%0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e66599 %T Correction: Smartphone-Based Survey and Message Compliance in Adults Initially Unready to Quit Smoking: Secondary Analysis of a Randomized Controlled Trial %A Ulm,Clayton %A Chen,Sixia %A Fleshman,Brianna %A Benson,Lizbeth %A Kendzor,Darla E %A Frank-Pearce,Summer %A Neil,Jordan M %A Vidrine,Damon %A De La Torre,Irene %A Businelle,Michael S %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001, michael-businelle@ouhsc.edu %D 2024 %7 15.10.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 39405527 %R 10.2196/66599 %U https://formative.jmir.org/2024/1/e66599 %U https://doi.org/10.2196/66599 %U http://www.ncbi.nlm.nih.gov/pubmed/39405527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50141 %T Understanding Pediatric Experiences With Symptomatic Varicoceles: Mixed Methods Study of an Online Varicocele Community %A Sollender,Grace E %A Jiang,Tommy %A Finkelshtein,Ilana %A Osadchiy,Vadim %A Zheng,Michael H %A Mills,Jesse N %A Singer,Jennifer S %A Eleswarapu,Sriram V %+ Department of Urology, Stanford University, 453 Quarry Road, Palo Alto, CA, 94063, United States, 1 8478265496, tommyjiang@stanford.edu %K adolescents %K online support %K online forums %K peer support %K natural language processing %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Varicoceles affect up to 30% of postpubertal adolescent males. Studying this population remains difficult due to this topic’s sensitive nature. Using the popularity of social media in this cohort and natural language processing (NLP) techniques, our aim was to identify perceptions of adolescent males on an internet varicocele forum to inform how physicians may better evaluate and counsel this pediatric population. Objective: We aimed to characterize themes of discussion and specific concerns expressed by adolescents using a mixed methods approach involving quantitative NLP and qualitative annotation of an online varicocele community. Methods: We extracted posts from the Reddit community “r/varicocele” (5100 members) with criteria of discussant age ≤21 years and word count >20. We used qualitative thematic analysis and the validated constant comparative method, as well as an NLP technique called the meaning extraction method with principal component analysis (MEM/PCA), to identify discussion themes. Two investigators independently interrogated 150 randomly selected posts to further characterize content based on NLP-identified themes and calculated the Kaiser-Meyer-Olkin (KMO) statistic and the Bartlett test. Both quantitative and qualitative approaches were then compared to identify key themes of discussion. Results: A total of 1103 posts met eligibility criteria from July 2015 to June 2022. Among the 150 randomly selected posts, MEM/PCA and qualitative thematic analysis separately revealed key themes: an overview of varicocele (40/150, 27%), management (29/150, 19%), postprocedural experience (28/150, 19%), seeking community (26/150, 17%) and second opinions after visiting a physician (27/150, 18%). Quantitative analysis also identified “hypogonadism” and “semen analysis” as concerns when discussing their condition. The KMO statistic was >0.60 and the Bartlett test was <0.01, indicating the appropriateness of MEM/PCA. The mean age was 17.5 (SD 2.2; range 14-21) years, and there were trends toward higher-grade (40/45, 89% had a grade of ≥2) and left-sided varicoceles. Urologists were the topic of over 50% (53/82) of discussions among discussants, and varicocelectomy remained the intervention receiving the most interest. A total of 60% (90/150) of discussants described symptomatic varicoceles, with 62 of 90 reporting pain, 24 of 90 reporting hypogonadism symptoms, and 45 of 90 reporting aesthetics as the primary concern. Conclusions: We applied a mixed methods approach to identify uncensored concerns of adolescents with varicoceles. Both qualitative and quantitative approaches identified that adolescents often turned to social media as an adjunct to doctors’ visits and to seek peer support. This population prioritized symptom control, with an emphasis on pain, aesthetics, sexual function, and hypogonadism. These data highlight how each adolescent may approach varicoceles uniquely, informing urologists how to better interface with this pediatric population. Additionally, these data may highlight the key drivers of decision-making when electing for procedural management of varicoceles. %M 39388695 %R 10.2196/50141 %U https://formative.jmir.org/2024/1/e50141 %U https://doi.org/10.2196/50141 %U http://www.ncbi.nlm.nih.gov/pubmed/39388695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54661 %T Concerns Over Vuse e-Cigarette Digital Marketing and Implications for Public Health Regulation: Content Analysis %A Han,Eileen %A Lempert,Lauren K %A Vescia,Francesca %A Halpern-Felsher,Bonnie %K e-cigarette %K social media marketing %K Vuse %K adolescents and young adults %K Food and Drug Administration %K FDA %K smoker %K smoking %K smoking device %K tobacco %K social media %K Instagram %K Facebook %K promote %K marketing %K mobile phone %D 2024 %7 27.12.2024 %9 %J JMIR Form Res %G English %X Background: Electronic cigarettes (e-cigarettes) are the most used form of tobacco products among adolescents and young adults, and Vuse is one of the most popular brands of e-cigarettes among US adolescents. In October 2021, Vuse Solo became the first e-cigarette brand to receive marketing granted orders (MGOs) from the US Food and Drug Administration (FDA), authorizing its marketing and their tobacco-flavored pods. Vuse Ciro and Vuse Vibe, and their tobacco-only (“original”) e-liquids, were authorized for marketing in May 2022 and Vuse Alto tobacco-flavored devices were authorized in July 2024. These marketing authorizations are contingent upon the company adhering to the MGOs’ stated marketing restrictions, including reducing exposure and appeal to youth via digital, radio, television, print, and point-of-sale advertising. Objective: In this study, we analyzed the official social media channels of Vuse (Instagram and Facebook) to examine how Vuse marketed its products on social media and whether these marketing posts contain potentially youth-appealing themes. Methods: We conducted content analysis of the official RJ Reynolds Vapor Company Instagram and Facebook accounts. We collected all posts from October 10, 2019, when RJ Reynolds Vapor Company submitted its premarket tobacco product application to the FDA, to February 21, 2022, to cover the first winter holiday season after the MGO. Two coders developed the codebook with 17 themes based on the Content Appealing to Youth index to capture the posts’ characteristics and potentially youth-appealing content. We calculated the percentage of posts in which each code was present. Results: A total of 439 unique posts were identified. During this study’s period, there were no posts on Instagram or Facebook marketing Vuse Solo (the authorized product at that time). Instead, Vuse Alto (unauthorized to date of study) was heavily marketed, with 59.5% (n=261) of the posts specifically mentioning the product name. Further, “Vuse” more generally was marketed on social media without differentiating between the authorized and unauthorized products (n=182, 41.5%). The marketing messages contained several potentially youth-appealing themes including creativity or innovation (n=189, 43.1%), individuality or freedom (n=106, 24.2%), and themes related to art (n=150, 34.2%), music (n=77, 17.5%), sports (n=125, 28.5%), nature (with n=49, 11.2% of the posts containing flora imageries), alcohol imagery (n=10, 2.3%), and technology (n=6, 1.4%). Conclusions: Although Vuse Alto e-cigarettes had not yet obtained FDA marketing authorization during the 28 months of data collection, they were the primary Vuse e-cigarette devices marketed on social media. Vuse social media posts use themes that are appealing to and likely promote youth use, including creativity and innovation, individuality or freedom, arts and music, nature, technology, and alcohol imagery. The FDA should (1) prohibit companies from comarketing unauthorized products alongside authorized products, and (2) exercise enforcement against even authorized products that are marketed using youth-appealing features. %R 10.2196/54661 %U https://formative.jmir.org/2024/1/e54661 %U https://doi.org/10.2196/54661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63777 %T Digital Platform for Pediatric Mental Health Support During Armed Conflicts: Development and Usability Study %A Segal,Hila %A Benis,Arriel %A Saar,Shirley %A Shachar-Lavie,Iris %A Fennig,Silvana %K pediatric mental health %K digital platform %K pediatricians %K prevention %K early intervention %D 2024 %7 26.12.2024 %9 %J JMIR Form Res %G English %X Background: The prevalence of mental health disorders among children and adolescents presents a significant public health challenge. Children exposed to armed conflicts are at a particularly high risk of developing mental health problems, necessitating prompt and robust intervention. The acute need for early intervention in these situations is well recognized, as timely support can mitigate long-term negative outcomes. Pediatricians are particularly suited to deliver such interventions due to their role as primary health care providers and their frequent contact with children and families. However, barriers such as limited training and resources often hinder their ability to effectively address these issues. Objectives: This study aimed to describe the rapid development of a digital mental health tool for community pediatricians, created in response to the urgent need for accessible resources following the October 7th terror attack in Israel. The goal was to create a comprehensive resource that addresses a wide range of emotional and behavioral challenges in children and adolescents, with a particular focus on those affected by armed conflict and significant trauma exposure. In addition, the study aimed to evaluate the platform’s usability and relevance through feedback from primary users, thereby assessing its potential for implementation in pediatric practice. Methods: A digital platform was developed using a collaborative approach that involved pediatricians and mental health professionals from various hospital clinics. The initial framework for the modules was drafted based on key emotional and behavioral issues identified through prior research. Following this, the detailed content of each module was cocreated with input from specialized mental health clinics within the hospital, ensuring comprehensive and practical guidance for community pediatricians. A focus group of 7 primary users, selected for their relevant hospital and community roles, provided feedback on the platform’s user experience, content relevance, and layout. The evaluation was conducted using a structured questionnaire complemented by qualitative comments. Results: Fifteen detailed modules were created, each providing information, including anamnesis, initial intervention strategies, parental guidance, and referral options. The focus group feedback demonstrated high satisfaction, indicating a very good user experience (mean 4.57, SD 0.53), content relevance (mean 4.71, SD 0.48), and layout suitability (mean 4.66, SD 0.52). Specific feedback highlighted the value of concise, actionable content and the inclusion of medication information. Participants expressed a strong willingness to regularly use the platform in their practice (mean 4.40, SD 0.53), suggesting its potential for broad application. Conclusions: This study demonstrates the effectiveness of a collaborative development process in creating a digital tool that addresses the mental health needs of children in crisis situations. The positive feedback from pediatricians indicated that the platform has the potential to become a valuable resource for early recognition, crisis intervention, and parental support in community pediatric settings. Future research will focus on broader implementation and assessing the platform’s impact on clinical outcomes. %R 10.2196/63777 %U https://formative.jmir.org/2024/1/e63777 %U https://doi.org/10.2196/63777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60483 %T Engagement With Digital Health Technologies Among Older People Living in Socially Deprived Areas: Qualitative Study of Influencing Factors %A Chadwick,Helen %A Laverty,Louise %A Finnigan,Robert %A Elias,Robert %A Farrington,Ken %A Caskey,Fergus J %A van der Veer,Sabine N %K aged %K digital health %K health equity %K intersectionality, qualitative research %K social deprivation %D 2024 %7 26.12.2024 %9 %J JMIR Form Res %G English %X Background: The potential benefits of incorporating digital technologies into health care are well documented. For example, they can improve access for patients living in remote or underresourced locations. However, despite often having the greatest health needs, people who are older or living in more socially deprived areas may be less likely to have access to these technologies and often lack the skills to use them. This puts them at risk of experiencing further health inequities. In addition, we know that digital health inequities associated with older age may be compounded by lower socioeconomic status. Yet, there is limited research on the intersectional barriers and facilitators for engagement with digital health technology by older people who are particularly marginalized. Objective: This study aimed to explore factors influencing engagement with digital health technologies among people at the intersection of being older and socially deprived. Methods: We conducted semistructured interviews with people who were 70 years or older, living in a socially deprived area, or both. Chronic kidney disease was our clinical context. We thematically analyzed interview transcripts using the Unified Theory of Acceptance and Use of Technology as a theoretical framework. Results: We interviewed 26 people. The majority were White British (n=20) and had moderate health and digital literacy levels (n=10 and n=11, respectively). A total of 13 participants were 70 years of age or older and living in a socially deprived area. Across participants, we identified 2 main themes from the interview data. The first showed that some individuals did not use digital health technologies due to a lack of engagement with digital technology in general. The second theme indicated that people felt that digital health technologies were “not for them.” We identified the following key engagement factors, with the first 2 particularly impacting participants who were both older and socially deprived: lack of opportunities in the workplace to become digitally proficient; lack of appropriate support from family and friends; negative perceptions of age-related social norms about technology use; and reduced intrinsic motivation to engage with digital health technology because of a perceived lack of relevant benefits. Participants on the intersection of older age and social deprivation also felt significant anxiety around using digital technology and reported a sense of distrust toward digital health care. Conclusions: We identified factors that may have a more pronounced negative impact on the health equity of older people living in socially deprived areas compared with their counterparts who only have one of these characteristics. Successful implementation of digital health interventions therefore warrants dedicated strategies for managing the digital health equity impact on this group. Future studies should further develop these strategies and investigate their effectiveness, as well as explore the influence of related characteristics, such as educational attainment and ethnicity. %R 10.2196/60483 %U https://formative.jmir.org/2024/1/e60483 %U https://doi.org/10.2196/60483 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55916 %T Consensus Between Radiologists, Specialists in Internal Medicine, and AI Software on Chest X-Rays in a Hospital-at-Home Service: Prospective Observational Study %A Grossbard,Eitan %A Marziano,Yehonatan %A Sharabi,Adam %A Abutbul,Eliyahu %A Berman,Aya %A Kassif-Lerner,Reut %A Barkai,Galia %A Hakim,Hila %A Segal,Gad %K chest x-ray %K hospital-at-home %K telemedicine %K artificial intelligence %K kappa %K x-ray %K home hospitalization %K clinical data %K chest %K implementation %K comparative analysis %K radiologist %K AI %D 2024 %7 24.12.2024 %9 %J JMIR Form Res %G English %X Background: Home hospitalization is a care modality growing in popularity worldwide. Telemedicine-driven hospital-at-home (HAH) services could replace traditional hospital departments for selected patients. Chest x-rays typically serve as a key diagnostic tool in such cases. Objective: The implementation, analysis, and clinical assimilation of chest x-rays into an HAH service has not been described yet. Our objective is to introduce this essential information to the realm of HAH services for the first time worldwide. Methods: The study involved a prospective follow-up, description, and analysis of the HAH patient population who underwent chest x-rays at home. A comparative analysis was performed to evaluate the level of agreement among three interpretation modalities: a radiologist, a specialist in internal medicine, and a designated artificial intelligence (AI) algorithm. Results: Between February 2021 and May 2023, 300 chest radiographs were performed at the homes of 260 patients, with the median age being 78 (IQR 65‐87) years. The most frequent underlying morbidity was cardiovascular disease (n=185, 71.2%). Of the x-rays, 286 (95.3%) were interpreted by a specialist in internal medicine, 29 (9.7%) by a specialized radiologist, and 95 (31.7%) by the AI software. The overall raw agreement level among these three modalities exceeded 90%. The consensus level evaluated using the Cohen κ coefficient showed substantial agreement (κ=0.65) and moderate agreement (κ=0.49) between the specialist in internal medicine and the radiologist, and between the specialist in internal medicine and the AI software, respectively. Conclusions: Chest x-rays play a crucial role in the HAH setting. Rapid and reliable interpretation of these x-rays is essential for determining whether a patient requires transfer back to in-hospital surveillance. Our comparative results showed that interpretation by an experienced specialist in internal medicine demonstrates a significant level of consensus with that of the radiologists. However, AI algorithm-based interpretation needs to be further developed and revalidated prior to clinical applications. %R 10.2196/55916 %U https://formative.jmir.org/2024/1/e55916 %U https://doi.org/10.2196/55916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59333 %T Developing a Mood and Menstrual Tracking App for People With Premenstrual Dysphoric Disorder: User-Centered Design Study %A Apsey,Chloe %A Di Florio,Arianna %A Stawarz,Katarzyna %K premenstrual dysphoric disorder %K menstrual tracking %K mood tracking %K mobile health %K mHealth %K user-centered design %K menstrual %K tracking app %K hormonal fluctuations %K mood monitoring %K menstruation %D 2024 %7 24.12.2024 %9 %J JMIR Form Res %G English %X Background: People with premenstrual dysphoric disorder (PMDD) experience a range of symptoms that increase and decline as a result of the natural hormonal fluctuations of the menstrual cycle. For the diagnosis of PMDD, symptom severity needs to be recorded daily for at least two symptomatic cycles. In recent years, the rise in interest in Femtech (tools and technology developed to address women’s health issues) has resulted in a large quantity of “period-tracking apps” being developed and downloaded. However, there is not currently a menstrual and mood tracking app that has the full capabilities to accurately capture the symptoms of PMDD to aid with diagnosis. Objective: This study aimed to collect feedback and insights from potential users (ie, people with lived experience of PMDD or severe premenstrual syndrome) to inform the development of a prototype app that could support prospective mood monitoring of PMDD symptoms for research, and to support diagnosis. Methods: We conducted two user-centered design studies. Study 1 consisted of 4 interviews with individual participants who had taken part in our previous web-based mood tracking study for PMDD. During the interviews, participants were encouraged to identify the strengths and weaknesses of the existing web-based mood tracking system. Study 2 consisted of 2 workshops with a total of 8 participants, in which participants were asked to discuss the needs and desirable features they would like in a PMDD-specific tracking app. Interviews and workshops were recorded, and the transcripts were analyzed inductively following a thematic approach. Results: A total of four themes were identified from the interviews and workshops with potential users: (1) ease of use as a key consideration for users with PMDD; (2) avoiding a reductionist approach for a broad range of symptoms; (3) recognizing the importance of correct language; and (4) integrating features for the users’ benefits. These suggestions align with the current understanding of the implications of PMDD symptoms on daily activities and with findings from previous research on encouraging long-term engagement with apps. Conclusions: To meet the needs of potential users with PMDD or suspected PMDD, there needs to be a special consideration to how their symptoms impact the way they might interact with the app. In order for users to want to interact with the app daily, particularly during the days where they may not have symptoms to track, the app needs to be simple yet engaging. In addition, if the app provides insights and feedback that can benefit the well-being of the users, it is suggested that this could ensure prolonged use. %R 10.2196/59333 %U https://formative.jmir.org/2024/1/e59333 %U https://doi.org/10.2196/59333 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59521 %T Accuracy of the Huawei GT2 Smartwatch for Measuring Physical Activity and Sleep Among Adults During Daily Life: Instrument Validation Study %A Mei,Longfei %A He,Ziwei %A Hu,Liang %K smartwatch %K accelerometry %K free-living %K physical activity %K sleep %K validity %D 2024 %7 20.12.2024 %9 %J JMIR Form Res %G English %X Background: Smartwatches are increasingly popular for physical activity and health promotion. However, ongoing validation studies on commercial smartwatches are still needed to ensure their accuracy in assessing daily activity levels, which is important for both promoting activity-related health behaviors and serving research purposes. Objective: This study aimed to evaluate the accuracy of a popular smartwatch, the Huawei Watch GT2, in measuring step count (SC), total daily activity energy expenditure (TDAEE), and total sleep time (TST) during daily activities among Chinese adults, and test whether there are population differences. Methods: A total of 102 individuals were recruited and divided into 2 age groups: young adults (YAs) and middle-aged and older (MAAO) adults. Participants’ daily activity data were collected for 1 week by wearing the Huawei Watch GT2 on their nondominant wrist and the Actigraph GT3X+ (ActiGraph) on their right hip as the reference measure. The accuracy of the GT2 was examined using the intraclass correlation coefficient (ICC), Pearson product-moment correlation coefficient (PPMCC), Bland-Altman analysis, mean percentage error, and mean absolute percentage error (MAPE). Results: The GT2 demonstrated reasonable agreement with the Actigraph, as evidenced by a consistency test ICC of 0.88 (P<.001) and an MAPE of 25.77% for step measurement, an ICC of 0.75 (P<.001) and an MAPE of 33.79% for activity energy expenditure estimation, and an ICC of 0.25 (P<.001) and an MAPE of 23.29% for sleep time assessment. Bland-Altman analysis revealed that the GT2 overestimated SC and underestimated TDAEE and TST. The GT2 was better at measuring SC and TDAEE among YAs than among MAAO adults, and there was no significant difference between these 2 groups in measuring TST (P=.12). Conclusions: The Huawei Watch GT2 demonstrates good accuracy in step counting. However, its accuracy in assessing activity energy expenditure and sleep time measurement needs further examination. The GT2 demonstrated higher accuracy in measuring SC and TDAEE in the YA group than in the MAAO group. However, the measurement errors for TST did not differ significantly between the 2 age groups. Therefore, the watch may be suitable for monitoring several key parameters (eg, SC) of daily activity, yet caution is advised for its use in research studies that require high accuracy. %R 10.2196/59521 %U https://formative.jmir.org/2024/1/e59521 %U https://doi.org/10.2196/59521 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56954 %T Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study %A Eze,Chinwe E %A Dorsch,Michael P %A Coe,Antoinette B %A Lester,Corey A %A Buis,Lorraine R %A Farris,Karen B %K remote blood pressure monitoring %K telemonitoring %K hypertension %K blood pressure %K technology %K health behaviors %K quantitative %K cross-sectional study %K United States %K lack of awareness %K health information %K health provider %K electronic communication channels %K adult %K aging %K mobile phone %D 2024 %7 23.12.2024 %9 %J JMIR Form Res %G English %X Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ≥18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6%). About one-third of participants were aware of RBPM (165/507, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3%) and their lack of awareness of RBPM (190/447, 42.5%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7%), and 61.7% (37/60) engage in daily BP measurement, compared with 62.6% (280/447) and 25.1% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7%) than those in the non-RBPM group (70/447, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35‐150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95% CI 1.39‐21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95% CI 1.62‐47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers’ recommendations, and tailoring RBPM services to patients’ preferred electronic communication channels. %R 10.2196/56954 %U https://formative.jmir.org/2024/1/e56954 %U https://doi.org/10.2196/56954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57403 %T Assessing the Feasibility and Acceptability of the Daybreak Drink Tracker: Prospective Observational Study %A Fletcher,Kathryn %A Robert-Hendren,Dominique %K app %K alcohol use %K self-monitoring %K tracker %K digital health %D 2024 %7 18.12.2024 %9 %J JMIR Form Res %G English %X Background: Excessive alcohol use is associated with significant harms, with wide-ranging social and economic impacts. Efforts to prevent and reduce the harmful use of alcohol are a public health priority. Smartphone apps have the potential to provide accessible and cost-effective support to those seeking to reduce alcohol consumption; however, the evidence base regarding which components are effective is lacking. Self-monitoring is considered as one of the most effective components for behavior change across multiple health domains, yet there is mixed evidence for its role in the alcohol use space. An improved understanding of the use, acceptability, and outcomes of smartphone apps and their inherent components is required to determine their potential role in alcohol behavior change. Objective: We investigated the feasibility and acceptability of the Drink Tracker, a novel feature of the commercially available Daybreak (Hello Sunday Morning) app. Methods: The Daybreak app is accessible worldwide via major app stores and is offered free of charge to Australian residents. Individuals (aged over 18 years) registering for Daybreak were invited to access the Drink Tracker to monitor their alcohol consumption as part of an uncontrolled observational prospective study. Feasibility was assessed via uptake and frequency of use of the Drink Tracker. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the Drink Tracker to others. Self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) and psychological distress (Kessler Psychological Distress Scale score) at 3-month follow-up were also measured. Preliminary data collected for the first 4 months (October 2023 to February 2024) of the study were reported, including 3-month follow-up outcomes. Results: Feasibility was demonstrated, with almost 70% (2847/4119) of those registering for Daybreak going on to access the Drink Tracker. Of those accessing the Drink Tracker, 71.1% (n=2024) consented to research, comprising the final participant sample. Frequency of use was high, with over half of participants (1112/2024, 54.9%) using the Drink Tracker more than once, and more than one-third (757/2024, 37.4%) using the Drink Tracker more than 5 times. Of the 30 participants completing a 3-month follow-up, acceptability was high, with 73% (n=22) reporting high satisfaction levels with the Drink Tracker overall, 87% (n=26) indicating it was easy to use and rating a mean score of 7.7 (SD 2.8) out of 10 in terms of likelihood of recommending to others. Significant reductions in alcohol consumption (P<.001) and psychological distress scores (P<.001) were observed at the 3-month follow-up. Conclusions: Our results suggest that the Daybreak Drink Tracker is highly feasible and acceptable in supporting individuals accessing commercially available smartphone apps to change their relationship with alcohol. While positive clinical outcomes were observed, the absence of a control group disallows any conclusions with regard to the efficacy of the Drink Tracker. Further testing via a randomized controlled trial is required. %R 10.2196/57403 %U https://formative.jmir.org/2024/1/e57403 %U https://doi.org/10.2196/57403 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46497 %T Mental Health Benefits of Listening to Music During COVID-19 Quarantine: Cross-Sectional Study %A Xian,Xuechang %A Zhang,Xiaoran %A Zheng,Danhe %A Wang,Yanlin %K COVID-19 %K quarantine %K social connectedness %K sense of security %K mental well-being %K cross-sectional study %K contagion %K treatment %K music %K security %K mental health %K questionnaire %K China %K intervention %K relaxation %K meditation %K mental illness %K stimuli %K environmental %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: COVID-19 has posed a significant global threat to public health due to its high contagion risk and lack of effective treatment. While quarantine measures have been crucial in controlling the virus’ spread, they have also contributed to negative impacts on individuals’ mental health. Music listening has emerged as a potential coping mechanism, yet it remains unclear whether mental well-being varies across music preferences. Objective: This study examined individuals’ music-listening preferences in the context of COVID-19 quarantine and assessed the mediation pathways linking 5 types of music to mental health levels, mediated by perceived social connectedness as well as sense of security. Methods: A web-based survey was conducted among people with quarantine experience in September 2022, in mainland China. A total of 712 valid questionnaires were returned and 596 samples were finally included in our study for mediation analysis. Results: The results revealed that the vast majority (596/623, 96%) of respondents had music-listening experiences during the COVID-19 quarantine, with pop music emerging as the most popular preference among respondents, while quyi was the least listened-to genre. Additionally, listening to music across 5 different genres appeared as a significant parameter indirectly linked to mental health through perceived social connectedness. Specifically, engaging with quyi was associated with higher levels of perceived social connectedness and sense of security, which in turn correlated with improved mental well-being. Conversely, individuals listening to jazz reported lower social connectedness and sense of security, which was subsequently linked to increased mental health problems. The potential reasons for these findings and implications are discussed. Conclusions: This study significantly contributes to the understanding of the mechanisms behind music-listening preferences in stressful environments. Specifically, our findings highlight the mediating roles of perceived social connectedness and sense of security in the relationship between music preferences and mental health outcomes during the quarantine period. These insights provide valuable guidance for developing interventions that use music to enhance mental health, thereby broadening the scope of studies on environmental stimuli and their impact on mental well-being. %R 10.2196/46497 %U https://formative.jmir.org/2024/1/e46497 %U https://doi.org/10.2196/46497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46860 %T Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study %A Bur,Oliver Thomas %A Berger,Thomas %K internet intervention %K depression %K guidance %K contact behavior %K messages %K adherence %K online %K intervention %K digital health %K therapy %K participant %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: The number of studies on internet-based guided self-help has rapidly increased during the last 2 decades. Guided self-help comprises 2 components: a self-help program that patients work through and usually weekly guidance from therapists who support patients using the self-management program. Little is known about participants' behavior patterns while interacting with therapists and their use of self-help programs in relation to intervention outcomes. Objective: This exploratory study aimed to investigate whether the number of messages sent to the therapist (ie, contact behavior) is an indicator of the outcome, that is, a reduction in depressive symptoms. Furthermore, we investigated whether adherence was associated with outcome. Most importantly, we investigated whether different combinations of adherence and contact behavior were associated with outcome. Methods: Drawing on a completer sample (n=113) from a randomized full factorial trial, participants were categorized into 4 groups. The groups were based on median splits of 2 variables, that is, the number of messages sent to therapists (low: groups 1 and 2; high: groups 3 and 4) and adherence (low: groups 1 and 3; high: groups 2 and 4). The 4 groups were compared in terms of change in depressive symptoms (measured with the Patient Health Questionnaire-9) from pre- to posttreatment and pretreatment to follow-up, respectively. Results: On average, participants sent 4.5 (SD 3.7) messages to their therapist and completed 18.2 (SD 5.2) pages of the program in 6.39 (SD 5.39) hours. Overall, analyses revealed no main effect for participants’ messages (H1=0.18, P=.67) but a significant main effect for adherence on changes in depressive symptoms from pre- to posttreatment (H1=5.10, P=.02). The combined consideration of adherence and messages sent to the therapist revealed group differences from pre- to posttreatment (H3=8.26, P=.04). Group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.84, P=.002). Furthermore, there were group differences from pretreatment to follow-up (H3=8.90, P=.03). Again, group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.62, P=.004) and group 2 (Z=–2.47, P=.007). All other group comparisons did not yield significant differences. Conclusion: This exploratory study suggests that participants characterized by low adherence and frequent messaging do not improve their symptoms as much as other participants. These participants might require more personalized support beyond the scope of guided internet interventions. The paper underscores the importance of considering individual differences in contact behavior when tailoring interventions. The results should be interpreted with caution and further investigated in future studies. Trial Registration: ClinicalTrials.gov NCT04318236; https://www.clinicaltrials.gov/study/NCT04318236 %R 10.2196/46860 %U https://formative.jmir.org/2024/1/e46860 %U https://doi.org/10.2196/46860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58510 %T Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: Survey Study %A Alfozan,Mohammed %A Alshahrani,Saad %A Alasmi,Raed %K delivery of health care %K social media %K urologists %K urology %K Saudi Arabia %K professional communication %K physician behavior %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: Social media (So-Me) platforms are valuable resources for health care professionals and academics to discover, discuss, and distribute current advances in research and clinical practices, including technology trends. Objective: This study aims to assess the role of So-Me in urological practice in Saudi Arabia. It explores the influence of digital platforms on patient interaction, professional communication, decision-making, and education. Methods: The survey was conducted among 145 urologists from July 2021 to July 2022 following institutional review board approval. A questionnaire designed using the SurveyMonkey platform examined urologists’ knowledge of So-Me. The survey was conducted using the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines and was open for 17 weeks. Data analysis was performed using SPSS 21.0. Results: Of the 145 participants, 70% (n=102) were Saudi Arabians. The most common age groups were 30‐40 (n=68, 46.8%) and 41‐50 (n=61, 42.2%) years, with a gender distribution of 44.8% (n=65) women and 55.2% (n=80) men. A total of 61.5% (n=89) of urologists reported using So-Me accounts for professional purposes, with 54.9% (n=80) sharing health-related information. Social media enhanced patient connections beyond clinic visits for 55.8% (n=81) of respondents, while 57.2% (n=83) used it to provide educational resources. Additionally, 56.5% (n=82) believed So-Me facilitated patient feedback and improved their practice. In terms of professional communication, 60.6% (n=88) of urologists agreed that So-Me facilitated collaboration with colleagues, while 63.3% (n=92) used it to stay updated on the latest advances in urology. Furthermore, 62% (n=90) followed professional societies or journals on So-Me, and 63.3% (n=92) used it for continuing medical education. A majority (n=94, 64.7%) reported that So-Me influenced treatment decisions based on new research findings, and 85.3% (n=124) learned about novel technologies and treatment options through these platforms. Regression analysis showed a significant positive correlation between gender and social media usage patterns (R=0.653, R2=0.426), indicating that approximately 42.6% of the differences in usage patterns can be attributed to gender. However, the Pearson χ2 analysis showed that gender did not significantly affect most aspects of social media use, except information sharing and participating in online discussions (both P<.05). Conclusions: This study highlights the widespread use of So-Me among urologists in Saudi Arabia, underscoring its role in enhancing patient interaction, professional development, and clinical decision-making. Strategically designed health care programs using social media could improve and modernize professional and patient-centered care in Saudi Arabia through legislative assistance and guidelines. %R 10.2196/58510 %U https://formative.jmir.org/2024/1/e58510 %U https://doi.org/10.2196/58510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58729 %T Association Between Visual Impairment and Daily Internet Use Among Older Japanese Individuals: Cross-Sectional Questionnaire Study %A Takesue,Atsuhide %A Hiratsuka,Yoshimune %A Kondo,Katsunori %A Aida,Jun %A Nakagomi,Atsushi %A Nakao,Shintaro %K visual impairment %K visually impaired %K internet %K internet use %K internet usage %K older adults %K digital divide %K telemedicine %K mobile phone %D 2024 %7 9.12.2024 %9 %J JMIR Form Res %G English %X Background: Older adults might not use computers due to psychological barriers, environmental barriers such as not owning a computer or lack of internet access, and health-related barriers such as difficulties with fine motor skills, low cognitive function, or low vision. Given the health benefits of internet use among older adults, inadequate use of the internet is an urgent public health issue in many countries. Objective: We aimed to determine whether visual impairment is associated with internet use in a population-based sample of older adults. Methods: This cross-sectional study sourced data for the year 2016 from the Japan Gerontological Evaluation Study. It included functionally independent community-dwelling individuals aged ≥65 years (N=19,452) in Japan. The respondents reported their visual status by answering the question, “Is your eyesight (without or with usual glasses or corrective lenses) excellent, very good, good, fair, or poor?” We defined “internet user” as a person who uses the internet “almost daily.” We used multivariate logistic regression with multiple imputations to analyze visual status, daily internet use, and any correlations between them. Results: We observed that 23.6% (4599/19,452) of respondents used the internet almost daily. Respondents with good visual status notably tended to use the internet more frequently than those with poor visual status. Specifically, 13% and 31% of respondents with poor and excellent vision, respectively, used the internet almost daily. In contrast, 66% and 45% of respondents with poor and excellent vision, respectively, did not use the internet. Even after adjusting for several covariates (age, sex, equivalized income, years of education, marital status, depression, history of systemic comorbidities, frequency of meeting friends, and total social participation score), significant associations persisted between visual status and daily internet usage. The odds ratios (ORs) tended to increase as visual status improved (P for trend <.001). The adjusted ORs for individuals with excellent and very good visual status who used the internet almost daily were 1.38 (95% CI 1.22-1.56) and 1.25 (95% CI 1.15-1.36), respectively. Conversely, the adjusted OR for those with fair or poor visual status was 0.73 (95% CI 0.62-0.86). Conclusions: In this study, we reaffirmed what several previous studies have pointed out using a very large dataset; visual impairment negatively impacted daily internet use by older adults. This highlights the need to address visual impairments to promote web use as health care services become more easily accessed on the web. %R 10.2196/58729 %U https://formative.jmir.org/2024/1/e58729 %U https://doi.org/10.2196/58729 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63288 %T eHealth Literacy and Health-Related Internet Use Among Swedish Primary Health Care Visitors: Cross-Sectional Questionnaire Study %A Sjöström,Anna %A Hajdarevic,Senada %A Hörnsten,Åsa %A Isaksson,Ulf %K eHealth literacy %K primary health care %K health-related internet information %K health literacy %K digitalization %K eHealth %K cost-effective care %K internet %K health applications %K digital health %K patient participation %K health behaviors %K questionnaire %K well-being %D 2024 %7 5.12.2024 %9 %J JMIR Form Res %G English %X Background: Digitalization has profoundly transformed health care delivery, especially within primary health care, as a crucial avenue for providing accessible, cost-effective care. While eHealth services are frequently highlighted for improving health care availability and promoting equality, it is essential to recognize that digitalization can inadvertently exclude individuals who lack the prerequisites to use eHealth services, that is, those with low eHealth literacy. Previous research has identified lower eHealth literacy among older individuals, those with lower educational levels, and those who use the internet less frequently. However, in a Swedish context, only a few studies have investigated eHealth literacy. Objective: This study investigated eHealth literacy and its association with health-related internet use and sociodemographic characteristics among primary health care visitors. Methods: This cross-sectional study used a quantitative, descriptive approach. Swedish-speaking patients visiting a primary health care center participated by answering the multidimensional eHealth Literacy Questionnaire (eHLQ) and questions regarding sociodemographic characteristics and internet usage. The study compared mean scores using the Mann-Whitney U test and the Kruskal-Wallis test. A logistic regression analysis also explored the associations between eHealth literacy and significant independent variables identified in the univariate analyses. Results: As a group, the 172 participants rated highest in understanding and engagement with their health (median eHLQ score 3, IQR 2.8‐3.4), as well as in feeling secure about the confidentiality of eHealth services (median eHLQ score 3, IQR 2‐3), while they rated lower in motivation to use eHealth (median eHLQ score 2.6, IQR 2‐3), the suitability of eHealth services to their personal needs (median eHLQ score 2.75, IQR 2‐3), and their perceived ability to understand and use health-related internet information (median eHLQ score 2.6, IQR 2‐3). The logistic regression analysis identified that lower eHealth literacy was associated with older age, particularly in domains related to finding, understanding, and using health-related internet information (odds ratio [OR] 1.02, 95% CI 1‐1.05; P=.03); digital technology use (OR 1.05, 95% CI 1.02‐1.08; P<.001); and accessing well-functioning eHealth services (OR 1.02, 95% CI 1‐1.05; P=.03). Additionally, in the logistic regression analysis, perceiving health-related internet information as not useful was linked to lower literacy in all eHLQ domains except one. Conclusions: Our findings regarding the primary challenges within our sample underscore the importance of developing and tailoring eHealth services to accommodate users’ individual needs better, enhancing motivation for eHealth use, and continuing efforts to improve overall health literacy. These measures, which both eHealth developers and health care professionals should consider, are crucial for addressing the digital divide and expanding access to eHealth services for as many people as possible. %R 10.2196/63288 %U https://formative.jmir.org/2024/1/e63288 %U https://doi.org/10.2196/63288 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63038 %T Insights From Art Therapists on Using AI-Generated Art in Art Therapy: Mixed Methods Study %A Shojaei,Fereshtehossadat %A Shojaei,Fatemehalsadat %A Osorio Torres,John %A Shih,Patrick C %K art therapy %K artificial intelligence %K AI %K therapeutic interventions %K assistive AI %K engagement %K health care %K therapy %K art %K therapists' insights %K daily life %K practitioner %K assistive %K AI-generated image %K accessibility %K therapy sessions %K AI-generated tool %D 2024 %7 4.12.2024 %9 %J JMIR Form Res %G English %X Background: With the increasing integration of artificial intelligence (AI) into various aspects of daily life, there is a growing interest among designers and practitioners in incorporating AI into their fields. In health care domains like art therapy, AI is also becoming a subject of exploration. However, the use of AI in art therapy is still undergoing investigation, with its benefits and challenges being actively explored. Objective: This study aims to investigate the integration of AI into art therapy practices to comprehend its potential impact on therapeutic processes and outcomes. Specifically, the focus is on understanding the perspectives of art therapists regarding the use of AI-assisted tools in their practice with clients, as demonstrated through the presentation of our prototype consisting of a deck of cards with words covering various categories alongside an AI-generated image. Methods: Using a co-design approach, 10 art therapists affiliated with the American Art Therapy Association participated in this study. They engaged in individual interviews where they discussed their professional perspectives on integrating AI into their therapeutic approaches and evaluating the prototype. Qualitative analysis was conducted to derive themes and insights from these sessions. Results: The study began in August 2023, with data collection involving 10 participants taking place in October 2023. Our qualitative findings provide a comprehensive evaluation of the impact of AI on facilitating therapeutic processes. The combination of a deck of cards and the use of an AI-generated tool demonstrated an enhancement in the quality and accessibility of therapy sessions. However, challenges such as credibility and privacy concerns were also identified. Conclusions: The integration of AI into art therapy presents promising avenues for innovation and progress within the field. By gaining insights into the perspectives and experiences of art therapists, this study contributes knowledge for both practical application and further research. %R 10.2196/63038 %U https://formative.jmir.org/2024/1/e63038 %U https://doi.org/10.2196/63038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63188 %T Comparing the Accuracy of Two Generated Large Language Models in Identifying Health-Related Rumors or Misconceptions and the Applicability in Health Science Popularization: Proof-of-Concept Study %A Luo,Yuan %A Miao,Yiqun %A Zhao,Yuhan %A Li,Jiawei %A Chen,Yuling %A Yue,Yuexue %A Wu,Ying %K rumor %K misconception %K health science popularization %K health education %K large language model %K LLM %K applicability %K accuracy %K effectiveness %K health related %K education %K health science %K proof of concept %D 2024 %7 2.12.2024 %9 %J JMIR Form Res %G English %X Background: Health-related rumors and misconceptions are spreading at an alarming rate, fueled by the rapid development of the internet and the exponential growth of social media platforms. This phenomenon has become a pressing global concern, as the dissemination of false information can have severe consequences, including widespread panic, social instability, and even public health crises. Objective: The aim of the study is to compare the accuracy of rumor identification and the effectiveness of health science popularization between 2 generated large language models in Chinese (GPT-4 by OpenAI and Enhanced Representation through Knowledge Integration Bot [ERNIE Bot] 4.0 by Baidu). Methods: In total, 20 health rumors and misconceptions, along with 10 health truths, were randomly inputted into GPT-4 and ERNIE Bot 4.0. We prompted them to determine whether the statements were rumors or misconceptions and provide explanations for their judgment. Further, we asked them to generate a health science popularization essay. We evaluated the outcomes in terms of accuracy, effectiveness, readability, and applicability. Accuracy was assessed by the rate of correctly identifying health-related rumors, misconceptions, and truths. Effectiveness was determined by the accuracy of the generated explanation, which was assessed collaboratively by 2 research team members with a PhD in nursing. Readability was calculated by the readability formula of Chinese health education materials. Applicability was evaluated by the Chinese Suitability Assessment of Materials. Results: GPT-4 and ERNIE Bot 4.0 correctly identified all health rumors and misconceptions (100% accuracy rate). For truths, the accuracy rate was 70% (7/10) and 100% (10/10), respectively. Both mostly provided widely recognized viewpoints without obvious errors. The average readability score for the health essays was 2.92 (SD 0.85) for GPT-4 and 3.02 (SD 0.84) for ERNIE Bot 4.0 (P=.65). For applicability, except for the content and cultural appropriateness category, significant differences were observed in the total score and scores in other dimensions between them (P<.05). Conclusions: ERNIE Bot 4.0 demonstrated similar accuracy to GPT-4 in identifying Chinese rumors. Both provided widely accepted views, despite some inaccuracies. These insights enhance understanding and correct misunderstandings. For health essays, educators can learn from readable language styles of GLLMs. Finally, ERNIE Bot 4.0 aligns with Chinese expression habits, making it a good choice for a better Chinese reading experience. %R 10.2196/63188 %U https://formative.jmir.org/2024/1/e63188 %U https://doi.org/10.2196/63188 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63262 %T Moving Toward Meaningful Evaluations of Monitoring in e-Mental Health Based on the Case of a Web-Based Grief Service for Older Mourners: Mixed Methods Study %A Brandl,Lena %A Jansen-Kosterink,Stephanie %A Brodbeck,Jeannette %A Jacinto,Sofia %A Mooser,Bettina %A Heylen,Dirk %K e-mental health %K digital mental health service %K mental health %K digital health %K internet intervention %K monitoring mental health %K monitor %K e-coach %K coaching %K grieve %K mourn %K old %K affective states %K artificial intelligence %K predictive %K repeatedly measured predictors in regression %K fuzzy cognitive map %K algorithm %K AI %D 2024 %7 28.11.2024 %9 %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) tools hold much promise for mental health care by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools limit their meaningfulness for health care contexts and therefore also the practical usefulness of such tools for professionals and clients alike. Objective: The aim of this study is to demonstrate the evaluation of an AI monitoring tool that detects the need for more intensive care in a web-based grief intervention for older mourners who have lost their spouse, with the goal of moving toward meaningful evaluation of AI tools in e-mental health. Method: We leveraged the insights from three evaluation approaches: (1) the F1-score evaluated the tool’s capacity to classify user monitoring parameters as either in need of more intensive support or recommendable to continue using the web-based grief intervention as is; (2) we used linear regression to assess the predictive value of users’ monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention; and (3) we collected qualitative experience data from e-coaches (N=4) who incorporated the monitoring in their weekly email guidance during the 10-week intervention. Results: Based on n=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. Due to minimal change in depression and loneliness scores after the 10-week intervention, only 1 linear regression was conducted. The difference score in grief before and after the intervention was included as a dependent variable. Participants’ (N=21) mean score on the self-report monitoring and the estimated slope of individually fitted growth curves and its standard error (ie, participants’ response pattern to the monitoring questions) were used as predictors. Only the mean monitoring score exhibited predictive value for the observed change in grief (R2=1.19, SE 0.33; t16=3.58, P=.002). The e-coaches appreciated the monitoring tool as an opportunity to confirm their initial impression about intervention participants, personalize their email guidance, and detect when participants’ mental health deteriorated during the intervention. Conclusions: The monitoring tool evaluated in this paper identified a need for more intensive support reasonably well in a nonclinical sample of older mourners, had some predictive value for the change in grief symptoms during a 10-week intervention, and was appreciated as an additional source of mental health information by e-coaches who supported mourners during the intervention. Each evaluation approach in this paper came with its own set of limitations, including (1) skewed class distributions in prediction tasks based on real-life health data and (2) choosing meaningful statistical analyses based on clinical trial designs that are not targeted at evaluating AI tools. However, combining multiple evaluation methods facilitates drawing meaningful conclusions about the clinical value of AI monitoring tools for their intended mental health context. %R 10.2196/63262 %U https://formative.jmir.org/2024/1/e63262 %U https://doi.org/10.2196/63262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57579 %T Feasibility of a Web-Based and Mobile-Supported Follow-Up Treatment Pathway for Adult Patients With Orthopedic Trauma in the Netherlands: Concurrent Mixed Methods Study %A Willinge,Gijs J A %A Spierings,Jelle F %A Romijnders,Kim A G J %A Mathijssen,Elke G E %A Twigt,Bas A %A Goslings,J Carel %A van Veen,Ruben N %K musculoskeletal extremity injury %K patient portal %K follow-up treatment %K healthcare utilization %K patient experience %K feasibility %K orthopedics %K trauma %K Netherlands %K mixed methods %K resource utilization %K electronic patient records %K thematic analysis %K qualitative data %K digital treatment %K mobile phone %D 2024 %7 26.11.2024 %9 %J JMIR Form Res %G English %X Background: Orthopedic trauma care encounters challenges in follow-up treatment due to limited patient information provision, treatment variation, and the chaotic settings in which it is provided. Additionally, pressure on health care resources is rising worldwide. In response, digital follow-up treatment pathways were implemented for patients with orthopedic trauma, aiming to optimize health care resource use and enhance patient experiences. Objective: We aim to assess digital follow-up treatment pathway feasibility from the patient’s perspective and its impact on health care resource use. Methods: A concurrent mixed methods study was conducted parallel to implementation of digital follow-up treatment pathways in an urban level-2 trauma center. Inclusion criteria were (1) minimum age of 18 years, (2) an active web-based patient portal account, (3) ability to read and write in Dutch, and (4) no cognitive or preexisting motor impairment. Data were collected via electronic patient records, and surveys at three time points: day 1‐3, 4‐6 weeks, and 10‐12 weeks after an initial emergency department visit. Semistructured interviews were performed at 10‐12 weeks post injury. Anonymous data from a pre-existing database were used to compare health care resource use between the digital treatment pathways and traditional treatment. Quantitative data were reported descriptively. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited efficacy. Results: Sixty-six patients were included for quantitative data collection. Survey response rates were 100% (66/66) at day 1‐3, 92% (61/66) at 4‐6 weeks, and 79% (52/66) at 10‐12 weeks. For qualitative data collection, 15 semistructured interviews were performed. Patients reported median satisfaction scores of 7 (IQR 6‐8) with digital treatment pathways and 8 (IQR 7‐9) for overall treatment, reflecting positive experiences regarding functionality, actual and intended use, and treatment safety. Digital treatment pathways reduced secondary health care use, with fewer follow-up appointments by phone (median 0, IQR 0‐0) versus the control group (median 1, IQR 0‐1; P<.001). Consequently, fewer physicians were involved in follow-up treatment for the intervention group (median 2, IQR 1‐2) than for the control group (median 2, IQR 1‐3; P<.001). Fewer radiographs were performed for the intervention group (median 1, IQR 0-1) than for the control group (P=.01). Qualitative data highlighted positive experiences with functionalities, intended use, and safety, but also identified areas for improvement, including managing patient expectations, platform usability, and protocol adherence. Conclusions: Use of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reducing health care resource use. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for health care professionals. These insights can guide clinicians and policy makers in effectively integrating similar tools into clinical practice. %R 10.2196/57579 %U https://formative.jmir.org/2024/1/e57579 %U https://doi.org/10.2196/57579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58666 %T Facilitating Trust Calibration in Artificial Intelligence–Driven Diagnostic Decision Support Systems for Determining Physicians’ Diagnostic Accuracy: Quasi-Experimental Study %A Sakamoto,Tetsu %A Harada,Yukinori %A Shimizu,Taro %K trust calibration %K artificial intelligence %K diagnostic accuracy %K diagnostic decision support %K decision support %K diagnosis %K diagnostic %K chart %K history %K reliable %K reliability %K accurate %K accuracy %K AI %D 2024 %7 27.11.2024 %9 %J JMIR Form Res %G English %X Background: Diagnostic errors are significant problems in medical care. Despite the usefulness of artificial intelligence (AI)–based diagnostic decision support systems, the overreliance of physicians on AI-generated diagnoses may lead to diagnostic errors. Objective: We investigated the safe use of AI-based diagnostic decision support systems with trust calibration by adjusting trust levels to match the actual reliability of AI. Methods: A quasi-experimental study was conducted at Dokkyo Medical University, Japan, with physicians allocated (1:1) to the intervention and control groups. A total of 20 clinical cases were created based on the medical histories recorded by an AI-driven automated medical history–taking system from actual patients who visited a community-based hospital in Japan. The participants reviewed the medical histories of 20 clinical cases generated by an AI-driven automated medical history–taking system with an AI-generated list of 10 differential diagnoses and provided 1 to 3 possible diagnoses. Physicians were asked whether the final diagnosis was in the AI-generated list of 10 differential diagnoses in the intervention group, which served as the trust calibration. We analyzed the diagnostic accuracy of physicians and the correctness of the trust calibration in the intervention group. We also investigated the relationship between the accuracy of the trust calibration and the diagnostic accuracy of physicians, and the physicians’ confidence level regarding the use of AI. Results: Among the 20 physicians assigned to the intervention (n=10) and control (n=10) groups, the mean age was 30.9 (SD 3.9) years and 31.7 (SD 4.2) years, the proportion of men was 80% and 60%, and the mean postgraduate year was 5.8 (SD 2.9) and 7.2 (SD 4.6), respectively, with no significant differences. The physicians’ diagnostic accuracy was 41.5% in the intervention group and 46% in the control group, with no significant difference (95% CI −0.75 to 2.55; P=.27). The overall accuracy of the trust calibration was only 61.5%, and despite correct calibration, the diagnostic accuracy was 54.5%. In the multivariate logistic regression model, the accuracy of the trust calibration was a significant contributor to the diagnostic accuracy of physicians (adjusted odds ratio 5.90, 95% CI 2.93‐12.46; P<.001). The mean confidence level for AI was 72.5% in the intervention group and 45% in the control group, with no significant difference. Conclusions: Trust calibration did not significantly improve physicians’ diagnostic accuracy when considering the differential diagnoses generated by reading medical histories and the possible differential diagnosis lists of an AI-driven automated medical history–taking system. As this was a formative study, the small sample size and suboptimal trust calibration methods may have contributed to the lack of significant differences. This study highlights the need for a larger sample size and the implementation of supportive measures of trust calibration. %R 10.2196/58666 %U https://formative.jmir.org/2024/1/e58666 %U https://doi.org/10.2196/58666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59837 %T Willingness to Be Contacted via a Patient Portal for Health Screening, Research Recruitment, and at-Home Self-Test Kits for Health Monitoring: Pilot Quantitative Survey %A Lockhart,Elizabeth %A Gootee,Jordan %A Copeland,Leah %A Turner,DeAnne %K patient portals %K patient engagement %K personal health records %K risk assessments %K health information %K information access %K open notes %K user perceptions %D 2024 %7 22.11.2024 %9 %J JMIR Form Res %G English %X Background: Patient portals are being increasingly used by health systems in the United States. Although some patients use portals for clinical use, patient perspectives on using portals for research-related activities, to complete health screenings, and to request at-home self-test kits are unclear. Objective: We aimed to understand patient perspectives on using electronic health portals for research; health-related screenings; and patient-initiated, home-based self-testing. Methods: Patients (N=105) from the Patient Engaged Research Center at a large, urban, midwestern health system completed a 23-item web-based survey on patient portal (MyChart) use and willingness to use the patient portal for research, risk assessments, and self-test kits. Frequencies and percentages were generated. Results: Almost all participants (102/105, 97.1%) had accessed MyChart at least once, with most (44/102, 43.1%) indicating they logged in at least once per month. Participants indicated logging into MyChart to check laboratory results or other health data (89/105, 84.8%), because they received a message to log in (85/105, 81%), and to message their health care professional (83/105, 79%). Fewer participants logged in to see what medications they had been prescribed (16/105, 15.2%) and to learn more about their health conditions (29/105, 27.6%). Most participants indicated logging into MyChart on a computer via a website (70/105, 66.7%) or on a smartphone via an app (54/105, 51.4%). When asked about how likely they would be to participate in different types of research if contacted via MyChart, most (90/105, 85.7%) said they would be likely to answer a survey, fill out a health assessment (87/105, 82.9%), or watch a video (86/105, 81.9%). Finally, participants would be willing to answer risk assessment questions on MyChart regarding sleep (74/101, 73.3%), stress (65/105, 61.9%), diabetes (60/105, 57.1%), anxiety (59/105, 56.2%), and depression (54/105, 51.4%) and would be interested in receiving an at-home self-test kit for COVID-19 (66/105, 62.9%), cholesterol (63/105, 60%), colon cancer (62/105, 59%), and allergies (56/105, 53.3%). There were no significant demographic differences for any results (all P values were >.05). Conclusions: Patient portals may be used for research recruitment; sending research-related information; and engaging patients to answer risk assessments, read about health information, and complete other clinical tasks. The lack of significant findings based on race and gender suggests that patient portals may be acceptable tools for recruiting research participants and conducting research. Allowing patients to request self-test kits and complete risk assessments in portals may help patients to take agency over their health care. Future research should examine if patient portal recruitment may help address persistent biases in clinical trial recruitment to increase enrollment of women and racial minority groups. %R 10.2196/59837 %U https://formative.jmir.org/2024/1/e59837 %U https://doi.org/10.2196/59837 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56553 %T An Educational Digital Tool to Improve the Implementation of Switching to a Biosimilar (Rapid Switch Trainer): Tool Development and Validation Study %A Marras,Carlos %A Labarga,María %A Ginard,Daniel %A Carrascosa,Jose Manuel %A Escudero-Contreras,Alejandro %A Collantes-Estevez,Eduardo %A de Mora,Fernando %A Robles,Tamara %A Romero,Elisa %A Martínez,Rafael %K consumer health information %K treatment switching %K biosimilar pharmaceuticals %K immune-mediated diseases %K education %K qualitative research %K training %K nocebo %K digital tool %K implementation %D 2024 %7 21.11.2024 %9 %J JMIR Form Res %G English %X Background: Switching to biosimilars is an effective and safe practice in treating inflammatory diseases; however, a nocebo effect may arise as a result of the way in which the switch is communicated to a given patient. Objective: We aimed to design a gaming-based digital educational tool (including a discussion algorithm) to support the training of health care professionals in efficiently communicating the switch to biosimilars, minimizing the generation of a nocebo effect and thus serving as an implementation strategy for the recommended switch. Methods: The tool was developed based on interviews and focus group discussions with key stakeholders, both patients and health care professionals. Messages likely to either generate trust or to trigger a nocebo effect were generated on the basis of the interviews and focus group discussions. Results: A total 7 clinicians and 4 nurses specializing in rheumatology, gastroenterology, and dermatology, with balanced levels of responsibility and experience, as well as balance between geographic regions, participated in the structured direct interviews and provided a list of arguments they commonly used, or saw used, to justify the switching, and objections given by the patients they attended. Patients with immune-mediated inflammatory diseases who were taking biologic drugs with (n=4) and without (n=5) experience in switching attended the focus groups and interviews. Major topics of discussion were the reason for the change, the nature of biosimilars, and their quality, safety, efficacy, and cost. Based on these discussions, a list of objections and of potential arguments was produced. Patients and health care professionals rated the arguments for their potential to evoke trust or a nocebo effect. Two sets of arguments, related to savings and sustainability, showed discrepant ratings between patients and health care professionals. Objections and arguments were organized by categories and incorporated into the tool as algorithms. The educators then developed additional arguments (with inadequate answers) to complement the valid ones worked on in the focus groups. The tool was then developed as a collection of clinical situations or vignettes that appear randomly to the user, who then has to choose an argument to counteract the given objections. After each interaction, the tool provides feedback. The tool was further supported by accredited medical training on biosimilars and switching. Conclusions: We have developed a digital training tool to improve communication on switching to biosimilars in the clinic and prevent a nocebo effect based on broad and in-depth experiences of patients and health care professionals. The validation of this implementation strategy is ongoing. %R 10.2196/56553 %U https://formative.jmir.org/2024/1/e56553 %U https://doi.org/10.2196/56553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50710 %T Health Perceptions and Practices of a Telewellness Fitness Program: Exploratory Case Study %A Ahumada-Newhart,Veronica %A Wood,Taffeta %A Satake,Noriko %A Marcin,James P %K telehealth %K telewellness %K online fitness %K health equity %K community health %K group exercise %K mobile phone %K mobile device %D 2024 %7 21.11.2024 %9 %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, many people lacked access to group fitness opportunities due to elevated risk of infection, lockdown, and closure of exercise facilities. Additionally, many people experienced higher than average rates of mental health burden (eg, anxiety and stress). To help address these needs, an existing in-person community exercise class, taught by a faculty member from an academic medical center, transitioned to an online synchronous (OS) physical fitness class via the Zoom (Zoom Video Communications) videoconferencing platform. As such, the instructor advertised the OS fitness classes through an existing email list of community members and university faculty, staff, students, or alumni email listservs. This telewellness intervention sought to create a sense of community, build social support, and promote physical and mental wellness during the COVID-19 pandemic. Objective: Our aim was to determine the perceived mental and physical health benefits of attending an OS fitness class for community members, including health care workers. We also assessed the use and functionality of related technologies necessary for delivering and attending the fitness classes. Methods: An online survey questionnaire was created and tested to collect quantitative and qualitative data for an exploratory study. Data were collected to evaluate the fitness class, motivation, perceived health benefits, and related technologies. A convenience sample of people who had participated in the OS fitness classes was recruited for this study via an emailed recruitment flyer. Results: A total of 51 participants accessed and completed the survey questionnaire. Survey participants consisted of 28 of 51 (55%) with a university affiliation, 17 of 51 (33%) with no university affiliation, and 6 of 51 (12%) who declined to state. The largest group of participants reporting full-time employment (18/51, 35%) also reported university affiliation with the academic medical center. In this group, 13 of 51 (25%) participants reported full-time employment, university affiliation, and doctoral degrees. High overall exercise class satisfaction was observed in the survey responses (mean 4.0, SD 1). Data analyses revealed significant perceived value of both mental and physical health benefits as motivating factors for participating in the OS fitness class. Challenges were identified as not being able to receive individual feedback from the instructor and the inability of some participants to see if they were in sync with the rest of the class. Conclusions: Results provide preliminary support for the use of online videoconferencing fitness platforms to promote wellness and facilitate group exercise in the community during times of high infection risk. Future studies should continue to explore perceived benefits, mental and physical wellness, best practices, and the design of related technologies. %R 10.2196/50710 %U https://formative.jmir.org/2024/1/e50710 %U https://doi.org/10.2196/50710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e39211 %T Comparing Self-Reported Running Distance and Pace With a Commercial Fitness Watch Data: Reliability Study %A Bullock,Garrett %A Stocks,Joanne %A Feakins,Benjamin %A Alizadeh,Zahra %A Arundale,Amelia %A Kluzek,Stefan %+ Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27411, United States, 1 3367144264, garrettbullock@gmail.com %K GPS %K Garmin %K training load %K running %K exercise %K fitness %K wearables %K running %K running distance %K pace %K pace distance %D 2024 %7 4.