ approval of using this app can stimulate the acceptance of this app. In addition, the belief that the use of (health) apps is reliable and secure, the belief that the use of the Iris app is easy to use, a higher perceived capability and personal control with using this app, the willingness to share their Iris app data, and others’ approval of using this app can stimulate the perceived usefulness of such an app. These TAM predictors explained a high variance in acceptance and perceived usefulness of the Iris app. Implications for practice are addressed. %M 35972769 %R 10.2196/34737 %U https://formative.jmir.org/2022/8/e34737 %U https://doi.org/10.2196/34737 %U http://www.ncbi.nlm.nih.gov/pubmed/35972769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38326 %T Associations of Maternal and Paternal Parenting Practices With Children’s Fruit and Vegetable Intake and Physical Activity: Preliminary Findings From an Ecological Momentary Study %A Lopez,Nanette Virginia %A Lai,Mark HC %A Yang,Chih-Hsiang %A Dunton,Genevieve Fridlund %A Belcher,Britni Ryan %+ Department of Health Sciences, Northern Arizona University, 1100 S Beaver St, Box 15095, Flagstaff, AZ, 86011, United States, 1 928 523 7913, nanette.lopez@nau.edu %K parenting %K ecological momentary assessment %K fruit and vegetable consumption %K physical activity %K pediatrics %K obesity %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevention interventions routinely focus on changing maternal parenting practices. Failure to assess how fathers’ weight-related (ie, diet and physical activity) parenting practices contribute to children’s energy balance behaviors limits the understanding of their paternal role within the family. Examining the independent and interacting effects of fathers’ and mothers’ weight-related parenting practices on children’s diet and physical activity addresses this important research gap. Objective: This study used ecological momentary assessment (EMA) to investigate the within-subject and between-subject independent and interactive effects of maternal and paternal encouragement to eat and preparation of fruits and vegetables (F/V) and encouragement of and taking their child to be physically active on their child’s self-reported F/V intake and physical activity engagement. Methods: Participants included mother-father-child triads (n=22 triads, n=205-213 prompts/occasions) in the Mothers and Their Children’s Health Study and the University of Southern California Fathers Study. Simultaneously, mothers and fathers (agesmean 44.2 years, SD 5.6, and 45.2 years, SD 8.1, respectively), and their children (agemean 12.0 years, SD 0.7) completed up to 8 randomly prompted EMA surveys per day on separate smartphones for 7 days. At each prompt, mothers and fathers each reported whether they did the following in the past 2 hours: (1) encouraged their child to eat F/V, (2) prepared F/V for their child, (3) encouraged their child to be physically active, or (4) took their child to be physically active. Children self-reported whether they consumed F/V or were physically active in the past 2 hours. Results: Results from Bayesian multilevel logistic models (all in log-odd units) indicated that at the within-subject level, greater maternal encouragement (β=2.28, 95% CI 0.08 to 5.68) of eating F/V was associated with greater child report of eating F/V, but paternal encouragement (β=1.50, 95% CI –0.83 to 4.52) showed no effects above and beyond maternal encouragement. Additionally, greater than usual paternal encouragement (β=2.28, 95% CI 0.08 to 5.54) and maternal encouragement (β=2.94, 95% CI 0.36 to 6.69) of physical activity had significant independent effects and were associated with greater child report of physical activity. No other within-subject or between-subject associations nor interactive effects were significant. Conclusions: Findings from this study suggest that fathers play a role in supporting their children’s physical activity but not their intake of F/V. Future EMA studies should recruit larger samples to evaluate the independent and interacting roles of mothers’ and fathers’ weight-related parenting practices on child’s obesogenic behaviors. %M 35947425 %R 10.2196/38326 %U https://formative.jmir.org/2022/8/e38326 %U https://doi.org/10.2196/38326 %U http://www.ncbi.nlm.nih.gov/pubmed/35947425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e23261 %T Effects of Feedback From Self-Monitoring Devices on Lifestyle Changes in Workers with Diabetes: 3-Month Randomized Controlled Pilot Trial %A Nagata,Tomohisa %A Aoyagi,Sona-Sanae %A Takahashi,Minekazu %A Nagata,Masako %A Mori,Koji %+ Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, yahatanishi-ku, Kitakyushu, 807-8555, Japan, 81 93 603 1611, tomohisa@med.uoeh-u.ac.jp %K mobile health %K digital health %K diabetes %K workers %K self-monitoring %K BMI %K daily activity %K randomized controlled trial %K smartphone %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although lifestyle interventions are useful in the prevention and management of diabetes, they can be expensive and time-consuming. There is some evidence on the effectiveness of automated mobile technology for health self-monitoring; however, few studies have used such devices in the occupational health field. Objective: We aimed to examine the effectiveness of a digital self-monitoring device on glucose levels and activity of workers with diabetes in Japan. The primary outcomes were changes in blood glucose levels, and the secondary outcomes were changes in weight and BMI. Methods: A 2-arm randomized controlled pilot trial was conducted with workers from 23 organizations. The intervention group (n=50) wore an armband activity monitor, a body composition monitor, and a blood pressure monitor for 3 months and received semiautomated weekly email messages tailored to their device data. The control group (n=53) engaged in no self-monitoring. Messages were developed by a physician and a dietician. Postintervention changes in blood glucose levels, weight, and BMI were compared between the intervention and control groups, using blood tests and questionnaires. Results: At the end of 3 months, the intervention group showed significantly lower blood glucose levels (HbA1c: intervention group mean 6.4% (SD 0.3%) vs control group mean 6.6% (SD 0.3%); Cohen d=0.7, 95% CI 0.2-1.1; P=.009). There were no significant between-group differences in weight and BMI. Conclusions: Mobile digital self-monitoring was effective in improving blood glucose levels in workers with diabetes. The use of digital health devices is a cost-effective way of implementing health self-monitoring for large numbers of individuals in the workplace. However, due to the large volume of missing values in this study, we need to be careful in interpreting the results, and well-designed intervention studies need to be conducted. Trial Registration: University Hospital Medical Information Network UMIN000023651; https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view_cb.cgi?recptno=R000027244&flwp_key=1008PYbOcXKmk7CAg4Th1FWS %M 35943766 %R 10.2196/23261 %U https://formative.jmir.org/2022/8/e23261 %U https://doi.org/10.2196/23261 %U http://www.ncbi.nlm.nih.gov/pubmed/35943766 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34497 %T The Assessment of a Personalized Nutrition Tool (eNutri) in Germany: Pilot Study on Usability Metrics and Users’ Experiences %A Kaiser,Birgit %A Stelzl,Tamara %A Finglas,Paul %A Gedrich,Kurt %+ Research Group Public Health Nutrition, ZIEL - Institute for Food & Health, TUM School of Life Sciences, Technical University of Munich, Weihenstephaner Berg 1, Freising, 85354, Germany, 49 8161 71 2483, kgedrich@tum.de %K Food Frequency Questionnaire %K dietary assessment %K Diet Quality Score %K web application %K digital nutrition %K personalized nutrition %K system usability %K internet %K eNutri %K EIT Food Quisper %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To address the epidemic burden of diet-related diseases, adequate dietary intake assessments are needed to determine the actual nutrition intake of a population. In this context, the eNutri web app has been developed, providing online automated personalized dietary advice, based on nutritional information recorded via an integrated and validated food frequency questionnaire (FFQ). Originally developed for a British population and their dietary habits, the eNutri tool has specifically been adapted to the German population, taking into account national eating habits and dietary recommendations. Objective: The primary aim of this study is to evaluate the system usability and users’ experience and feedback on the eNutri app in a small-scale preliminary study. The secondary aim is to investigate the efficacy of personalized nutrition (PN) recommendations versus general dietary advice in altering eating habits. Methods: The app was piloted for 4 weeks by 106 participants from across Germany divided into a PN group and a control group. The groups differed according to the degree of personalization of dietary recommendations obtained. Results: An overall System Usability Scale (SUS) score of 78.4 (SD 12.2) was yielded, indicating an above average user experience. Mean completion time of the FFQ was 26.7 minutes (SD 10.6 minutes). Across subgroups (age, sex, device screen sizes) no differences in SUS or completion time were found, indicating an equal performance for all users independent of the assigned experimental group. Participants’ feedback highlighted the need for more personalized dietary advice for controls, while personalized nutritional recommendations improved the awareness of healthy eating behavior. Further improvements to the eNutri app were suggested by the app users. Conclusions: In total, the eNutri app has proven to be a suitable instrument to capture the dietary habits of a German population sample. Regarding functionality, system usability, and handling, direct user feedback was quite positive. Nutritional advice given was rated ambivalent, pointing to several weaknesses in the eNutri app, minimizing the system’s full potential. A higher level of personalization within nutritional advice subjectively improved the app’s usability. The insights gained will be used as a basis to further develop and improve this digital diet assessment tool. %M 35925664 %R 10.2196/34497 %U https://formative.jmir.org/2022/8/e34497 %U https://doi.org/10.2196/34497 %U http://www.ncbi.nlm.nih.gov/pubmed/35925664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35268 %T Just-in-Time Prompts for Running, Walking, and Performing Strength Exercises in the Built Environment: 4-Week Randomized Feasibility Study %A Sporrel,Karlijn %A Wang,Shihan %A Ettema,Dick D F %A Nibbeling,Nicky %A Krose,Ben J A %A Deutekom,Marije %A de Boer,Rémi D D %A Simons,Monique %+ Human Geography and Spatial Planning, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, Netherlands, 31 642514287, k.sporrel@uu.nl %K just-in-time interventions %K context-based %K prompts %K reminders %K physical activity %K mobile health %K mHealth %K exercise application %K Fogg Behavior Model %K user experience %K engagement %K feasibility study %K mobile phone %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based mobile health exercise interventions can motivate individuals to engage in more physical activity (PA). According to the Fogg Behavior Model, it is important that the individual receive prompts at the right time to be successfully persuaded into PA. These are referred to as just-in-time (JIT) interventions. The Playful Active Urban Living (PAUL) app is among the first to include 2 types of JIT prompts: JIT adaptive reminder messages to initiate a run or walk and JIT strength exercise prompts during a walk or run (containing location-based instruction videos). This paper reports on the feasibility of the PAUL app and its JIT prompts. Objective: The main objective of this study was to examine user experience, app engagement, and users’ perceptions and opinions regarding the PAUL app and its JIT prompts and to explore changes in the PA behavior, intrinsic motivation, and the perceived capability of the PA behavior of the participants. Methods: In total, 2 versions of the closed-beta version of the PAUL app were evaluated: a basic version (Basic PAUL) and a JIT adaptive version (Smart PAUL). Both apps send JIT exercise prompts, but the versions differ in that the Smart PAUL app sends JIT adaptive reminder messages to initiate running or walking behavior, whereas the Basic PAUL app sends reminder messages at randomized times. A total of 23 participants were randomized into 1 of the 2 intervention arms. PA behavior (accelerometer-measured), intrinsic motivation, and the perceived capability of PA behavior were measured before and after the intervention. After the intervention, participants were also asked to complete a questionnaire on user experience, and they were invited for an exit interview to assess user perceptions and opinions of the app in depth. Results: No differences in PA behavior were observed (Z=−1.433; P=.08), but intrinsic motivation for running and walking and for performing strength exercises significantly increased (Z=−3.342; P<.001 and Z=−1.821; P=.04, respectively). Furthermore, participants increased their perceived capability to perform strength exercises (Z=2.231; P=.01) but not to walk or run (Z=−1.221; P=.12). The interviews indicated that the participants were enthusiastic about the strength exercise prompts. These were perceived as personal, fun, and relevant to their health. The reminders were perceived as important initiators for PA, but participants from both app groups explained that the reminder messages were often not sent at times they could exercise. Although the participants were enthusiastic about the functionalities of the app, technical issues resulted in a low user experience. Conclusions: The preliminary findings suggest that the PAUL apps are promising and innovative interventions for promoting PA. Users perceived the strength exercise prompts as a valuable addition to exercise apps. However, to be a feasible intervention, the app must be more stable. %M 35916693 %R 10.2196/35268 %U https://formative.jmir.org/2022/8/e35268 %U https://doi.org/10.2196/35268 %U http://www.ncbi.nlm.nih.gov/pubmed/35916693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37108 %T Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study %A Zaslavsky,Oleg %A Kaneshiro,Jasmine %A Chu,Frances %A Teng,Andrew %A Domoto-Reilly,Kimiko %A Chen,Annie T %+ University of Washington, 1959 Pacific Street NE, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K dementia %K caregiver %K internet based %K digital health %K digital intervention %K eHealth %K feasibility %K web-based %K peer support %K didactic training %K caregiving %K informal care %K spousal care %K remote intervention %K Lewy body %K Lewy bodies %K discussion forum %K discussion platform %K online support %K distress %K stress reduction %K online discussion %K support group %K discussion group %K burden %K depression %K depressive symptom %K lonely %K loneliness %K mental health %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Compared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances. Objective: We performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population. Methods: We recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience–Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment. Results: Participants’ baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them “a great deal” to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one’s abilities to provide care to the care recipient (4/12, 33%). Conclusions: The study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency. %M 35904843 %R 10.2196/37108 %U https://formative.jmir.org/2022/7/e37108 %U https://doi.org/10.2196/37108 %U http://www.ncbi.nlm.nih.gov/pubmed/35904843 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34248 %T The Burden of Cold Agglutinin Disease on Patients’ Daily Life: Web-Based Cross-sectional Survey of 50 American Patients %A Joly,Florence %A Schmitt,Lisa Anne %A Watson,Patricia Ann McGee %A Pain,Emilie %A Testa,Damien %+ Health Economics And Outcomes Research, Sanofi, 1 Avenue Pierre Brossolette, Chilly-Mazarin, 91380, France, 33 01 60 49 77 77, florence.joly@sanofi.com %K autoimmune diseases %K fatigue %K perception %K rare diseases %K surveys and questionnaires %K cold agglutinin disease %K cold autoimmune hemolytic anemia %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cold agglutinin disease (CAD) is a rare disorder, affecting 15% of patients with autoimmune hemolytic anemia. Few studies have assessed CAD symptoms and their impact on daily life, but these studies did not address the patients’ perspectives. Objective: The aims of this study were to increase the knowledge about CAD through a patient-centric survey and to gain a better understanding of the burden of this disease. Methods: We conducted an internet-based survey in September 2020 among American patients registered on the CAD Unraveled website and members of the Cold Agglutinin Disease Foundation. Results: A total of 50 respondents were included in this study. Totally, 90% (45/50) of the patients reported having experienced fatigue. Fatigue was mainly reported on a daily basis, and approximately one-third of these patients (13/45, 29%) said that their fatigue was constant throughout the day. It has also been shown that CAD has a great impact on patients’ physical well-being, emotional well-being, social life, and household finances. The disease varies over time, with or without symptoms. A total of 88% (44/50) of the patients reported previous episodes of the increased intensity or sensitivity of their CAD symptoms, with a mean of 4.5 (SD 5.4) episodes reported during the past year. More than half of the patients (27/50, 54%) considered their disease to be moderate or severe, and 42% (21/50) of the study group reported that their symptoms had worsened since the time of diagnosis. Conclusions: Our study has provided new data on CAD symptoms, particularly data on the importance and type of fatigue and the fluctuation of CAD symptoms. %M 35867390 %R 10.2196/34248 %U https://formative.jmir.org/2022/7/e34248 %U https://doi.org/10.2196/34248 %U http://www.ncbi.nlm.nih.gov/pubmed/35867390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35352 %T Health-Related Quality of Life Among Members Using an On Demand Behavioral Health Platform: Pilot Observational Study %A Shih,Emily %A Aylward,Brandon S %A Kunkle,Sarah %A Graziani,Grant %+ Ginger, 116 New Montgomery St. Suite 500, San Francisco, CA, 94105, United States, 1 6282079974, eshih@ginger.io %K behavioral coaching %K mental health %K telehealth %K Healthy Days %K clinical care %K behavior %K coach %K quality of life %K platform %K tool %K pilot study %K observational %K health-related quality of life %K virtual care %K association %K text-based %K outcome %K evaluation %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry, and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and thus, traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, this study used the health-related quality of life (HRQoL) tool from the Centers for Disease Control and Prevention “Healthy Days” measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical and subclinical individuals. Objective: The purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL. Methods: A total of 288 members completed the 4-item HRQoL measure at baseline and at 1 month following use of the Ginger on demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively. Results: Members completed on average 1.92 (SD 2.16) coaching sessions and 0.91 (SD 1.37) clinical sessions during the assessment month. Paired samples t tests revealed significant reductions in the average number of unhealthy mental health days between baseline (mean 16, SD 8.77 days) and follow-up (mean 13.2, SD 9.02 days; t287=5.73; P<.001), and in the average number of days adversely impacted (meanbaseline 10.9, meanfollow-up 8.19; t287=6.26; P<.001). Both subclinical members (t103=3.04; P=.003) and clinical members (t183=5.5; P<.001) demonstrated significant improvements through reductions in adversely impacted days over a month. Clinical members also demonstrated significant improvements through reductions in unhealthy mental health days (t183=5.82; P<.001). Finally, member engagement with virtual clinical sessions significantly predicted changes in unhealthy mental health days (B=–0.96; P=.04). Conclusions: To our knowledge, this study is one of the first to use the HRQoL measure as an outcome in an evaluation of a digital behavioral health platform. Using real-world longitudinal data, our preliminary yet promising results show that short-term engagement with virtual care can be an effective means to improve HRQoL for members with subclinical and clinical symptoms. Further follow-up of reported HRQoL over several months is needed. %M 35802408 %R 10.2196/35352 %U https://formative.jmir.org/2022/7/e35352 %U https://doi.org/10.2196/35352 %U http://www.ncbi.nlm.nih.gov/pubmed/35802408 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34087 %T A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study %A El Ayadi,Alison M %A Duggal,Mona %A Bagga,Rashmi %A Singh,Pushpendra %A Kumar,Vijay %A Ahuja,Alka %A Kankaria,Ankita %A Hosapatna Basavarajappa,Darshan %A Kaur,Jasmeet %A Sharma,Preetika %A Gupta,Swati %A Pendse,Ruchita S %A Weil,Laura %A Swendeman,Dallas %A Diamond-Smith,Nadia G %+ Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, United States, 1 4156598367, alison.elayadi@ucsf.edu %K mHealth %K group care %K postpartum %K postnatal %K antenatal %K India %K pilot %K mobile phone %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Structural and cultural barriers limit Indian women’s access to adequate postnatal care and support despite their importance for maternal and neonatal health. Targeted postnatal education and support through a mobile health intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. Objective: We sought to understand the feasibility and acceptability of our first pilot phase, a flexible 6-week postnatal mobile health intervention delivered to 3 groups of women in Punjab, India, and adapt our intervention for our next pilot phase, which will formally assess intervention feasibility, acceptability, and preliminary efficacy. Methods: Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice- and text-based group approach to connect new mothers with a social support group of other new mothers, increase their health-related communication with providers, and refer them to care needed. We targeted deployment using feature phones to include participants from diverse socioeconomic groups. We held moderated group calls weekly, disseminated educational audios, and created SMS text messaging groups. We varied content delivery, group discussion participation, and chat moderation. Three groups of postpartum women from Punjab were recruited for the pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (N=29), weekly moderator reports, structured end-line in-depth interviews among a subgroup of participants (15/29, 52%), and back-end technology data. Results: The participants were aged 24 to 28 years and 1 to 3 months postpartum. Of the 29 participants, 17 (59%) had their own phones. Half of the participants (14/29, 48%) attended ≥3 of the 6 calls; the main barriers were childcare and household responsibilities and network or phone issues. Most participants were very satisfied with the intervention (16/19, 84%) and found the educational content (20/20, 100%) and group discussions (17/20, 85%) very useful. The participants used the SMS text messaging chat, particularly when facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and sociocultural challenges. Conclusions: The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings and developed a smartphone app for the participants. We seek to overcome sociocultural challenges through new strategies for increasing group engagement, including targeting midlevel female community health care providers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at 6 months. Ultimately, we seek to support the health and well-being of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies. %M 35767348 %R 10.2196/34087 %U https://formative.jmir.org/2022/6/e34087 %U https://doi.org/10.2196/34087 %U http://www.ncbi.nlm.nih.gov/pubmed/35767348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37028 %T The AI Will See You Now: Feasibility and Acceptability of a Conversational AI Medical Interviewing System %A Hong,Grace %A Smith,Margaret %A Lin,Steven %+ Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, 585 Broadway, Suite 800, Redwood City, CA, 94063, United States, 1 847 800 1377, hongrace@stanford.edu %K artificial intelligence %K feasibility studies %K patient acceptance of health care %K diagnostic errors %K patient-generated health data %K clinical %K medical history %K healthcare %K health care %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Primary care physicians (PCPs) are often limited in their ability to collect detailed medical histories from patients, which can lead to errors or delays in diagnosis. Recent advances in artificial intelligence (AI) show promise in augmenting current human-driven methods of collecting personal and family histories; however, such tools are largely unproven. Objective: The main aim of this pilot study was to evaluate the feasibility and acceptability of a conversational AI medical interviewing system among patients. Methods: The study was conducted among adult patients empaneled at a family medicine clinic within a large academic medical center in Northern California. Participants were asked to test an AI medical interviewing system, which uses a conversational avatar and chatbot to capture medical histories and identify patients with risk factors. After completing an interview with the AI system, participants completed a web-based survey inquiring about the performance of the system, the ease of using the system, and attitudes toward the system. Responses on a 7-point Likert scale were collected and evaluated using descriptive statistics. Results: A total of 20 patients with a mean age of 50 years completed an interview with the AI system, including 12 females (60%) and 8 males (40%); 11 were White (55%), 8 were Asian (40%), and 1 was Black (5%), and 19 had at least a bachelor’s degree (95%). Most participants agreed that using the system to collect histories could help their PCPs have a better understanding of their health (16/20, 80%) and help them stay healthy through identification of their health risks (14/20, 70%). Those who reported that the system was clear and understandable, and that they were able to learn it quickly, tended to be younger; those who reported that the tool could motivate them to share more comprehensive histories with their PCPs tended to be older. Conclusions: In this feasibility and acceptability pilot of a conversational AI medical interviewing system, the majority of patients believed that it could help clinicians better understand their health and identify health risks; however, patients were split on the effort required to use the system, and whether AI should be used for medical interviewing. Our findings suggest areas for further research, such as understanding the user interface factors that influence ease of use and adoption, and the reasons behind patients’ attitudes toward AI-assisted history-taking. %M 35759326 %R 10.2196/37028 %U https://formative.jmir.org/2022/6/e37028 %U https://doi.org/10.2196/37028 %U http://www.ncbi.nlm.nih.gov/pubmed/35759326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34995 %T A Telehealth-Delivered Tai Chi Intervention (TaiChi4Joint) for Managing Aromatase Inhibitor–Induced Arthralgia in Patients With Breast Cancer During COVID-19: Longitudinal Pilot Study %A Gomaa,Sameh %A West,Carly %A Lopez,Ana Maria %A Zhan,Tingting %A Schnoll,Max %A Abu-Khalaf,Maysa %A Newberg,Andrew %A Wen,Kuang-Yi %+ Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street Suite 300, Philadelphia, PA, 19106, United States, 1 2155034623, Kuang-Yi.Wen@jefferson.edu %K breast cancer %K arthralgia %K tai chi %K telehealth, pain %K mind-body therapy %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Estrogen receptor–positive breast cancer is the most common type of breast cancer in postmenopausal women. Aromatase inhibitors (AIs) are the endocrine therapy of choice recommended for these patients. Up to 50% of those treated with an AI develop arthralgia, often resulting in poor adherence and decreased quality of life. Objective: The study is a single-arm longitudinal pilot study aiming to evaluate the safety, feasibility, acceptability, and potential efficacy of TaiChi4Joint, a remotely delivered 12-week tai chi intervention designed to relieve AI-induced joint pain. Methods: Women diagnosed with stage 0-III breast cancer who received an AI for at least 2 months and reported arthralgia with a ≥4 score on a 0 to 10 scale for joint pain were eligible for study enrollment. Participants were encouraged to join tai chi classes delivered over Zoom three times a week for 12 weeks. Program engagement strategies included using a private Facebook study group and a Box cloud for archiving live class recordings. The program uses SMS text messaging and emails with periodic positive quotes and evidence-based information on tai chi for facilitating community bonding and class attendance. Participants were invited to complete the following assessments at baseline and at 1-, 2-, and 3-month intervals from study enrollment: Brief Pain Inventory, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Fatigue Symptom Inventory, Hot Flash Related Daily Interference Scale (HFRDIS), Pittsburgh Sleep Quality Index (PSQI), and Center for Epidemiological Studies–Depression (CES-D). Results: A total of 55 eligible patients were invited to participate, and 39 (71%) consented and completed the baseline assessments. Participants attended 61% (median) of the suggested classes, with no tai chi–related adverse events reported. Of the 39 participants, 22 completed the 3-month follow-up assessment with a 56% retention rate. Study participants reported improvement from baseline compared to 3 months as follows (paired t test): Brief Pain Inventory (P<.001), AUSCAN pain subscale (P=.007), AUSCAN function subscale (P=.004), Fatigue Symptom Inventory (P=.004) and PSQI (P<.001), and HFRDIS (P=.02) and CES-D (P<.001). In particular, for our primary end point of interest, improvements in hip and knee symptoms, measured by WOMAC’s three subscales, were clinically meaningful and statistically significant when adjusted for multiple comparisons from baseline to 3 months post intervention. Conclusions: The COVID-19 global pandemic has resulted in the need to rethink how mind-body therapies can be delivered. This study demonstrated the feasibility, acceptability, and potential efficacy of a telehealth-based tai chi intervention for reducing AI-induced arthralgia. The intervention decreased patient-reported pain and stiffness, and improved sleep quality and depressive symptoms. Fully powered, large, telehealth-based tai chi trials for AI-associated arthralgia are needed considering our promising findings. Trial Registration: ClinicalTrials.gov NCT04716920; https://www.clinicaltrials.gov/ct2/show/NCT04716920 %M 35727609 %R 10.2196/34995 %U https://formative.jmir.org/2022/6/e34995 %U https://doi.org/10.2196/34995 %U http://www.ncbi.nlm.nih.gov/pubmed/35727609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33693 %T Online Knowledge Translation Program Involving Video Games and University Student–Led Tutorials About Cannabis and Psychosis for Black Youth: Mixed Method Feasibility Study %A Jani,Payal %A Song,Nuri %A Artna,Erin %A Lyeo,Joonsoo %A Assam,Ashley %A Maelzer,Faith %A Murphy,Andriene %A Grant,Angelo %A Archie,Suzanne %+ Faculty of Health Sciences, McMaster University, East Region Mental Health Services, King Campus - St Joseph's Healthcare Hamilton, 2757 King St East, Hamilton, ON, L8N 3K7, Canada, 1 905 573 4801, archies@mcmaster.ca %K knowledge translation %K Black youth %K video game %K psychosis %K cannabis use %K knowledge %K young adult %K race %K demographic %K minority %K gaming %K mental health %K drug %K cannabis %K acceptability %K feasibility %K risk %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: We have piloted a new online knowledge translation (KT) program created to educate youth about cannabis effects, which uniquely focuses on mental health risks for Black youth. Youth are generally unaware of the research linking underage usage and the risk of psychosis. Youth from some Black racialized communities in Ontario may be disproportionately affected and in need of this knowledge. Objective: Because very little is known about the acceptability and feasibility of programs educating Black youth about cannabis and psychosis risk, we evaluated this KT program, which consists of tutorials facilitated by university students and video games. Methods: This mixed methods pilot study evaluates the transfer of knowledge about cannabis and psychosis risk before and after the online KT program and, at the same time, explores participant satisfaction with the program and views about underage use. Eligible participants were youth 16-19 years of age of Black African or Caribbean descent. Trained undergraduate students from McMaster University administered a quiz (psychosis and cannabis test; PCT) to evaluate knowledge before and after the KT program. After playing the psychoeducational video games, participants attended two tutorial group sessions led by undergraduate students. The undergraduate students facilitated the online tutorials about cannabis and psychosis. The tutorials augmented the educational content embedded within the gameplay: participants discussed what they learned from the video games and their understanding of psychosis and the effects of cannabis. In addition, undergraduate students qualitatively analyzed the tutorial discussions for themes, and the prequiz and postquiz scores were analyzed for significant differences in scores. Results: A total of 9 Black youth were recruited and completed this pilot study. The mean PCT scores were 5.67 (SD 1.7) and 7.78 (SD 1.8) before and after the KT program, respectively. There was a significant improvement in scores (P<.05) post-KT program. Thematic analysis of the facilitated tutorials revealed three major themes: video game satisfaction, marijuana and psychosis literacy, and help-seeking awareness. Overall, participants showed an increased awareness and understanding of the subject matter after the gameplay and tutorial intervention. Conclusions: When supplemented with tutorial sessions, the Back to Reality Series shows promise for addressing the gap in knowledge about cannabis and psychosis, and the results provide preliminary evidence that the games appeal to Black youth. %M 35315782 %R 10.2196/33693 %U https://formative.jmir.org/2022/6/e33693 %U https://doi.org/10.2196/33693 %U http://www.ncbi.nlm.nih.gov/pubmed/35315782 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37743 %T Time-Varying Associations Between Device-Based and Ecological Momentary Assessment–Reported Sedentary Behaviors and the Concurrent Affective States Among Adolescents: Proof-of-Concept Study %A Zink,Jennifer %A Yang,Chih-Hsiang %A Alves,Jasmin M %A McAlister,Kelsey L %A Huh,Jimi %A Pentz,Mary