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is substantial evidence exploring the reliability of running distance self-reporting and GPS wearable technology, but there are currently no studies investigating the reliability of participant self-reporting in comparison to GPS wearable technology. There is also a critical sports science and medical research gap due to a paucity of reliability studies assessing self-reported running pace. Objective: The purpose of this study was to assess the reliability of weekly self-reported running distance and pace compared to a commercial GPS fitness watch, stratified by sex and age. These data will give clinicians and sports researchers insights into the reliability of runners’ self-reported pace, which may improve training designs and rehabilitation prescriptions. Methods: A prospective study of recreational runners was performed. Weekly running distance and average running pace were captured through self-report and a fitness watch. Baseline characteristics collected included age and sex. Intraclass correlational coefficients were calculated for weekly running distance and running pace for self-report and watch data. Bland-Altman plots assessed any systemic measurement error. Analyses were then stratified by sex and age. Results: Younger runners reported improved weekly distance reliability (median 0.93, IQR 0.92-0.94). All ages demonstrated similar running pace reliability. Results exhibited no discernable systematic bias. Conclusions: Weekly self-report demonstrated good reliability for running distance and moderate reliability for running pace in comparison to the watch data. Similar reliability was observed for male and female participants. Younger runners demonstrated improved running distance reliability, but all age groups exhibited similar pace reliability. Running pace potentially should be monitored through technological means to increase precision. %M 38175696 %R 10.2196/39211 %U https://formative.jmir.org/2024/1/e39211 %U https://doi.org/10.2196/39211 %U http://www.ncbi.nlm.nih.gov/pubmed/38175696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46515 %T Prevalence of Body Dysmorphic Disorder in the Spanish Population: Cross-Sectional Web-Based Questionnaire Study %A Loewen,Álvaro %A Blasco-Fontecilla,Hilario %A Li,Chao %A Bella-Fernández,Marcos %A Ruiz-Antorán,Belén %+ Servicio de Psiquiatría Infanto-juvenil, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, C/ Manuel de Falla, 1, Majadahonda, 28222, Spain, 34 911911690, hmblasco@yahoo.es %K body dysmorphic disorder %K prevalence %K adults %K Spain %K comorbidities %K mental health %K depression %K anxiety %K OCD %K obsessive-compulsive disorder %D 2024 %7 4.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Body dysmorphic disorder (BDD) is defined as excessive concern with mild or nonexistent defects in personal physical appearance, which are not perceived by others. The worldwide prevalence of BDD ranges between 0.5% and 3.2%, with no differences across genders. The mean age of onset of BDD is 16.9 years. BDD is typically associated with young age, psychiatric disorders, and dermatological procedures. Patients with BDD typically display poorer mental health status than patients diagnosed with other mental disorders. Objective: The aim of this study was to estimate the prevalence of BDD in Spain and to identify the variables associated with BDD. Methods: We performed a cross-sectional descriptive study by collecting data through an anonymous web-based survey targeting the Spanish population aged 18 years or older. The measures in this study were (1) sociodemographic variables, (2) variables associated with dermatological and psychiatric disorders and cosmetic procedures, (3) scales measuring quality of life (12-item Short Form health survey, version 2) and (4) BDD (BDD Questionnaire). Statistical analysis was performed with SPSS software version 21. P values less than .05 were considered significant. Results: Of the 2091 participants who took the survey, 322 (15.2%) met the criteria of having BDD. The mean age of the participants with BDD was 23.5 (SD 9.6) years. In terms of BDD prevalence, women accounted for 19.9% (284/1421), men accounted for 5.2% (34/653), and students accounted for 25.2% (263/1043). Approximately 46.6% (150/322) of the participants with BDD reported a history of psychiatric comorbidities, including anxiety disorders, depressive disorders, and eating disorders. BDD was significantly associated with female gender, younger age (18-24 years), students, monthly income of less than €500 (€1=US $1.11), and the presence of dermatological and some psychiatric disorders such as depression, anxiety, and eating disorders (P<.05). The number of body parts of concern in participants with BDD was significantly higher than that in those without BDD (4.6 vs 2.2, respectively; P<.001). Regarding the body parts of concern, body fat was the most common concern for both groups with BDD and without BDD, followed by thighs, face, hips, and skin in the BDD group and thighs, teeth, and hair in the non-BDD group. Participants with BDD showed a significantly poorer self-perception of their mental health, irrespective of the presence of any mental disorder (P<.001). Conclusions: Our findings showed that the prevalence of BDD in Spain was higher than expected. Further, BDD is frequently associated with other psychiatric disorders, particularly depressive disorder, anxiety disorder, and eating disorder. Participants with BDD had a poorer perception of quality of life associated with mental but not physical health problems. Finally, the perception of quality of mental health life in participants with BDD was independent of diagnosis of any mental disorder. %M 38175692 %R 10.2196/46515 %U https://formative.jmir.org/2024/1/e46515 %U https://doi.org/10.2196/46515 %U http://www.ncbi.nlm.nih.gov/pubmed/38175692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51839 %T Methodological Insights on Recruitment and Retention From a Remote Randomized Controlled Trial Examining the Effectiveness of an Alcohol Reduction App: Descriptive Analysis Study %A Oldham,Melissa %A Dinu,Larisa %A Loebenberg,Gemma %A Field,Matt %A Hickman,Matthew %A Michie,Susan %A Brown,Jamie %A Garnett,Claire %+ University College London, London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 883, m.oldham@ucl.ac.uk %K alcohol reduction %K alcohol %K digital care %K digital intervention %K ethnic minority %K methods %K mHealth %K randomised controlled trial %K recruitment %K retention %K social media %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Randomized controlled trials (RCTs) with no in-person contact (ie, remote) between researchers and participants offer savings in terms of cost and time but present unique challenges. Objective: The goal of this study is to examine the differences between different forms of remote recruitment (eg, National Health Service [NHS] website, social media, and radio advertising) in the proportion of participants recruited, demographic diversity, follow-up rates, and cost. We also examine the cost per participant of sequential methods of follow-up (emails, phone calls, postal surveys, and postcards). Finally, our experience with broader issues around study advertising and participant deception is discussed. Methods: We conducted a descriptive analysis of 5602 increasing-and-higher-risk drinkers (Alcohol Use Disorders Identification Test score ≥8), taking part in a 2-arm, parallel group, remote RCT with a 1:1 allocation, comparing the intervention (Drink Less app) with usual digital care (NHS alcohol advice web page). Participants were recruited between July 2020 and March 2022 and compensated with gift vouchers of up to £36 (a currency exchange rate of £1=US $1.26988 is applicable) for completing follow-up surveys, with 4 stages of follow-up: email reminders, phone calls, postal survey, and postcard. Results: The three main recruitment methods were advertisements on (1) social media (2483/5602, 44.32%), (2) the NHS website (1961/5602, 35.01%), and (3) radio and newspapers (745/5602, 13.3%), with the remaining methods of recruitment accounting 7.37% (413/5602) of the sample. The overall recruitment cost per participant varied from £0 to £11.01. Costs were greater when recruiting participants who were men (£0-£28.85), from an ethnic minority group (£0-£303.81), and more disadvantaged (£0-£49.12). Targeted approaches were useful for recruiting more men but less useful in achieving diversity in ethnicity and socioeconomic status. Follow-up at 6 months was 79.58% (4458/5602). Of those who responded, 92.4% (4119/4458) responded by email. Each additional stage of follow-up resulted in an additional 2-3 percentage points of the overall sample being followed up, although phone calls, postal surveys, and postcards were more resource intensive than email reminders. Conclusions: For remote RCTs, researchers could benefit from using a range of recruitment methods and cost-targeted approaches to achieve demographic diversity. Automated emails with substantial financial incentives for prompt completion can achieve good follow-up rates, and sequential, offline follow-up options, such as phone calls and postal surveys, can further increase follow-up rates but are comparatively expensive. We also make broader recommendations focused on striking the right balance when designing remote RCTs. Careful planning, ongoing maintenance, and dynamic decision-making are required throughout a trial to balance the competing demands of participation among those eligible, deceptive participation among those who are not eligible, and ensuring no postrandomization bias is introduced by data-checking protocols. %M 38180802 %R 10.2196/51839 %U https://formative.jmir.org/2024/1/e51839 %U https://doi.org/10.2196/51839 %U http://www.ncbi.nlm.nih.gov/pubmed/38180802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52969 %T Remote Delivery of the Cuidándome Telehealth Intervention for Self-Management of Depression and Anxiety Among Latina Immigrant Women: Randomized Controlled Trial %A Alvarez,Carmen %A Aryal,Subhash %A Vrany,Elizabeth %A Sanchez R,Maria Jose %A Quiles,Rosalphie %A Escobar-Acosta,Lia %A Hill-Briggs,Felicia %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 2158980715, alcarmen@nursing.upenn.edu %K Latina immigrant %K mental health %K depression %K anxiety %K problem-solving %K intervention study %K trauma-informed %K depressive %K Latinx %K Latin %K Latino %K Latina %K Hispanic %K Spanish %K immigrant %K immigrants %K survivor %K child %K children %K childhood %K trauma %K traumatic %K adverse %K telehealth %K telemedicine %K eHealth %K digital health %K feasibility %K acceptability %K randomized %K controlled trial %K controlled trials %K mobile phone %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Growing evidence suggests that Latina immigrant survivors of adverse childhood experiences (ACEs) are at increased risk for developing and remaining with either depression or anxiety or both symptoms. This study examined the feasibility and acceptability of a telehealth intervention—Cuidándome (quee-DAN-doh-meh, “taking care of myself”). Cuidándome is a 10-week, patient-centered, trauma-informed intervention delivered by a trained facilitator that promotes self-management of depression and anxiety symptoms through improved problem-solving skills and strategies. Objective: The aim of this study was to examine the feasibility and acceptability of Cuidándome delivered remotely (via Zoom) with Latina immigrant ACE survivors with either depression or anxiety or both symptoms. We also estimated the effect sizes associated with the intervention on decreasing depression and anxiety symptoms and improving social problem–solving styles. Methods: We evaluated Cuidándome using a randomized controlled trial design. Latina immigrants (N=47) who had experienced at least 1 ACE and had at least mild depression or anxiety symptoms were randomized to Cuidándome or a comparison group delivered by trained facilitators. We assessed for changes in depression and anxiety symptoms as well as social problem–solving styles at baseline, post intervention, and 3- and 6-month follow-up. Results: Analyses indicated significant decreases over time within both Cuidándome and comparison groups for depression and anxiety symptoms and maladaptive problem-solving. The intervention effect was largest for anxiety; at 6-month follow-up, Cuidándome participants had significantly lower anxiety scores than the comparison group. In addition, we observed a greater average point reduction in depression symptoms at 6 months among Cuidándome participants (5.7 points) than in the comparison group (3.7 points). Conclusions: A mental health program delivered via Zoom by a trained facilitator was feasible and acceptable to Latina immigrant women and can be beneficial for reducing anxiety and depression symptoms. More research is needed to assess the effectiveness of Cuidándome among a powered sample size of Latina immigrants. Trial Registration: ISRCTN Registry ISRCTN16668518; https://www.isrctn.com/ISRCTN16668518 %M 38190239 %R 10.2196/52969 %U https://formative.jmir.org/2024/1/e52969 %U https://doi.org/10.2196/52969 %U http://www.ncbi.nlm.nih.gov/pubmed/38190239 %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 8 %N %P e46222 %T The Sukaribit Smartphone App for Better Self-Management of Type 2 Diabetes: Randomized Controlled Feasibility Study %A Josefsson,Cecilia %A Liljeroos,Thea %A Hellgren,Margareta %A Pöder,Ulrika %A Hedström,Mariann %A Olsson,Erik M G %+ Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, Uppsala, 751 22, Sweden, 46 18 471 66 72, cecilia.josefsson@pubcare.uu.se %K diabetes mellitus %K type 2 %K health behavior %K mobile health %K mobile application %K pilot study %K mobile app %K mHealth %K diabetes %K diabetic %K RCT %K randomized %K glycemic %K self care %K self management %K blood sugar %K T2D %K diabetes type 2 %K home-testing %K digital health %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A new app, Sukaribit, was designed to enable contact between the caregiver and the patient with the intent to improve self-care and glycemic control (hemoglobin A1c [HbA1c]). Objective: This study investigated the feasibility of the study methodology and the intervention in preparation for a larger effectiveness study. Methods: Adults with type 2 diabetes were recruited in this randomized controlled feasibility study with a mixed methods design. The intervention group (n=28) tried Sukaribit for 2 months. They were encouraged to report blood glucose levels and medications, and they received feedback from a physician. The control group (n=31) received standard care. Both groups were evaluated with pre and postmeasurements of glycemic control (HbA1c), diabetes distress, physical activity, and self-care. Feasibility was evaluated against 5 progression criteria regarding recruitment, study methods, and active participation. Results: Of the 5 progression criteria, only 2 were met or partially met. The recruitment process exceeded expectations, and data collection worked well for self-reported data but not for HbA1c measured with a home testing kit. The participants were less active than anticipated, and the effect sizes were small. Only the number of blood glucose tests per day was positively affected by the intervention, with 0.6 more tests per day in the intervention group. Conclusions: Recruitment of participants to a future fully powered study may work with minor adjustments. The collection of HbA1c using home testing constituted a major problem, and an alternative strategy is warranted. Finally, the app was not used as intended. In order to proceed with a larger study, the app and study procedures need improvement. %M 38198200 %R 10.2196/46222 %U https://formative.jmir.org/2024/1/e46222 %U https://doi.org/10.2196/46222 %U http://www.ncbi.nlm.nih.gov/pubmed/38198200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47308 %T Office Workers’ Views About the Uses, Concerns, and Acceptance of Hand Hygiene Data Collected From Smart Sanitizers: Exploratory Qualitative Interview Study %A Rutter,Sophie %A Sanger,Sally %A Madden,Andrew D %A Ehdeed,Sukaina %A Stones,Catherine %+ Information School, University of Sheffield, The Wave 2, Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 0114 222 2659, s.rutter@sheffield.ac.uk %K hand hygiene %K smart sanitizers %K Internet of Things %K IoT %K offices %K workplaces %K smart systems %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 and the prospect of future pandemics have emphasized the need to reduce disease transmission in workplaces. Despite the well-established link between good hand hygiene (HH) and employee health, HH in nonclinical workplaces has received little attention. Smart sanitizers have been deployed in clinical settings to motivate and enforce HH. This study is part of a large project that explores the potential of smart sanitizers in office settings. Objective: Our previous study found that for office workers to accept the deployment of smart sanitizers, they would need to find the data generated as useful and actionable. The objectives of this study were to identify (1) the potential uses and actions that could be taken from HH data collected by smart sanitizers (2) the concerns of office workers for the identified uses and actions and (3) the circumstances in which office workers accept HH monitoring. Methods: An interview study was conducted with 18 office workers from various professions. Interview questions were developed using a framework from personal informatics. Transcripts were analyzed thematically. Results: A wide range of uses of smart sanitizer data was identified including managing hygiene resources and workflows, finding operating sanitizers, communicating the (high) standard of organizational hygiene, promoting and enforcing organizational hygiene policies, improving workers’ own hygiene practices, executing more effective interventions, and identifying the causes of outbreaks. However, hygiene is mostly considered as a private matter, and it is also possible that no action would be taken. Office workers were also concerned about bullying, coercion, and use of hygiene data for unintended purposes. They were also worried that the data could be inaccurate or incomplete, leading to misrepresentation of hygiene practices. Office workers suggested that they would be more likely to accept monitoring in situations where hygiene is considered important, when there are clear benefits to data collection, if their privacy is respected, if they have some control over how their data are collected, and if the ways in which the data will be used are clearly communicated. Conclusions: Smart sanitizers could have a valuable role in improving hygiene practices in offices and reducing disease transmission. Many actionable uses for data collected from smart systems were identified. However, office workers consider HH as a personal matter, and acceptance of smart systems is likely to be dynamic and will depend on the broad situation. Except when there are disease outbreaks, smart systems may need to be restricted to uses that do not require the sharing of personal data. Should organizations wish to implement smart sanitizers in offices, it would be advisable to consult widely with staff and develop systems that are customizable and personalizable. %M 38206674 %R 10.2196/47308 %U https://formative.jmir.org/2024/1/e47308 %U https://doi.org/10.2196/47308 %U http://www.ncbi.nlm.nih.gov/pubmed/38206674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48935 %T Population-Level Portal-Based Anxiety and Depression Screening Perspectives in HIV Care Clinicians: Qualitative Study Using the Consolidated Framework for Implementation Research %A Zimmer,Daniela %A Staab,Erin M %A Ridgway,Jessica P %A Schmitt,Jessica %A Franco,Melissa %A Hunter,Scott J %A Motley,Darnell %A Laiteerapong,Neda %+ Section of General Internal Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States, 1 312 702 8847, dazimmer@bsd.uchicago.edu %K HIV %K patient portal %K clinic staff perspectives %K depression and anxiety screening %K implementation %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety are common among people with HIV and are associated with inadequate viral suppression, disease progression, and increased mortality. However, depression and anxiety are underdiagnosed and undertreated in people with HIV owing to inadequate visit time and personnel availability. Conducting population-level depression and anxiety screening via the patient portal is a promising intervention that has not been studied in HIV care settings. Objective: We aimed to explore facilitators of and barriers to implementing population-level portal-based depression and anxiety screening for people with HIV. Methods: We conducted semistructured hour-long qualitative interviews based on the Consolidated Framework for Implementation Research with clinicians at an HIV clinic. Results: A total of 10 clinicians participated in interviews. In total, 10 facilitators and 7 barriers were identified across 5 Consolidated Framework for Implementation Research domains. Facilitators included advantages of systematic screening outside clinic visits; the expectation that assessment frequency could be tailored to patient needs; evidence from the literature and previous experience in other settings; respect for patient privacy; empowering patients and facilitating communication about mental health; compatibility with clinic culture, workflows, and systems; staff beliefs about the importance of mental health screening and benefits for HIV care; engaging all clinic staff and leveraging their strengths; and clear planning and communication with staff. Barriers included difficulty in ensuring prompt response to suicidal ideation; patient access, experience, and comfort using the portal; limited availability of mental health services; variations in how providers use the electronic health record and communicate with patients; limited capacity to address mental health concerns during HIV visits; staff knowledge and self-efficacy regarding the management of mental health conditions; and the impersonal approach to a sensitive topic. Conclusions: We proposed 13 strategies for implementing population-level portal-based screening for people with HIV. Before implementation, clinics can conduct local assessments of clinicians and clinic staff; engage clinicians and clinic staff with various roles and expertise to support the implementation; highlight advantages, relevance, and evidence for population-level portal-based mental health screening; make screening frequency adaptable based on patient history and symptoms; use user-centered design methods to refine results that are displayed and communicated in the electronic health record; make screening tools available for patients to use on demand in the portal; and create protocols for positive depression and anxiety screeners, including those indicating imminent risk. During implementation, clinics should communicate with clinicians and clinic staff and provide training on protocols; provide technical support and demonstrations for patients on how to use the portal; use multiple screening methods for broad reach; use patient-centered communication in portal messages; provide clinical decision support tools, training, and mentorship to help clinicians manage mental health concerns; and implement integrated behavioral health and increase mental health referral partnerships. %M 38206651 %R 10.2196/48935 %U https://formative.jmir.org/2024/1/e48935 %U https://doi.org/10.2196/48935 %U http://www.ncbi.nlm.nih.gov/pubmed/38206651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51200 %T Dentists’ Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study %A Li,Shuning %A Felix Gomez,Grace Gomez %A Xu,Huiping %A Rajapuri,Anushri Singh %A Dixon,Brian E %A Thyvalikakath,Thankam %+ Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, 415 Lansing St, Indianapolis, IN, 46201, United States, 1 3172745460, tpt@iu.edu %K dentistry %K medical history %K integrated medical and dental records %K health information exchange %K medical record %K dental record %K dental %K medical information %K dental care %K adverse drug effect %K medication %K allergies %K cost %K data safety %K data accuracy %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists’ information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. Objective: This study aims to determine Indiana dentists’ information needs regarding patients’ medical information and their opinions about accessing it via an HIE. Methods: We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents’ characteristics and responses. Results: Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients’ medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient’s information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. Conclusions: Patients’ medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs. %M 38206667 %R 10.2196/51200 %U https://formative.jmir.org/2024/1/e51200 %U https://doi.org/10.2196/51200 %U http://www.ncbi.nlm.nih.gov/pubmed/38206667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52157 %T Promoting Self-Efficacy of Individuals With Autism in Practicing Social Skills in the Workplace Using Virtual Reality and Physiological Sensors: Mixed Methods Study %A Kim,Sung-In %A Jang,So-youn %A Kim,Taewan %A Kim,Bogoan %A Jeong,Dayoung %A Noh,Taehyung %A Jeong,Mingon %A Hall,Kaely %A Kim,Meelim %A Yoo,Hee Jeong %A Han,Kyungsik %A Hong,Hwajung %A Kim,Jennifer G %+ Georgia Institute of Technology, 225 North Ave, Atlanta, GA, 30332, United States, 1 404 894 2000, jennifer.kim@cc.gatech.edu %K autism %K virtual reality %K workplace %K self-efficacy %K social skills %K data reflection %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with autism often experience heightened anxiety in workplace environments because of challenges in communication and sensory overload. As these experiences can result in negative self-image, promoting their self-efficacy in the workplace is crucial. Virtual reality (VR) systems have emerged as promising tools for enhancing the self-efficacy of individuals with autism in navigating social scenarios, aiding in the identification of anxiety-inducing situations, and preparing for real-world interactions. However, there is limited research exploring the potential of VR to enhance self-efficacy by facilitating an understanding of emotional and physiological states during social skills practice. Objective: This study aims to develop and evaluate a VR system that enabled users to experience simulated work-related social scenarios and reflect on their behavioral and physiological data through data visualizations. We intended to investigate how these data, combined with the simulations, can support individuals with autism in building their self-efficacy in social skills. Methods: We developed WorkplaceVR, a comprehensive VR system designed for engagement in simulated work-related social scenarios, supplemented with data-driven reflections of users’ behavioral and physiological responses. A within-subject deployment study was subsequently conducted with 14 young adults with autism to examine WorkplaceVR’s feasibility. A mixed methods approach was used, compassing pre- and postsystem use assessments of participants’ self-efficacy perceptions. Results: The study results revealed WorkplaceVR’s effectiveness in enhancing social skills and self-efficacy among individuals with autism. First, participants exhibited a statistically significant increase in perceived self-efficacy following their engagement with the VR system (P=.02). Second, thematic analysis of the interview data confirmed that the VR system and reflections on the data fostered increased self-awareness among participants about social situations that trigger their anxiety, as well as the behaviors they exhibit during anxious moments. This increased self-awareness prompted the participants to recollect their related experiences in the real world and articulate anxiety management strategies. Furthermore, the insights uncovered motivated participants to engage in self-advocacy, as they wanted to share the insights with others. Conclusions: This study highlights the potential of VR simulations enriched with physiological and behavioral sensing as a valuable tool for augmenting self-efficacy in workplace social interactions for individuals with autism. Data reflection facilitated by physiological sensors helped participants with autism become more self-aware of their emotions and behaviors, advocate for their characteristics, and develop positive self-beliefs. %M 38206652 %R 10.2196/52157 %U https://formative.jmir.org/2024/1/e52157 %U https://doi.org/10.2196/52157 %U http://www.ncbi.nlm.nih.gov/pubmed/38206652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43683 %T Mapping the Cardiometabolic Patient Experience and Self-Care Behaviors to Inform Design, Implementation, and Persistent Use of Digital Health Care Solutions: Mixed Methods Study %A Liska,Jan %A Mical,Marie %A Maillard,Christophe %A Dessapt,Cécile %A Bendig,Europa %A Mai,Daniel %A Piette,John D %A De Geest,Sabina %A Fontaine,Guillaume %+ Sanofi, 46-48 Avenue de la Grande Armée, Paris, 75017, France, 33 141247000, Jan.Liska@sanofi.com %K self-care %K adherence %K digital health %K design %K implementation %K coronary %K type 2 diabetes %K care %K patient engagement %K behavior %K interview %K treatment %K tool %K digital tool %K support %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiometabolic conditions including acute coronary syndrome (ACS) and type 2 diabetes (T2D) require comprehensive care and patient engagement in self-care behaviors, and the drivers of those behaviors at the individual and health system level are still poorly understood. Objective: We aim to gain insights into self-care behaviors of individuals with cardiometabolic conditions. Methods: A convenience sample of 98 adult patients with ACS and T2D was recruited in the United States, Germany, and Taiwan to participate in a mixed methods study using ethnographic methods. All participants completed 7-day web-based diaries tracking their level of engagement, and 48 completed 90-minute web-based semistructured interviews between February 4, 2021, and March 27, 2021, focusing on themes including moments of engagement. Qualitative analysis identified factors influencing self-care practices and a Patient Mind States Model prototype. Results: Patient reports indicate that many patients feel social pressure to adhere to treatment. Patients’ experience can be understood within 5 categories defined in terms of their degree of engagement and adherence (“ignoring,” “struggling,” “juggling,” “controlling,” and “reframing”). Conclusions: For people living with ACS and T2D, the self-care journey is defined by patterns of patient experiences, which can identify areas that tailored digital health care interventions may play a meaningful role. %M 38214969 %R 10.2196/43683 %U https://formative.jmir.org/2024/1/e43683 %U https://doi.org/10.2196/43683 %U http://www.ncbi.nlm.nih.gov/pubmed/38214969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51795 %T Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study %A Efe,Zeki %A Baldofski,Sabrina %A Kohls,Elisabeth %A Eckert,Melanie %A Saee,Shadi %A Thomas,Julia %A Wundrack,Richard %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstr 10, Haus 13, Leipzig, 04103, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K e-mental health %K chat counseling %K crisis %K helpline %K linguistic %K language %K Linguistic Inquiry and Word Count %K LIWC %K psychiatric symptoms %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person’s mental health state and is known to be a marker for psychopathology. Objective: The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. Methods: For this study, the anonymized chat content of a German messenger–based psychosocial chat counseling service for children and adolescents (“krisenchat”) between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. Results: Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. Conclusions: This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users’ psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services. %M 38214955 %R 10.2196/51795 %U https://formative.jmir.org/2024/1/e51795 %U https://doi.org/10.2196/51795 %U http://www.ncbi.nlm.nih.gov/pubmed/38214955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51361 %T Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study %A Nguyen,Quynh C %A Aparicio,Elizabeth M %A Jasczynski,Michelle %A Channell Doig,Amara %A Yue,Xiaohe %A Mane,Heran %A Srikanth,Neha %A Gutierrez,Francia Ximena Marin %A Delcid,Nataly %A He,Xin %A Boyd-Graber,Jordan %+ Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 4254 Stadium Dr., College Park, MD, 20742, United States, 1 301 405 6425, qtnguyen@umd.edu %K chatbot %K health information %K maternal and child health %K health disparities %K health equity %K health informatics %K preventive health care %K postpartum care %K patient education %K newborn care %K prenatal care %K mobile phone %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. Objective: In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. Methods: Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ≥14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52% received the Rosie app) or control group (14/29, 48% received a children’s book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie’s knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial’s sample size calculations. Results: Of 41 individuals who were screened and eligible, 31 (76%) enrolled and 29 (71%) were retained in the study. More than 87% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33%) or weekly (8/15, 53%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93%) and provided responses quickly (13/15, 87%). The remaining issues identified included crashing of the app (8/15, 53%), and users were not satisfied with some of Rosie’s answers (12/15, 80%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9%) compared with control group members (3/13, 23%). Nonetheless, no between-group differences reached statistical significance at P<.05. Conclusions: Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot’s ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515 %M 38214963 %R 10.2196/51361 %U https://formative.jmir.org/2024/1/e51361 %U https://doi.org/10.2196/51361 %U http://www.ncbi.nlm.nih.gov/pubmed/38214963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45391 %T Clinical Needs Assessment of a Machine Learning–Based Asthma Management Tool: User-Centered Design Approach %A Zheng,Lu %A Ohde,Joshua W %A Overgaard,Shauna M %A Brereton,Tracey A %A Jose,Kristelle %A Wi,Chung-Il %A Peterson,Kevin J %A Juhn,Young J %+ Center for Digital Health, Mayo Clinic, 200 1st Street South West, Rochester, MN, United States, 1 480 758 0664, zheng.lu@mayo.edu %K asthma %K formative research %K user-centered design %K machine learning (ML) %K artificial intelligence (AI) %K qualitative %K user needs. %D 2024 %7 15.