Ann %A Page,Kathleen A %A Dunton,Genevieve F %A Belcher,Britni R %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St, Los Angeles, CA, 90032, United States, 1 323 442 8225, bbelcher@usc.edu %K accelerometry %K intensive longitudinal data %K mood %K youth %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies on affective state–sedentary behavior (SB) associations have not accounted for their potentially time-varying nature and have used inconsistent SB measurement modalities. We investigated whether the strength of the associations between affective states and SB varied as a function of the time of day and by SB measurement modality (device-measured SB vs ecological momentary assessment–reported screen-based SB) in youth. Objective: This study aimed to establish a proof of concept that SB–affective state associations may not be static during the day. In addition, we aimed to inform the methodology of future work, which may need to model associations as functions of the time of day and carefully consider how SB is operationalized or measured. Methods: A total of 15 adolescents (age: mean 13.07, SD 1.03 years; 10/15, 67% female; 6/15, 40% Hispanic; 10/15, 67% healthy weight) wore thigh-mounted activPAL accelerometers and simultaneously reported their screen-based SBs and concurrent positive and negative affective states via ecological momentary assessment for 7 to 14 days (N=636 occasions). Time-varying effect models (varying slopes) examined how each measure of SB was associated with concurrent affective states from 7 AM to 8 PM. Results: Time-varying effect model plots revealed that these associations varied in strength throughout the day. Specifically, device-based SB was related to greater concurrent negative affect only after approximately 5 PM and was unrelated to concurrent positive affect. Screen-based SB was related to greater concurrent negative affect only from 7 AM to approximately 9 AM. This was also related to greater concurrent positive affect from 7 AM to approximately 9:30 AM and from approximately 3 PM to approximately 7 PM. Conclusions: We provide preliminary evidence to suggest that future confirmatory studies investigating the SB–affective state relationship should consider the time-varying nature of these associations and SB measurement modality. There may be critical time windows when specific types of SBs co-occur with affect, suggesting that interventions may need tailoring to the time of day and type of SB if future studies using similar methodologies can replicate our findings. %M 35687383 %R 10.2196/37743 %U https://formative.jmir.org/2022/6/e37743 %U https://doi.org/10.2196/37743 %U http://www.ncbi.nlm.nih.gov/pubmed/35687383 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32147 %T Home Telemonitoring Technology for Patients With Heart Failure: Cost-Consequence Analysis of a Pilot Study %A Apantaku,Glory %A Mitton,Craig %A Wong,Hubert %A Ho,Kendall %+ School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 2772, glory.apantaku@ubc.ca %K cost-consequence analysis %K feasibility study %K pilot study %K heart failure %K cardiology %K cardiovascular disease %K economic analysis %K telehealth %K health care cost %K home monitoring %K digital monitor %K health monitor %D 2022 %7 2.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is a costly health condition and a major public health problem. It is estimated that 2%-3% of the population in developed countries has HF, and the prevalence increases to 8% among patients aged ≥75 years. Home telemonitoring is a form of noninvasive, remote patient monitoring that aims to improve the care and management of patients with chronic HF. Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring (TEC4Home) is a project that implements and evaluates a comprehensive home monitoring protocol designed to support patients with HF as they transition from the emergency department to home. Objective: The aim of this study is to assess the cost of using the home monitoring platform (TEC4Home) relative to usual care for patients with HF. Methods: This study is a cost-consequence analysis of the TEC4Home pilot study. The analysis was conducted from a partial societal perspective, including direct and indirect health care costs. The aim is to assess the costs of the home monitoring platform relative to usual care and track costs related to health care utilization during the 90-day postdischarge period. Results: Economic analysis of the TEC4Home pilot study showed a positive trend in cost savings for patients using TEC4Home. From both the health system perspective (Pre TEC4Home cost per patient: CAD $2924 vs post TEC4Home cost per patient: CAD $1293; P=.01) and partial societal perspective (Pre TEC4Home cost per patient: CAD $2411 vs post TEC4Home cost per patient: CAD $1108; P=.01), we observed a statistically significant cost saving per patient. Conclusions: In line with the advantages of conducting an economic analysis alongside a feasibility study, the economic analysis of the TEC4Home pilot study facilitated the piloting of patient questionnaires and informed the methodology for a full clinical trial. %M 35653179 %R 10.2196/32147 %U https://formative.jmir.org/2022/6/e32147 %U https://doi.org/10.2196/32147 %U http://www.ncbi.nlm.nih.gov/pubmed/35653179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e32740 %T Pilot Testing in the Wild: Feasibility, Acceptability, Usage Patterns, and Efficacy of an Integrated Web and Smartphone Platform for Bipolar II Disorder %A Fletcher,Kathryn %A Lindblom,Katrina %A Seabrook,Elizabeth %A Foley,Fiona %A Murray,Greg %+ Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, Melbourne, 3122, Australia, 61 92148300, kfletcher@swin.edu.au %K bipolar disorder %K smartphone %K app %K web-based intervention %K ecological momentary assessment %K mobile phone %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Bipolar II disorder (BD-II) is associated with significant burden, disability, and mortality; however, there continues to be a dearth of evidence-based psychological interventions for this condition. Technology-mediated interventions incorporating self-management have untapped potential to help meet this need as an adjunct to usual clinical care. Objective: The objective of this pilot study is to assess the feasibility, acceptability, and clinical utility of a novel intervention for BD-II (Tailored Recovery-oriented Intervention for Bipolar II Experiences; TRIBE), in which mindfulness-based psychological content is delivered via an integrated web and smartphone platform. The focus of the study is evaluation of the dynamic use patterns emerging from ecological momentary assessment and intervention to assist the real-world application of mindfulness skills learned from web-delivered modules. Methods: An open trial design using pretest and posttest assessments with nested qualitative evaluation was used. Individuals (aged 18-65 years) with a diagnosis of BD-II were recruited worldwide and invited to use a prototype of the TRIBE intervention over a 3-week period. Data were collected via web-based questionnaires and phone interviews at baseline and 3-week follow-up. Results: A total of 25 participants completed baseline and follow-up assessments. Adherence rates (daily app use) were 65.6% across the 3-week study, with up to 88% (22/25) of participants using the app synergistically alongside the web-based program. Despite technical challenges with the prototype intervention (from user, hardware, and software standpoints), acceptability was adequate, and most participants rated the intervention positively in terms of concept (companion app with website: 19/25, 76%), content (19/25, 76%), and credibility and utility in supporting their management of bipolar disorder (17/25, 68%). Evaluation using behavioral archetypes identified important use pathways and a provisional model to inform platform refinement. As hypothesized, depression scores significantly decreased after the intervention (Montgomery-Asberg Depression Rating Scale baseline mean 8.60, SD 6.86, vs follow-up mean 6.16, SD 5.11; t24=2.63; P=.01; Cohen d=0.53, 95% CI 0.52-4.36). Conclusions: Our findings suggest that TRIBE is feasible and represents an appropriate and acceptable self-management program for patients with BD-II. Preliminary efficacy results are promising and support full development of TRIBE informed by the present behavioral archetype analysis. Modifications suggested by the pilot study include increasing the duration of the intervention and increasing technical support. %M 35639462 %R 10.2196/32740 %U https://formative.jmir.org/2022/5/e32740/ %U https://doi.org/10.2196/32740 %U http://www.ncbi.nlm.nih.gov/pubmed/35639462 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30294 %T A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial %A Laird,Breanne %A Puzia,Megan %A Larkey,Linda %A Ehlers,Diane %A Huberty,Jennifer %+ Arizona State University, 425 N 5th St, Phoenix, AZ, 85004, United States, 1 7046043782, bmlaird@asu.edu %K stress %K meditation %K mHealth %K COVID-19 %K mobile app %K mental health %K mindfulness %K digital intervention %K psychological outcomes %D 2022 %7 24.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app–based studies have reported a low proportion of or even no male participants. Objective: This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions. Methods: This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance. Results: Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed. Conclusions: A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men. Trial Registration: ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138 %M 34989677 %R 10.2196/30294 %U https://formative.jmir.org/2022/5/e30294 %U https://doi.org/10.2196/30294 %U http://www.ncbi.nlm.nih.gov/pubmed/34989677 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34906 %T An In-Home Medication Dispensing System to Support Medication Adherence for Patients With Chronic Conditions in the Community Setting: Prospective Observational Pilot Study %A Patel,Tejal %A Ivo,Jessica %A Pitre,Teresa %A Faisal,Sadaf %A Antunes,Kristen %A Oda,Kasumi %+ School of Pharmacy, University of Waterloo, 10 Victoria Street S, Kitchener, ON, N2G 1C5, Canada, 1 519 888 4567 ext 21337, t5patel@uwaterloo.ca %K smart %K medication adherence %K usability %K geriatric %K in-home %K community %K chronic diseases %K medication dispensing %K eHealth %K platform %K self management %K support tool %K chronic disease %K caregiver %K usability %K satisfaction %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Innovative digital technology systems that support and monitor real-time medication intake are now available commercially; however, there is limited knowledge of the use of such technology in patients’ homes. One such smart medication dispenser, spencer, provides alerts to patients to take their medications and allows for tracking and reporting real-time medication adherence data. Objective: The objectives of this study were to examine the use of a smart medication dispenser as a medication adherence and self-management support tool for community dwelling adults over a 6-month period, in addition to usability, usefulness, satisfaction, and impact on caregiver support. Methods: This prospective, observational study invited community-dwelling adults aged 45 years and older taking at least one chronic medication and their caregivers to use this smart medication dispenser for their medication administration for 6 months. Adherence was defined as a dose intake within 2 hours post scheduled time. Real-time adherence data were collected using the smart medication dispenser and the AdhereNet platform. Usability, usefulness, and satisfaction were measured using the System Usability Scale and the Usefulness, Satisfaction, and Ease of Use questionnaire, respectively. Caregiver burden was measured on a visual analog scale at baseline and at the end of the 6-month study period. Results: A total of 58 participants were recruited, of which 55% (32/58) were female with a mean age of 66.36 (SD 11.28; range 48-90) years. Eleven caregiver participants were recruited, of whom 91% (10/11) were female. The average monthly adherence over 6 months was 98% (SD 3.1%; range 76.5%-100%). The average System Usability score was 85.74 (n=47; SD 12.7; range 47.5-100). Of the 46 participants who provided data, 44 (96%) rated the product as easy, 43 (93%) as simple to use, and 43 (93%) were satisfied with the product. Caregiver burden prior to and following smart medication dispenser use for 6 months was found to be statistically significantly different (P<.001; CI 2.11-5.98). Conclusions: Smart medication adherence products such as spencer, when connected and clinically monitored, can be a useful solution for medication management and have the potential to improve caregiver burden. %M 35587371 %R 10.2196/34906 %U https://formative.jmir.org/2022/5/e34906 %U https://doi.org/10.2196/34906 %U http://www.ncbi.nlm.nih.gov/pubmed/35587371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e35803 %T Objective Measurement of Hyperactivity Using Mobile Sensing and Machine Learning: Pilot Study %A Lindhiem,Oliver %A Goel,Mayank %A Shaaban,Sam %A Mak,Kristie J %A Chikersal,Prerna %A Feldman,Jamie %A Harris,Jordan L %+ Department of Psychiatry, School of Medicine, University of Pittsburgh, 100 N Bellefield Ave, Pittsburgh, PA, 15206, United States, 1 412 246 5909, lindhiemoj@upmc.edu %K assessment %K machine learning %K hyperactivity %K attention-deficit/hyperactivity disorder %K ADHD %K wearables %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although hyperactivity is a core symptom of attention-deficit/hyperactivity disorder (ADHD), there are no objective measures that are widely used in clinical settings. Objective: We describe the development of a smartwatch app to measure hyperactivity in school-age children. The LemurDx prototype is a software system for smartwatches that uses wearable sensor technology and machine learning to measure hyperactivity. The goal is to differentiate children with ADHD combined presentation (a combination of inattentive and hyperactive/impulsive presentations) or predominantly hyperactive/impulsive presentation from children with typical levels of activity. Methods: In this pilot study, we recruited 30 children, aged 6 to 11 years, to wear a smartwatch with the LemurDx app for 2 days. Parents also provided activity labels for 30-minute intervals to help train the algorithm. Half of the participants had ADHD combined presentation or predominantly hyperactive/impulsive presentation (n=15), and half were in the healthy control group (n=15). Results: The results indicated high usability scores and an overall diagnostic accuracy of 0.89 (sensitivity=0.93; specificity=0.86) when the motion sensor output was paired with the activity labels. Conclusions: State-of-the-art sensors and machine learning may provide a promising avenue for the objective measurement of hyperactivity. %M 35468089 %R 10.2196/35803 %U https://formative.jmir.org/2022/4/e35803 %U https://doi.org/10.2196/35803 %U http://www.ncbi.nlm.nih.gov/pubmed/35468089 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e17761 %T Blended Treatment for Alcohol Use Disorder (Blend-A): Explorative Mixed Methods Pilot and Feasibility Study %A Tarp,Kristine %A Rasmussen,Johan %A Mejldal,Anna %A Folker,Marie Paldam %A Nielsen,Anette Søgaard %+ Centre for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Heden 11, Odense, 5000, Denmark, 45 24661404, kristine.tarp@rsyd.dk %K alcohol use disorder %K blended treatment %K usability %K patient perceptions %K therapist perspectives %K mobile phone %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Denmark, approximately 150,000 people have alcohol use disorder (AUD). However, only approximately 10% seek AUD treatment, preferably outside conventional health care settings and opening hours. The AUD treatment area experiences low adherence to treatment, as well as high numbers of no-show and premature dropouts. Objective: The purpose of the Blend-A (Blended Treatment for Alcohol Use Disorder) feasibility and pilot study was to describe the process of translating and adapting the Dutch treatment protocol into Danish and Danish culture with a high amount of user involvement and to report how patients and therapists perceived the adapted version, when trying it out. Methods: The settings were 3 Danish public municipal outpatient alcohol clinics. Study participants were patients and therapists from the 3 settings. Data consisted of survey data from the System Usability Scale, individual patient interviews, and therapist group interviews. Statistical analyses were conducted using the Stata software and Excel. Qualitative analysis was conducted using a theoretical thematic analysis. Results: The usability of the treatment platform was rated above average. The patients chose to use the blended treatment format because it ensured anonymity and had a flexible design. Platform use formed the basis of face-to-face sessions. The use of the self-determined platform resulted in a more thorough process. Patient involvement qualified development of a feasible system. Managerial support for time use was essential. Guidance from an experienced peer was useful. Conclusions: This study indicates that, during the processes of translating, adapting, and implementing blended, guided, internet-based, and face-to-face AUD treatment, it is relevant to focus on patient involvement, managerial support, and guidance from experienced peers. Owing to the discrete and flexible design of the blended offer, it appears that it may reach patient groups who would not otherwise have sought treatment. Therefore, blended treatment may increase access to treatment and contribute to reaching people