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Personalized asthma management depends on a clinician’s ability to efficiently review patient’s data and make timely clinical decisions. Unfortunately, efficient and effective review of these data is impeded by the varied format, location, and workflow of data acquisition, storage, and processing in the electronic health record. While machine learning (ML) and clinical decision support tools are well-positioned as potential solutions, the translation of such frameworks requires that barriers to implementation be addressed in the formative research stages. Objective: We aimed to use a structured user-centered design approach (double-diamond design framework) to (1) qualitatively explore clinicians’ experience with the current asthma management system, (2) identify user requirements to improve algorithm explainability and Asthma Guidance and Prediction System prototype, and (3) identify potential barriers to ML-based clinical decision support system use. Methods: At the “discovery” phase, we first shadowed to understand the practice context. Then, semistructured interviews were conducted digitally with 14 clinicians who encountered pediatric asthma patients at 2 outpatient facilities. Participants were asked about their current difficulties in gathering information for patients with pediatric asthma, their expectations of ideal workflows and tools, and suggestions on user-centered interfaces and features. At the “define” phase, a synthesis analysis was conducted to converge key results from interviewees’ insights into themes, eventually forming critical “how might we” research questions to guide model development and implementation. Results: We identified user requirements and potential barriers associated with three overarching themes: (1) usability and workflow aspects of the ML system, (2) user expectations and algorithm explainability, and (3) barriers to implementation in context. Even though the responsibilities and workflows vary among different roles, the core asthma-related information and functions they requested were highly cohesive, which allows for a shared information view of the tool. Clinicians hope to perceive the usability of the model with the ability to note patients’ high risks and take proactive actions to manage asthma efficiently and effectively. For optimal ML algorithm explainability, requirements included documentation to support the validity of algorithm development and output logic, and a request for increased transparency to build trust and validate how the algorithm arrived at the decision. Acceptability, adoption, and sustainability of the asthma management tool are implementation outcomes that are reliant on the proper design and training as suggested by participants. Conclusions: As part of our comprehensive informatics-based process centered on clinical usability, we approach the problem using a theoretical framework grounded in user experience research leveraging semistructured interviews. Our focus on meeting the needs of the practice with ML technology is emphasized by a user-centered approach to clinician engagement through upstream technology design. %M 38224482 %R 10.2196/45391 %U https://formative.jmir.org/2024/1/e45391 %U https://doi.org/10.2196/45391 %U http://www.ncbi.nlm.nih.gov/pubmed/38224482 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50222 %T Exploring Adolescents’ Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study %A Høgsdal,Helene %A Kyrrestad,Henriette %A Rye,Marte %A Kaiser,Sabine %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT The Arctic University of Norway, Campus Tromsø, Tromsø, 9019, Norway, 47 77646619, helene.hogsdal@uit.no %K mental health applications %K mental health %K adolescents %K adolescent %K youth %K mobile health %K app %K apps %K application %K applications %K opinion %K opinions %K cross sectional %K survey %K surveys %K questionnaire %D 2024 %7 15.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. Objective: This study aims to explore adolescents’ attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. Methods: In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, “What do you think about mental health apps in general?”). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. Results: A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Conclusions: Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents. %M 38224474 %R 10.2196/50222 %U https://formative.jmir.org/2024/1/e50222 %U https://doi.org/10.2196/50222 %U http://www.ncbi.nlm.nih.gov/pubmed/38224474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44923 %T The Impact of Social Media Use on Mental Health and Family Functioning Within Web-Based Communities in Saudi Arabia: Ethnographic Correlational Study %A Alwuqaysi,Bdour %A Abdul-Rahman,Alfie %A Borgo,Rita %+ King's College London, 155 Wandsworth Road, Apt 3004, Sky Gardns, London, SW8 2FZ, United Kingdom, 44 07470334344, bdour.alwuqaysi@hotmail.com %K social media use %K mental health %K family functioning %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, increasing numbers of parents, activists, and decision-makers have raised concerns about the potential adverse effects of social media use on both mental health and family functioning. Although some studies have indicated associations between social media use and negative mental health outcomes, others have found no evidence of mental health harm. Objective: This correlation study investigated the interplay between social media use, mental health, and family functioning. Analyzing data from 314 users, this study explores diverse mental health outcomes. The study places particular emphasis on the Saudi Arabian sample, providing valuable insights into the cultural context and shedding light on the specific dynamics of social media’s impact on mental well-being and family dynamics in this demographic context. Methods: We collected data through a subsection of an anonymous web-based survey titled “The Effect of COVID-19 on Social Media Usage, Mental Health, and Family Functioning.” The survey was distributed through diverse web-based platforms in Saudi Arabia, emphasizing the Saudi sample. The participants indicated their social media accounts and estimated their daily use. Mental health was assessed using the General Health Questionnaire and family functioning was evaluated using the Family Assessment Device Questionnaire. In addition, 6 mental health conditions (anxiety, self-esteem, depression, body dysmorphia, social media addiction, and eating disorders) were self-reported by participants. Results: The study demonstrates a pattern of frequent social media use, with a significant portion dedicating 3-5 hours daily for web-based activities, and most of the sample accessed platforms multiple times a day. Despite concerns about social media addiction and perceived unhealthiness, participants cited staying connected with friends and family as their primary motivation for social media use. WhatsApp was perceived as the most positively impactful, whereas TikTok was considered the most negative for our Saudi sample. YouTube, Instagram, and Snapchat users reported poorer mental health compared with nonusers of these platforms. Mental health effects encompassed anxiety and addiction, with age and gender emerging as significant factors. Associations between social media use and family functioning were evident, with higher social media quartiles correlating with a greater likelihood of mental health and unhealthy family functioning. Logistic regression identified age and gender as factors linked to affected mental health, particularly noting that female participants aged 25-34 years were found to be more susceptible to affected mental health. In addition, multivariable analysis identified age and social media use quartiles as factors associated with poor family functioning. Conclusions: This study examined how social media affects mental health and family functioning in Saudi Arabia. These findings underscore the need for culturally tailored interventions to address these challenges, considering diverse demographic needs. Recognizing these nuances can guide the development of interventions to promote digital well-being, acknowledging the importance of familial connections in Saudi society. %M 38227352 %R 10.2196/44923 %U https://formative.jmir.org/2024/1/e44923 %U https://doi.org/10.2196/44923 %U http://www.ncbi.nlm.nih.gov/pubmed/38227352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51732 %T Enabling Personalization for Digital Cognitive Stimulation to Support Communication With People With Dementia: Pilot Intervention Study as a Prelude to AI Development %A Hird,Nick %A Osaki,Tohmi %A Ghosh,Samik %A Palaniappan,Sucheendra K %A Maeda,Kiyoshi %+ Aikomi Ltd Co, Yokohama Blue Avenue 12th Floor, 4-4-2 Minatomirai, Yokohama, Kanagawa, 220-0012, Japan, 81 70 4538 2854, nick.hird@aikomi.co.jp %K dementia %K digital technology %K communication %K engagement %K cognitive stimulation %K artificial intelligence %K AI %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining good communication and engagement between people with dementia and their caregivers is a major challenge in dementia care. Cognitive stimulation is a psychosocial intervention that supports communication and engagement, and several digital applications for cognitive stimulation have been developed. Personalization is an important factor for obtaining sustainable benefits, but the time and effort required to personalize and optimize applications often makes them difficult for routine use by nonspecialist caregivers and families. Although artificial intelligence (AI) has great potential to support automation of the personalization process, its use is largely unexplored because of the lack of suitable data from which to develop and train machine learning models. Objective: This pilot study aims to evaluate a digital application called Aikomi in Japanese care homes for its potential to (1) create and deliver personalized cognitive stimulation programs to promote communication and engagement between people with dementia and usual care staff and (2) capture meaningful personalized data suitable for the development of AI systems. Methods: A modular technology platform was developed and used to create personalized programs for 15 people with dementia living in 4 residential care facilities in Japan with the cooperation of a family member or care staff. A single intervention with the program was conducted with the person with dementia together with a care staff member, and for some participants, smell stimulation was provided using selected smell sticks in conjunction with the digital program. All sessions were recorded using a video camera, and the combined personalized data obtained by the platform were analyzed. Results: Most people with dementia (10/15, 67%) showed high levels of engagement (>40 on Engagement of a Person with Dementia Scale), and there were no incidences of negative reactions toward the programs. Care staff reported that some participants showed extended concentration and spontaneous communication while using Aikomi, which was not their usual behavior. Smell stimulation promoted engagement for some participants even when they were unable to identify the smell. No changes in well-being were observed following the intervention according to the Mental Function Impairment Scale. The level of response to each type of content in the stimulation program varied greatly according to the person with dementia, and personalized data captured by the Aikomi platform enabled understanding of correlations between stimulation content and responses for each participant. Conclusions: This study suggests that the Aikomi digital application is acceptable for use by persons with dementia and care staff and may have the potential to promote communication and engagement. The platform captures personalized data, which can provide suitable input for machine learning. Further investigation of Aikomi will be conducted to develop AI systems and create personalized digital cognitive stimulation applications that can be easily used by nonspecialist caregivers. %M 38227357 %R 10.2196/51732 %U https://formative.jmir.org/2024/1/e51732 %U https://doi.org/10.2196/51732 %U http://www.ncbi.nlm.nih.gov/pubmed/38227357 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50823 %T Designing and Developing a Mobile App for Management and Treatment of Gestational Diabetes in Nepal: User-Centered Design Study %A Shanmugavel,Aarthi %A Shakya,Prabin Raj %A Shrestha,Archana %A Nepal,Jyoti %A Shrestha,Abha %A Daneault,Jean-Francois %A Rawal,Shristi %+ Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Stanley S Bergen, Jr Building, Suite 923, 65 Bergen Street, Newark, NJ, 07107, United States, 1 973 972 2710, shristi.rawal@rutgers.edu %K mHealth %K mobile health %K gestational diabetes %K telehealth %K usability testing %K LMICs %K low- and middle-income countries %K user-centric design %K social cognitive theory %K South Asians %K maternal health %K diabetes %K diabetes mellitus %K daily glucose monitoring %K hospital %K medical institution %K health center %K clinical utility %K Nepal %K low income %K clinical trial %K focus group %K interview %K health care provider %K medical practitioner %K mobile app %K application %K digital health %K app %K apps %K health education %K web based %K self-monitoring %K glucose %K physical activity %K intervention %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps can aid with the management of gestational diabetes mellitus (GDM) by providing patient education, reinforcing regular blood glucose monitoring and diet/lifestyle modification, and facilitating clinical and social support. Objective: This study aimed to describe our process of designing and developing a culturally tailored app, Garbhakalin Diabetes athawa Madhumeha—Dhulikhel Hospital (GDM-DH), to support GDM management among Nepalese patients by applying a user-centered design approach. Methods: A multidisciplinary team of experts, as well as health care providers and patients in Dhulikhel Hospital (Dhulikhel, Nepal), contributed to the development of the GDM-DH app. After finalizing the app’s content and features, we created the app’s wireframe, which illustrated the app’s proposed interface, navigation sequences, and features and function. Feedback was solicited on the wireframe via key informant interviews with health care providers (n=5) and a focus group and in-depth interviews with patients with GDM (n=12). Incorporating their input, we built a minimum viable product, which was then user-tested with 18 patients with GDM and further refined to obtain the final version of the GDM-DH app. Results: Participants in the focus group and interviews unanimously concurred on the utility and relevance of the proposed mobile app for patients with GDM, offering additional insight into essential modifications and additions to the app’s features and content (eg, inclusion of example meal plans and exercise videos).The mean age of patients in the usability testing (n=18) was 28.8 (SD 3.3) years, with a mean gestational age of 27.2 (SD 3.0) weeks. The mean usability score across the 10 tasks was 3.50 (SD 0.55; maximum score=5 for “very easy”); task completion rates ranged from 55.6% (n=10) to 94.4% (n=17). Findings from the usability testing were reviewed to further optimize the GDM-DH app (eg, improving data visualization). Consistent with social cognitive theory, the final version of the GDM-DH app supports GDM self-management by providing health education and allowing patients to record and self-monitor blood glucose, blood pressure, carbohydrate intake, physical activity, and gestational weight gain. The app uses innovative features to minimize the self-monitoring burden, as well as automatic feedback and data visualization. The app also includes a social network “follow” feature to add friends and family and give them permission to view logged data and a progress summary. Health care providers can use the web-based admin portal of the GDM-DH app to enter/review glucose levels and other clinical measures, track patient progress, and guide treatment and counseling accordingly. Conclusions: To the best of our knowledge, this is the first mobile health platform for GDM developed for a low-income country and the first one containing a social support feature. A pilot clinical trial is currently underway to explore the clinical utility of the GDM-DH app. %M 38231562 %R 10.2196/50823 %U https://formative.jmir.org/2024/1/e50823 %U https://doi.org/10.2196/50823 %U http://www.ncbi.nlm.nih.gov/pubmed/38231562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46367 %T Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study %A Sommer,Jordana L %A Reynolds,Kristin %A Hebbard,Pamela %A Smith,Michael S D %A Mota,Natalie %A Mutch,W Alan C %A Maples-Keller,Jessica %A Roos,Leslie %A El-Gabalawy,Renée %+ Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, AE207 Harry Medovy House, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada, 1 204 787 4713, sommerj@myumanitoba.ca %K virtual reality %K preoperative anxiety and distress %K breast cancer surgery %K anesthesia %K feasibility %K pilot %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. Objective: This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. Methods: Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants’ impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. Results: Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, “It was realistic to my past surgical experiences”), impacting their degree of preparedness and expectations for surgery (eg, “The sounds and sights and procedures give you a test run; they prepare you for the actual day”), and having a calming or relaxing effect (eg, “You feel more relaxed for the surgery”). Conclusions: This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. Trial Registration: ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618 %M 38231570 %R 10.2196/46367 %U https://formative.jmir.org/2024/1/e46367 %U https://doi.org/10.2196/46367 %U http://www.ncbi.nlm.nih.gov/pubmed/38231570 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50211 %T Educational Video Intervention to Improve Health Misinformation Identification on WhatsApp Among Saudi Arabian Population: Pre-Post Intervention Study %A Alsaad,Ebtihal %A AlDossary,Sharifah %+ Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Al Haras Al Watani St, Prince Mutib Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, Riyadh, Riyadh, PO Box 3660/ 11481, Saudi Arabia, 966 114299999, ebtihalalsaad@gmail.com %K misinformation %K education %K WhatsApp %K intervention %K pre-postintervention design %K health literacy %K educational %K video %K videos %K consumer %K consumers %K patient education %K survey %K surveys %K web-based information %K health information %K reliability %K accuracy %K reliable %K social media %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation can adversely affect individuals’ quality of life and increase the risk of mortality. People often fail to assess the content of messages before sharing them on the internet, increasing the spread of misinformation. The problem is exacerbated by the growing variety of digital information environments, especially social media, which presents as an effective platform for spreading misinformation due to its rapid information-sharing capabilities. Educational interventions have been developed to help consumers verify the validity of digital health information. However, tools designed to detect health misinformation on social media content have not been validated. Given the increased use of social media platforms, particularly WhatsApp, it is crucial to develop tools to help consumers assess the credibility of messages and detect misinformation. Objective: The main objective of this study is to develop and assess an educational tool aimed at educating consumers about detecting health misinformation on WhatsApp. The secondary objective is to assess the association between demographic factors and knowledge levels. Methods: The study used a single-arm, pre-post intervention design to evaluate the effectiveness of an educational video in improving participants’ ability to detect health-related misinformation in WhatsApp messages. In the first phase, an educational video intervention was developed and validated. In the second phase, participants were invited to complete a web-based survey that consisted of pre-evaluation questions, followed by the educational video intervention. Subsequently, they were asked to answer the same questions as the postevaluation questions. Results: The web-based survey received 485 responses. The completion rate was 99.6% (n=483). Statistically significant associations existed between knowledge level and age, gender, employment, and region of residence (P<.05). The video intervention did elicit a statistically significant change in the participants’ abilities to identify misinformation in WhatsApp messages (z=–6.887; P<.001). Viewing the video was associated with increased knowledge about the following concepts: checking the “forwarded” label (P<.001), looking for spelling and grammatical errors (P<.001), analyzing the facts (P=.03), checking links (P=.002, P=.001), and assessing the photos and videos (P<.001). There was a statistically significant difference in knowledge level before and after the intervention (P<.001). Conclusions: This study developed and evaluated the effectiveness of an educational video intervention to improve health misinformation identification on WhatsApp among the Saudi Arabian population. The results indicate that educational videos can be valuable tools for improving participants’ abilities to identify misinformation. The outcomes of this research can contribute to our understanding of what constitutes an effective tool for enhancing health misinformation awareness. Such interventions may be particularly useful in combating misinformation among Arabic-speaking populations on WhatsApp, which may ultimately improve eHealth literacy. Limiting the prevalence and impact of misinformation allows people to make better-informed health decisions. %M 38231563 %R 10.2196/50211 %U https://formative.jmir.org/2024/1/e50211 %U https://doi.org/10.2196/50211 %U http://www.ncbi.nlm.nih.gov/pubmed/38231563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53931 %T A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study %A Nordby,Emilie S %A Guribye,Frode %A Schønning,Viktor %A Andersen,Sander Lindholm %A Kuntsi,Jonna %A Lundervold,Astri J %+ Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, Bergen, 5036, Norway, 47 45440197, emilie.nordby@uib.no %K ADHD %K adult %K adults %K app %K applications %K apps %K attention deficit %K blended intervention %K blended %K develop %K development %K digital %K emotion regulation %K emotion %K emotional %K emotions %K feasibility %K group session %K group sessions %K hybrid %K hyperactivity %K inattention %K mental health %K neurodevelopmental %K psychotherapy %K satisfaction %K skill %K training %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. Objective: This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. Methods: This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. Results: Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. Conclusions: The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028 %M 38231536 %R 10.2196/53931 %U https://formative.jmir.org/2024/1/e53931 %U https://doi.org/10.2196/53931 %U http://www.ncbi.nlm.nih.gov/pubmed/38231536 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48945 %T Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study %A Calear,Alison L %A Batterham,Philip J %A McCallum,Sonia M %A Banfield,Michelle %A Moore,Elizabeth %A Johnson,Natalie %A Morse,Alyssa R %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, 2601, Australia, 61 261258406, Alison.Calear@anu.edu.au %K mental health services %K youth %K navigation tool %K mental health %K website %K user experience %K design %K service %K services %K access %K accessibility %K health care system %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. Objective: This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. Methods: A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants’ views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. Results: A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. Conclusions: This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support. %M 38236625 %R 10.2196/48945 %U https://formative.jmir.org/2024/1/e48945 %U https://doi.org/10.2196/48945 %U http://www.ncbi.nlm.nih.gov/pubmed/38236625 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52835 %T Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study %A Danielson,Carla Kmett %A Moreland,Angela %A Hahn,Austin %A Banks,Devin %A Ruggiero,Kenneth J %+ Department of Psychiatry & Behavioral Science, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, United States, 1 8437922945, danielso@musc.edu %K traumatic stress %K prevention %K substance use %K HIV %K qualitative methods %K adolescents %K mobile phone %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non–trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. Objective: The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. Methods: Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. Results: In total, 4 overarching themes emerged from the participants’ answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users’ favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: “This app has much that is of interest to me.” Adolescents generally found the app easier to use than did caregivers and clinicians. Conclusions: The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. Trial Registration: ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720 %M 38236634 %R 10.2196/52835 %U https://formative.jmir.org/2024/1/e52835 %U https://doi.org/10.2196/52835 %U http://www.ncbi.nlm.nih.gov/pubmed/38236634 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45637 %T Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population %A Le Roy,Barbara %A Martin-Krumm,Charles %A Poupon,Charlotte %A Richieri,Raphaëlle %A Malbos,Eric %A Barthélémy,Fanny %A Guedj,Eric %A Trousselard,Marion %+ Unité neurophysiologie du stress, Institut de recherche biomédicale des armées, Place Général Valérie André, Brétigny-sur-Orge, 91220, France, 33 123456789, barbara.m.le.roy@gmail.com %K countermeasures %K mental health %K physical activity %K virtual reality %K user experience %D 2024 %7 22.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system). Objective: This study aims to investigate the impact of physical exercise in a VR environment. Methods: A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence). Results: First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality–stimulation=1.90; hedonic quality–identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04). Conclusions: These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine. %M 38252484 %R 10.2196/45637 %U https://formative.jmir.org/2024/1/e45637 %U https://doi.org/10.2196/45637 %U http://www.ncbi.nlm.nih.gov/pubmed/38252484 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38064 %T Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research %A Morsa,Maxime %A Perrin,Amélie %A David,Valérie %A Rault,Gilles %A Le Roux,Enora %A Alberti,Corinne %A Gagnayre,Rémi %A Pougheon Bertrand,Dominique %+ Adaptation, Resilience and Change Research Unit, University of Liège, 1 Place des Orateurs, Liège, 4000, Belgium, 32 4 3662272, maxime.morsa@uliege.be %K cystic fibrosis %K mobile health %K mHealth %K patient education %K chronic disease %K empowerment %K devices %K patients %K detection %K treatment %K respiratory %K education %K monitoring %K care %D 2024 %7 23.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. Objective: This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users’ point of view to detect PEx early and treat it. This study focused on the patients’ experiences as the first and main users of home monitoring. Methods: A qualitative study was conducted to explore patients’ and professionals’ experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. Results: A total of 20 patients completed the study. Three main categories emerged from the patients’ verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients’ learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. Conclusions: We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 %M 38261372 %R 10.2196/38064 %U https://formative.jmir.org/2024/1/e38064 %U https://doi.org/10.2196/38064 %U http://www.ncbi.nlm.nih.gov/pubmed/38261372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46941 %T Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach %A Messina,Anna %A Amati,Rebecca %A Annoni,Anna Maria %A Bano,Beatrice %A Albanese,Emiliano %A Fiordelli,Maddalena %+ Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 0782104055, anna.messina@usi.ch %K informal caregivers %K iSupport %K dementia %K digital interventions %K mHealth %K community-based participatory research %K community %K caregiver %K mental distress %K physical distress %K support %K development %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based digital program developed by the World Health Organization to provide education and support for the informal everyday care of people living with dementia. Objective: Our study aims to describe in detail the cultural adaptation process of iSupport in Switzerland. We specifically focused on the participatory strategies we used to design a culturally adapted, Swiss version of iSupport that informed the development of the desktop version, mobile app, and printed manual. Methods: We used a mixed methods design, with a community-based participatory approach. The adaptation of iSupport followed the World Health Organization adaptation guidelines and was developed in 4 phases: content translation, linguistic and cultural revision by the members of the community advisory board, validation with formal and informal caregivers, and refinement and final adaptation. Results: The findings from each phase showed and consolidated the adjustments needed for a culturally adapted, Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (eg, from “lesson” to “chapter” and from “suffering from” dementia to “affected by” dementia), resources (hyperlinks to local resources for dementia), contents (eg, from general nonfamiliar scenarios to local and verisimilar examples), graphics (eg, from generalized illustrations of objects to human illustrations), and extra features (eg, a glossary, a forum session, and a read-aloud option, as well as a navigation survey). Conclusions: Our study provides evidence on how to culturally adapt a digital program for informal caregivers of people living with dementia. Our results suggest that adopting a community-based participatory approach and collecting lived experiences from the final users and stakeholders is crucial to meet local needs and to inform the further development, testing, and implementation of digital interventions in a specific cultural context. %M 38265857 %R 10.2196/46941 %U https://formative.jmir.org/2024/1/e46941 %U https://doi.org/10.2196/46941 %U http://www.ncbi.nlm.nih.gov/pubmed/38265857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47157 %T A Bluetooth-Enabled Device for Real-Time Detection of Sitting, Standing, and Walking: Cross-Sectional Validation Study %A Daryabeygi-Khotbehsara,Reza %A Rawstorn,Jonathan C %A Dunstan,David W %A Shariful Islam,Sheikh Mohammed %A Abdelrazek,Mohamed %A Kouzani,Abbas Z %A Thummala,Poojith %A McVicar,Jenna %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hw, Melbourne Burwood, 3125, Australia, 61 3 924 45936, reza.d@deakin.edu.au %K activity tracker %K algorithms %K deep neural network %K machine learning %K real-time data %K Sedentary behaviOR Detector %K sedentary behavior %K SORD %K standing %K validation %K walking %K wearables %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study assesses the accuracy of a Bluetooth-enabled prototype activity tracker called the Sedentary behaviOR Detector (SORD) device in identifying sedentary, standing, and walking behaviors in a group of adult participants. Objective: The primary objective of this study was to determine the criterion and convergent validity of SORD against direct observation and activPAL. Methods: A total of 15 healthy adults wore SORD and activPAL devices on their thighs while engaging in activities (lying, reclining, sitting, standing, and walking). Direct observation was facilitated with cameras. Algorithms were developed using the Python programming language. The Bland-Altman method was used to assess the level of agreement. Results: Overall, 1 model generated a low level of bias and high precision for SORD. In this model, accuracy, sensitivity, and specificity were all above 0.95 for detecting sitting, reclining, standing, and walking. Bland-Altman results showed that mean biases between SORD and direct observation were 0.3% for sitting and reclining (limits of agreement [LoA]=–0.3% to 0.9%), 1.19% for standing (LoA=–1.5% to 3.42%), and –4.71% for walking (LoA=–9.26% to –0.16%). The mean biases between SORD and activPAL were –3.45% for sitting and reclining (LoA=–11.59% to 4.68%), 7.45% for standing (LoA=–5.04% to 19.95%), and –5.40% for walking (LoA=–11.44% to 0.64%). Conclusions: Results suggest that SORD is a valid device for detecting sitting, standing, and walking, which was demonstrated by excellent accuracy compared to direct observation. SORD offers promise for future inclusion in theory-based, real-time, and adaptive interventions to encourage physical activity and reduce sedentary behavior. %M 38265864 %R 10.2196/47157 %U https://formative.jmir.org/2024/1/e47157 %U https://doi.org/10.2196/47157 %U http://www.ncbi.nlm.nih.gov/pubmed/38265864 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50572 %T Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study %A Sharma,Pravesh %A Kamath,Celia %A Brockman,Tabetha A %A Roche,Anne %A Sinicrope,Pamela %A Jiang,Ruoxiang %A Decker,Paul A %A Pazdernik,Vanessa %A Patten,Christi %+ Psychiatry and Psychology, Mayo Clinic Health System, 1221 Whipple Street, Eau Claire, WI, 54703, United States, 1 7158385369, sharma.pravesh@mayo.edu %K digital health %K telemedicine %K telehealth %K video visits %K appointments %K SDoH, social determinants of health %K social determinants %K appointment %K users %K sociodemographic %K prevention %K discomfort %K video communication %K communication %K willingness %K mobile phone %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. Objective: This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. Methods: We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ≥18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, “Have you ever had a video appointment with a healthcare provider?” “Yes” respondents were defined as “users” (adapted to video appointments), and “no” respondents were defined as “persistent nonusers” of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Results: Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Conclusions: Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients’ decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients’ negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a “digital health coordinator” could be assigned to assist with various digital health solutions. %M 38265855 %R 10.2196/50572 %U https://formative.jmir.org/2024/1/e50572 %U https://doi.org/10.2196/50572 %U http://www.ncbi.nlm.nih.gov/pubmed/38265855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52414 %T Transfer of Knowledge on Pneumoconiosis Care Among Rural-Based Members of a Digital Community of Practice: Cross-Sectional Study %A Soller,Brian %A Myers,Orrin %A Sood,Akshay %+ Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico MSC 10 5550, Albuquerque, NM, 871310001, United States, 1 5052724751, asood@salud.unm.edu %K community of practice %K knowledge transfer %K pneumoconiosis %K telementoring %K rural health care %K transfer %K information %K rural %K virtual community %K lung diseases %K lung disease %K rural professionals %K rural professional %K multidisciplinary management %K multidisciplinary %K miners %K miner %K health equity %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the re-emergence of coal workers’ pneumoconiosis in Appalachia and Mountain West United States, there is a tremendous need to train rural professionals in its multidisciplinary management. Since 2016, the Miners’ Wellness TeleECHO (Extension for Community Health Outcomes) Program held by the University of New Mexico, Albuquerque, and Miners’ Colfax Medical Center, Raton, New Mexico, provides structured longitudinal multidisciplinary telementoring to diverse professionals taking care of miners by creating a digital community of practice. Program sessions emphasize active learning through discussion, rather than didactic training. Professional stakeholder groups include respiratory therapists, home health professionals, benefits counselors, lawyers or attorneys, clinicians, and others. Rural-urban differences in knowledge transfer in such a community of practice, however, remain unknown. Objective: We aim to evaluate the role of the rurality of the patient or client base in the transfer of knowledge to professionals caring for miners using the digital community of practice approach. Methods: This is a cross-sectional study of 70 professionals participating in the Miners’ Wellness TeleECHO Program between 2018 and 2019. Drawing insights from social network analysis, we examined the association between the rurality of participants’ patient or client base and their self-reported receipt of knowledge. Our focal independent variable was the respondent’s self-reported percentage of patients or clients who reside in rural areas. We measured knowledge transfer sources by asking participants if they received knowledge regarding the care of miners during and outside of TeleECHO sessions from each of the other participants. Our dependent variables included the number of knowledge sources, number of cross-stakeholder knowledge sources, number of same stakeholder knowledge sources, and range and heterogeneity of knowledge sources. Results: Respondents, on average, identified 4.46 (SD 3.16) unique knowledge sources within the community, with a greater number of cross-stakeholder knowledge sources (2.80) than same stakeholder knowledge sources (1.72). The mean knowledge source range was 2.50 (SD 1.29), indicating that, on average, respondents received knowledge sources from roughly half of the 5 stakeholder groups. Finally, the mean heterogeneity of knowledge sources, which can range between 0 and 0.80, was near the midpoint of the scale at 0.44 (SD 0.30). Multivariable analyses revealed that as the rurality of patient or client bases increased, participants reported more knowledge sources overall, more knowledge sources from outside of their stakeholder groups, a higher knowledge source range, and greater heterogeneity of knowledge sources (P<.05 for all comparisons). Conclusions: Our findings suggest that participants who serve rural areas especially benefit from knowledge transfer within the TeleECHO community of practice. Additionally, the knowledge they receive comes from diverse information sources, emphasizing its multidisciplinary nature. Our results underscore the capacity of the TeleECHO model to leverage technology to promote rural health equity for miners. %M 38265861 %R 10.2196/52414 %U https://formative.jmir.org/2024/1/e52414 %U https://doi.org/10.2196/52414 %U http://www.ncbi.nlm.nih.gov/pubmed/38265861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47572 %T Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study %A El Barbari,Jan Siad %A Fikuart,Maxim %A Beisemann,Nils %A Müller,Michael %A Syrek,Hannah %A Grützner,Paul Alfred %A Franke,Jochen %A Vetter,Sven Yves %+ Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str 13, Ludwigshafen am Rhein, 67071, Germany, 49 621 6810 2480, sven.vetter@bgu-ludwigshafen.de %K app %K device usability %K digital camera %K medical photo %K medical photography %K mRay app %K PACS %K patient care %K patient education %K picture archiving and communication system %K questionnaire %K smartphone %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. Objective: This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. Methods: We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. Results: A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer’s intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. Conclusions: Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size. %M 38271087 %R 10.2196/47572 %U https://formative.jmir.org/2024/1/e47572 %U https://doi.org/10.2196/47572 %U http://www.ncbi.nlm.nih.gov/pubmed/38271087 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54747 %T Machine Learning and Symptom Patterns in Degenerative Cervical Myelopathy: Web-Based Survey Study %A Touzet,Alvaro Yanez %A Rujeedawa,Tanzil %A Munro,Colin %A Margetis,Konstantinos %A Davies,Benjamin M %+ University of Cambridge, The Old Schools, Trinity Ln, Cambridge, Cambridge, CB2 1TN, United Kingdom, 44 01223 337733, bd375@cam.ac.uk %K cervical %K myelopathy %K machine learning %K cluster %K clusters %K clustering %K spine %K spinal %K compression %K neck %K degenerative %K k-means %K patient reported %K degenerative cervical myelopathy %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM), a progressive spinal cord injury caused by spinal cord compression from degenerative pathology, often presents with neck pain, sensorimotor dysfunction in the upper or lower limbs, gait disturbance, and bladder or bowel dysfunction. Its symptomatology is very heterogeneous, making early detection as well as the measurement or understanding of the underlying factors and their consequences challenging. Increasingly, evidence suggests that DCM may consist of subgroups of the disease, which are yet to be defined. Objective: This study aimed to explore whether machine learning can identify clinically meaningful groups of patients based solely on clinical features. Methods: A survey was conducted wherein participants were asked to specify the clinical features they had experienced, their principal presenting complaint, and time to diagnosis as well as demographic information, including disease severity, age, and sex. K-means clustering was used to divide respondents into clusters according to their clinical features using the Euclidean distance measure and the Hartigan-Wong algorithm. The clinical significance of groups was subsequently explored by comparing their time to presentation, time with disease severity, and other demographics. Results: After a review of both ancillary and cluster data, it was determined by consensus that the optimal number of DCM response groups was 3. In Cluster 1, there were 40 respondents, and the ratio of male to female participants was 13:21. In Cluster 2, there were 92 respondents, with a male to female participant ratio of 27:65. Cluster 3 had 57 respondents, with a male to female participant ratio of 9:48. A total of 6 people did not report biological sex in Cluster 1. The mean age in this Cluster was 56.2 (SD 10.5) years; in Cluster 2, it was 54.7 (SD 9.63) years; and in Cluster 3, it was 51.8 (SD 8.4) years. Patients across clusters significantly differed in the total number of clinical features reported, with more clinical features in Cluster 3 and the least clinical features in Cluster 1 (Kruskal-Wallis rank sum test: χ22=159.46; P<.001). There was no relationship between the pattern of clinical features and severity. There were also no differences between clusters regarding time since diagnosis and time with DCM. Conclusions: Using machine learning and patient-reported experience, 3 groups of patients with DCM were defined, which were different in the number of clinical features but not in the severity of DCM or time with DCM. Although a clearer biological basis for the clusters may have been missed, the findings are consistent with the emerging observation that DCM is a heterogeneous disease, difficult to diagnose or stratify. There is a place for machine learning methods to efficiently assist with pattern recognition. However, the challenge lies in creating quality data sets necessary to derive benefit from such approaches. %M 38271070 %R 10.2196/54747 %U https://formative.jmir.org/2024/1/e54747 %U https://doi.org/10.2196/54747 %U http://www.ncbi.nlm.nih.gov/pubmed/38271070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44029 %T Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study %A Vanderkruik,Rachel C %A Ferguson,Craig %A Kobylski,Lauren A %A Locascio,Joseph J %A Hamlett,Gabriella E %A Killenberg,Parker C %A Lewis,Robert %A Jones,Noah %A Rossa,Ella T %A Dineen,Hannah %A Picard,Rosalind %A Cohen,Lee S %+ Center for Women's Mental Health, Massachusetts General Hospital, 185 Cambridge St, Ste 2200, Boston, MA, 02114, United States, 1 781 691 9071, rvanderkruik@mgh.harvard.edu %K perinatal depression %K pregnancy %K behavioral activation %K mobile app %K digital intervention %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. Objective: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. Methods: This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. Results: The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (β=−.35; t61=−3.05; P=.003), number of activities completed (β=−.12; t61=−2.05; P=.04), days played (β=−.12; t58=−2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (β=−3.05; t45=−2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. Conclusions: Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression. %M 38277191 %R 10.2196/44029 %U https://formative.jmir.org/2024/1/e44029 %U https://doi.org/10.2196/44029 %U http://www.ncbi.nlm.nih.gov/pubmed/38277191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45506 %T Telephone-Based Training Intervention for Using Digital Communication Technologies for Social Housing Residents During the COVID-19 Pandemic: Mixed Methods Feasibility and Acceptability Evaluation %A Walker,Tim %A Buckingham,Sarah Ann %A Poole,Ria %A Elliott,Lewis Roland %A Menneer,Tamaryn %A Tu,Gengyang %A Morrissey,Karyn %+ European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Truro, TR1 3HD, United Kingdom, 44 (0) 1872 258131, t.w.walker@exeter.ac.uk %K digital training %K telephone-based %K social housing %K feasibility %K acceptability %K communication technologies %K sociodigital inequalities %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion. Objective: This study aims to evaluate the feasibility and acceptability of a telephone-based training intervention designed to empower people to confidently use digital communication technologies (ie, video calls and web-based messaging). Methods: Conducted in collaboration with a UK social housing association, the intervention was facilitated by a unitary authority’s Digital Inclusion Team during the COVID-19 pandemic. A mixed methods approach was used, encompassing quantitative and qualitative data collection on demand, reach, implementation, and potential outcomes. Demographic and qualitative data on the reasons for undertaking or not undertaking the training were collected via telephone interviews during the recruitment process. Digital competency and well-being data were collected via a self-reported survey before and after the intervention. Results: Among the 4485 residents who were offered training, 67 (1.49%) expressed interest, of whom 12 (18%) of the 67 completed the training. The findings indicate a demand for basic digital training among social housing residents. The key findings revolve around the substantial dropout rate among those who were interested in undertaking the training. Barriers were strongly influenced by socioeconomic and health circumstances, reflecting the sociodigital inequalities commonly found in this group. For the training participants, the intervention was acceptable and achieved its goals, demonstrating the potential of tailored, persistent training efforts in overcoming barriers. There were no changes in self-reported well-being or digital competency outcomes (but this was limited by the small sample size). Conclusions: Sociodigital inequalities impact the reach, implementation, and acceptability of telephone-based digital training for social housing residents. Barriers to reaching and training digitally excluded groups can be overcome through the use of trusted intermediaries, personalized recruitment approaches, the minimization of administrative barriers, and tailored and agile training programs. Recognizing the resource-intensive nature of such initiatives, this study calls for enhanced recognition of intermediary efforts in national digital inclusion policies. %M 38277209 %R 10.2196/45506 %U https://formative.jmir.org/2024/1/e45506 %U https://doi.org/10.2196/45506 %U http://www.ncbi.nlm.nih.gov/pubmed/38277209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48880 %T Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study %A Schröder,Sonja %A Buntrock,Claudia %A Neumann,Louisa %A Müller,Jürgen L %A Fromberger,Peter %+ Clinic for Psychiatry and Psychotherapy – Forensic Psychiatry, University Medical Center Göttingen, Rosdorfer Weg 70, Göttingen, 37081, Germany, 49 5514022114, sonja.schroeder@med.uni-goettingen.de %K mHealth %K web-based intervention %K acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K sexual offenses against children %K child abuse %K child pornography %K children %K sexual offense %K cross-sectional study %K community %K anxiety %K psychiatry %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown. Objective: For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry. Methods: This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline. Results: Most participants (61.1%, 69/113), reported high acceptance, while 36.3% (41/113) of them indicated moderate acceptance, and 2.7% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95% CI 0.16-0.64; P=.001) and SI (B=0.183, 95% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants’ belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect. Conclusions: For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants’ attitudes toward web-based interventions were important in predicting acceptance. Trial Registration: German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256 %M 38277200 %R 10.2196/48880 %U https://formative.jmir.org/2024/1/e48880 %U https://doi.org/10.2196/48880 %U http://www.ncbi.nlm.nih.gov/pubmed/38277200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54274 %T Development and Implementation of Digital Diagnostic Algorithms for Neonatal Units in Zimbabwe and Malawi: Development and Usability Study %A Gannon,Hannah %A Larsson,Leyla %A Chimhuya,Simbarashe %A Mangiza,Marcia %A Wilson,Emma %A Kesler,Erin %A Chimhini,Gwendoline %A Fitzgerald,Felicity %A Zailani,Gloria %A Crehan,Caroline %A Khan,Nushrat %A Hull-Bailey,Tim %A Sassoon,Yali %A Baradza,Morris %A Heys,Michelle %A Chiume,Msandeni %+ Population, Policy and Practice, Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, United Kingdom, 44 (0) 20 7905 ext 2600, h.gannon@ucl.ac.uk %K mobile health %K mHealth %K neonatology %K digital health %K mobile apps %K newborn %K Malawi, Zimbabwe %K usability %K clinical decision support %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite an increase in hospital-based deliveries, neonatal mortality remains high in low-resource settings. Due to limited laboratory diagnostics, there is significant reliance on clinical findings to inform diagnoses. Accurate, evidence-based identification and management of neonatal conditions could improve outcomes by standardizing care. This could be achieved through digital clinical decision support (CDS) tools. Neotree is a digital, quality improvement platform that incorporates CDS, aiming to improve neonatal care in low-resource health care facilities. Before this study, first-phase CDS development included developing and implementing neonatal resuscitation algorithms, creating initial versions of CDS to address a range of neonatal conditions, and a Delphi study to review key algorithms. Objective: This second-phase study aims to codevelop and implement neonatal digital CDS algorithms in Malawi and Zimbabwe. Methods: Overall, 11 diagnosis-specific web-based workshops with Zimbabwean, Malawian, and UK neonatal experts were conducted (August 2021 to April 2022) encompassing the following: (1) review of available evidence, (2) review of country-specific guidelines (Essential Medicines List and Standard Treatment Guidelinesfor Zimbabwe and Care of the Infant and Newborn, Malawi), and (3) identification of uncertainties within the literature for future studies. After agreement of clinical content, the algorithms were programmed into a test script, tested with the respective hospital’s health care professionals (HCPs), and refined according to their feedback. Once finalized, the algorithms were programmed into the Neotree software and implemented at the tertiary-level implementation sites: Sally Mugabe Central Hospital in Zimbabwe and Kamuzu Central Hospital in Malawi, in December 2021 and May 2022, respectively. In Zimbabwe, usability was evaluated through 2 usability workshops and usability questionnaires: Post-Study System Usability Questionnaire (PSSUQ) and System Usability Scale (SUS). Results: Overall, 11 evidence-based diagnostic and management algorithms were tailored to local resource availability. These refined algorithms were then integrated into Neotree. Where national management guidelines differed, country-specific guidelines were created. In total, 9 HCPs attended the usability workshops and completed the SUS, among whom 8 (89%) completed the PSSUQ. Both usability scores (SUS mean score 75.8 out of 100 [higher score is better]; PSSUQ overall score 2.28 out of 7 [lower score is better]) demonstrated high usability of the CDS function but highlighted issues around technical complexity, which continue to be addressed iteratively. Conclusions: This study describes the successful development and implementation of the only known neonatal CDS system, incorporated within a bedside data capture system with the ability to deliver up-to-date management guidelines, tailored to local resource availability. This study highlighted the importance of collaborative participatory design. Further implementation evaluation is planned to guide and inform the development of health system and program strategies to support newborn HCPs, with the ultimate goal of reducing preventable neonatal morbidity and mortality in low-resource settings. %M 38277198 %R 10.2196/54274 %U https://formative.jmir.org/2024/1/e54274 %U https://doi.org/10.2196/54274 %U http://www.ncbi.nlm.nih.gov/pubmed/38277198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52200 %T Patient Phenotyping for Atopic Dermatitis With Transformers and Machine Learning: Algorithm Development and Validation Study %A Wang,Andrew %A Fulton,Rachel %A Hwang,Sy %A Margolis,David J %A Mowery,Danielle %+ University of Pennsylvania, A206 Richards Building, 3700 Hamilton Walk, Philadelphia, PA, 19104, United States, 1 2157466677, dlmowery@pennmedicine.upenn.edu %K atopic dermatitis %K classification %K classifier %K dermatitis %K dermatology %K EHR %K electronic health record %K health records %K health %K informatics %K machine learning %K natural language processing %K NLP %K patient phenotyping %K phenotype %K skin %K transformer %K transformers %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Atopic dermatitis (AD) is a chronic skin condition that millions of people around the world live with each day. Performing research into identifying the causes and treatment for this disease has great potential to provide benefits for these individuals. However, AD clinical trial recruitment is not a trivial task due to the variance in diagnostic precision and phenotypic definitions leveraged by different clinicians, as well as the time spent finding, recruiting, and enrolling patients by clinicians to become study participants. Thus, there is a need for automatic and effective patient phenotyping for cohort recruitment. Objective: This study aims to present an approach for identifying patients whose electronic health records suggest that they may have AD. Methods: We created a vectorized representation of each patient and trained various supervised machine learning methods to classify when a patient has AD. Each patient is represented by a vector of either probabilities or binary values, where each value indicates whether they meet a different criteria for AD diagnosis. Results: The most accurate AD classifier performed with a class-balanced accuracy of 0.8036, a precision of 0.8400, and a recall of 0.7500 when using XGBoost (Extreme Gradient Boosting). Conclusions: Creating an automated approach for identifying patient cohorts has the potential to accelerate, standardize, and automate the process of patient recruitment for AD studies; therefore, reducing clinician burden and informing the discovery of better treatment options for AD. %M 38277207 %R 10.2196/52200 %U https://formative.jmir.org/2024/1/e52200 %U https://doi.org/10.2196/52200 %U http://www.ncbi.nlm.nih.gov/pubmed/38277207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46418 %T Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study %A Hiemstra,Madison S %A Reichert,Sonja M %A Mitchell,Marc S %+ School of Kinesiology, Western University, 1151 Richmond Street, Thames Hall, Room TH 3199, London, ON, N6A 3K7, Canada, 1 (519) 661 2111 ext 87936, marc.mitchell@uwo.ca %K activity monitor %K diabetes self-management education %K flash glucose monitor %K glycated hemoglobin %K group education %K HbA1c %K T2D %K type 2 diabetes %K virtual care %K wearables %D 2024 %7 29.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To date, most group-based diabetes self-management education (DSME) programs for type 2 diabetes (T2D) have been delivered in person. The rapid transition to remote care at the outset of the COVID-19 pandemic presented opportunities to test, evaluate, and iterate a new remote DSME program. Objective: We aim to refine the delivery and evaluation of a multicomponent remote DSME program for adults living with T2D by examining several feasibility outcomes. Methods: We recruited a convenience sample of patients from a London, Canada, outpatient diabetes clinic (serving high-risk, low-income adults) to participate in a 6-week, single cohort feasibility study from November 2020 to March 2021. This small ORBIT phase 1b feasibility study represents the first in a planned series guided by the ORBIT model for developing behavioral interventions for chronic diseases (phase 1: design; phase 2: preliminary testing; phase 3: efficacy; and phase 4: effectiveness). The feasibility of delivering and evaluating a remote DSME program, including (1) live video education classes, (2) individualized physical activity (PA) prescription and counseling, and (3) intermittently scanned continuous glucose and wearable PA monitoring, was assessed. Feasibility outcomes included recruitment and retention rates, program adherence, and acceptability (ie, technology issues and exit survey feedback). PA was assessed with Fitbit Inspire 2 (Fitbit Inc) and estimated glycated hemoglobin (HbA1c) using the FreeStyle Libre (Abbot). Given the small study sample, group- and individual-level data are reported descriptively. Results: A total of 10 adults living with T2D were recruited (female 60%; age 49.9, SD 14.3 years; estimated HbA1c 6.2%, SD 0.5%). Recruitment and retention rates were 29% and 80%, respectively. Participants attended 83% (25/30) and 93% (37/40) of education classes and PA counseling phone calls, respectively. There were 3.2 (SD 2.6) technology issues reported per person, most of which were related to study data transfer. Exit survey responses suggest most participants (8/9, 89%) were “satisfied” with the program. Recognizing the small sample size and the fact that no inferential statistics were conducted, the mean (SD) for the weekly daily step count and estimated HbA1c are provided for illustrative purposes. Participants accumulated 7103 (SD 2900) and 7515 (SD 3169) steps per day at baseline and week 6, respectively. The estimated HbA1c was 6.2% (SD 0.5%) and 6.2% (SD 0.6%) at baseline and week 6, respectively. Conclusions: This ORBIT phase 1b study served to refine the delivery (eg, automatic study data upload process recommended to reduce participant burden) and evaluation (eg, purposeful sampling of participants with baseline HbA1c >8% recommended to address selection bias) of a remote DSME program. Preliminary proof-of-concept testing (ORBIT phase 2) incorporating some of these learnings is now warranted. Trial Registration: ClinicalTrials.gov NCT04498819; https://clinicaltrials.gov/study/NCT04498819 %M 38285502 %R 10.2196/46418 %U https://formative.jmir.org/2024/1/e46418 %U https://doi.org/10.2196/46418 %U http://www.ncbi.nlm.nih.gov/pubmed/38285502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49592 %T Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study %A Tran,Karen C %A Mak,Meagan %A Kuyper,Laura M %A Bittman,Jesse %A Mangat,Birinder %A Lindsay,Heather %A Kim Sing,Chad %A Xu,Liang %A Wong,Hubert %A Dawes,Martin %A Khan,Nadia %A Ho,Kendall %+ Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 5181, karen.tran4@vch.ca %K hypertension %K remote-home monitoring %K feasibility study %K health monitor %K telehealth %K pilot study %K mobile phone %K monitoring %K telemonitoring %K blood pressure %K emergency department %K hypertension %K morbidity %K mortality %K primary care %K physician care %K management %K hypertension medication %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Objective: Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Methods: Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient’s condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. Results: A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ≥80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by –13/–5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. Conclusions: HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control. %M 38111177 %R 10.2196/49592 %U https://formative.jmir.org/2024/1/e49592 %U https://doi.org/10.2196/49592 %U http://www.ncbi.nlm.nih.gov/pubmed/38111177 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45659 %T Acceptability of a Self-Led Mindfulness-Based Intervention for Teens with Type 1 Diabetes: Pilot Randomized Controlled Trial %A Humiston,Tori %A Cummings,Caroline %A Suss,Stephen %A Cohen,Laura B %A Hazlett-Stevens,Holly %A Hughes Lansing,Amy %+ Department of Psychological Sciences, University of Vermont, 2 Colchester Ave, Burlington, VT, 05401, United States, 1 8026562670, tori.humiston@uvm.edu %K adolescents %K diabetes distress %K diabetes %K health group intervention %K intervention %K mindfulness %K psychosocial intervention %K self-led mindfulness %K type 1 diabetes %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes distress among adolescents with type 1 diabetes has been associated with suboptimal diabetes outcomes, including lower quality of life, increased diabetes self-management challenges, and suboptimal glycemic outcomes. Objective: This study examined the feasibility and acceptability of a scalable self-led mindfulness-based intervention to reduce diabetes distress in adolescents with type 1 diabetes. Methods: Adolescents (N=25) aged between 14 and 18 years diagnosed with type 1 diabetes completed a baseline assessment. Participants were randomized to receive a 10-week self-guided mindfulness-based stress reduction workbook program (e-book or paper option) immediately (n=15) or after a 10-week wait (n=10). During the intervention period, participants completed weekly assignments and feedback surveys. At 10 weeks and 20 weeks, follow-up assessments were completed. Results: Findings indicated that participants did not find the original intervention feasible or acceptable. Adolescents reported barriers to completing the weekly material, such as that they forgot or that the material was not sufficiently related to their diabetes management. Adolescents also reported that a digital format rather than a workbook or e-book may be more acceptable. Results from weekly surveys provided the foundation for recommendations for future iterations of the mindfulness-based intervention for adolescents with type 1 diabetes. Conclusions: Participant feedback informed recommendations for self-led mindfulness programs for youth with type 1 diabetes. Adolescents indicated that a shorter, digital mindfulness-based intervention focused on diabetes-specific behaviors may be more helpful. Trial Registration: ClinicalTrials.gov NCT05115175; https://clinicaltrials.gov/study/NCT05115175 %M 38289663 %R 10.2196/45659 %U https://formative.jmir.org/2024/1/e45659 %U https://doi.org/10.2196/45659 %U http://www.ncbi.nlm.nih.gov/pubmed/38289663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49561 %T “I Just Wanted a Dentist in My Phone”—Designing Evidence-Based mHealth Prototype to Improve Preschool Children’s Oral and Dental Health: Multimethod Study of the Codevelopment of an App for Children’s Teeth %A Al-yaseen,Waraf %A Raggio,Daniela Procida %A Araujo,Mariana %A Innes,Nicola %+ School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom, 44 07413162068, Al-yaseenw1@cardiff.ac.uk %K oral health promotion %K mobile health %K mHealth %K children %K oral health %K behavior change %K coproduction %K mobile phone %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dental caries in preschool children is a global health concern. With increased access to technology and the disruption of health care during the pandemic, mobile health apps have been of interest as potential vehicles for individuals’ health maintenance. However, little is known about caring for their child’s teeth and what their preferences would be regarding the content or design of an oral health app. Objective: This study aims to co-design the prototype of an app named App for Children’s Teeth with parents, providing a source of information for them about caring for their children’s teeth and promoting positive dental habits. Methods: This multimethod study conducted user involvement research with a purposive sample of parents or carers of children aged ≤6 years to (1) understand their use of the internet through the eHealth Literacy Scale and interviews, (2) determine their opinions about content related to children’s oral health, and (3) collect feedback about the app’s acceptability using the Theoretical Framework of Acceptability. There were three stages: (1) interviews with parents to understand their needs, preferences, and abilities; (2) prototype design with app developers; and (3) parent feedback interviews using the think aloud method for data collection. Data were deductively analyzed using a codebook strategy, whereas data from the think aloud sessions were analyzed inductively using reflexive thematic analysis. Results: The prototype design stage involved 10 parents who reported using the internet for health information but found it to be scattered and contradictory. Parents generally welcomed the App for Children’s Teeth but expressed concerns about screen time and practicality. They suggested guidance regarding oral hygiene practices, teething symptoms, and pain relief. Parents appreciated features such as clear fonts, categorization according to their child’s age, and “In a Nutshell” bullet points. Topics that resonated with parents included information about teething, finding a dentist, and breastfeeding. They believed that the app aligned with their goals and offered suggestions for future developments, such as outlining the process of finding a dentist and incorporating a forum for parents to communicate and exchange ideas. Conclusions: The coproduction design approach highlighted parents’ need for solutions such as mobile health apps to access reliable information about oral health. Parents identified key design concepts for the app, including a simple and uncluttered interface, content categorization according to their child’s age, and practical guidance supported by visual aids. Despite potential challenges related to screen time restrictions, parents provided insights into how such an app could fit seamlessly into their lives. Trial Registration: Open Science Framework; https://osf.io/uj9az %M 38289667 %R 10.2196/49561 %U https://formative.jmir.org/2024/1/e49561 %U https://doi.org/10.2196/49561 %U http://www.ncbi.nlm.nih.gov/pubmed/38289667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53439 %T Administrative Dashboard for Monitoring Use of a Web-Based Parent Training Intervention: Usability Study %A Breitenstein,Susan M %A Berteletti,Julia %A Smoske,Shea %A Barger,Charles %A Tipps,Kyrie %A Helsabeck,Nathan P %+ College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, United States, 1 6146884614, breitenstein.5@osu.edu %K usability %K development %K dashboard %K portal %K implementation %K design %K System Usability Scale %K internet-based intervention %K parents %K parent %K child %K children %K web-based %K web-based parent training %K PT %K descriptive survey %K single group %K survey %K system usability %K ezParent %K videoconference %K information %K reviews on usage %K improvement %K qualitative %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based parent training (PT) programs can strengthen parent-child relationships by equipping caregivers with knowledge and evidence-based strategies to manage behavior. Hybrid facilitation of PT includes facilitator interaction paired with self-administered and web-based PT. Web-based administrative dashboards provide users (eg, administrators, facilitators, and researchers) with an integrated platform to monitor parent progress and activities within a PT program or website. Despite the utility and prevalence of administrative dashboards for web-based behavioral interventions, to our knowledge, no research studies have explored the perspectives and insights of dashboard users to enhance user experience and program delivery. Objective: The purpose of this study is to evaluate the usability of the administrative dashboard (ezDashboard) for the ezParent program, a 6-module web-based PT program for parents of children aged 2-5 years. Methods: This study used a descriptive, single-group design with administrators who were overseeing the implementation of the ezParent program and trained facilitators for hybrid ezParent delivery. Participants spent at least 30 minutes reviewing and evaluating the ezDashboard and then completed a survey of their experience with the dashboard. The survey included the validated 10-item System Usability Scale and open-ended questions focusing on user performance, navigation ease, and overall usefulness of the ezDashboard. Results: Participants (N=15) indicated high usability of the ezDashboard with System Usability Scale scoring a total mean score of 83.5 (SD 16.3). Most participants (n=13, 87%) rated the overall user-friendliness of the ezDashboard as good (n=3, 20%), excellent (n=9, 60%), or best imaginable (n=1, 7%). Open-ended questions revealed the ezDashboard is or would be useful to monitor parent progress and trends in engagement (n=8, 53%) and for reviewing topics for discussion and communicating