affected by excessive alcohol use, who would not otherwise have sought treatment. In addition, it seems that the blended offer may enhance the participants’ perceived satisfaction and the effect of the treatment course. Thus, it appears that Blend-A may be able to contribute to existing treatment offers. Such findings highlight the need to determine the actual effect of the Blend-A offer; therefore, an effectiveness study with a controlled design is warranted. %M 35468082 %R 10.2196/17761 %U https://formative.jmir.org/2022/4/e17761 %U https://doi.org/10.2196/17761 %U http://www.ncbi.nlm.nih.gov/pubmed/35468082 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33057 %T Pilot Results of a Digital Hypertension Self-management Program Among Adults With Excess Body Weight: Single-Arm Nonrandomized Trial %A Wilson-Anumudu,Folasade %A Quan,Ryan %A Cerrada,Christian %A Juusola,Jessie %A Castro Sweet,Cynthia %A Bradner Jasik,Carolyn %A Turken,Michael %+ Omada Health, Inc, 500 Sansome Street, Suite 200, San Francisco, CA, 94111, United States, 1 6502696532, folasade.anumudu@omadahealth.com %K hypertension %K self-management %K digital health %K home measurement %K lifestyle %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Home-measured blood pressure (HMBP) in combination with comprehensive medication support and lifestyle change are the mainstays of evidence-based hypertension (HTN) management. To date, the precise components needed for effective HTN self-management programs have yet to be defined, and access to multicomponent targeted support for HTN management that include telemonitoring remain inaccessible and costly. Objective: The aim of this pilot study was to evaluate the impact of a digital HTN self-management program on blood pressure (BP) control among adults with excess body weight. Methods: A single-arm, nonrandomized trial was performed to evaluate a digital HTN self-management program that combines comprehensive lifestyle counseling with HTN education, guided HMBP, support for taking medications, and led by either a registered nurse or certified diabetes care and education specialist. A sample of 151 participants were recruited using a web-based research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in systolic BP from baseline to 3 months, and secondary outcomes included change in diastolic BP and medication adherence. Results: Participants’ mean age was 44.0 (SD 9.3) years and mean BP was 139/85 mm Hg. At follow-up, systolic and diastolic BP decreased by 7 mm Hg (P<.001, 95% CI –9.3 to –4.7) and 4.7 mm Hg (P<.001, 95% CI –6.3 to –3.2), respectively. Participants who started with baseline BP at goal remained at goal. For participants with stage 1 HTN, systolic and diastolic BP decreased by 3.6 mm Hg (P=.09, 95% CI –7.8 to 0.6) and 2.5 mm Hg (P=.03, 95% CI –4.9 to –0.3). Systolic and diastolic BP decreased by 10.3 mm Hg (P<.001, 95% CI –13.4 to –7.1) and 6.5 mm Hg (P<.001, 95% CI –8.6 to –4.4), respectively, for participants with stage 2 HTN. Medication adherence significantly improved (P=.02). Conclusions: This pilot study provides initial evidence that a digital HTN self-management program improves BP and medication adherence. %M 35353040 %R 10.2196/33057 %U https://formative.jmir.org/2022/3/e33057 %U https://doi.org/10.2196/33057 %U http://www.ncbi.nlm.nih.gov/pubmed/35353040 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28081 %T App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study %A Krohn,Holly %A Guintivano,Jerry %A Frische,Rachel %A Steed,Jamie %A Rackers,Hannah %A Meltzer-Brody,Samantha %+ Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, MacNider 304 CB 7160, Chapel Hill, NC, 27599, United States, 1 919 445 0218, holly_krohn@med.unc.edu %K postpartum care %K depression %K mobile health %K mHealth %K ecological momentary assessment (EMA) %K mobile apps %K personalized care %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective: This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods: This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results: Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions: Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic. %M 35319483 %R 10.2196/28081 %U https://formative.jmir.org/2022/3/e28081 %U https://doi.org/10.2196/28081 %U http://www.ncbi.nlm.nih.gov/pubmed/35319483 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e22544 %T Leveraging Polio Geographic Information System Platforms in the African Region for Mitigating COVID-19 Contact Tracing and Surveillance Challenges: Viewpoint %A Akpan,Godwin Ubong %A Bello,Isah Mohammed %A Touray,Kebba %A Ngofa,Reuben %A Oyaole,Daniel Rasheed %A Maleghemi,Sylvester %A Babona,Marie %A Chikwanda,Chanda %A Poy,Alain %A Mboussou,Franck %A Ogundiran,Opeayo %A Impouma,Benido %A Mihigo,Richard %A Yao,Nda Konan Michel %A Ticha,Johnson Muluh %A Tuma,Jude %A A Mohamed,Hani Farouk %A Kanmodi,Kehinde %A Ejiofor,Nonso Ephraim %A Kipterer,John Kapoi %A Manengu,Casimir %A Kasolo,Francis %A Seaman,Vincent %A Mkanda,Pascal %+ Regional Office of Africa, World Health Organization, World Health Organization,Regional Office for Africa, Cite Du Djoue, Brazzaville, 500101, Congo, 242 055736476, akpang@who.int %K contact tracing %K GIS %K COVID-19 %K surveillance %D 2022 %7 17.3.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Background: The ongoing COVID-19 pandemic in Africa is an urgent public health crisis. Estimated models projected over 150,000 deaths and 4,600,000 hospitalizations in the first year of the disease in the absence of adequate interventions. Therefore, electronic contact tracing and surveillance have critical roles in decreasing COVID-19 transmission; yet, if not conducted properly, these methods can rapidly become a bottleneck for synchronized data collection, case detection, and case management. While the continent is currently reporting relatively low COVID-19 cases, digitized contact tracing mechanisms and surveillance reporting are necessary for standardizing real-time reporting of new chains of infection in order to quickly reverse growing trends and halt the pandemic. Objective: This paper aims to describe a COVID-19 contact tracing smartphone app that includes health facility surveillance with a real-time visualization platform. The app was developed by the AFRO (African Regional Office) GIS (geographic information system) Center, in collaboration with the World Health Organization (WHO) emergency preparedness and response team. The app was developed through the expertise and experience gained from numerous digital apps that had been developed for polio surveillance and immunization via the WHO’s polio program in the African region. Methods: We repurposed the GIS infrastructures of the polio program and the database structure that relies on mobile data collection that is built on the Open Data Kit. We harnessed the technology for visualization of real-time COVID-19 data using dynamic dashboards built on Power BI, ArcGIS Online, and Tableau. The contact tracing app was developed with the pragmatic considerations of COVID-19 peculiarities. The app underwent testing by field surveillance colleagues to meet the requirements of linking contacts to cases and monitoring chains of transmission. The health facility surveillance app was developed from the knowledge and assessment of models of surveillance at the health facility level for other diseases of public health importance. The Integrated Supportive Supervision app was added as an appendage to the pre-existing paper-based surveillance form. These two mobile apps collected information on cases and contact tracing, alongside alert information on COVID-19 reports at the health facility level; the information was linked to visualization platforms in order to enable actionable insights. Results: The contact tracing app and platform were piloted between April and June 2020; they were then put to use in Zimbabwe, Benin, Cameroon, Uganda, Nigeria, and South Sudan, and their use has generated some palpable successes with respect to COVID-19 surveillance. However, the COVID-19 health facility–based surveillance app has been used more extensively, as it has been used in 27 countries in the region. Conclusions: In light of the above information, this paper was written to give an overview of the app and visualization platform development, app and platform deployment, ease of replicability, and preliminary outcome evaluation of their use in the field. From a regional perspective, integration of contact tracing and surveillance data into one platform provides the AFRO with a more accurate method of monitoring countries’ efforts in their response to COVID-19, while guiding public health decisions and the assessment of risk of COVID-19. %M 34854813 %R 10.2196/22544 %U https://mhealth.jmir.org/2022/3/e22544 %U https://doi.org/10.2196/22544 %U http://www.ncbi.nlm.nih.gov/pubmed/34854813 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e36446 %T Culturally Tailored Social Media Content to Reach Latinx Immigrant Sexual Minority Men for HIV Prevention: Web-Based Feasibility Study %A Lee,Jane J %A Aguirre Herrera,Joel %A Cardona,José %A Cruz,Loren Yesenia %A Munguía,Lésster %A Leyva Vera,Christopher A %A Robles,Gabriel %+ School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, United States, 1 2066168984, janejlee@uw.edu %K social media %K eHealth %K feasibility %K Latinx %K immigrant %K sexual minorities %K gay %K homosexual %K bisexual %K pre-exposure prophylaxis %K HIV prevention %K HIV %K prevention %K web-based %K internet-based %K sexual minority %K sexual health %K digital health %K health technology %K web-based health %K web-based prevention %K health information %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Latinx gay, bisexual, and other sexual minority men are disproportionately affected by HIV in the United States. As Latinx sexual minority men, particularly those who are foreign-born, experience inequitable access to health services, tailored strategies to engage them for HIV prevention are urgently needed. Objective: Our study seeks to address the need for enhanced access to HIV prevention among Latinx immigrant sexual minority men. We developed and piloted a culturally sensitive technology-based campaign focused on HIV testing and pre-exposure prophylaxis (PrEP) uptake. Methods: We used a two-phase approach to assess the feasibility of community-informed social media content in engaging Latinx immigrant sexual minority men for HIV testing and PrEP use. First, we conducted three iterative focus groups with 15 Latinx immigrant sexual minority men to refine the HIV prevention content to be piloted on social media platforms. The finalized content was placed on Instagram and Facebook for 9 days in July and September 2021 to individuals who were in Washington State. Individuals who clicked on the content were directed to a website with additional HIV prevention information. Second, we conducted online surveys (n=60) with website visitors that assessed sociodemographic characteristics, barriers to HIV prevention, and HIV-related transmission risk and prevention behaviors. We conducted descriptive analyses to examine the overall profile of survey respondents and determine the feasibility of culturally informed social media content in reaching Latinx immigrant sexual minority men. Results: Overall, 739 unique users visited the website during the 9-day period when the social media content was posted on Instagram and Facebook. Our sample included 60 Latinx immigrant sexual minority men who completed the online survey. Participants’ mean age was 30.8 years and more than half (n=34, 57%) completed the survey in Spanish. A quarter of participants indicated that they were unauthorized immigrants and 57% (n=34) reported not having medical insurance. Participants reported, on average, having 6 different sexual partners in the last 6 months. Nearly a third of respondents had not tested for HIV in the last 6 months. Only about half (n=32, 53%) of respondents had used PrEP in the last 12 months. Conclusions: Community-driven social media and web-based strategies are feasible ways to engage Latinx immigrant sexual minority men who may traditionally lack access to HIV prevention information and services due to structural and social barriers. The results highlight that culturally relevant social media and web-based outreach strategies that are informed and developed by the community can reach Latinx immigrant sexual minority men for HIV prevention. Findings underscore the need to examine the effectiveness of social media content in promoting HIV testing and PrEP uptake in marginalized Latinx populations. %M 35182416 %R 10.2196/36446 %U https://formative.jmir.org/2022/3/e36446 %U https://doi.org/10.2196/36446 %U http://www.ncbi.nlm.nih.gov/pubmed/35182416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34458 %T Patients’ Experiences of Using an eHealth Pain Management Intervention Combined With Psychomotor Physiotherapy: Qualitative Study %A Eiken,Anne-Grethe %A Nordanger,Dag Ø %A Solberg Nes,Lise %A Varsi,Cecilie %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Trondheimsveien 235, Oslo, 0424, Norway, 47 90856339, cecilie.varsi@usn.no %K chronic pain %K psychomotor physiotherapy %K EPIO %K self-management %K telemedicine %K mHealth %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is a major health challenge to those affected. Blended care with psychomotor physiotherapy (PMP) combined with eHealth self-management might be beneficial. Objective: This study aims to explore how patients with chronic pain experience the combination of PMP and the use of EPIO, an eHealth self-management intervention for chronic pain. Methods: Individual semistructured interviews were conducted with 5 adult patients with chronic pain (ie, participants) who used EPIO in combination with PMP over a period of 10 to 15 weeks. Interviews explored participants’ experiences using this treatment combination in relation to their pain and analyzed their experiences using systematic text condensation. Results: Participants described having benefited from using EPIO in combination with PMP in terms of increased awareness of bodily signals and how pain was related to stress and activity. They also described changes in the relationship to themselves in terms of increased self-acceptance, self-assertion, and hope and their relationship to their pain in terms of seeing pain as less harmful and engaging in more active coping strategies. Conclusions: Results indicate that a blended care approach combining eHealth self-management interventions such as EPIO with PMP may be of value to patients living with chronic pain. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 %M 35293866 %R 10.2196/34458 %U https://formative.jmir.org/2022/3/e34458 %U https://doi.org/10.2196/34458 %U http://www.ncbi.nlm.nih.gov/pubmed/35293866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34901 %T Motivations Toward Using Digital Health and Exploring the Possibility of Using Digital Health for Mental Health in Bangladesh University Students: Cross-sectional Questionnaire Study %A Sifat,Munjireen S %A Saperstein,Sandra L %A Tasnim,Naima %A Green,Kerry M %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052716872 ext 50477, Munjireen-sifat@ouhsc.edu %K digital health %K mental health %K Bangladesh %K university students %K mental health service use %K mobile phone %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health is efficacious for the management and prevention of mental health (MH) problems. It is particularly helpful for the young adult population, who appreciate the autonomy digital health provides, and in low-income countries, where the prevalence of MH problems is high but the supply of professionals trained in MH is low. Objective: The objectives of this study are 2-fold: to determine whether university students in Bangladesh find using digital health for MH promotion acceptable and to examine motivational factors for using digital health for MH. Methods: This study used a cross-sectional survey to examine the likelihood that university students in Bangladesh (n=311) would use different forms of digital health platforms for MH promotion and assessed drivers of intention to use and actual use of digital health generally and digital health for MH through the lens of the Technology Acceptance Model. The results provided evidence that the university student population in Bangladesh is likely to use digital health to promote their MH. Results: Social influence (adjusted odds ratio [aOR] 1.68, 95% CI 1.40-2.01; P<.001), ease of use (aOR 1.85, 95% CI 1.35-2.53; P<.001), and perceived usefulness (aOR 4.12, 95% CI 1.79-9.51; P=.001) of digital health were found to be significant drivers of the intention to use general digital health, and having an intention to use digital health (aOR 2.10, 95% CI 1.17-3.78; P=.01) had the greatest influence on actual use of digital health. Social influence (aOR 1.71, 95% CI 1.43-2.04; P<.001), perceived usefulness (aOR 8.92, 95% CI 4.18-19.04; P<.001), and use of general digital health (aOR 2.16, 95% CI 1.18-3.97; P=.01) were associated with higher intention to use digital health for MH. The use of general digital health (aOR 4.19, 95% CI 2.37-7.41; P<.001) was associated with the actual use of digital health for MH, as were greater non–stigma-related barriers to using traditional clinical MH services (aOR 2.05, 95% CI 1.10-3.80; P=.02). Conclusions: Overall, we see that the use of digital health for MH is acceptable in this population and can be helpful for students who perceive barriers to receiving traditional care. We also gain insight into how to promote the intention to use digital health, which in turn promotes the actual use of digital health. %M 35254267 %R 10.2196/34901 %U https://formative.jmir.org/2022/3/e34901 %U https://doi.org/10.2196/34901 %U http://www.ncbi.nlm.nih.gov/pubmed/35254267 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33701 %T Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study %A Banerjee,Rahul %A Huang,Chiung-Yu %A Dunn,Lisa %A Knoche,Jennifer %A Ryan,Chloe %A Brassil,Kelly %A Jackson,Lindsey %A Patel,Dhiren %A Lo,Mimi %A Arora,Shagun %A Wong,Sandy W %A Wolf,Jeffrey %A Martin III,Thomas %A Dhruva,Anand %A Shah,Nina %+ Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94158, United States, 1 415 353 8000, rahul.banerjee.md@gmail.com %K digital health %K life coaching %K multiple myeloma %K stem cell transplantation %K stem cell therapy %K cancer %K high-dose chemotherapy %K patient engagement %K feasibility %K digital life coaching %K mobile phone %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized well-being–related support via phone calls and SMS text messaging, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period, which is generally characterized by symptomatic exacerbations and 2-week hospitalizations. Objective: We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period. Methods: We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning on day −5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to well-being. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations occurring at least once every 4 weeks during the study period. Secondary endpoints were electronic patient-reported outcome assessments of QOL, distress, and sleep disturbances. Results: Of the 20 patients who were screened, 17 (85%) chose to enroll and 15 (75%) underwent SCT as planned. Of these 15 patients (median age 65 years, range 50-81 years), 11 (73%) demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during the 3-month study period was once every 6.2 days (range 3.9-28 days). During index hospitalizations with median lengths of stay of 16 days (range 14-31 days), the median frequency of conversations was once every 5.3 days (range 2.7-15 days). Electronic patient-reported outcome assessments (94% adherence) demonstrated an expected QOL nadir during the second week after SCT. The prevalence of elevated distress was highest immediately before and after SCT, with 69% of patients exhibiting elevated distress on day −5 and on day +2. Conclusions: DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous SCT for multiple myeloma. The limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC use. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is underway to investigate the efficacy of DLC with regard to patient well-being. Trial Registration: ClinicalTrials.gov NCT04432818; https://clinicaltrials.gov/ct2/show/NCT04432818. %M 35039279 %R 10.2196/33701 %U https://formative.jmir.org/2022/3/e33701 %U https://doi.org/10.2196/33701 %U http://www.ncbi.nlm.nih.gov/pubmed/35039279 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31615 %T Performance of a Computational Phenotyping Algorithm for Sarcoidosis Using Diagnostic Codes in Electronic Medical Records: Case Validation Study From 2 Veterans Affairs Medical Centers %A Seedahmed,Mohamed I %A Mogilnicka,Izabella %A Zeng,Siyang %A Luo,Gang %A Whooley,Mary A %A McCulloch,Charles E %A Koth,Laura %A Arjomandi,Mehrdad %+ Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep, Department of Medicine, University of California San Francisco, 513 Parnassus Ave, HSE 1314, Box 0111, San Francisco, CA, 94143, United States, 1 (415) 476 0735, mohamed.seedahmed@ucsf.edu %K sarcoidosis %K electronic medical records %K EMRs %K computational phenotype %K diagnostic codes %K Veterans Affairs %K VA %K practice guidelines %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic medical records (EMRs) offer the promise of computationally identifying sarcoidosis cases. However, the accuracy of identifying these cases in the EMR is unknown. Objective: The aim of this study is to determine the statistical performance of using the International Classification of Diseases (ICD) diagnostic codes to identify patients with sarcoidosis in the EMR. Methods: We used the ICD diagnostic codes to identify sarcoidosis cases by searching the EMRs of the San Francisco and Palo Alto Veterans Affairs medical centers and randomly selecting 200 patients. To improve the diagnostic accuracy of the computational algorithm in cases where histopathological data are unavailable, we developed an index of suspicion to identify cases with a high index of suspicion for sarcoidosis (confirmed and probable) based on clinical and radiographic features alone using the American Thoracic Society practice guideline. Through medical record review, we determined the positive predictive value (PPV) of diagnosing sarcoidosis by two computational methods: using ICD codes alone and using ICD codes plus the high index of suspicion. Results: Among the 200 patients, 158 (79%) had a high index of suspicion for sarcoidosis. Of these 158 patients, 142 (89.9%) had documentation of nonnecrotizing granuloma, confirming biopsy-proven sarcoidosis. The PPV of using ICD codes alone was 79% (95% CI 78.6%-80.5%) for identifying sarcoidosis cases and 71% (95% CI 64.7%-77.3%) for identifying histopathologically confirmed sarcoidosis in the EMRs. The inclusion of the generated high index of suspicion to identify confirmed sarcoidosis cases increased the PPV significantly to 100% (95% CI 96.5%-100%). Histopathology documentation alone was 90% sensitive compared with high index of suspicion. Conclusions: ICD codes are reasonable classifiers for identifying sarcoidosis cases within EMRs with a PPV of 79%. Using a computational algorithm to capture index of suspicion data elements could significantly improve the case-identification accuracy. %M 35081036 %R 10.2196/31615 %U https://formative.jmir.org/2022/3/e31615 %U https://doi.org/10.2196/31615 %U http://www.ncbi.nlm.nih.gov/pubmed/35081036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32982 %T A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study %A McGinnis,Ellen %A O'Leary,Aisling %A Gurchiek,Reed %A Copeland,William E %A McGinnis,Ryan %+ M-Sense Research Group, University of Vermont, 33 Colchester Avenue, Burlington, VT, 05401, United States, 1 2025095783, ryan.mcginnis@uvm.edu %K mental health %K mHealth %K biofeedback %K panic attack %K digital medicine %K app %K mobile health %K application %K biofeedback %K mobile phone %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Panic attacks (PAs) are an impairing mental health problem that affects >11% of adults every year. PAs are episodic, and it is difficult to predict when or where they may occur; thus, they are challenging to study and treat. Objective: The aim of this study is to present PanicMechanic, a novel mobile health app that captures heart rate–based data and delivers biofeedback during PAs. Methods: In our first analysis, we leveraged this tool to capture profiles of real-world PAs in the largest sample to date (148 attacks from 50 users). In our second analysis, we present the results from a pilot study to assess the usefulness of PanicMechanic as a PA intervention (N=18). Results: The results demonstrate that heart rate fluctuates by about 15 beats per minute during a PA and takes approximately 30 seconds to return to baseline from peak, cycling approximately 4 times during each attack despite the consistently decreasing anxiety ratings. Thoughts about health were the most common trigger and potential lifestyle contributors include slightly worse stress, sleep, and eating habits and slightly less exercise and drug or alcohol consumption than typical. Conclusions: The pilot study revealed that PanicMechanic is largely feasible to use but would be made more so with modifications to the app and the integration of consumer wearables. Similarly, participants found PanicMechanic useful, with 94% (15/16) indicating that they would recommend PanicMechanic to others who have PAs. These results highlight the need for future development and a controlled trial to establish the effectiveness of this digital therapeutic for preventing PAs. %M 35113031 %R 10.2196/32982 %U https://formative.jmir.org/2022/2/e32982 %U https://doi.org/10.2196/32982 %U http://www.ncbi.nlm.nih.gov/pubmed/35113031 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33265 %T Remote Monitoring of Patients With Hematologic Malignancies at High Risk of Febrile Neutropenia: Exploratory Study %A Kroloff,Maxwell %A Ramezani,Ramin %A Wilhalme,Holly %A Naeim,Arash %+ UCLA Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, 10911 Weyburn Ave, Suite 300, Los Angeles, CA, 90024, United States, 1 310 794 8788, anaeim@mednet.ucla.edu %K remote monitoring %K febrile neutropenia %K temperature %K heart rate %K oxygen saturation %K mobile health %K mHealth %K hematologic malignancies %K hematology %K malignancies %K digital health %K clinical outcomes %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Febrile neutropenia is one of the most common oncologic emergencies and is associated with significant, preventable morbidity and mortality. Most patients who experience a febrile neutropenia episode are hospitalized, resulting in significant economic cost. Objective: This exploratory study implemented a remote monitoring system comprising a digital infrared thermometer and a pulse oximeter with the capability to notify providers in real time of abnormalities in vital signs that could suggest early clinical deterioration and thereby improve clinical outcomes. Methods: The remote monitoring system was implemented and compared to standard-of-care vital signs monitoring in hospitalized patients with underlying hematologic malignancies complicated by a febrile neutropenia episode in order to assess the feasibility and validity of the system. Statistical analysis was performed using the intraclass correlation coefficient (ICC) to assess the consistency between the measurements taken using traditional methods and those taken with the remote monitoring system for each of the vital sign parameters (temperature, heart rate, and oxygen saturation). A linear mixed-effects model with a random subject effect was used to estimate the variance components. Bland-Altman plots were created for the parameters to further delineate the direction of any occurring bias. Results: A total of 23 patients were enrolled in the study (mean age 56, SD 23-75 years; male patients: n=11, 47.8%). ICC analysis confirmed the high repeatability and accuracy of the heart rate assessment (ICC=0.856), acting as a supplement to remote temperature assessment. While the sensitivity and specificity for capturing tachycardia above a rate of 100 bpm were excellent (88% and 97%, respectively), the sensitivity of the remote monitoring system in capturing temperatures >37.8 °C and oxygen saturation <92% was 45% and 50%, respectively. Conclusions: Overall, this novel approach using temperature, heart rate, and oxygen saturation assessments successfully provided real-time, clinically valuable feedback to providers. While temperature and oxygen saturation assessments lagged in terms of sensitivity compared to a standard in-hospital system, the heart rate assessment provided highly accurate complementary data. As a whole, the system provided additional information that can be applied to a clinically vulnerable population. By transitioning its application to high-risk patients in the outpatient setting, this system can help prevent additional use of health care services through early provider intervention and potentially improve outcomes. %M 35076403 %R 10.2196/33265 %U https://formative.jmir.org/2022/1/e33265 %U https://doi.org/10.2196/33265 %U http://www.ncbi.nlm.nih.gov/pubmed/35076403 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31989 %T A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study %A Smart,Mary H %A Nabulsi,Nadia A %A Gerber,Ben S %A Gupta,Itika %A Di Eugenio,Barbara %A Ziebart,Brian %A Sharp,Lisa K %+ Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, 833 South Wood St, Chicago, IL, 60612, United States, 1 312 355 3569, sharpl@uic.edu %K mHealth %K Fitbit %K SMART goals %K texting %K health coach %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods: Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results: Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. %M 35044308 %R 10.2196/31989 %U https://formative.jmir.org/2022/1/e31989 %U https://doi.org/10.2196/31989 %U http://www.ncbi.nlm.nih.gov/pubmed/35044308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32627 %T Expert-Moderated Peer-to-Peer Online Support Group for People With Knee Osteoarthritis: Mixed Methods Randomized Controlled Pilot and Feasibility Study %A Egerton,Thorlene %A Lawford,Belinda J %A Campbell,Penny K %A Plinsinga,Melanie L %A Spiers,Libby %A Mackenzie,David A %A Graham,Bridget %A Mills,Kathryn %A Eyles,Jillian %A Knox,Gabrielle %A Metcalf,Ben %A Maclachlan,Liam R %A Besomi,Manuela %A Dickson,Chris %A Abraham,Charles %A Vicenzino,Bill %A Hodges,Paul W %A Hunter,David J %A Bennell,Kim L %+ Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Level 7, Alan Gilbert Building, Melbourne, VIC 3010, Australia, 61 3 83441233, thorlene.egerton@unimelb.edu.au %K support group %K online support group %K knee %K osteoarthritis %K arthritis %K online forums %K patient education %K self-efficacy %K health literacy %K self-management %K qualitative %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management. Objective: The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations. Methods: This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed. Results: Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs. Conclusions: Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958 %M 35037880 %R 10.2196/32627 %U https://formative.jmir.org/2022/1/e32627 %U https://doi.org/10.2196/32627 %U http://www.ncbi.nlm.nih.gov/pubmed/35037880 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31698 %T Assessment of Patient Journey Metrics for Users of a Digital Obstructive Sleep Apnea Program: Single-Arm Feasibility Pilot Study %A Kumar,Shefali %A Rudie,Emma %A Dorsey,Cynthia %A Blase,Amy %A Benjafield,Adam V %A Sullivan,Shannon S %+ Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, United States, 1 6502530000, shefalikumar@verily.com %K obstructive sleep apnea %K virtual care %K remote care %K OSA diagnosis %K sleep apnea %K OSA %K underdiagnosed %K feasibility %K patient-centered %K treatment pathway %K diagnostic %K eHealth %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the importance of diagnosis and treatment, obstructive sleep apnea (OSA) remains a vastly underdiagnosed condition; this is partially due to current OSA identification methods and a complex and fragmented diagnostic pathway. Objective: This prospective, single-arm, multistate feasibility pilot study aimed to understand the journey in a nonreferred sample of participants through the fully remote OSA screening and diagnostic and treatment pathway, using the Primasun Sleep Apnea Program (formally, Verily Sleep Apnea Program). Methods: Participants were recruited online from North Carolina and Texas to participate in the study entirely virtually. Eligible participants were invited to schedule a video telemedicine appointment with a board-certified sleep physician who could order a home sleep apnea test (HSAT) to be delivered to the participant's home. The results were interpreted by the sleep physician and communicated to the participant during a second video telemedicine appointment. The participants who were diagnosed with OSA during the study and prescribed a positive airway pressure (PAP) device were instructed to download an app that provides educational and support-related content and access to personalized coaching support during the study’s 90-day PAP usage period. Surveys were deployed throughout the study to assess baseline characteristics, prior knowledge of sleep apnea, and satisfaction with the program. Results: For the 157 individuals who were ordered an HSAT, it took a mean of 7.4 (SD 2.6) days and median 7.1 days (IQR 2.0) to receive their HSAT after they completed their first televisit appointment. For the 114 individuals who were diagnosed with OSA, it took a mean of 13.9 (SD 9.6) days and median 11.7 days (IQR 10.1) from receiving their HSAT to being diagnosed with OSA during their follow-up televisit appointment. Overall, the mean and median time from the first televisit appointment to receiving an OSA diagnosis was 21.4 (SD 9.6) days and 18.9 days (IQR 9.2), respectively. For those who were prescribed PAP therapy, it took a mean of 8.1 (SD 9.3) days and median 6.0 days (IQR 4.0) from OSA diagnosis to PAP therapy initiation. Conclusions: These results demonstrate the possibility of a highly efficient, patient-centered pathway for OSA workup and treatment. Such findings support pathways that could increase access to care, reduce loss to follow-up, and reduce health burden and overall cost. The program’s ability to efficiently diagnose patients who otherwise may have not been diagnosed with OSA is important, especially during a pandemic, as the United States shifted to remote care models and may sustain this direction. The potential economic and clinical impact of the program’s short and efficient journey time and low attrition rate should be further examined in future analyses. Future research also should examine how a fast and positive diagnosis experience impacts success rates for PAP therapy initiation and adherence. Trial Registration: ClinicalTrials.gov NCT04599803; https://clinicaltrials.gov/ct2/show/NCT04599803 %M 34792470 %R 10.2196/31698 %U https://formative.jmir.org/2022/1/e31698 %U https://doi.org/10.2196/31698 %U http://www.ncbi.nlm.nih.gov/pubmed/34792470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28957 %T Peer-to-Peer Social Media Communication About Dietary Supplements Used for Weight Loss and Sports Performance Among Military Personnel: Pilot Content Analysis of 11 Years of Posts on Reddit %A Sharp,Kendall J %A Vitagliano,Julia A %A Weitzman,Elissa R %A Fitzgerald,Susan %A Dahlberg,Suzanne E %A Austin,S Bryn %+ Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 5129837561, kendall.sharp@utsouthwestern.edu %K dietary supplements %K social media %K Reddit %K OPSS %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 60% of military personnel in the United States currently use dietary supplements. Two types of dietary supplements, weight loss and sports performance (WLSP) supplements, are commonly used by military personnel despite the associated serious adverse effects such as dehydration and stroke. Objective: To understand peer-to-peer communication about WLSP supplements among military personnel, we conducted a pilot study using the social media website, Reddit. Methods: A total of 64 relevant posts and 243 comments from 2009 to 2019 were collected from 6 military subreddits. The posts were coded for year of posting, subreddit, and content consistent with the following themes: resources about supplement safety and regulation, discernability of supplement use through drug testing, serious adverse effects, brand names or identifiers, and reasons for supplement use. Results: A primary concern posted by personnel who used supplements was uncertainty about the supplements that were not detectable on a drug test. Supplements to improve workout performance were the most frequently used. Conclusions: Our pilot study suggests that military personnel may seek out peer advice about WLSP supplements on Reddit and spread misinformation about the safety and effectiveness of these products through this platform. Future directions for the monitoring of WLSP supplement use in military personnel are discussed. %M 34605769 %R 10.2196/28957 %U https://formative.jmir.org/2021/10/e28957 %U https://doi.org/10.2196/28957 %U http://www.ncbi.nlm.nih.gov/pubmed/34605769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26887 %T Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study %A Patel,Kunal N %A Mazurenko,Olena %A Ford,Eric %+ Northern Illinois University, 1425 West Lincoln Highway, DeKalb, IL, 60115, United States, 1 815 753 1891, kpatel27@niu.edu %K chargemaster %K standard charge %K price transparency %K health care %K diagnosis-related group %K DRG %K quality measures %K the Centers for Medicare and Medicaid Services regulation %K CMS %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective: This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods: In this cross-sectional study, we collected and analyzed a random 5.02% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results: We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality (β=.929; P<.001) and readmissions (β=.514; P<.001). Other quality indicators, such as the effectiveness of care (β=−.919; P<.001), efficient use of medical imaging (β=−.458; P=.001), and patient recommendation scores (β=−.414; P<.001), were negatively associated with standard charges. Conclusions: We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100% of US hospital prices posted publicly on the internet and their relationship with quality measures. %M 34420914 %R 10.2196/26887 %U https://formative.jmir.org/2021/8/e26887 %U https://doi.org/10.2196/26887 %U http://www.ncbi.nlm.nih.gov/pubmed/34420914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e16156 %T A Novel Digital Patient-Reported Outcome Platform (Noona) for Clinical Use in Patients With Cancer: Pilot Study Assessing Suitability %A Peltola,Maria Kristiina %A Poikonen-Saksela,Paula %A Mattson,Johanna %A Parkkari,Timo %+ Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Paciuksenkatu 3, Helsinki, 00029, Finland, 358 504900591, maria.k.peltola@hus.fi %K electronic patient-reported outcome %K adverse events %K patients with cancer %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the incidence of cancer is on the rise, there is a need to develop modern communication tools between patients and the medical personnel. Electronic patient-reported outcome (ePRO) measures increase the safety of cancer treatments and may have an impact on treatment outcome as well. ePRO may also provide a cost-efficient way to organize follow-up for patients with cancer. Noona is an internet-based system for patients to self-report symptoms and adverse events of cancer treatments from home via a computer or a smart device (eg, smartphone, tablet). Objective: In this pilot study, we assessed the suitability of a novel ePRO application (Noona) for patients with cancer, nurses, and doctors at the Helsinki University Hospital, Finland. Methods: The study included 44 patients with cancer (different solid tumor types) and 17 health care professionals (nurses or medical doctors). Patients were either operated or received systemic treatment or radiotherapy. Patients reported their symptoms to the medical staff via Noona. In addition, patients and clinicians answered a questionnaire, based on which Noona’s suitability for clinical use was evaluated in terms of usability (ease of use, operability, and learnability), reliability (subjective opinion of the participant), and incidence of harmful events reported by the participants. Results: A total of 41/44 (93%) patients and 15/17 (88%) professionals reported that the program was easy or quite easy to use; 38/44 (86%) patients and 11/17 (65%) professionals found Noona reliable, and 38/44 (86%) patients and 10/17 (59%) professionals would recommend Noona to other patients or their colleagues. No harmful incidences caused by the use of Noona were reported by the patients; however, 1 harmful incidence was reported by one of the professionals. Conclusions: The majority of the participants felt that Noona appeared reliable and it was easy to use. Noona seems to be a useful tool for monitoring patient’s symptoms during cancer therapy. Future studies will determine the impact of this ePRO platform in routine clinical practice. %M 33955841 %R 10.2196/16156 %U https://formative.jmir.org/2021/5/e16156 %U https://doi.org/10.2196/16156 %U http://www.ncbi.nlm.nih.gov/pubmed/33955841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e15598 %T Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study %A O'Cathail,Micheal %A Aznar-Garcia,Luis %A Sivanandan,Ananth %A Diver,Claire %A Patel,Poulam %A Tang,Pui-Shan %A Christian,Judith %+ Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Hucknall Road, Nottingham, NG5 1PB, United Kingdom, 44 07460617317, mocathail@gmail.com %K telemedicine %K teleconsultations %K brain metastases %K stereotactic radiosurgery %K mobile phone %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment. Conclusions: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses. %M 33544082 %R 10.2196/15598 %U http://formative.jmir.org/2021/2/e15598/ %U https://doi.org/10.2196/15598 %U http://www.ncbi.nlm.nih.gov/pubmed/33544082 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21156 %T COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results %A Geronikolou,Styliani %A Chrousos,George %+ University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias 1, Athens, Greece, 30 2132013362, sgeronik@gmail.com %K COVID-19 %K social media %K misinformation %K infodemics %K infodemiology %K infoveillance %K fear %K meta-analysis %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective: The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results: The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions: Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects. %M 33400681 %R 10.2196/21156 %U https://formative.jmir.org/2021/2/e21156 %U https://doi.org/10.2196/21156 %U http://www.ncbi.nlm.nih.gov/pubmed/33400681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22041 %T A Relaxation App (HeartBot) for Stress and Emotional Well-Being Over a 21-Day Challenge: Randomized Survey Study %A Iyer,Laya %A Iyer,Ranjani B %A Kumar,Vetriliaa %+ Heartfulness Program for Schools, Heartfulness Institute, 24977 Glenda St, Novi, MI, 48375, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness %K stress management %K iOS app %K social-emotional %K mental health %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: HeartBot is an app designed to enable people 14 years and older to use relaxation tools offered by Heartfulness Institute to deal with daily stress and anxiety in a healthy, productive manner. These tools have proven effective in stress management and mental wellness when administered in a controlled environment by a certified proctor. Objective: This study aimed to explore the app’s effectiveness and evaluate the implementation of the tools. Methods: In this study, 88 participants were recruited and randomly sorted into 2 groups, the HeartBot intervention group (n=46) and the waitlist control group (n=42). Pre- and postsurveys measured participants’ stress levels using the Perceived Stress Scale (PSS) and their social-emotional well-being using the EPOCH (Engagement, Perseverance, Optimism, Connectedness, and Happiness) Measure of Adolescent Well-Being before and after they used the app for 21 days for 30 minutes every day. Results: The study received institutional review board approval on August 18, 2019. Participant recruitment lasted from the approval date until September 30, 2019. The 21-day challenge started on October 1, 2019. Of the 135 people who signed up, 88 completed the study. There was a statistically significant difference in the mean PSS scores before and after the intervention (from 18.3 to 7.89; P<.001). The paired Wilcoxon rank sum test on the EPOCH scores indicated a significant difference in the medians of the total scores (W=411.5, P<.001). Conclusions: Evidence from this study shows that HeartBot is an effective app that can be used to manage stress and improve positive characteristics of emotional wellness. Future research and widespread usage of the app under this study are encouraged based on this preliminary evidence of its effectiveness. Trial Registration: ClinicalTrials.gov NCT04589520; https://clinicaltrials.gov/ct2/show/NCT04589520 %M 33455902 %R 10.2196/22041 %U http://formative.jmir.org/2021/1/e22041/ %U https://doi.org/10.2196/22041 %U http://www.ncbi.nlm.nih.gov/pubmed/33455902 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e19677 %T Development and Feasibility of an App to Decrease Risk Factors for Type 2 Diabetes in Hispanic Women With Recent Gestational Diabetes (Hola Bebé, Adiós Diabetes): Pilot Pre-Post Study %A Seely,Ellen W %A Weitzman,Patricia Flynn %A Cortes,Dharma %A Romero Vicente,Sara %A Levkoff,Sue E %+ Endocrinology, Diabetes and Hypertension Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, United States, 1 6177325012, eseely@bwh.harvard.edu %K gestational diabetes mellitus %K diabetes prevention %K Hispanic %K Latina %K intervention %K mobile apps %K mHealth %D 2020 %7 31.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. In addition, Hispanic women are less likely to engage in healthy eating and physical activity, which are both risk factors for type 2 diabetes. Supporting patients to engage in healthy lifestyle behaviors through mobile health (mHealth) interventions is increasingly recognized as a viable, underused tool for disease prevention, as they reduce barriers to access frequently experienced in face-to-face interventions. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking. Objective: This study aimed to (1) develop a mobile app (¡Hola Bebé, Adiós Diabetes!) to pilot test a culturally tailored, bilingual (Spanish/English) lifestyle program to reduce risk factors for type 2 diabetes in Hispanic women with GDM in the prior 5 years; (2) examine the acceptability and usability of the app; and (3) assess the short-term effectiveness of the app in increasing self-efficacy for both healthy eating and physical activity, and in decreasing weight. Methods: Social cognitive theory provided the framework for the study. A prototype app was developed based on prior research and cultural tailoring of content. Features included educational audiovisual modules on healthy eating and physical activity; personal action plans; motivational text messages; weight tracking; user-friendly, easy-to-follow recipes; directions on building a balanced plate; and tiered badges to reward achievements. Perceptions of the app’s acceptability and usability were explored through four focus groups. Short-term effectiveness of the app was tested in an 8-week single group pilot study. Results: In total, 11 Hispanic women, receiving care at a federally qualified community health center, aged 18-45 years, and with GDM in the last 5 years, participated in four focus groups to evaluate the app’s acceptability and usability. Participants found the following sections most useful: audiovisual modules, badges for completion of activities, weight-tracking graphics, and recipes. Suggested modifications included adjustments in phrasing, graphics, and a tiering system of badges. After app modifications, we conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a “how-to tutorial.” To assess short-term effectiveness, 21 Hispanic women with prior GDM participated in the pilot. There was a statistically significant improvement in both self-efficacy for physical activity (P=.003) and self-efficacy for healthy eating (P=.007). Weight decreased but not significantly. Backend process data revealed a high level of user engagement. Conclusions: These data support the app’s acceptability, usability, and short-term effectiveness, suggesting that this mHealth program has the potential to fill the gap in care experienced by Hispanic women with prior GDM following pregnancy. Future studies are needed to determine the effectiveness of an enhanced app in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04149054; https://clinicaltrials.gov/ct2/show/NCT04149054 %M 33382039 %R 10.2196/19677 %U http://formative.jmir.org/2020/12/e19677/ %U https://doi.org/10.2196/19677 %U http://www.ncbi.nlm.nih.gov/pubmed/33382039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18982 %T Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study %A Biran,Noa %A Anthony Kouyaté,Robin %A Yucel,Emre %A McGovern,Gillian E %A Schoenthaler,Antoinette M %A Durling,Olivia G %A Unawane,Rashmi %A Schutt,Andrew %A Panjabi,Sumeet %+ Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, United States, 1 551 996 8704, Noa.Biran@hackensackmeridian.org %K mHealth %K digital health %K electronic patient-reported outcome %K ePRO %K patient-reported outcome %K PRO %K mobile %K app %K implementation science %K multiple myeloma %K relapsed refractory multiple myeloma %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. %M 33200997 %R 10.2196/18982 %U http://formative.jmir.org/2020/11/e18982/ %U https://doi.org/10.2196/18982 %U http://www.ncbi.nlm.nih.gov/pubmed/33200997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21995 %T Consumers’ Intentions to Adopt Blockchain-Based Personal Health Records and Data Sharing: Focus Group Study %A Lu,Chang %A Batista,Danielle %A Hamouda,Hoda %A Lemieux,Victoria %+ Blockchain@UBC, University of British Columbia, 179 - 2366 Main Mall, Vancouver, BC, V6T 1Z4, Canada, chang.lu@ubc.ca %K blockchain %K personal health record %K health data sharing %K consumers’ intentions to adopt %K focus group study %K microinterlocutor analysis %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although researchers are giving increased attention to blockchain-based personal health records (PHRs) and data sharing, the majority of research focuses on technical design. Very little is known about health care consumers’ intentions to adopt the applications. Objective: This study aims to explore the intentions and concerns of health care consumers regarding the adoption of blockchain-based personal health records and data sharing. Methods: Three focus groups were conducted, in which 26 participants were shown a prototype of a user interface for a self-sovereign blockchain-based PHR system (ie, a system in which the individual owns, has custody of, and controls access to their personal health information) to be used for privacy and secure health data sharing. A microinterlocutor analysis of focus group transcriptions was performed to show a descriptive overview of participant responses. NVivo 12.0 was used to code the categories of the responses. Results: Participants did not exhibit a substantial increase in their willingness to become owners of health data and share the data with third parties after the blockchain solution was introduced. Participants were concerned about the risks of losing private keys, the resulting difficulty in accessing care, and the irrevocability of data access on blockchain. They did, however, favor a blockchain-based PHR that incorporates a private key recovery system and offers a health wallet hosted by government or other positively perceived organizations. They were more inclined to share data via blockchain if the third party used the data for collective good and offered participants nonmonetary forms of compensation and if the access could be revoked from the third party. Conclusions: Health care consumers were not strongly inclined to adopt blockchain-based PHRs and health data sharing. However, their intentions may increase when the concerns and recommendations demonstrated in this study are considered in application design. %M 33151149 %R 10.2196/21995 %U http://formative.jmir.org/2020/11/e21995/ %U https://doi.org/10.2196/21995 %U http://www.ncbi.nlm.nih.gov/pubmed/33151149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19876 %T Investigating the Impact of COVID-19 Lockdown on the Psychological Health of University Students and Their Attitudes Toward Mobile Mental Health Solutions: Two-Part Questionnaire Study %A Drissi,Nidal %A Alhmoudi,Ayat %A Al Nuaimi,Hana %A Alkhyeli,Mahra %A Alsalami,Shaikha %A Ouhbi,Sofia %+ United Arab Emirates University, , Al Ain, United Arab Emirates, 971 37135568, sofia.ouhbi@uaeu.ac.ae %K COVID-19 %K GHQ-12 %K mobile %K apps %K m-health %K m-mental health %K UAE %K attitudes %K university students %K questionnaire %D 2020 %7 20.