with parents (n=5, 33%). ezParent administrators (n=4) identified that real-time data for ezParent use helps overall management of program uptake. Suggestions for features to add to the ezDashboard included the ability to track partial progress of program modules (4/14, 29%), total time spent per module (2/14, 14%), and exportable reports (4/14, 29%). Other ideas for improvement included direct messaging capabilities, videoconferencing platform integration, and being able to modify participant account and contact information. Conclusions: Results indicate that the ezDashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Qualitative results indicate that integrating suggested features into the ezDashboard may help provide a smoother experience for facilitators, administrators, and ultimately the parents using the program. Providing resources for facilitators and administrators in real time to monitor intervention participants’ progress in a program can be helpful in tracking progress and providing facilitated support in tailoring program content and program completion. %M 38289675 %R 10.2196/53439 %U https://formative.jmir.org/2024/1/e53439 %U https://doi.org/10.2196/53439 %U http://www.ncbi.nlm.nih.gov/pubmed/38289675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54132 %T Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study %A Landry,Caeleigh A %A McCall,Hugh C %A Beahm,Janine D %A Titov,Nickolai %A Dear,Blake %A Carleton,R Nicholas %A Hadjistavropoulos,Heather D %+ Department of Psychology, University of Regina, Administration-Humanities, AH 345, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, heather.hadjistavropoulos@uregina.ca %K public safety personnel %K PSP %K internet therapy %K mindfulness %K meditation %K internet-delivered cognitive behavioral therapy %K iCBT %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Public safety personnel (PSP) are individuals who work to ensure the safety and security of communities (eg, correctional workers, firefighters, paramedics, and police officers). PSP have a high risk of developing mental disorders and face unique barriers to traditional mental health treatments. The PSP Wellbeing Course is a transdiagnostic, internet-delivered cognitive behavioral therapy (iCBT) course tailored to assist PSP with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The initial course outcomes are promising, but some clients report some challenges with learning skills and recommend adding additional resources. Mindfulness meditations, which help people to experience the world and their reactions to the world in open and nonjudgmental ways, may complement the existing PSP Wellbeing Course. Objective: This study aims to examine the feasibility of mindfulness meditations in iCBT tailored for PSP. Information was gathered to evaluate engagement and client experiences with mindfulness meditations, symptom change, and the relationship between mindfulness meditation use and symptom change. Methods: A mixed methods study was conducted on PSP enrolled in the PSP Wellbeing Course who were offered 5 mindfulness meditations during the program (ie, 1/lesson). Clients completed questionnaires on depression, anxiety, PTSD, anger, insomnia, resilience, and mindfulness at pretreatment and at 8 weeks; an 8-week treatment satisfaction questionnaire; and brief weekly measures of mindfulness meditation engagement. We used paired sample t tests (2-tailed) to assess changes in outcomes over time and partial correlations to assess whether mindfulness meditation use predicted outcomes at posttreatment. A total of 12 clients were interviewed about their perceptions of the mindfulness meditations, and interviews were analyzed using directed content analysis. Results: Among the 40 clients enrolled, 27 (68%) reported using the mindfulness meditations, practicing for an average of 4.8 (SD 8.1) minutes each week. Most interviewees described the mindfulness meditations as beneficial but also reported challenges, such as discomfort while sitting with their feelings. Clients provided suggestions for better integration of mindfulness into iCBT. Overall, clients who completed the PSP Wellbeing Course with mindfulness meditations experienced statistically significant improvements in symptoms of anxiety (P=.001), depression (P=.001), PTSD (P=.001), and anger (P=.001) but not insomnia (P=.02). Clients also experienced improvements in resilience (P=.01) and mindfulness (P=.001). Self-reported time spent meditating was not associated with changes in symptoms over time. Conclusions: This study provides new insight into the integration of mindfulness meditations with iCBT for PSP. It demonstrates the partial feasibility of adding mindfulness meditations to iCBT, revealing that some, but not all, PSP engaged with the meditations and reported benefits. PSP reported using the mindfulness meditations inconsistently and described challenges with the meditations. Improvements can be made to better integrate mindfulness meditation into iCBT, including offering mindfulness meditation as an optional resource, providing more psychoeducation on managing challenges, and offering shorter meditations. %M 38289655 %R 10.2196/54132 %U https://formative.jmir.org/2024/1/e54132 %U https://doi.org/10.2196/54132 %U http://www.ncbi.nlm.nih.gov/pubmed/38289655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43286 %T Formative Evaluation of a Comprehensive Self-Management Intervention for Irritable Bowel Syndrome, Comorbid Anxiety, and Depression: Mixed Methods Study %A Kamp,Kendra %A Yang,Pei-Lin %A Friedman,Emily %A Lopez,Alejandra %A Iribarren,Sarah %A Barney,Pamela %A Munson,Sean %A Heitkemper,Margaret %A Levy,Rona %+ Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, United States, 1 206 221 4617, kamp@uw.edu %K acceptability %K anxiety %K depression %K design %K effectiveness %K feasibility %K implementation %K intervention %K irritable bowel syndrome %K management %K mixed methods %K patient %K self-management %K support %K usability %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Irritable bowel syndrome (IBS) is a disorder of the gut-brain interaction that is associated with abdominal pain, altered bowel patterns, and reduced quality of life. Up to 50% of patients with IBS also report anxiety or depressive symptoms. Although effective self-management interventions exist for individuals with IBS, few have been effectively implemented, and most do not consider the unique needs of patients with comorbid IBS and anxiety or depression. Objective: This study aimed to determine the anticipated acceptability, appropriateness, feasibility, and usability of a comprehensive self-management intervention using an implementation science and human-centered design approach among individuals with comorbid IBS and anxiety or depression and health care providers. Methods: A convergent mixed methods design was used to elicit feedback on the comprehensive self-management intervention outline and content to identify refinement needs before testing. Patients with IBS and moderate to severe anxiety or depression and health care providers were purposefully sampled from primary care and gastroenterology settings. Participants completed semistructured interviews and surveys on anticipated acceptability, appropriateness, feasibility, and usability. Results: Patient participants (n=12) were on average 36.8 (SD 12.2) years of age, and 42% (5/12) were currently receiving psychological therapy. Health care providers (n=14) were from primary care (n=7) and gastroenterology (n=7) settings. The mean usability scores (out of 100) were 52.5 (SD 14.5) for patients and 45.6 (SD 11.6) for providers. For patients and providers, qualitative data expanded the quantitative findings for acceptability and appropriateness. Acceptability findings were the comprehensive nature of the intervention and discussion of the gut-brain interaction. For appropriateness, participants reported that the intervention provided structure, accountability, and support. Feasibility was confirmed for patients, but there was a divergence of findings between quantitative and qualitative measures for providers. Patients focused on intervention feasibility, while providers focused on implementation feasibility in the clinic. Identified usability issues to address before implementation included the intervention delivery format, length, and lack of integration into health care settings that, if not addressed, may limit the reach of the intervention. Conclusions: Patients and health care providers found the intervention acceptable and appropriate. Several feasibility and usability issues were identified, including intervention delivery methods, length of intervention, and the best methods to implement in the clinic setting. The next steps are to refine the intervention to address the identified issues and test in a pilot study whether addressing usability issues leads to the anticipated improvements in implementation and uptake. %M 38294871 %R 10.2196/43286 %U https://formative.jmir.org/2024/1/e43286 %U https://doi.org/10.2196/43286 %U http://www.ncbi.nlm.nih.gov/pubmed/38294871 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51571 %T Investigating the Potential of a Conversational Agent (Phyllis) to Support Adolescent Health and Overcome Barriers to Physical Activity: Co-Design Study %A Moore,Richard %A Al-Tamimi,Abdel-Karim %A Freeman,Elizabeth %+ Sheffield Hallam University, Sport and Physical Activity Research Centre / Advanced Wellbeing Research Centre, Sheffield Hallam University, Olympic Legacy Park, 2 Old Hall Road, Advanced Wellbeing Research Centre, Sheffield, S9 3TU, United Kingdom, 44 7751234185, r.moore@shu.ac.uk %K physical activity %K inactivity %K conversational agent %K CA %K adolescent %K public health %K digital health interventions %K mobile phone %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Conversational agents (CAs) are a promising solution to support people in improving physical activity (PA) behaviors. However, there is a lack of CAs targeted at adolescents that aim to provide support to overcome barriers to PA. This study reports the results of the co-design, development, and evaluation of a prototype CA called “Phyllis” to support adolescents in overcoming barriers to PA with the aim of improving PA behaviors. The study presents one of the first theory-driven CAs that use existing research, a theoretical framework, and a behavior change model. Objective: The aim of the study is to use a mixed methods approach to investigate the potential of a CA to support adolescents in overcoming barriers to PA and enhance their confidence and motivation to engage in PA. Methods: The methodology involved co-designing with 8 adolescents to create a relational and persuasive CA with a suitable persona and dialogue. The CA was evaluated to determine its acceptability, usability, and effectiveness, with 46 adolescents participating in the study via a web-based survey. Results: The co-design participants were students aged 11 to 13 years, with a sex distribution of 56% (5/9) female and 44% (4/9) male, representing diverse ethnic backgrounds. Participants reported 37 specific barriers to PA, and the most common barriers included a “lack of confidence,” “fear of failure,” and a “lack of motivation.” The CA’s persona, named “Phyllis,” was co-designed with input from the students, reflecting their preferences for a friendly, understanding, and intelligent personality. Users engaged in 61 conversations with Phyllis and reported a positive user experience, and 73% of them expressed a definite intention to use the fully functional CA in the future, with a net promoter score indicating a high likelihood of recommendation. Phyllis also performed well, being able to recognize a range of different barriers to PA. The CA’s persuasive capacity was evaluated in modules focusing on confidence and motivation, with a significant increase in students’ agreement in feeling confident and motivated to engage in PA after interacting with Phyllis. Adolescents also expect to have a personalized experience and be able to personalize all aspects of the CA. Conclusions: The results showed high acceptability and a positive user experience, indicating the CA’s potential. Promising outcomes were observed, with increasing confidence and motivation for PA. Further research and development are needed to create further interventions to address other barriers to PA and assess long-term behavior change. Addressing concerns regarding bias and privacy is crucial for achieving acceptability in the future. The CA’s potential extends to health care systems and multimodal support, providing valuable insights for designing digital health interventions including tackling global inactivity issues among adolescents. %M 38294857 %R 10.2196/51571 %U https://formative.jmir.org/2024/1/e51571 %U https://doi.org/10.2196/51571 %U http://www.ncbi.nlm.nih.gov/pubmed/38294857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54253 %T Improvements in Adolescents’ Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study %A Huffman,Landry Goodgame %A Lawrence-Sidebottom,Darian %A Beam,Aislinn Brenna %A Parikh,Amit %A Guerra,Rachael %A Roots,Monika %A Huberty,Jennifer %+ Bend Health Inc, 2810 Marshall Ct, Madison, WI, 53705, United States, 1 8005160975, darian.lawrence@bendhealth.com %K behavioral care %K mental health %K web-based coaching %K web-based therapy %K eating disorders %K eating %K anorexia %K coach %K coaching %K pediatric %K pediatrics %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K digital mental health intervention %K DMHI %K collaborative %K digital health %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors. Objective: This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents’ disordered eating behaviors. Methods: Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care. Results: Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001). Conclusions: Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms. %M 38294855 %R 10.2196/54253 %U https://formative.jmir.org/2024/1/e54253 %U https://doi.org/10.2196/54253 %U http://www.ncbi.nlm.nih.gov/pubmed/38294855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49497 %T Data Representation Structure to Support Clinical Decision-Making in the Pediatric Intensive Care Unit: Interview Study and Preliminary Decision Support Interface Design %A Yakob,Najia %A Laliberté,Sandrine %A Doyon-Poulin,Philippe %A Jouvet,Philippe %A Noumeir,Rita %+ Pediatric Intensive Care Unit, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada, 1 514 345 4927, philippe.jouvet@umontreal.ca %K data representation %K decision support %K critical care %K clinical workflow %K clinical decision-making %K prototype %K design %K intensive care unit %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical decision-making is a complex cognitive process that relies on the interpretation of a large variety of data from different sources and involves the use of knowledge bases and scientific recommendations. The representation of clinical data plays a key role in the speed and efficiency of its interpretation. In addition, the increasing use of clinical decision support systems (CDSSs) provides assistance to clinicians in their practice, allowing them to improve patient outcomes. In the pediatric intensive care unit (PICU), clinicians must process high volumes of data and deal with ever-growing workloads. As they use multiple systems daily to assess patients’ status and to adjust the health care plan, including electronic health records (EHR), clinical systems (eg, laboratory, imaging and pharmacy), and connected devices (eg, bedside monitors, mechanical ventilators, intravenous pumps, and syringes), clinicians rely mostly on their judgment and ability to trace relevant data for decision-making. In these circumstances, the lack of optimal data structure and adapted visual representation hinder clinician’s cognitive processes and clinical decision-making skills. Objective: In this study, we designed a prototype to optimize the representation of clinical data collected from existing sources (eg, EHR, clinical systems, and devices) via a structure that supports the integration of a home-developed CDSS in the PICU. This study was based on analyzing end user needs and their clinical workflow. Methods: First, we observed clinical activities in a PICU to secure a better understanding of the workflow in terms of staff tasks and their use of EHR on a typical work shift. Second, we conducted interviews with 11 clinicians from different staff categories (eg, intensivists, fellows, nurses, and nurse practitioners) to compile their needs for decision support. Third, we structured the data to design a prototype that illustrates the proposed representation. We used a brain injury care scenario to validate the relevance of integrated data and the utility of main functionalities in a clinical context. Fourth, we held design meetings with 5 clinicians to present, revise, and adapt the prototype to meet their needs. Results: We created a structure with 3 levels of abstraction—unit level, patient level, and system level—to optimize clinical data representation and display for efficient patient assessment and to provide a flexible platform to host the internally developed CDSS. Subsequently, we designed a preliminary prototype based on this structure. Conclusions: The data representation structure allows prioritizing patients via criticality indicators, assessing their conditions using a personalized dashboard, and monitoring their courses based on the evolution of clinical values. Further research is required to define and model the concepts of criticality, problem recognition, and evolution. Furthermore, feasibility tests will be conducted to ensure user satisfaction. %M 38300695 %R 10.2196/49497 %U https://formative.jmir.org/2024/1/e49497 %U https://doi.org/10.2196/49497 %U http://www.ncbi.nlm.nih.gov/pubmed/38300695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49616 %T Comparison of Blended Learning With Traditional Dermatology Learning for Medical Students: Prospective Evaluation Study %A Silva,Cristiana Silveira %A Vasconcellos,Cidia %A Souza,Murilo Barreto %A Fernandes,Juliana Dumet %A Rego,Vitoria Regina Pedreira de Almeida %+ Department of Dermatology, Federal University of Bahia, Av. Milton Santos, s/nº - Ondina, Salvador, BA, 40170-110, Brazil, 55 7133362850, silveira.cristiana@gmail.com %K dermatology %K distance education %K distance learning %K e-learning %K medical education %K undergraduate medical education %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Novel internet-based applications and associated technologies have influenced all aspects of society, ranging from commerce and business to entertainment and health care, and education is no exception. In this context, this study was designed to evaluate the impact of a dermatology e-learning program on the academic performance of medical students in dermatology. Objective: The aim of this study is to develop a dermatology blended-learning course for undergraduate medical students, evaluate the knowledge gained by students exposed to this course, and compare the results to those of traditional teaching methods. Methods: In this prospective study, we evaluated the performance of fourth-semester medical students at the Federal University of Bahia, Brazil. Students who had been in their second year of the medical course in 2019 were considered the control group, while students in their second year in 2020 were considered the blended or hybrid group. The first group attended traditional classes, using printed material (books and handouts), while the second group used our web-based course and e-book as a supplement in a hybrid web-plus-traditional fashion. Neither participants nor evaluators were blinded. The students in both groups were subjected to the same pre- and postcourse face-to-face, multiple-choice, paper-based evaluations, and we compared their performances. The content of the classes was the same for both groups. All didactic activities were developed by a team of certified dermatologists and professors from the university. Results: A total of 129 students were selected and divided into 2 groups: the control group (n=57) and the hybrid group (n=72). The precourse tests did not indicate any difference between the control group (mean score 2.74, SD 1.25) and the hybrid group (mean score 3.2, SD 1.22 SD; P>.05). The hybrid group had better final-term grades (mean 8.18, SD 1.26) than the traditional group (mean 7.11, SD 1.04). This difference was statistically significant (P<.05). Conclusions: This study explores pedagogical possibilities in the field of dermatology teaching for medical school students. The results suggest that the performance of undergraduate students who attended the course with additional e-learning material was superior when compared to the performance of those who participated in the traditional course alone. %M 38300698 %R 10.2196/49616 %U https://formative.jmir.org/2024/1/e49616 %U https://doi.org/10.2196/49616 %U http://www.ncbi.nlm.nih.gov/pubmed/38300698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51021 %T Support for Chronic Pain Management for Breast Cancer Survivors Through Novel Digital Health Ecosystems: Pilot Usability Study of the PainRELife Mobile App %A Masiero,Marianna %A Filipponi,Chiara %A Fragale,Elisa %A Pizzoli,Silvia Francesca Maria %A Munzone,Elisabetta %A Milani,Alessandra %A Guido,Luca %A Guardamagna,Vittorio %A Marceglia,Sara %A Prandin,Roberto %A Prenassi,Marco %A Caruso,Annamaria %A Manzelli,Vania %A Savino,Chiara %A Conti,Costanza %A Rizzi,Federica %A Casalino,Alice %A Candiani,Giulia %A Memini,Francesca %A Chiveri,Luca %A Vitali,Andrea Luigi %A Corbo,Massimo %A Grasso,Roberto %A Didier,Florence %A Ferrucci,Roberta %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372009, marianna.masiero@unimi.it %K chronic pain %K eHealth %K cancer %K decision-making %K survivorship %K self-efficacy %K pain %K oncology %K health ecosystem %K health ecosystems %K breast %K survivor %K survivors %K mHealth %K mobile health %K app %K apps %K applications %K MARS %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is one of the most common and critical long-term effects of breast cancer. Digital health technologies enhance the management of chronic pain by monitoring physical and psychological health status and supporting pain self-management and patient treatment decisions throughout the clinical pathway. Objective: This pilot study aims to evaluate patients’ experiences, including usability, with a novel digital integrated health ecosystem for chronic pain named PainRELife. The sample included patients with breast cancer during survivorship. The PainRELife ecosystem comprises a cloud technology platform interconnected with electronic health records and patients' devices to gather integrated health care data. Methods: We enrolled 25 patients with breast cancer (mean age 47.12 years) experiencing pain. They were instructed to use the PainRELife mobile app for 3 months consecutively. The Mobile Application Rating Scale (MARS) was used to evaluate usability. Furthermore, pain self-efficacy and participation in treatment decisions were evaluated. The study received ethical approval (R1597/21-IEO 1701) from the Ethical Committee of the European Institute of Oncology. Results: The MARS subscale scores were medium to high (range: 3.31-4.18), and the total app quality score was 3.90. Patients with breast cancer reported reduced pain intensity at 3 months, from a mean of 5 at T0 to a mean of 3.72 at T2 (P=.04). The total number of times the app was accessed was positively correlated with pain intensity at 3 months (P=.03). The engagement (P=.03), information (P=.04), and subjective quality (P=.007) subscales were positively correlated with shared decision-making. Furthermore, participants with a lower pain self-efficacy at T2 (mean 40.83) used the mobile app more than participants with a higher pain self-efficacy (mean 48.46; P=.057). Conclusions: The data collected in this study highlight that digital health technologies, when developed using a patient-driven approach, might be valuable tools for increasing participation in clinical care by patients with breast cancer, permitting them to achieve a series of key clinical outcomes and improving quality of life. Digital integrated health ecosystems might be important tools for improving ongoing monitoring of physical status, psychological burden, and socioeconomic issues during the cancer survivorship trajectory. International Registered Report Identifier (IRRID): RR2-10.2196/41216 %M 38306176 %R 10.2196/51021 %U https://formative.jmir.org/2024/1/e51021 %U https://doi.org/10.2196/51021 %U http://www.ncbi.nlm.nih.gov/pubmed/38306176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52560 %T Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial %A Laird,Breanne %A Zuniga,Sabrina %A Hook,Joshua N %A Van Tongeren,Daryl R %A Joeman,Lynda %A Huberty,Jennifer %+ Pray, Inc, 4607 Lakeview Canyon Rd #456, Westlack Village, CA, 91361, United States, 1 9095574002, breanne.laird@pray.com %K religion %K spirituality %K mobile apps %K mental health %K well-being %K app %K ethnic %K technology %K engagement %K stress %K depression %K anxiety %K quality of life %K spiritual well-being %K racial %K spiritual practices %K spiritual practice %K mobile phone %K mobile health %K mHealth %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. Objective: This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. Methods: This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. Results: Participants reported (54/72, 75% responded with “very likely” or “likely” to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. Conclusions: This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted. %M 38306173 %R 10.2196/52560 %U https://formative.jmir.org/2024/1/e52560 %U https://doi.org/10.2196/52560 %U http://www.ncbi.nlm.nih.gov/pubmed/38306173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46746 %T Attitudes Toward School-Based Surveillance of Adolescents’ Social Media Activity: Convergent Parallel Mixed Methods Survey %A Burke,Colin %A Triplett,Cynthia %A Rubanovich,Caryn Kseniya %A Karnaze,Melissa M %A Bloss,Cinnamon S %+ Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive MC0811, La Jolla, CA, 92093-0811, United States, 1 (858) 534 2230, cbloss@eng.ucsd.edu %K social media %K surveillance %K privacy %K public health %K students %K schools %K social media monitoring %K SMM %K school safety %K mental health %K adolescents %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults’ overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. %M 38319696 %R 10.2196/46746 %U https://formative.jmir.org/2024/1/e46746 %U https://doi.org/10.2196/46746 %U http://www.ncbi.nlm.nih.gov/pubmed/38319696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46824 %T Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study %A Yu,Chou Chuen %A Tou,Nien Xiang %A Low,James Alvin %+ Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore, 65 68078024, yu.chou.chuen@geri.com.sg %K COVID-19 %K digital divide %K well-being %K older adults %K information and communication technology %K internet of things %K online %K mental health %K lockdown %K depression %K stress %K anxiety %K digital technology %K pandemic %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. %M 38319700 %R 10.2196/46824 %U https://formative.jmir.org/2024/1/e46824 %U https://doi.org/10.2196/46824 %U http://www.ncbi.nlm.nih.gov/pubmed/38319700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47372 %T Explainable Machine Learning Classification to Identify Vulnerable Groups Among Parenting Mothers: Web-Based Cross-Sectional Questionnaire Study %A Hanai,Akiko %A Ishikawa,Tetsuo %A Sugao,Shoko %A Fujii,Makoto %A Hirai,Kei %A Watanabe,Hiroko %A Matsuzaki,Masayo %A Nakamoto,Goji %A Takeda,Toshihiro %A Kitabatake,Yasuji %A Itoh,Yuichi %A Endo,Masayuki %A Kimura,Tadashi %A Kawakami,Eiryo %+ Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, W507/509 West Research Building,, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, 230-0045, Japan, 81 455039455, tetsuo.ishikawa@riken.jp %K explainable machine-learning %K unsupervised clustering %K perceived support %K resilience %K adaptation %K mother’s health %K mobile phone %K machine learning %K web-based %K parenting %K postpartum %K antenatal %K survey %K mother %K women %K newborn %K psychosocial %K infant %K parents %K children %K depression %K digital health %K maternal %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: One life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. Objective: This study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. Methods: A web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. Results: A total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child’s temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. Conclusions: The classifier, based on a combination of resilience and adaptation to the child’s temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality. %M 38324356 %R 10.2196/47372 %U https://formative.jmir.org/2024/1/e47372 %U https://doi.org/10.2196/47372 %U http://www.ncbi.nlm.nih.gov/pubmed/38324356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50561 %T Tumor Immunotherapy–Related Information on Internet-Based Videos Commonly Used by the Chinese Population: Content Quality Analysis %A Ni,Chen-xu %A Fei,Yi-bo %A Wu,Ran %A Cao,Wen-xiang %A Liu,Wenhao %A Huang,Fang %A Shen,Fu-ming %A Li,Dong-jie %+ Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, China, 86 021 66302570, djli@tongji.edu.cn %K immunotherapy %K internet videos %K quality %K misinformation %K health informatics %K Chinese %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tumor immunotherapy is an innovative treatment today, but there are limited data on the quality of immunotherapy information on social networks. Dissemination of misinformation through the internet is a major social issue. Objective: Our objective was to characterize the quality of information and presence of misinformation about tumor immunotherapy on internet-based videos commonly used by the Chinese population. Methods: Using the keyword “tumor immunotherapy” in Chinese, we searched TikTok, Tencent, iQIYI, and BiliBili on March 5, 2022. We reviewed the 118 screened videos using the Patient Education Materials Assessment Tool—a validated instrument to collect consumer health information. DISCERN quality criteria and the JAMA (Journal of the American Medical Association) Benchmark Criteria were used for assessing the quality and reliability of the health information. The videos’ content was also evaluated. Results: The 118 videos about tumor immunotherapy were mostly uploaded by channels dedicated to lectures, health-related animations, and interviews; their median length was 5 minutes, and 79% of them were published in and after 2018. The median understandability and actionability of the videos were 71% and 71%, respectively. However, the quality of information was moderate to poor on the validated DISCERN and JAMA assessments. Only 12 videos contained misinformation (score of >1 out of 5). Videos with a doctor (lectures and interviews) not only were significantly less likely to contain misinformation but also had better quality and a greater forwarding number. Moreover, the results showed that more than half of the videos contain little or no content on the risk factors and management of tumor immunotherapy. Overall, over half of the videos had some or more information on the definition, symptoms, evaluation, and outcomes of tumor immunotherapy. Conclusions: Although the quality of immunotherapy information on internet-based videos commonly used by Chinese people is moderate, these videos have less misinformation and better content. Caution must be exercised when using these videos as a source of tumor immunotherapy–related information. %M 38324352 %R 10.2196/50561 %U https://formative.jmir.org/2024/1/e50561 %U https://doi.org/10.2196/50561 %U http://www.ncbi.nlm.nih.gov/pubmed/38324352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54299 %T Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App %A Young,Stephanie Ruth %A Dworak,Elizabeth McManus %A Byrne,Greg Joseph %A Jones,Callie Madison %A Yao,Lihua %A Yoshino Benavente,Julia Noelani %A Diaz,Maria Varela %A Curtis,Laura %A Gershon,Richard %A Wolf,Michael %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue 21st Floor, Chicago, IL, 60611-3008, United States, 1 3125033303, stephanieruth.young@northwestern.edu %K cognitive screening %K cognitive %K cognition %K psychometric %K usability %K feasibility %K early detection %K dementia %K Alzheimer’s disease, Alzheimer's %K Alzheimer’s disease and age-related dementia %K mHealth, mobile health apps %K detection %K screening %K mobile health %K mobile phone %K app %K apps %K applications %K applications %K user experience %K smartphone %K smartphones %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians’ ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics’ time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? Methods: A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. Results: All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants’ rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants’ abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Conclusions: Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia. %M 38324368 %R 10.2196/54299 %U https://formative.jmir.org/2024/1/e54299 %U https://doi.org/10.2196/54299 %U http://www.ncbi.nlm.nih.gov/pubmed/38324368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e32690 %T Vision-Language Model for Generating Textual Descriptions From Clinical Images: Model Development and Validation Study %A Ji,Jia %A Hou,Yongshuai %A Chen,Xinyu %A Pan,Youcheng %A Xiang,Yang %+ Peng Cheng Laboratory, No. 2 Xingke 1st Street, Shenzhen, 518000, China, 86 18566668732, panyoucheng4@gmail.com %K clinical image %K radiology report generation %K vision-language model %K multistage fine-tuning %K prior knowledge %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The automatic generation of radiology reports, which seeks to create a free-text description from a clinical radiograph, is emerging as a pivotal intersection between clinical medicine and artificial intelligence. Leveraging natural language processing technologies can accelerate report creation, enhancing health care quality and standardization. However, most existing studies have not yet fully tapped into the combined potential of advanced language and vision models. Objective: The purpose of this study was to explore the integration of pretrained vision-language models into radiology report generation. This would enable the vision-language model to automatically convert clinical images into high-quality textual reports. Methods: In our research, we introduced a radiology report generation model named ClinicalBLIP, building upon the foundational InstructBLIP model and refining it using clinical image-to-text data sets. A multistage fine-tuning approach via low-rank adaptation was proposed to deepen the semantic comprehension of the visual encoder and the large language model for clinical imagery. Furthermore, prior knowledge was integrated through prompt learning to enhance the precision of the reports generated. Experiments were conducted on both the IU X-RAY and MIMIC-CXR data sets, with ClinicalBLIP compared to several leading methods. Results: Experimental results revealed that ClinicalBLIP obtained superior scores of 0.570/0.365 and 0.534/0.313 on the IU X-RAY/MIMIC-CXR test sets for the Metric for Evaluation of Translation with Explicit Ordering (METEOR) and the Recall-Oriented Understudy for Gisting Evaluation (ROUGE) evaluations, respectively. This performance notably surpasses that of existing state-of-the-art methods. Further evaluations confirmed the effectiveness of the multistage fine-tuning and the integration of prior information, leading to substantial improvements. Conclusions: The proposed ClinicalBLIP model demonstrated robustness and effectiveness in enhancing clinical radiology report generation, suggesting significant promise for