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 outbreak was first reported to the World Health Organization on December 31, 2019, and it was officially declared a public health emergency of international concern on January 30, 2020. The COVID-19 outbreak and the safety measures taken to control it caused many psychological issues in populations worldwide, such as depression, anxiety, and stress. Objective: The objectives of this study were to assess the psychological effects of the lockdown due to the COVID-19 outbreak on university students in the United Arab Emirates (UAE) and to investigate the students’ awareness of mobile mental health care apps as well as their attitudes toward the use of these apps. Methods: A two-part self-administered web-based questionnaire was delivered to students at United Arab Emirates University. The first part of the questionnaire assessed the mental state of the participants using the 12-item General Health Questionnaire (GHQ-12), while the second part contained questions investigating the participants’ awareness of and attitudes toward mental health care apps. Students were invited to fill out the web-based questionnaire via social media and mailing lists. Results: A total of 154 students participated in the survey, and the majority were female. The results of the GHQ-12 analysis showed that the students were experiencing psychological issues related to depression and anxiety as well as social dysfunction. The results also revealed a lack of awareness of mental health care apps and uncertainty regarding the use of such apps. Approximately one-third of the participants (44/154, 28.6%) suggested preferred functionalities and characteristics of mobile mental health care apps, such as affordable price, simple design, ease of use, web-based therapy, communication with others experiencing the same issues, and tracking of mental status. Conclusions: Like many groups of people worldwide, university students in the UAE were psychologically affected by the lockdown due to the COVID-19 outbreak. Although apps can be useful tools for mental health care delivery, especially in circumstances such as those produced by the outbreak, the students in this study showed a lack of awareness of these apps and mixed attitudes toward them. Improving the digital health literacy of university students in the UAE by increasing their awareness of mental health care apps and the treatment methods and benefits of the apps, as well as involving students in the app creation process, may encourage students to use these tools for mental health care. %M 32969340 %R 10.2196/19876 %U http://formative.jmir.org/2020/10/e19876/ %U https://doi.org/10.2196/19876 %U http://www.ncbi.nlm.nih.gov/pubmed/32969340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e16800 %T Message Appeals on an Instagram Account Promoting Seat Belt Use That Attract Adolescents and Young Adults: Elaboration-Likelihood Perspective Study %A Zhang,Ni %A Drake,Stacy A %A Ding,Kele %+ San Jose State University, One Washington Square, SPX203, San Jose, CA, 95123, United States, 1 4089248109, ni.zhang01@sjsu.edu %K rational appeal %K ego appeal %K social appeal %K fun appeal %K positive emotional appeal %K fear appeal %K social media %K youth %K adolescents %K health information %K car safety %D 2020 %7 28.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults demonstrate the highest rate of unrestrained motor vehicle fatalities, making the promotion of seat belt restraint a priority for public health practitioners. Because social media use among adolescents and young adults has proliferated in recent years, it is critical to explore how to use this tool to promote seat belt use among this population. Social media posts can contain various types of information within each post and this information can be communicated using different modalities. Objective: In this study, based on the elaboration likelihood model, we aimed to examine how adolescents and young adults reacted to different appeals in various components of posts in the pilot of a promotion intervention on the Instagram BuckleUp4Life account. Methods: Using thematic analysis, we examined different appeals in 3 components (photo, text, and caption) of 199 posts in BuckleUp4Life and compared the number of likes for different appeals. Results: We found that 6 appeals were used in the posts: rational, ego, social, fun, positive emotional, and fear appeals. The results of our study showed that in photos, fun appeals were the most popular. Rational and positive emotional appeals were the most appealing in text and captions. Regardless of the location of the components (photo, text, or captions), rational appeal was the most popular appeal. Conclusions: Based on the findings of our study, we recommend that public health practitioners utilize fun photos with rational and positive emotional appeals in text and captions rather than fear or social appeals, when promoting seat belt use through social media, especially Instagram. %M 32985998 %R 10.2196/16800 %U http://formative.jmir.org/2020/9/e16800/ %U https://doi.org/10.2196/16800 %U http://www.ncbi.nlm.nih.gov/pubmed/32985998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e13637 %T Recruiting Student Health Coaches to Improve Digital Blood Pressure Management: Randomized Controlled Pilot Study %A Vasti,Elena %A Pletcher,Mark J %+ University of California, San Francisco School of Medicine, Stanford Internal Medicine Residency, 300 N Pasteur Dr s101, Stanford, CA, 94305, United States, 1 2094703263, ecvasti@stanford.edu %K mobile health %K hypertension %K coaching %K health-related behavior %K mobile phone %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is a significant problem in the United States, affecting 1 in 3 adults aged above 18 years and is associated with a higher risk for cardiovascular disease and stroke. The prevalence of hypertension has increased in medically underserved areas (MUAs). Mobile health technologies, such as digital self-monitoring devices, have been shown to improve the management of chronic health conditions. However, patients from MUAs have reduced access to these devices because of limited resources and low health literacy. Health coaches and peer training programs are a potentially cost-effective solution for the shortage of physicians available to manage hypertension in MUAs. Activating young people as student health coaches (SHCs) is a promising strategy to improve community health. Objective: This pilot study aims to assess (1) the feasibility of training high school students as health technology coaches in MUAs and (2) whether the addition of SHCs to digital home monitoring improves the frequency of self-monitoring and overall blood pressure (BP) control. Methods: In total, 15 high school students completed 3-day health coach training. Patients who had a documented diagnosis of hypertension were randomly assigned to 1 of the 3 intervention arms. The QardioArm alone (Q) group was provided a QardioArm cuff only for convenience. The SHC alone (S) group was instructed to meet with a health coach for 30 min once a week for 5 weeks to create action plans for reducing BP. The student+QardioArm (S+Q) group received both interventions. Results: Participants (n=27) were randomly assigned to 3 groups in a ratio of 9:9:9. All 15 students completed training, of which 40% (6/15) of students completed all the 5 meetings with their assigned patient. Barriers to feasibility included transportation and patient response drop-off at the end of the study. Overall, 92% (11/12) of the students rated their experience as very good or higher and 69% (9/13) reported that this experience made them more likely to go into the medical field. There was a statistically significant difference in the frequency of cuff use (S+Q vs Q groups: 37 vs 17; P<.001). Participants in the S+Q group reported better BP control after the intervention compared with the other groups. The average BP at the end of the intervention was 145/84 (SD 9/18) mm Hg, 150/85 (SD 18/12) mm Hg, and 128/69 (SD 20/14) mm Hg in the Q, S, and S+Q groups, respectively. Conclusions: This pilot study demonstrates the feasibility of pairing technology with young student coaches, although challenges existed. The S+Q group used their cuff more than the Q group. Patients were more engaged in the S+Q group, reporting higher satisfaction with their SHC and better control of their BP. %M 32840489 %R 10.2196/13637 %U https://formative.jmir.org/2020/8/e13637 %U https://doi.org/10.2196/13637 %U http://www.ncbi.nlm.nih.gov/pubmed/32840489 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e16422 %T Occupation Coding of Job Titles: Iterative Development of an Automated Coding Algorithm for the Canadian National Occupation Classification (ACA-NOC) %A Bao,Hongchang %A Baker,Christopher J O %A Adisesh,Anil %+ Department of Computer Science, Faculty of Science, Applied Science and Engineering, University of New Brunswick, 100 Tucker Park Rd, Saint John, NB, E2K5E2, Canada, 1 (506) 648 2302, bakerc@unb.ca %K occupation coding %K automated coding %K occupational health %K job title %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In many research studies, the identification of social determinants is an important activity, in particular, information about occupations is frequently added to existing patient data. Such information is usually solicited during interviews with open-ended questions such as “What is your job?” and “What industry sector do you work in?” Before being able to use this information for further analysis, the responses need to be categorized using a coding system, such as the Canadian National Occupational Classification (NOC). Manual coding is the usual method, which is a time-consuming and error-prone activity, suitable for automation. Objective: This study aims to facilitate automated coding by introducing a rigorous algorithm that will be able to identify the NOC (2016) codes using only job title and industry information as input. Using manually coded data sets, we sought to benchmark and iteratively improve the performance of the algorithm. Methods: We developed the ACA-NOC algorithm based on the NOC (2016), which allowed users to match NOC codes with job and industry titles. We employed several different search strategies in the ACA-NOC algorithm to find the best match, including exact search, minor exact search, like search, near (same order) search, near (different order) search, any search, and weak match search. In addition, a filtering step based on the hierarchical structure of the NOC data was applied to the algorithm to select the best matching codes. Results: The ACA-NOC was applied to over 500 manually coded job and industry titles. The accuracy rate at the four-digit NOC code level was 58.7% (332/566) and improved when broader job categories were considered (65.0% at the three-digit NOC code level, 72.3% at the two-digit NOC code level, and 81.6% at the one-digit NOC code level). Conclusions: The ACA-NOC is a rigorous algorithm for automatically coding the Canadian NOC system and has been evaluated using real-world data. It allows researchers to code moderate-sized data sets with occupation in a timely and cost-efficient manner such that further analytics are possible. Initial assessments indicate that it has state-of-the-art performance and is readily extensible upon further benchmarking on larger data sets. %M 32755893 %R 10.2196/16422 %U https://formative.jmir.org/2020/8/e16422 %U https://doi.org/10.2196/16422 %U http://www.ncbi.nlm.nih.gov/pubmed/32755893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e14649 %T Technical and Psychosocial Challenges of mHealth Usage for Antiretroviral Therapy Adherence Among People Living With HIV in a Resource-Limited Setting: Case Series %A Ngowi,Kennedy Michael %A Lyamuya,Furaha %A Mmbaga,Blandina T %A Muro,Eva %A Hillu,Zawadiel %A Shirima,Mary %A Aarnoutse,Rob E %A AG Sprangers,Mirjam %A Nieuwkerk,Pythia T %A Reiss,Peter %A Sumari-de Boer,Marion %+ Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, 2236, Moshi, United Republic of Tanzania, 1 2754201, k.ngowi@kcri.ac.tz %K mHealth %K case series %K adherence %K HIV %K real-time medication monitoring %K SMS %K antiretroviral therapy %D 2020 %7 10.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile communication has been found to improve antiretroviral therapy (ART) adherence among people living with HIV. In an ongoing randomized clinical trial, 2 mobile communication strategies (ie, sending SMS text messages and real-time medication monitoring [RTMM]) were used to improve adherence to ART among people living with HIV in Tanzania. We noticed remarkable discrepancies between self-reported adherence and adherence recorded by SMS text messaging or RTMM among some of the first trial participants. Objective: Our objective was to describe these cases and the observed discrepancies in more detail, to serve as a useful illustration of some of the challenges in using mobile health in resource-limited settings. Methods: In an ongoing randomized trial, adults living with HIV from two HIV treatment centers in Tanzania who were suspected of low levels of adherence were randomly assigned in a 1:1:1 ratio to receive (1) SMS text message reminders, (2) an RTMM device, or (3) no additional intervention to standard HIV care. During bimonthly study visits, the participants self-reported their level of adherence, received feedback about their level of adherence based on SMS text messaging or RTMM, and discussed strategies to overcome adherence problems with nurses providing HIV care. For the purpose of this report, we selected people living with HIV who had completed 5 follow-up visits and consistently reported more than 95% adherence, while SMS text messaging or RTMM recorded lower than 75% adherence. The participants were invited for a short, face-to-face in-depth interview to explore reasons for this discrepancy. Results: At the time of this analysis, 26 participants had completed follow-up. Six of these evidenced the above-mentioned discrepancies, with an average adherence of 46% based on SMS text messaging or RTMM, while self-reported adherence was 98%. Five of these 6 participants insisted that their adherence to ART was good, with 4 reporting that their adherence to properly using the monitoring device was low. Three participants mentioned concerns about involuntary disclosure of HIV status as a main reason for low adherence to using the device. Two participants were still depending on other reminder cues despite receiving SMS text message or RTMM reminders. Poor network coverage caused low adherence in 1 participant. Conclusions: Psychosocial barriers were reported as importantly contributing to low adherence, both with respect to use of ART and proper use of the adherence-monitoring device. This case series illustrates that when introducing new digital adherence monitoring technology, researchers should consider psychosocial barriers and distinguish between adherence to device use and adherence to treatment. Trial Registration: Pan African Clinical Trials Registry PACTR201712002844286; https://tinyurl.com/y98q4p3l %M 32519966 %R 10.2196/14649 %U http://formative.jmir.org/2020/6/e14649/ %U https://doi.org/10.2196/14649 %U http://www.ncbi.nlm.nih.gov/pubmed/32519966 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16880 %T Association Between Electroencephalogram-Derived Sleep Measures and the Change of Emotional Status Analyzed Using Voice Patterns: Observational Pilot Study %A Miyashita,Hirotaka %A Nakamura,Mitsuteru %A Svensson,Akiko Kishi %A Nakamura,Masahiro %A Tokuno,Shinichi %A Chung,Ung-Il %A Svensson,Thomas %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku,, Tokyo, 113-8656, Japan, 81 3 5841 4737, t-svensson@umin.ac.jp %K voice analysis %K emotional status %K vitality %K sleep %K mobile phone %D 2020 %7 9.