real-world clinical applications. %M 38329788 %R 10.2196/32690 %U https://formative.jmir.org/2024/1/e32690 %U https://doi.org/10.2196/32690 %U http://www.ncbi.nlm.nih.gov/pubmed/38329788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38891 %T A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort %A Gannamani,Rahul %A Castela Forte,José %A Folkertsma,Pytrik %A Hermans,Sven %A Kumaraswamy,Sridhar %A van Dam,Sipko %A Chavannes,Niels %A van Os,Hendrikus %A Pijl,Hanno %A Wolffenbuttel,Bruce H R %+ Ancora Health BV, Hereplein 34, Groningen, 9711LM, Netherlands, 31 628218360, jose@ancora.health %K lifestyle intervention %K prevention %K obesity %K overweight %K weight loss %K digital health %K intervention %K weight %K pilot %K digital %K data %K Fogg Behavior Model %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands. Objective: The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention. Methods: Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals. Results: Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals. Conclusions: Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL. %M 38329792 %R 10.2196/38891 %U https://formative.jmir.org/2024/1/e38891 %U https://doi.org/10.2196/38891 %U http://www.ncbi.nlm.nih.gov/pubmed/38329792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43770 %T Predictors of Mental Health Literacy in a Sample of Health Care Major Students: Pilot Evaluation Study %A Tohme,Pia %A Abi Fadel,Nour %A Yaktine,Nour %A Abi-Habib,Rudy %+ Department of Social and Education Sciences, Lebanese American University, Beirut Campus, Chouran, Beirut, 5056, Lebanon, 961 01786456 ext 2733, rudy.abihabib@lau.edu.lb %K awareness %K COVID-19 %K digital health literacy %K digital health %K disorder %K empathy %K health literacy %K literacy %K mental health literacy %K mental health %K mentalizing %K questionnaire %K students %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The numerous mental health awareness campaigns during the COVID-19 pandemic have shifted our understanding and perception of mental health. Objective: The purpose of this study is to evaluate predictors of mental health literacy (MHL), that is, one’s knowledge and beliefs about mental disorders. We evaluate whether digital health literacy, empathy, and mentalizing contribute to MHL. Methods: Our sample consisted of 89 health care major students, aged between 17 and 32 years, studying at a university in Lebanon. The Mental Health Literacy Scale for Healthcare Students (MHLS-HS), the eHealth Literacy Questionnaire (eHLQ), the Basic Empathy Scale (BES), and the Reflective Functioning Questionnaire-8 (RFQ-8) were used. Results: Multiple regression analyses revealed that the Engagement in Own Health subscale of digital health literacy constituted a predictor of MHL. While empathy and mentalizing did not directly predict MHL, they were found to predict components of MHL. Conclusions: This is the first study to evaluate digital health literacy, empathy, and mentalizing as predictors of MHL in Lebanon, a country where mental health is still considered taboo. Moreover, this pilot study is the first to provide some support for the predictive role of some digital health literacy subscales on MHL in light of the rise of the digital era following the COVID-19 pandemic. %M 38329801 %R 10.2196/43770 %U https://formative.jmir.org/2024/1/e43770 %U https://doi.org/10.2196/43770 %U http://www.ncbi.nlm.nih.gov/pubmed/38329801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47360 %T Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study %A Bhattacharjee,Ananya %A Chen,Pan %A Mandal,Abhijoy %A Hsu,Anne %A O'Leary,Katie %A Mariakakis,Alex %A Williams,Joseph Jay %+ Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON, M5S 2E4, Canada, 1 647 619 6982, ananya@cs.toronto.edu %K reflection %K mental health %K stress %K reflective questioning activity %K RQA %K brief intervention %K computer-mediated communication %K email %K SMS text messaging %K mobile phone %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives. Objective: The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure. Methods: We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA’s real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants. Results: In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants’ subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations. Conclusions: This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles. %M 38329800 %R 10.2196/47360 %U https://formative.jmir.org/2024/1/e47360 %U https://doi.org/10.2196/47360 %U http://www.ncbi.nlm.nih.gov/pubmed/38329800 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47555 %T Investigation of the Impact of Wellinks on the Quality of Life and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Interventional Research Study %A Pierz,Kerri A %A Locantore,Nicholas %A McCreary,Gretchen %A Calvey,Robert J %A Hackney,Nickole %A Doshi,Pooja %A Linnell,John %A Sundaramoorthy,Abirammy %A Reed,Carol R %A Yates,Julie %+ Wellinks (Convexity Scientific, Inc), 85 Willow Street, New Haven, CT, 06511, United States, 1 203 240 5619, kerri.pierz@wellinks.com %K chronic obstructive pulmonary disease %K COPD %K health coaching %K pulmonary rehabilitation %K remote care %K disease management %K patient engagement %K Wellinks %K digital health %K adult %K mobile app %K remote model of care %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Wellinks is a remote disease management solution that provides novel chronic obstructive pulmonary disease (COPD) care delivery. Objective: This study evaluated the satisfaction, engagement, and clinical outcomes of Wellinks participants. This study also investigated the cadence of health coaching for patients with COPD. Methods: A 24-week interventional study was conducted by Wellinks and the COPD Foundation in 2022. Adults with COPD were recruited by the COPD Foundation in the United States and determined to be eligible if they had phone and internet access, owned a smartphone, and were not currently participating in pulmonary rehabilitation. All study participants provided written informed consent. The Wellinks solution included remote health coaching, pulmonary rehabilitation, and group education; participants were provided the Wellinks app and smart spirometry and pulse oximetry devices. Participants were offered 6 coaching sessions in the first 12 weeks. For the second 12-week period, participants either reduced frequency or discontinued coaching; all other components of the Wellinks solution remained unchanged. The COPD Self-Efficacy Scale, Modified Medical Research Council dyspnea scale, pulmonary function, pulse oximetry, and patient-reported healthcare resource utilization were the clinical outcome measures. Nonclinical outcomes included engagement and satisfaction with Wellinks and net promoter score. Results: In total, 141 adults consented and completed Wellinks onboarding; 84.4% (n=119) of whom remained engaged throughout the 24-week study. Participants had a mean age of 70 (SD 7.8; range 48-88) years, and 55.7% (n=78) were female. Most participants (n=119, 84.4%) completed all 6 coaching sessions during the first 12-week period. Compliance with spirometer and pulse oximeter use was 82.3% and 89.4%, respectively, at week 1 but waned over the study period to 8.5% and 9.2%, respectively, at the end of the study. Participants indicated a high degree of satisfaction with Wellinks, with 95.5% (n=85) and 91% (n=81) of participants indicating that they agreed or strongly agreed that the educational content and health coaching, respectively, were valuable. At the end of the study, the net promoter score was +64 and +55 in the coaching continuation and discontinuation arms, respectively. A significant improvement from baseline to end of the study was observed in the COPD Self-Efficacy Scale total score (P<.001) and domain scores (P<.001 for each domain). In total, 35.1% (n=27) of participants improved by at least 1 category of change on the 5-point Modified Medical Research Council dyspnea scale from baseline to week 24. Conclusions: This study confirmed the feasibility of using a remote model of care delivery to support people living with COPD. The insights gained in this study have allowed for further refinement and personalization of the Wellinks care model. Findings related to the combined use of technology and personal care delivery should be considered by others developing remote disease management tools. Trial Registration: ClinicalTrials.gov NCT05259280; https://clinicaltrials.gov/ct2/show/NCT05259280 %M 38335023 %R 10.2196/47555 %U https://formative.jmir.org/2024/1/e47555 %U https://doi.org/10.2196/47555 %U http://www.ncbi.nlm.nih.gov/pubmed/38335023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51225 %T The Impact of Intervention Design on User Engagement in Digital Therapeutics Research: Factorial Experiment With a Mixed Methods Study %A Lee,Hyerim %A Choi,Eung Ho %A Shin,Jung U %A Kim,Tae-Gyun %A Oh,Jooyoung %A Shin,Bokyoung %A Sim,Jung Yeon %A Shin,Jaeyong %A Kim,Meelim %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, Atkinson Hall, 9500 Gilman Dr, La Jolla, San Diego, CA, 92121, United States, 1 323 776 5171, mek007@health.ucsd.edu %K atopic %K dermatitis %K experimental design %K mobile health %K patient engagement %K research methodology %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: User engagement is crucial for digital therapeutics (DTx) effectiveness; due to variations in the conceptualization of engagement and intervention design, assessment and retention of engagement remain challenging. Objective: We investigated the influence of the perceived acceptability of experimental intervention components and satisfaction with core intervention components in DTx on user engagement, while also identifying potential barriers and facilitators to user engagement. Methods: We conducted a mixed methods study with a 2 × 2 factorial design, involving 12 outpatients with atopic dermatitis. Participants were randomized into 4 experimental groups based on push notification (“basic” or “advanced”) and human coach (“on” or “off”) experimental intervention components. All participants engaged in self-monitoring and learning courses as core intervention components within an app-based intervention over 8 weeks. Data were collected through in-app behavioral data, physician- and self-reported questionnaires, and semistructured interviews assessed at baseline, 4 weeks, and 8 weeks. Descriptive statistics and thematic analysis were used to evaluate user engagement, perceived acceptability of experimental intervention components (ie, push notification and human coach), satisfaction with core intervention components (ie, self-monitoring and learning courses), and intervention effectiveness through clinical outcomes. Results: The primary outcome indicated that group 4, provided with “advanced-level push notifications” and a “human coach,” showed higher completion rates for self-monitoring forms and learning courses compared to the predetermined threshold of clinical significance. Qualitative data analysis revealed three key themes: (1) perceived acceptability of the experimental intervention components, (2) satisfaction with the core intervention components, and (3) suggestions for improvement in the overall intervention program. Regarding clinical outcomes, the Perceived Stress Scale and Dermatology Life Quality Index scores presented the highest improvement in group 4. Conclusions: These findings will help refine the intervention and inform the design of a subsequent randomized trial to test its effectiveness. Furthermore, this design may serve as a model for broadly examining and optimizing overall engagement in DTx and for future investigation into the complex relationship between engagement and clinical outcomes. Trial Registration: Clinical Research Information Service KCT0007675; http://tinyurl.com/2m8rjrmv %M 38335015 %R 10.2196/51225 %U https://formative.jmir.org/2024/1/e51225 %U https://doi.org/10.2196/51225 %U http://www.ncbi.nlm.nih.gov/pubmed/38335015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38372 %T Privacy, Security, and Legal Issues in the Health Cloud: Structured Review for Taxonomy Development %A Zandesh,Zahra %+ Information Technology and Statistics Department, Tehran University of Medical Sciences, Keshavarz Blvd, next to the intersection of Qods St., Tehran, 1417653761, Iran, 98 2181633102, Zandesh.z@gmail.com %K taxonomy %K privacy %K security %K legal %K cloud computing %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Privacy in our digital world is a very complicated topic, especially when meeting cloud computing technological achievements with its multidimensional context. Here, privacy is an extended concept that is sometimes referred to as legal, philosophical, or even technical. Consequently, there is a need to harmonize it with other aspects in health care in order to provide a new ecosystem. This new ecosystem can lead to a paradigm shift involving the reconstruction and redesign of some of the most important and essential requirements like privacy concepts, legal issues, and security services. Cloud computing in the health domain has markedly contributed to other technologies, such as mobile health, health Internet of Things, and wireless body area networks, with their increasing numbers of embedded applications. Other dependent applications, which are usually used in health businesses like social networks, or some newly introduced applications have issues regarding privacy transparency boundaries and privacy-preserving principles, which have made policy making difficult in the field. Objective: One way to overcome this challenge is to develop a taxonomy to identify all relevant factors. A taxonomy serves to bring conceptual clarity to the set of alternatives in in-person health care delivery. This study aimed to construct a comprehensive taxonomy for privacy in the health cloud, which also provides a prospective landscape for privacy in related technologies. Methods: A search was performed for relevant published English papers in databases, including Web of Science, IEEE Digital Library, Google Scholar, Scopus, and PubMed. A total of 2042 papers were related to the health cloud privacy concept according to predefined keywords and search strings. Taxonomy designing was performed using the deductive methodology. Results: This taxonomy has 3 layers. The first layer has 4 main dimensions, including cloud, data, device, and legal. The second layer has 15 components, and the final layer has related subcategories (n=57). This taxonomy covers some related concepts, such as privacy, security, confidentiality, and legal issues, which are categorized here and defined by their expansion and distinctive boundaries. The main merits of this taxonomy are its ability to clarify privacy terms for different scenarios and signalize the privacy multidisciplinary objectification in eHealth. Conclusions: This taxonomy can cover health industry requirements with its specifications like health data and scenarios, which are considered as the most complicated among businesses and industries. Therefore, the use of this taxonomy could be generalized and customized to other domains and businesses that have less complications. Moreover, this taxonomy has different stockholders, including people, organizations, and systems. If the antecedent effort in the taxonomy is proven, subject matter experts could enhance the extent of privacy in the health cloud by verifying, evaluating, and revising this taxonomy. %M 38345858 %R 10.2196/38372 %U https://formative.jmir.org/2024/1/e38372 %U https://doi.org/10.2196/38372 %U http://www.ncbi.nlm.nih.gov/pubmed/38345858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44111 %T Evaluating the Intensity of Exposure to MTV Shuga, an Edutainment Program for HIV Prevention: Cross-Sectional Study in Eastern Cape, South Africa %A Mulwa,Sarah %A Baker,Venetia %A Cawood,Cherie %A Khanyile,David %A O'Donnell,Dominique %A Sarrassat,Sophie %A Cousens,Simon %A Birdthistle,Isolde %+ Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 863, sarah.mulwa@lshtm.ac.uk %K young people %K media %K evaluation %K dose-response %K edutainment %K HIV prevention %K mobile phone %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: MTV Shuga is an edutainment campaign designed to equip young people with knowledge, motivation, and informed choices to protect themselves from HIV infection. From 2019 to 2020, a total of 10 episodes of a new dramatic series, MTV Shuga “Down South 2” (DS2), were broadcast via television and the internet, alongside complementary media activities. Objective: This study aims to investigate whether the intensity of DS2 exposure was linked with positive HIV prevention outcomes in a setting with high HIV prevalence and relatively low levels of HIV testing. Methods: We analyzed data from a web-based survey of participants aged 15 to 24 years in South Africa in 2020. The survey was promoted via social media platforms of schools, universities, and communities in Eastern Cape, South Africa. The primary exposure of interest was the intensity of exposure to DS2, measured by the number of episodes of DS2 watched on the television or the internet or listened to on the radio (out of 10 episodes). Individuals who had not watched or listened to any DS2 episode were classified according to other MTV Shuga content that they had accessed. We estimated associations between the intensity of DS2 exposure and HIV-related outcomes, including knowledge of HIV status, awareness of HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP), uptake of HIVST, and demand for HIVST and PrEP, adjusting for potential confounders using multivariable logistic regression. Results: Among the 3431 survey participants, 827 (24.1%) were exposed to DS2. Specifically, 18.1% (622/3431) watched or listened to only 1 DS2 episode, and 2.4% (82/3431), 1.7% (58/3431), and 1.8% (62/3431) watched or listened to 2 to 4, 5 to 7, and 8 to 10 DS2 episodes, respectively. Increasing the exposure to DS2 was associated with improvements in most outcomes. Exposure to multiple episodes (eg, 2-4, 5-7, and 8-10) was associated with successively higher odds of knowing one’s HIV status, awareness of PrEP and HIVST, and uptake of HIVST compared with no MTV Shuga exposure, albeit with statistical uncertainty around some estimates. The interest in using HIVST or PrEP was high overall (>80%), with no measurable differences by DS2 intensity. Conclusions: We found evidence consistent with a dose-response relationship between MTV Shuga DS2 exposure and outcomes, including knowledge of HIV status, awareness and uptake of HIVST, and awareness of PrEP among young people in Eastern Cape. This indicates that greater engagement with a youth-focused edutainment campaign can improve HIV testing and prevention options in a setting and population with high need. However, only a few participants accessed multiple DS2 episodes despite its availability on multiple media platforms. We conclude that there is potential to benefit more young people by increasing access to and interest in the show. %M 38349729 %R 10.2196/44111 %U https://formative.jmir.org/2024/1/e44111 %U https://doi.org/10.2196/44111 %U http://www.ncbi.nlm.nih.gov/pubmed/38349729 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45471 %T Nonuse of Blended Web-Based and Face-To-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study %A Tarp,Kristine %A Christiansen,Regina %A Bilberg,Randi %A Borkner,Simone %A Dalsgaard,Caroline %A Folker,Marie Paldam %A Nielsen,Anette Søgaard %+ The National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 21292332, ket@nfa.dk %K alcohol use disorder %K blended internet-based and face-to-face cognitive behavioral therapy %K nonuse %K patient perceptions %K qualitative %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital technologies for health care has been the focus of social studies, which have concentrated on the digital divide between individuals who use technology and those who do not—with the latter often being considered as individuals with shortcomings. In Denmark, 91% of the population have computers and 97 out of 100 families have internet access, indicating that lack of access to technology is not the primary reason for nonuse. Although previous studies have primarily focused on participants' perspectives of using internet-based treatment for alcohol use disorder (AUD), no study has investigated individuals’ reasons to prefer face-to-face treatment over blended face-to-face and internet-based cognitive behavioral therapy (bCBT) for AUD among treatment-seeking populations. Objective: The aim of this qualitative study was to investigate the nonuse of bCBT among patients with AUD. Specifically, this study aims to explore patients' reasons for choosing not to receive treatment via this format. Methods: This study was conducted among Danish patients with AUD who were enrolled in the study “Blending internet treatment into conventional face-to-face treatment for alcohol use disorder (Blend-A)” but had not used bCBT. The participant group consisted of 11 patients with AUD: 3 women and 8 men. The age range of the participants was 29-78 years (mean 59 years). Individual semistructured interviews were conducted using cell phones to gather participants’ reasons for not choosing bCBT. The interviews were recorded, transcribed, and analyzed using thematic analysis. Five authors performed the analysis in 3 steps: (1) two authors read the transcripts and coded themes from their immediate impression of the material, (2) one author provided feedback, which was used to group overlapping themes together or create new themes that better reflected the content, and (3) the remaining two authors provided feedback on the analysis to improve its structure, readability, and relevance to the research aim. Results: We found that the participants had various reasons for choosing face-to-face treatment over bCBT; these reasons were more related to personal matters and lesser to digital health literacy. We identified 4 themes related to personal matters for choosing face-to-face treatment over bCBT: (1) patients’ need for attending sessions in person, (2) preference for verbal communication, (3) desire for immediate feedback, and (4) feeling more empowered and motivated with face-to-face sessions. Conclusions: This study provides valuable insight into participants’ perspectives on blended therapy for AUD and highlights the importance of considering personal factors when designing digital health interventions. Our study indicates that most of the participants choose not to use bCBT for AUD because they perceive such treatment formats as impersonal. Instead, they prefer direct communication with the therapist, including the ability to express and comprehend facial expressions and body language. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03122-4 %M 38349711 %R 10.2196/45471 %U https://formative.jmir.org/2024/1/e45471 %U https://doi.org/10.2196/45471 %U http://www.ncbi.nlm.nih.gov/pubmed/38349711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49322 %T The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial %A Salas-Groves,Emily %A Alcorn,Michelle %A Childress,Allison %A Galyean,Shannon %+ Nutritional Sciences, Texas Tech University, 1301 Akron Avenue, Lubbock, TX, 79409, United States, 1 806 834 2286, shannon.galyean@ttu.edu %K older adults %K culinary medicine %K protein %K muscle mass %K muscle strength %K physical activity %K nutrition intervention %K online %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality. Objective: This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults’ muscle strength and mass. Methods: A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group’s muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG. Results: No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P≤.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95% CI 5.77-27.97) g higher than that at the prestudy visit. Conclusions: This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed. Trial Registration: ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978 %M 38349721 %R 10.2196/49322 %U https://formative.jmir.org/2024/1/e49322 %U https://doi.org/10.2196/49322 %U http://www.ncbi.nlm.nih.gov/pubmed/38349721 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52660 %T Using #ActuallyAutistic on Twitter for Precision Diagnosis of Autism Spectrum Disorder: Machine Learning Study %A Jaiswal,Aditi %A Washington,Peter %+ Department of Information and Computer Sciences, University of Hawaii at Manoa, Room 312C, Pacific Ocean Science and Technology, 1680 East-West Road, Honolulu, HI, 96822, United States, 1 8088296359, ajaiswal@hawaii.edu %K autism %K autism spectrum disorder %K machine learning %K natural language processing %K public health %K sentiment analysis %K social media analysis %K Twitter %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The increasing use of social media platforms has given rise to an unprecedented surge in user-generated content, with millions of individuals publicly sharing their thoughts, experiences, and health-related information. Social media can serve as a useful means to study and understand public health. Twitter (subsequently rebranded as “X”) is one such social media platform that has proven to be a valuable source of rich information for both the general public and health officials. We conducted the first study applying Twitter data mining to autism screening. Objective: We aimed to study the feasibility of autism screening from Twitter data and discuss the ethical implications of such models. Methods: We developed a machine learning model to attempt to distinguish individuals with autism from their neurotypical peers based on the textual patterns from their public communications on Twitter. We collected 6,515,470 tweets from users’ self-identification with autism using “#ActuallyAutistic” and a separate control group. To construct the data set, we targeted English-language tweets using the search query “#ActuallyAutistic” posted from January 1, 2014 to December 31, 2022. We encrypted all user IDs and stripped the tweets of identifiable information such as the associated email address prior to analysis. From these tweets, we identified unique users who used keywords such as “autism” OR “autistic” OR “neurodiverse” in their profile description and collected all the tweets from their timelines. To build the control group data set, we formulated a search query excluding the hashtag “#ActuallyAutistic” and collected 1000 tweets per day during the same time period. We trained a word2vec model and an attention-based, bidirectional long short-term memory model to validate the performance of per-tweet and per-profile classification models. We deleted the data set and the models after our analysis. Results: Our tweet classifier reached a 73% accuracy, a 0.728 area under the receiver operating characteristic curve score, and an 0.71 F1-score using word2vec representations fed into a logistic regression model, while the user profile classifier achieved an 0.78 area under the receiver operating characteristic curve score and an F1-score of 0.805 using an attention-based, bidirectional long short-term memory model. Conclusions: We have shown that it is feasible to train machine learning models using social media data to predict use of the #ActuallyAutistic hashtag, an imperfect proxy for self-reported autism. While analyzing textual differences in naturalistic text has the potential to help clinicians screen for autism, there remain ethical questions that must be addressed for such research to move forward and to translate into the real world. While machine learning has the potential to improve behavioral research, there are still a plethora of ethical issues in digital phenotyping studies using social media with respect to user consent of marginalized populations. Achieving this requires a more inclusive approach during the model development process that involves the autistic community directly in the ideation and consent processes. %M 38354045 %R 10.2196/52660 %U https://formative.jmir.org/2024/1/e52660 %U https://doi.org/10.2196/52660 %U http://www.ncbi.nlm.nih.gov/pubmed/38354045 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47181 %T Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study %A Locke,Sean %A Osborne,Jenna %+ Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON, L2S 3A1, Canada, 1 905 668 5550 ext 4958, slocke@brocku.ca %K mobile health %K mHealth %K behavior change %K stress management %K intervention %K pilot study %K heart rate variability %K health coaching %K coach %K coaching %K coaches %K work-related stress %K stress %K wellness %K burnout %K behavioral intervention %K work %K worker %K workers %K employee %K employees %K occupational health %K job %K satisfaction %K web-based %K remote %K corporate %K web analytics %K biofeedback %K survey %K surveys %K interview %K interviews %K experience %K experiences %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. Objective: This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. Methods: The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Results: Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. Conclusions: The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner. %M 38354036 %R 10.2196/47181 %U https://formative.jmir.org/2024/1/e47181 %U https://doi.org/10.2196/47181 %U http://www.ncbi.nlm.nih.gov/pubmed/38354036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54194 %T Measurement of Head Circumference Using a Smartphone: Feasibility Cohort Study %A Yordanov,Stefan %A Akhter,Kalsoom %A Quan Teh,Jye %A Naushahi,Jawad %A Jalloh,Ibrahim %+ Academic Division of Neurosurgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, United Kingdom, 44 01223 805000 ext 348134, yordanov.stefan@yahoo.com %K head circumference %K HC %K hydrocephalus %K neurosurgery %K pediatric neurosurgery %K paediatric neurosurgery %K neurology %K neuro %K neurosurgeon %K neurologist %K mobile health %K mHealth %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K toddler %K toddlers %K child %K children %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate head circumference (HC) measurement is essential when assessing neonates and infants. Tape measure HC measurements are prone to errors, particularly when performed by parents/guardians, due to individual differences in head shape, hair style and texture, subject cooperation, and examiner techniques, including tape measure placement and tautness. There is, therefore, the need for a more reliable method. Objective: The primary objective of this study was to evaluate the validity, reliability, and consistency of HC app measurement compared to the current standard of practice, serving as a proof-of-concept for use by health care professionals. Methods: We recruited infants attending the neurosurgery clinic, and parents/guardians were approached and consented to participate in the study. Along with the standard head circumference measurement, measurements were taken with the head circumference app (HC app) developed in-house, and we also collected baseline medical history and characteristics. For the statistical analysis, we used RStudio (version 4.1.1). In summary, we analyzed covariance and intraclass correlation coefficient (ICC) to compare the measurement's within-rater and interrater reliability. The F test was used to analyze the variance between measurements and the Bland-Altman agreement, t test, and correlation coefficients were used to compare the tape measurement to the measures taken by the HC app. We also used nonvalidated questionnaires to explore parental or guardians’ experiences, assess their views on app utility, and collect feedback. Results: The total number of recruited patients was 37. Comparison between the app measurements and the measurements with a tape measure showed poor reliability (ICC=0.177) and wide within-app variations (ICC=0.341). The agreement between the measurements done by parents/guardians and the tape measurements done by the researcher was good (ICC=0.901). Parental/guardian feedback was overall very positive, with most of the parents/guardians reporting that the app was easy to use (n=31, 84%) and that they are happy to use the app in an unsupervised setting, provided that they are assured of the measurement quality. Conclusions: We developed this project as a proof-of-concept study, and as such, the app has shown great potential to be used both in a clinical setting and by parents/guardians in their own homes. %M 38354022 %R 10.2196/54194 %U https://formative.jmir.org/2024/1/e54194 %U https://doi.org/10.2196/54194 %U http://www.ncbi.nlm.nih.gov/pubmed/38354022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38803 %T Use Intention and User Expectations of Human-Supported and Self-Help eHealth Interventions: Internet-Based Randomized Controlled Trial %A Cohen Rodrigues,Talia R %A Reijnders,Thomas %A Breeman,Linda D %A Janssen,Veronica R %A Kraaijenhagen,Roderik A %A Atsma,Douwe E %A Evers,Andrea WM %+ Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 71 527 3627, t.r.cohen.rodrigues@fsw.leidenuniv.nl %K eHealth %K human support %K Unified Theory of Acceptance and Use of Technology %K use intention %K UTAUT %K working alliance %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-help eHealth interventions provide automated support to change health behaviors without any further human assistance. The main advantage of self-help eHealth interventions is that they have the potential to lower the workload of health care professionals. However, one disadvantage is that they generally have a lower uptake. Possibly, the absence of a relationship with a health care professional (referred to as the working alliance) could lead to negative expectations that hinder the uptake of self-help interventions. The Unified Theory of Acceptance and Use of Technology (UTAUT) identifies which expectations predict use intention. As there has been no previous research exploring how expectations affect the adoption of both self-help and human-supported eHealth interventions, this study is the first to investigate the impact of expectations on the uptake of both kinds of eHealth interventions. Objective: This study investigated the intention to use a self-help eHealth intervention compared to a human-supported eHealth intervention and the expectations that moderate this relationship. Methods: A total of 146 participants were randomly assigned to 1 of 2 conditions (human-supported or self-help eHealth interventions). Participants evaluated screenshots of a human-supported or self-help app–based stress intervention. We measured intention to use the intervention-expected working alliance and the UTAUT constructs: performance expectancy, effort expectancy, and social influence. Results: Use intention did not differ significantly between the 2 conditions (t142=–1.133; P=.26). Performance expectancy (F1,140=69.269; P<.001), effort expectancy (F1,140=3.961; P=.049), social influence (F1,140=90.025; P<.001), and expected working alliance (F1,140=26.435; P<.001) were positively related to use intention regardless of condition. The interaction analysis showed that performance expectancy (F1,140=4.363; P=.04) and effort expectancy (F1,140=4.102; P=.045) more strongly influenced use intention in the self-help condition compared to the human-supported condition. Conclusions: As we found no difference in use intention, our results suggest that we could expect an equal uptake of self-help eHealth interventions and human-supported ones. However, attention should be paid to people who have doubts about the intervention’s helpfulness or ease of use. For those people, providing additional human support would be beneficial to ensure uptake. Screening user expectations could help health care professionals optimize self-help eHealth intervention uptake in practice. Trial Registration: OSF Registries osf.io/n47cz; https://osf.io/n47cz %M 38358784 %R 10.2196/38803 %U https://formative.jmir.org/2024/1/e38803 %U https://doi.org/10.2196/38803 %U http://www.ncbi.nlm.nih.gov/pubmed/38358784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e34162 %T Effects