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Measuring emotional status objectively is challenging, but voice pattern analysis has been reported to be useful in the study of emotion. Objective: The purpose of this pilot study was to investigate the association between specific sleep measures and the change of emotional status based on voice patterns measured before and after nighttime sleep. Methods: A total of 20 volunteers were recruited. Their objective sleep measures were obtained using a portable single-channel electroencephalogram system, and their emotional status was assessed using MIMOSYS, a smartphone app analyzing voice patterns. The study analyzed 73 sleep episodes from 18 participants for the association between the change of emotional status following nighttime sleep (Δvitality) and specific sleep measures. Results: A significant association was identified between total sleep time and Δvitality (regression coefficient: 0.036, P=.008). A significant inverse association was also found between sleep onset latency and Δvitality (regression coefficient: –0.026, P=.001). There was no significant association between Δvitality and sleep efficiency or number of awakenings. Conclusions: Total sleep time and sleep onset latency are significantly associated with Δvitality, which indicates a change of emotional status following nighttime sleep. This is the first study to report the association between the emotional status assessed using voice pattern and specific sleep measures. %M 32515745 %R 10.2196/16880 %U https://formative.jmir.org/2020/6/e16880 %U https://doi.org/10.2196/16880 %U http://www.ncbi.nlm.nih.gov/pubmed/32515745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16670 %T Patient Perception of Plain-Language Medical Notes Generated Using Artificial Intelligence Software: Pilot Mixed-Methods Study %A Bala,Sandeep %A Keniston,Angela %A Burden,Marisha %+ College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, , United States, 1 321 299 8429, ucfbala@knights.ucf.edu %K artificial intelligence %K patient education %K natural language processing %K OpenNotes %K Open Notes %K patient-physician relationship %K simplified notes %K plain-language notes %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinicians’ time with patients has become increasingly limited due to regulatory burden, documentation and billing, administrative responsibilities, and market forces. These factors limit clinicians’ time to deliver thorough explanations to patients. OpenNotes began as a research initiative exploring the ability of sharing medical notes with patients to help patients understand their health care. Providing patients access to their medical notes has been shown to have many benefits, including improved patient satisfaction and clinical outcomes. OpenNotes has since evolved into a national movement that helps clinicians share notes with patients. However, a significant barrier to the widespread adoption of OpenNotes has been clinicians’ concerns that OpenNotes may cost additional time to correct patient confusion over medical language. Recent advances in artificial intelligence (AI) technology may help resolve this concern by converting medical notes to plain language with minimal time required of clinicians. Objective: This pilot study assesses patient comprehension and perceived benefits, concerns, and insights regarding an AI-simplified note through comprehension questions and guided interview. Methods: Synthea, a synthetic patient generator, was used to generate a standardized medical-language patient note which was then simplified using AI software. A multiple-choice comprehension assessment questionnaire was drafted with physician input. Study participants were recruited from inpatients at the University of Colorado Hospital. Participants were randomly assigned to be tested for their comprehension of the standardized medical-language version or AI-generated plain-language version of the patient note. Following this, participants reviewed the opposite version of the note and participated in a guided interview. A Student t test was performed to assess for differences in comprehension assessment scores between plain-language and medical-language note groups. Multivariate modeling was performed to assess the impact of demographic variables on comprehension. Interview responses were thematically analyzed. Results: Twenty patients agreed to participate. The mean number of comprehension assessment questions answered correctly was found to be higher in the plain-language group compared with the medical-language group; however, the Student t test was found to be underpowered to determine if this was significant. Age, ethnicity, and health literacy were found to have a significant impact on comprehension scores by multivariate modeling. Thematic analysis of guided interviews highlighted patients’ perceived benefits, concerns, and suggestions regarding such notes. Major themes of benefits were that simplified plain-language notes may (1) be more useable than unsimplified medical-language notes, (2) improve the patient-clinician relationship, and (3) empower patients through an enhanced understanding of their health care. Conclusions: AI software may translate medical notes into plain-language notes that are perceived as beneficial by patients. Limitations included sample size, inpatient-only setting, and possible confounding factors. Larger studies are needed to assess comprehension. Insight from patient responses to guided interviews can guide the future study and development of this technology. %M 32442148 %R 10.2196/16670 %U https://formative.jmir.org/2020/6/e16670 %U https://doi.org/10.2196/16670 %U http://www.ncbi.nlm.nih.gov/pubmed/32442148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13989 %T A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study %A Weerahandi,Himali %A Paul,Soaptarshi %A Quintiliani,Lisa M %A Chokshi,Sara %A Mann,Devin M %+ Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St, 6th Fl, New York, NY, 10016, United States, 1 212 263 8313, devin.mann@nyulangone.org %K eHealth %K mobile %K telemedicine %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. Objective: This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. Methods: We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. Results: A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (P>.10 for all parameters). Conclusions: In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes. %M 32379049 %R 10.2196/13989 %U http://formative.jmir.org/2020/5/e13989/ %U https://doi.org/10.2196/13989 %U http://www.ncbi.nlm.nih.gov/pubmed/32379049 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16262 %T Testing Usability and Feasibility of a Mobile Educator Tool for Pediatric Diabetes Self-Management: Mixed Methods Pilot Study %A Otis,Marisa %A Zhu,Jack %A Mustafa-Kutana,Suleiman N %A Bernier,Angelina V %A Ma Shum,Julio %A Soros Dupre,Arlette A %A Wang,Monica L %+ Department of Community Health Sciences, Boston University School of Public Health, Crosstown Center, 4th Floor, 801 Massachusetts Avenue, Boston, MA, 02118, United States, 1 617 414 1357, mlwang@bu.edu %K diabetes mellitus %K self-management %K health education %K mHealth %K mobile health %K child health %D 2020 %7 1.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile interventions hold promise as an intervention modality to engage children in improving diabetes self-management education, attitudes, and behaviors. Objective: This pilot study aimed to explore the usability, acceptability, and feasibility of delivering a mobile diabetes educational tool to parent-child pairs in a clinical setting. Methods: This mixed methods pilot study comprised two concurrent phases with differing study participants. Phase 1 used user testing interviews to collect qualitative data on the usability and acceptability of the tool. Phase 2 used a single-arm pre- and poststudy design to quantitatively evaluate the feasibility and preliminary efficacy of the intervention. Study participants (English-speaking families with youth aged 5-14 years with insulin-dependent diabetes) were recruited from an urban hospital in Massachusetts, United States. In phase 1, parent-child pairs were invited to complete the intervention together and participate in 90-min user testing interviews assessing the tool’s usability and acceptability. Interview transcripts were analyzed using a directed content analysis approach. In phase 2, parent-child pairs were invited to complete the intervention together in the clinical setting. Measures included parental and child knowledge, attitudes, and behaviors related to diabetes management (self-report surveys) and child hemoglobin A1c levels (medical record extractions); data were collected at baseline and 1-month follow-up. Pre- and postoutcomes were compared using paired t tests and the Fisher exact test. Results: A total of 11 parent-child pairs (N=22) participated in phase 1 of the study, and 10 parent-child pairs (N=20) participated in phase 2 of the study. Participants viewed the mobile educational tool as acceptable (high engagement and satisfaction with the layout, activities, and videos) and identified the areas of improvement for tool usability (duration, directions, and animation). Conclusions: The findings from this pilot study suggest that the mobile educational tool is an informative, engaging, and feasible way to deliver diabetes self-management education to parents and children in an urban hospital setting. Data will inform future iterations of this mobile diabetes educational intervention to improve usability and test intervention efficacy. %M 32356773 %R 10.2196/16262 %U https://formative.jmir.org/2020/5/e16262 %U https://doi.org/10.2196/16262 %U http://www.ncbi.nlm.nih.gov/pubmed/32356773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e16151 %T Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study %A Nicklas,Jacinda M %A Leiferman,Jenn A %A Lockhart,Steven %A Daly,Kristen M %A Bull,Sheana S %A Barbour,Linda A %+ Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E Montview Blvd, Aurora, CO, 80045, United States, 1 3037249028, Jacinda.Nicklas@cuanschutz.edu %K mobile health %K postpartum %K chronic disease %K prevention %K weight loss %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases. Objective: We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program. Methods: For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app. Results: We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version. Conclusions: This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women. Trial Registration: ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226 %M 32271149 %R 10.2196/16151 %U https://formative.jmir.org/2020/4/e16151 %U https://doi.org/10.2196/16151 %U http://www.ncbi.nlm.nih.gov/pubmed/32271149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e14508 %T Usability of Wearable Devices to Remotely Monitor Sleep Patterns Among Patients With Ischemic Heart Disease: Observational Study %A Fortunato,Michael %A Adusumalli,Srinath %A Chokshi,Neel %A Harrison,Joseph %A Rareshide,Charles %A Patel,Mitesh %+ Crescenz Veterans Affairs Medical Center, 3800 Woodland Ave, South Pavilion 14-176, Philadelphia, PA, , United States, 1 215 823 5800, mpatel@pennmedicine.upenn.edu %K sleep %K wearable devices %K ischemic heart disease %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing interest in using wearable devices to remotely monitor patient behaviors. However, there has been little evaluation of how often these technologies are used to monitor sleep patterns over longer term periods, particularly among more high-risk patients. Objective: The goal of the research was to evaluate the proportion of time that patients with ischemic heart disease used wearable devices to monitor their sleep and identify differences in characteristics of patients with higher versus lower use. Methods: We evaluated wearable device data from a previously conducted clinical trial testing the use of wearable devices with personalized goal-setting and financial incentives. Patients with ischemic heart disease established a sleep baseline and were then followed for 24 weeks. The proportion of days that sleep data was collected was compared over the 24 weeks and by study arm. Characteristics of patients were compared to groups with high, low, or no sleep data. Results: The sample comprised 99 patients with ischemic heart disease, among which 79% (78/99) used the wearable device to track their sleep. During the 6-month trial, sleep data were collected on 60% (10,024/16,632) of patient-days. These rates declined over time from 77% (4292/5544) in months 1 and 2 to 58% (3188/5544) in months 3 and 4 to 46% (2544/5544) in months 5 and 6. Sleep data were collected at higher rates among the intervention group compared with control (67% vs 55%, P<.001). In the main intervention period (months 3 and 4), patients with higher rates of sleep data were on average older (P=.03), had a history of smoking (P=.007), and had higher rates of commercial health insurance (P=.03). Conclusions: Among patients with ischemic heart disease in a physical activity trial, a high proportion used wearable devices to track their sleep; however, rates declined over time. Future research should consider larger evaluations coupled with behavioral interventions. Trial Registration: ClinicalTrials.gov NCT02531022; https://clinicaltrials.gov/ct2/show/NCT02531022 %M 32254044 %R 10.2196/14508 %U https://formative.jmir.org/2020/4/e14508 %U https://doi.org/10.2196/14508 %U http://www.ncbi.nlm.nih.gov/pubmed/32254044 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10688 %T Implementing Web-Based Interventions in HIV Primary Care Clinics: Pilot Implementation Evaluation of Positive Health Check %A Harshbarger,Camilla %A Burrus,Olivia %A Zulkiewicz,Brittany A %A Ortiz,Alexa M %A Galindo,Carla A %A Garner,Bryan R %A Furberg,Robert D %A Lewis,Megan A %+ Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MSE-37, Atlanta, GA,, United States, 1 404 639 4267, uzz9@cdc.gov %K internet %K patient care %K attitudes %K vulnerable populations %K public health practice %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based interventions can help people living with HIV achieve better clinical outcomes and behaviors, but integrating them into clinical practice remains challenging. There is a gap in understanding the feasibility of implementing these interventions in HIV clinic settings from the clinicians’ perspective. Objective: The goal of the research was to determine whether Positive Health Check (PHC)—a Web-based, tailored video counseling tool focused on increasing patient adherence and retention in care and reducing HIV risk among HIV-positive patients—was acceptable, appropriate, and feasible for HIV primary care clinic staff to implement in clinic workflows. Methods: A multiple-case study design was used to evaluate the pilot implementation. Four primary care clinics located in the southeastern United States implemented PHC over a 1-month period. Nine clinic staff across the clinics participated in structured interviews before, during, and after the implementation. In total, 54 interviews were conducted. We used a framework analysis approach to code the data and identify themes related to implementation outcomes, including acceptability, appropriateness, and feasibility. We also analyzed patient intervention use metrics (n=104) to quantify patient intervention completion rates (n=68). Results: Overall, clinicians viewed PHC as acceptable and appropriate. Themes that emerged related to these implementation outcomes include the ability for PHC to increase provider-patient communication and its ability to engage patients due to the tailored and interactive design. While generally feasible to implement, challenges to the clinic workflow and physical environment were areas that clinics needed to manage to make PHC work in their clinics. Conclusions: Findings from this pilot implementation suggest that clinical staff viewed PHC as acceptable and appropriate, especially as more patients used the intervention over the pilot period. Feasibility of implementation was challenging in some cases, and lessons learned from this pilot implementation can provide information for larger scale tests of the intervention that include assessment of both implementation outcomes and clinical outcomes. %M 30998219 %R 10.2196/10688 %U http://formative.jmir.org/2019/2/e10688/ %U https://doi.org/10.2196/10688 %U http://www.ncbi.nlm.nih.gov/pubmed/30998219 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11404 %T Consumption of Health-Related Content on Social Media Among Adolescent Girls: Mixed-Methods Pilot Study %A Leary,Miriam P %A Clegg,Emily N %A Santella,Madison E %A Murray,Pamela J %A Downs,Julie S %A Olfert,Melissa D %+ Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, G25 Agriculture Sciences Building, 1194 Evansdale Drive, Morgantown, WV, 26505, United States, 1 3042931918, melissa.olfert@mail.wvu.edu %K adolescent %K female %K social media %K health information %K health behaviors %D 2019 %7 01.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Consumption of health- and fitness-related social media content is a predominant behavior among teenage girls, which puts them at risk for consuming unreliable health-related information. Objective: This mixed-methods study (qualitative and quantitative) assessed health behavior attitudes and practices as well as social media use among adolescent girls. Additionally, similar practices and behaviors of adults who regularly interact with this population were studied. Methods: Girls aged 12-18 years were recruited to complete a 28-item survey and participate in a 45- to 60-minute focus group. Adults who regularly interact with adolescent girls, including parents, teachers, and healthcare professionals, were recruited from the local community and given a link to provide online consent and complete a survey. Results: A total of 27 adolescent girls participated in one of nine focus groups. Participants included 18 high school (age: mean 16.1 years; SD 1.3 years) and 9 middle school (age: mean 12.4 years; SD 0.7 years) girls. Eleven adults completed the online survey. Adolescents used social media to communicate and connect with friends, rather than as a source of health information. Although adolescents may see health-related content, most do not follow health-related pages or share such pages themselves, and fewer are actively searching for this information. Adolescents tend to trust information from familiar sources, and the participants reported that they do not follow official news accounts. Adults considered modeling and discussing healthy behaviors important and reportedly expected adolescents to see some level of health-related, especially fitness-related, content on social media. Conclusions: Education interventions are warranted for both adolescents and adults with whom adolescent girls regularly interact, in the areas of sedentary behavior to guide them to access reliable online health-related information and be judicious consumers of online health information. %M 30821696 %R 10.2196/11404 %U http://formative.jmir.org/2019/1/e11404/ %U https://doi.org/10.2196/11404 %U http://www.ncbi.nlm.nih.gov/pubmed/30821696