of Embodiment in Virtual Reality for Treatment of Chronic Pain: Pilot Open-Label Study %A Saby,Adam %A Alvarez,Anthony %A Smolins,David %A Petros,James %A Nguyen,Lincoln %A Trujillo,Michael %A Aygün,Oytun %+ Karuna Labs, 185 Wythe Avenue Brooklyn, New York, NY, 11249, United States, 1 641824514, oytunsultanaygun@gmail.com %K centralized pain %K dicentralized pain %K digital therapeutics %K visual analog scale %K Fear-Avoidance Beliefs Questionnaire %K Oswestry %K Oswestry Low Back Pain Disability Questionnaire %K Pain Catastrophizing Scale %K Patient Health Questionnaire %K sensorimotor %K virtual reality %K chronic pain %K pain %K rehabilitation %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and nonpharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Further, because of its noninvasive nature, virtual reality (VR) provides an attractive platform for potentially developing novel therapeutic modalities. Objective: The purpose of this study was to determine the feasibility of a novel VR-based digital therapy for the treatment of chronic pain. Methods: An open-label study assessed the feasibility of using virtual embodiment in VR to treat chronic pain. In total, 24 patients with chronic pain were recruited from local pain clinics and completed 8 sessions of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of 4 weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as the primary outcome measure. Additionally, a battery of patient-reported pain questionnaires (Fear-Avoidance Beliefs Questionnaire, Oswestry Low Back Pain Disability Questionnaire, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after 8 sessions of virtual embodiment training as exploratory outcome measures to assess if the measures are appropriate and warrant a larger randomized controlled trial. Results: A 2-way ANOVA on session × pre- versus postvirtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by the visual analog scale (P<.001). Perceived disability due to lower back pain as measured by the Oswestry Low Back Pain Disability Questionnaire significantly improved (P=.003) over the 4-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale (P=.02). Conclusions: This study provides evidence that functional rehabilitation exercises delivered in VR are safe and may have positive effects on alleviating the symptoms of chronic pain. Additionally, the virtual embodiment intervention may improve perceived disability and helplessness of patients with chronic pain after 8 sessions. The results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. Trial Registration: ClinicalTrials.gov NCT04060875; https://clinicaltrials.gov/ct2/show/NCT04060875 %M 38363591 %R 10.2196/34162 %U https://formative.jmir.org/2024/1/e34162 %U https://doi.org/10.2196/34162 %U http://www.ncbi.nlm.nih.gov/pubmed/38363591 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44717 %T Contactless Monitoring System Versus Gold Standard for Respiratory Rate Monitoring in Emergency Department Patients: Pilot Comparison Study %A Goldfine,Charlotte E %A Oshim,Md Farhan Tasnim %A Chapman,Brittany P %A Ganesan,Deepak %A Rahman,Tauhidur %A Carreiro,Stephanie P %+ Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 617 732 5640, cgoldfine@bwh.harvard.edu %K cardiopulmonary monitoring %K contactless monitor %K radar %K respiratory rate %K vital signs %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Respiratory rate is a crucial indicator of disease severity yet is the most neglected vital sign. Subtle changes in respiratory rate may be the first sign of clinical deterioration in a variety of disease states. Current methods of respiratory rate monitoring are labor-intensive and sensitive to motion artifacts, which often leads to inaccurate readings or underreporting; therefore, new methods of respiratory monitoring are needed. The PulsON 440 (P440; TSDR Ultra Wideband Radios and Radars) radar module is a contactless sensor that uses an ultrawideband impulse radar to detect respiratory rate. It has previously demonstrated accuracy in a laboratory setting and may be a useful alternative for contactless respiratory monitoring in clinical settings; however, it has not yet been validated in a clinical setting. Objective: The goal of this study was to (1) compare the P440 radar module to gold standard manual respiratory rate monitoring and standard of care telemetry respiratory monitoring through transthoracic impedance plethysmography and (2) compare the P440 radar to gold standard measurements of respiratory rate in subgroups based on sex and disease state. Methods: This was a pilot study of adults aged 18 years or older being monitored in the emergency department. Participants were monitored with the P440 radar module for 2 hours and had gold standard (manual respiratory counting) and standard of care (telemetry) respiratory rates recorded at 15-minute intervals during that time. Respiratory rates between the P440, gold standard, and standard telemetry were compared using Bland-Altman plots and intraclass correlation coefficients. Results: A total of 14 participants were enrolled in the study. The P440 and gold standard Bland-Altman analysis showed a bias of –0.76 (–11.16 to 9.65) and an intraclass correlation coefficient of 0.38 (95% CI 0.06-0.60). The P440 and gold standard had the best agreement at normal physiologic respiratory rates. There was no change in agreement between the P440 and the gold standard when grouped by admitting diagnosis or sex. Conclusions: Although the P440 did not have statistically significant agreement with gold standard respiratory rate monitoring, it did show a trend of increased agreement in the normal physiologic range, overestimating at low respiratory rates, and underestimating at high respiratory rates. This trend is important for adjusting future models to be able to accurately detect respiratory rates. Once validated, the contactless respiratory monitor provides a unique solution for monitoring patients in a variety of settings. %M 38363588 %R 10.2196/44717 %U https://formative.jmir.org/2024/1/e44717 %U https://doi.org/10.2196/44717 %U http://www.ncbi.nlm.nih.gov/pubmed/38363588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52337 %T An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation %A Kwa,Zhi Yin %A Li,Jinqiu %A Loh,Dale Lincoln %A Lee,Yang Yang %A Liu,Guangyu %A Zhu,Lixia %A Pikkarainen,Minna %A He,Honggu %A Mali,Vidyadhar Padmakar %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, MD 11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65167448, nurhhg@nus.edu.sg %K circumcision %K self-efficacy %K perioperative anxiety %K postoperative pain %K mobile phone %K postoperative %K pain %K anxiety %K distractions %K distraction %K perioperative %K interview %K interviews %K child %K children %K surgery %K surgical %K recovery %K health outcome %K health outcomes %K pediatric %K pediatrics %K content analysis %K emotional %K mobile health %K app %K apps %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. Objective: This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. Methods: Based on the review of the literature and previous studies, Bandura’s self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. Results: The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. Conclusions: ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404 %M 38363589 %R 10.2196/52337 %U https://formative.jmir.org/2024/1/e52337 %U https://doi.org/10.2196/52337 %U http://www.ncbi.nlm.nih.gov/pubmed/38363589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53654 %T Development of Cost-Effective Fatty Liver Disease Prediction Models in a Chinese Population: Statistical and Machine Learning Approaches %A Zhang,Liang %A Huang,Yueqing %A Huang,Min %A Zhao,Chun-Hua %A Zhang,Yan-Jun %A Wang,Yi %+ Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baitaxi Road, Gusu District, Suzhou, 215000, China, 86 13812757566, huangyq_sz@163.com %K NAFLD %K artificial intelligence %K public health %K transient elastography %K diagnosis %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The increasing prevalence of nonalcoholic fatty liver disease (NAFLD) in China presents a significant public health concern. Traditional ultrasound, commonly used for fatty liver screening, often lacks the ability to accurately quantify steatosis, leading to insufficient follow-up for patients with moderate-to-severe steatosis. Transient elastography (TE) provides a more quantitative diagnosis of steatosis and fibrosis, closely aligning with biopsy results. Moreover, machine learning (ML) technology holds promise for developing more precise diagnostic models for NAFLD using a variety of laboratory indicators. Objective: This study aims to develop a novel ML-based diagnostic model leveraging TE results for staging hepatic steatosis. The objective was to streamline the model’s input features, creating a cost-effective and user-friendly tool to distinguish patients with NAFLD requiring follow-up. This innovative approach merges TE and ML to enhance diagnostic accuracy and efficiency in NAFLD assessment. Methods: The study involved a comprehensive analysis of health examination records from Suzhou Municipal Hospital, spanning from March to May 2023. Patient data and questionnaire responses were meticulously inputted into Microsoft Excel 2019, followed by thorough data cleaning and model development using Python 3.7, with libraries scikit-learn and numpy to ensure data accuracy. A cohort comprising 978 residents with complete medical records and TE results was included for analysis. Various classification models, including logistic regression (LR), k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), light gradient boosting machine (LightGBM), and extreme gradient boosting (XGBoost), were constructed and evaluated based on the area under the receiver operating characteristic curve (AUROC). Results: Among the 916 patients included in the study, 273 were diagnosed with moderate-to-severe NAFLD. The concordance rate between traditional ultrasound and TE for detecting moderate-to-severe NAFLD was 84.6% (231/273). The AUROC values for the RF, LightGBM, XGBoost, SVM, KNN, and LR models were 0.91, 0.86, 0.83, 0.88, 0.77, and 0.81, respectively. These models achieved accuracy rates of 84%, 81%, 78%, 81%, 76%, and 77%, respectively. Notably, the RF model exhibited the best performance. A simplified RF model was developed with an AUROC of 0.88, featuring 62% sensitivity and 90% specificity. This simplified model used 6 key features: waist circumference, BMI, fasting plasma glucose, uric acid, total bilirubin, and high-sensitivity C-reactive protein. This approach offers a cost-effective and user-friendly tool while streamlining feature acquisition for training purposes. Conclusions: The study introduces a groundbreaking, cost-effective ML algorithm that leverages health examination data for identifying moderate-to-severe NAFLD. This model has the potential to significantly impact public health by enabling targeted investigations and interventions for NAFLD. By integrating TE and ML technologies, the study showcases innovative approaches to advancing NAFLD diagnostics. %M 38363597 %R 10.2196/53654 %U https://formative.jmir.org/2024/1/e53654 %U https://doi.org/10.2196/53654 %U http://www.ncbi.nlm.nih.gov/pubmed/38363597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50113 %T Patient and Therapist Perceptions of a Publicly Funded Internet-Based Cognitive Behavioral Therapy (iCBT) Program for Ontario Adults During the COVID-19 Pandemic: Qualitative Study %A Thapar,Serena %A Nguyen,Megan %A Khan,Bilal Noreen %A Fanaieyan,Roz %A Kishimoto,Vanessa %A Liu,Rebecca %A Bolea-Alamañac,Blanca %A Leon-Carlyle,Marisa %A O’Riordan,Anne %A Keresteci,Maggie %A Bhattacharyya,Onil %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 6474580101, serena.thapar@mail.mcgill.ca %K depression %K anxiety %K cognitive behavioral therapy %K digital health %K internet-delivered cognitive behavioral therapy %K iCBT %K CBT %K implementation %K facilitators %K barriers %K interviews %K qualitative %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address the anticipated rise in mental health symptoms experienced at the population level during the COVID-19 pandemic, the Ontario government provided 2 therapist-assisted internet-delivered cognitive behavioral therapy (iCBT) programs to adults free of charge at the point of service. Objective: The study aims to explore the facilitators of and barriers to implementing iCBT at the population level in Ontario, Canada, from the perspective of patients and therapists to better understand how therapist-assisted iCBT programs can be effectively implemented at the population level and inform strategies for enhancing service delivery and integration into the health care system. Methods: Using a convenience sampling methodology, semistructured interviews were conducted with 10 therapists who delivered iCBT and 20 patients who received iCBT through either of the publicly funded programs to explore their perspectives of the program. Interview data were analyzed using inductive thematic analysis to generate themes. Results: Six salient themes were identified. Facilitators included the therapist-assisted nature of the program; the ease of registration and the lack of cost; and the feasibility of completing the psychoeducational modules given the online and self-paced nature of the program. Barriers included challenges with the online remote modality for developing the therapeutic alliance; the program’s generalized nature, which limited customization to individual needs; and a lack of formal integration between the iCBT program and the health care system. Conclusions: Although the program was generally well-received by patients and therapists due to its accessibility and feasibility, the digital format of the program presented both benefits and unique challenges. Strategies for improving the quality of service delivery include opportunities for synchronous communication between therapists and patients, options for increased customization, and the formal integration of iCBT into a broader stepped-care model that centralizes patient referrals between care providers and promotes continuity of care. %M 38373027 %R 10.2196/50113 %U https://formative.jmir.org/2024/1/e50113 %U https://doi.org/10.2196/50113 %U http://www.ncbi.nlm.nih.gov/pubmed/38373027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52195 %T Assessment of a Daily Diary Study Including Biospecimen Collections in a Sample of Sexual and Gender Minority Young Adults: Feasibility and Acceptability Study %A Cook,Stephanie H %A Wood,Erica P %A Rodrigues,Mariana %A Jachero Caldas,Janice %A Delorme,Maxline %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, Room 757, New York, NY, 10003, United States, 1 212 992 5635, sc5810@nyu.edu %K study protocol %K young sexual minority men %K YSSM %K cardiovascular disease risk %K health behaviors %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race). Objective: This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years. Methods: Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest. Results: The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one’s finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=−0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 µg/dL for White participants; mean 0.34, SD 0.34 µg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 µg/dL for White participants; mean 0.09, SD 0.13 µg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 µg/dL for Hispanic participants; mean 0.23, SD 0.15 µg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 µg/dL for Hispanic participants; mean 0.03, SD 0.02 µg/dL for Black participants) among Hispanic and Black YSMM. Conclusions: Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples. %M 38373036 %R 10.2196/52195 %U https://formative.jmir.org/2024/1/e52195 %U https://doi.org/10.2196/52195 %U http://www.ncbi.nlm.nih.gov/pubmed/38373036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49526 %T Acceptance of Telemedicine by Specialists and General Practitioners in Cardiology Care: Cross-Sectional Survey Study %A Muehlensiepen,Felix %A Hoffmann,Marie Josephine %A Nübel,Jonathan %A Ignatyev,Yury %A Heinze,Martin %A Butter,Christian %A Haase-Fielitz,Anja %+ Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB), Fehrbelliner Str 38, Neuruppin, 16816, Germany, 49 49333869 ext 4649, anja.haase-fielitz@mhb-fontane.de %K acceptance %K adoption %K cardiac %K cardiology %K cross sectional %K health services research %K heart %K preference %K survey %K telecardiology %K telehealth %K telemedicine %D 2024 %7 20.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the coming years, telemedicine will play a key role in health care. Especially in rural areas with weak infrastructure, telemedicine could be crucial to providing adequate and personalized medical care. Objective: We investigated the acceptance and preferences of telemedicine among cardiologists, internists, and general practitioners. In addition, we aimed to identify knowledge, explore factors that influence the decision to adopt or reject this technology, and create starting points for demand-oriented further research. Methods: We conducted a web-based survey between May 2021 and February 2022. The 34-item questionnaire covered a wide range of questions regarding knowledge, acceptance, and use of telemedicine in cardiology care. Participants (cardiologists, internists, and general practitioners) were contacted through their professional email addresses, through a QR code published in a regional health journal, and through X (formerly known as Twitter). After exclusion of questionnaires with missed values, multidimensional scaling and k-means clustering were performed. Participants were divided into 3 clusters (C1, C2, and C3) based on their attitudes toward telecardiology. C1 uses telemedicine for personal health and clinical practice; C2 shows reluctance; C3 uses telemedicine mainly clinically. Results: We contacted 929 physicians. Of those 12.1% (112/929) completed the questionnaires. Participants were 56% male (54/97), 29% female (28/97), and 2% (2/97) diverse (median age 50 years). About 16% (18/112) of the respondents currently use telemedicine daily, 14.3% (16/112) 3-4 times a week, and 43% (48/112) did not use telemedicine at all. Overall, 35.1% (34/97) rated their knowledge of telemedicine as very good or good. Most of the respondents replied that telemedicine could support cardiology care in monitoring of blood pressure and electrocardiograms (57/97, 58.8%, both), consultation (57/97, 58.8%), and extending follow-up time (59/97, 60.8%). Reported barriers to implementation were mostly administration (26/97, 26.8%), inadequate reimbursement (25/97, 25.8%), and the purchase of technology equipment (23/97, 23.7%). Attitudes toward telemedicine in clinical practice were closely related to the number of patients being treated per annual quarter: C3 (median 1350, IQR 1000-1500) versus C1 (median 750, IQR 300-1200) and C2 (median 500, IQR 105-825). The differences between clinical caseloads of C1-C3 members were significant: C1 versus C2 (P=.03), C1 versus C3 (P=.02), and C2 versus C3 (P<.001). Most participants (87/112, 77.7%) would like to expand telemedicine approaches in the future. In the field of cardiology, the participants reported a high suitability of telemedicine. The willingness to train in telemedicine is high to very high for > 50% of the participants. Conclusions: Our results indicate generally moderate use but positive attitudes toward telemedicine among participating physicians with a higher clinical caseload. The lack of a structural framework seems to be a barrier to the effective implementation of telecardiology. %M 38376898 %R 10.2196/49526 %U https://formative.jmir.org/2024/1/e49526 %U https://doi.org/10.2196/49526 %U http://www.ncbi.nlm.nih.gov/pubmed/38376898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51727 %T Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study %A Hashtarkhani,Soheil %A Schwartz,David L %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center, 50 N Dunlap Street, R492, Memphis, TN, 38103, United States, 1 9012875863, ashabann@uthsc.edu %K geographical information system %K geoprocessing tool %K health disparities %K health equity %K health services management %K hemodialysis services %K spatial accessibility %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. Objective: In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. Methods: Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users’ choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. Results: The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. Conclusions: These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively. %M 38381503 %R 10.2196/51727 %U https://formative.jmir.org/2024/1/e51727 %U https://doi.org/10.2196/51727 %U http://www.ncbi.nlm.nih.gov/pubmed/38381503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52338 %T Group, Blended and Individual, Unguided Online Delivery of Mindfulness-Based Cognitive Therapy for People With Cancer: Feasibility Uncontrolled Trial %A Badaghi,Nasim %A van Kruijsbergen,Mette %A Speckens,Anne %A Vilé,Joëlle %A Prins,Judith %A Kelders,Saskia %A Kwakkenbos,Linda %+ Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 0624835397, nasim.badaghimoreno@radboudumc.nl %K cancer %K eHeath %K online interventions %K mindfulness %K psycho-oncology %K qualitative research %K oncology %K CBT %K blended %K eMBCT %K iCBT %K cognitive therapy %K unguided %K psychotherapy %K MBCT %K co-creation %K therapist %K self-guided %K peer-support %K co-design %K participatory %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online mindfulness based cognitive therapy (eMBCT) has been shown to reduce psychological distress in people with cancer. However, this population has reported lack of support and asynchronous communication as barriers to eMBCT, resulting in higher nonadherence rates than with face-to-face MBCT. Using a co-creation process, we developed 2 formats of eMBCT: group, blended (combination of therapist-guided group and individual online sessions) and individual, unguided (individual, unguided online sessions only). Group, blended eMBCT offers peer support and guidance, whereas individual, unguided eMBCT offers flexibility and the possibility of large-scale implementation. Objective: The objective of this nonrandomized feasibility study was to assess aspects of feasibility of the group, blended and individual, unguided eMBCT interventions. Methods: Participants were people with cancer who chose between group, blended and individual, unguided eMBCT. Both intervention conditions followed the same 8-week eMBCT program, including an introductory session and a silent day (10 sessions total). All sessions for individual, unguided eMBCT occurred via the platform Minddistrict, whereas group, blended eMBCT consisted of 3 online videoconference sessions guided by a mindfulness teacher and 5 sessions via Minddistrict. We assessed the feasibility of the intervention quantitatively and qualitatively by evaluating its acceptability among participants. Additionally, we assessed limited efficacy by looking at the number of questionnaires participants completed pre- and postintervention. Results: We included 12 participants for each eMBCT condition. Participants in group, blended eMBCT completed, on average, 9.7 of 10 sessions, compared with an average 8.3 sessions for individual, unguided eMBCT (excluding dropouts). Of the 24 participants, 13 (54%) agreed to be interviewed (5 unguided and 8 blended). Participants in both conditions reported positive experiences, including the convenience of not having to travel and the flexibility to choose when and where to participate. However, among the barriers for participation, participants in the group, blended condition reported a preference for more group sessions, and participants in the individual, unguided condition reported a lack of guidance. Additionally, for the group, blended condition, the effect sizes were small for all outcome measures (Hedges g range=0.01-0.36), except for fatigue, which had a moderate effect size (Hedges g=0.57). For the individual, unguided condition, the effect sizes were small for all outcome measures (Hedges g range=0.24-0.46), except for mindfulness skills (Hedges g=0.52) and engagement with the intervention (Hedges g=1.53). Conclusions: Participants in this study had a positive experience with group, blended and individual, unguided eMBCT. Based on the results from this study, we will adjust the intervention prior to conducting a full-scale randomized controlled trial to evaluate effectiveness; we will add 1 group session to the group, blended eMBCT using Zoom as the platform for the group sessions; and we will send reminders to participants to complete questionnaires. Trial Registration: ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/ct2/show/NCT05336916 %M 38381493 %R 10.2196/52338 %U https://formative.jmir.org/2024/1/e52338 %U https://doi.org/10.2196/52338 %U http://www.ncbi.nlm.nih.gov/pubmed/38381493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51996 %T Comprehensive Assessment and Early Prediction of Gross Motor Performance in Toddlers With Graph Convolutional Networks–Based Deep Learning: Development and Validation Study %A Chun,Sulim %A Jang,Sooyoung %A Kim,Jin Yong %A Ko,Chanyoung %A Lee,JooHyun %A Hong,JaeSeong %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 6th floor, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2493, yurangpark@yuhs.ac %K child development %K digital health %K artificial intelligence %K gross %K motor %K movement %K development %K developmental %K machine learning %K pediatric %K pediatrics %K paediatric %K paediatrics %K toddler %K toddlers %K child %K children %K limb %K limbs %K algorithm %K algorithms %K kinesiology %K GCN %K graph convolutional networks %K convolutional network %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate and timely assessment of children’s developmental status is crucial for early diagnosis and intervention. More accurate and automated developmental assessments are essential due to the lack of trained health care providers and imprecise parental reporting. In various areas of development, gross motor development in toddlers is known to be predictive of subsequent childhood developments. Objective: The purpose of this study was to develop a model to assess gross motor behavior and integrate the results to determine the overall gross motor status of toddlers. This study also aimed to identify behaviors that are important in the assessment of overall gross motor skills and detect critical moments and important body parts for the assessment of each behavior. Methods: We used behavioral videos of toddlers aged 18-35 months. To assess gross motor development, we selected 4 behaviors (climb up the stairs, go down the stairs, throw the ball, and stand on 1 foot) that have been validated with the Korean Developmental Screening Test for Infants and Children. In the child behavior videos, we estimated each child’s position as a bounding box and extracted human keypoints within the box. In the first stage, the videos with the extracted human keypoints of each behavior were evaluated separately using a graph convolutional networks (GCN)–based algorithm. The probability values obtained for each label in the first-stage model were used as input for the second-stage model, the extreme gradient boosting (XGBoost) algorithm, to predict the overall gross motor status. For interpretability, we used gradient-weighted class activation mapping (Grad-CAM) to identify important moments and relevant body parts during the movements. The Shapley additive explanations method was used for the assessment of variable importance, to determine the movements that contributed the most to the overall developmental assessment. Results: Behavioral videos of 4 gross motor skills were collected from 147 children, resulting in a total of 2395 videos. The stage-1 GCN model to evaluate each behavior had an area under the receiver operating characteristic curve (AUROC) of 0.79 to 0.90. Keypoint-mapping Grad-CAM visualization identified important moments in each behavior and differences in important body parts. The stage-2 XGBoost model to assess the overall gross motor status had an AUROC of 0.90. Among the 4 behaviors, “go down the stairs” contributed the most to the overall developmental assessment. Conclusions: Using movement videos of toddlers aged 18-35 months, we developed objective and automated models to evaluate each behavior and assess each child’s overall gross motor performance. We identified the important behaviors for assessing gross motor performance and developed methods to recognize important moments and body parts while evaluating gross motor performance. %M 38381519 %R 10.2196/51996 %U https://formative.jmir.org/2024/1/e51996 %U https://doi.org/10.2196/51996 %U http://www.ncbi.nlm.nih.gov/pubmed/38381519 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48881 %T Perception of Apps for Mental Health Assessment With Recommendations for Future Design: United Kingdom Semistructured Interview Study %A Funnell,Erin L %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Benacek,Jiri %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K app design %K digital health %K eHealth %K interviews %K mental health %K mHealth %K mobile phone %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health care provision in the United Kingdom is overwhelmed by a high demand for services. There are high rates of under-, over-, and misdiagnosis of common mental health disorders in primary care and delays in accessing secondary care. This negatively affects patient functioning and outcomes. Digital tools may offer a time-efficient avenue for the remote assessment and triage of mental health disorders that can be integrated directly into existing care pathways to support clinicians. However, despite the potential of digital tools in the field of mental health, there remain gaps in our understanding of how the intended user base, people with lived experiences of mental health concerns, perceive these technologies. Objective: This study explores the perspectives and attitudes of individuals with lived experiences of mental health concerns on mental health apps that are designed to support self-assessment and triage. Methods: A semistructured interview approach was used to explore the perspectives of the interviewees using 5 open-ended questions. Interviews were transcribed verbatim from audio data recordings. The average interview lasted 46 minutes (rounded to the nearest min; SD 12.93 min). A thematic analysis was conducted. Results: Overall, 16 individuals were interviewed in this study. The average age was 42.25 (SD 15.18) years, half of the interviewees identified as women (8/16, 50%), and all were White (16/16, 100%). The thematic analysis revealed six major themes: (1) availability and accessibility, (2) quality, (3) attitudes, (4) safety, (5) impact, and (6) functionality. Conclusions: Engaging in clear communication regarding data security and privacy policies, adopting a consent-driven approach to data sharing, and identifying gaps in the app marketplace to foster the inclusion of a range of mental health conditions and avoid oversaturation of apps for common mental health disorders (eg, depression and anxiety) were identified as priorities from interviewees’ comments. Furthermore, reputation was identified as a driver of uptake and engagement, with endorsement from a respected source (ie, health care provider, academic institution) or direct recommendation from a trusted health care professional associated with increased interest and trust. Furthermore, there was an interest in the role that co-designed digital self-assessments could play in existing care pathways, particularly in terms of facilitating informed discussions with health care professionals during appointments and by signposting individuals to the most appropriate services. In addition, interviewees discussed the potential of mental health apps to provide waiting list support to individuals awaiting treatment by providing personalized psychoeducation, self-help tips, and sources of help. However, concerns regarding the quality of care being affected because of digital delivery have been reported; therefore, frequent monitoring of patient acceptability and care outcomes is warranted. In addition, communicating the rationale and benefits of digitizing services will likely be important for securing interest and uptake from health care service users. %M 38393760 %R 10.2196/48881 %U https://formative.jmir.org/2024/1/e48881 %U https://doi.org/10.2196/48881 %U http://www.ncbi.nlm.nih.gov/pubmed/38393760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49110 %T Co-Production of a Flexibly Delivered Relapse Prevention Tool to Support the Self-Management of Long-Term Mental Health Conditions: Co-Design and User Testing Study %A Milton,Alyssa %A Ozols A M,Ingrid %A Cassidy,Tayla %A Jordan,Dana %A Brown,Ellie %A Arnautovska,Urska %A Cook,Jim %A Phung,Darren %A Lloyd-Evans,Brynmor %A Johnson,Sonia %A Hickie,Ian %A Glozier,Nick %+ Faculty of Medicine and Health, The University of Sydney, Level 5 Professor Marie Bashir Centre, 67-73 Missenden Rd, Camperdown, 2050, Australia, 61 02 9515 1461, alyssa.milton@sydney.edu.au %K self-management %K serious mental illness %K self-care %K digital health tools %K blended interventions %K peer support %K mobile phone %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Supported self-management interventions, which assist individuals in actively understanding and managing their own health conditions, have a robust evidence base for chronic physical illnesses, such as diabetes, but have been underused for long-term mental health conditions. Objective: This study aims to co-design and user test a mental health supported self-management intervention, My Personal Recovery Plan (MyPREP), that could be flexibly delivered via digital and traditional paper-based mediums. Methods: This study adopted a participatory design, user testing, and rapid prototyping methodologies, guided by 2 frameworks: the 2021 Medical Research Council framework for complex interventions and an Australian co-production framework. Participants were aged ≥18 years, self-identified as having a lived experience of using mental health services or working in a peer support role, and possessed English proficiency. The co-design and user testing processes involved a first round with 6 participants, focusing on adapting a self-management resource used in a large-scale randomized controlled trial in the United Kingdom, followed by a second round with 4 new participants for user testing the co-designed digital version. A final round for gathering qualitative feedback from 6 peer support workers was conducted. Data analysis involved transcription, coding, and thematic interpretation as well as the calculation of usability scores using the System Usability Scale. Results: The key themes identified during the co-design and user testing sessions were related to (1) the need for self-management tools to be flexible and well-integrated into mental health services, (2) the importance of language and how language preferences vary among individuals, (3) the need for self-management interventions to have the option of being supported when delivered in services, and (4) the potential of digitization to allow for a greater customization of self-management tools and the development of features based on individuals’ unique preferences and needs. The MyPREP paper version received a total usability score of 71, indicating C+ or good usability, whereas the digital version received a total usability score of 85.63, indicating A or excellent usability. Conclusions: There are international calls for mental health services to promote a culture of self-management, with supported self-management interventions being routinely offered. The resulting co-designed prototype of the Australian version of the self-management intervention MyPREP provides an avenue for supporting self-management in practice in a flexible manner. Involving end users, such as consumers and peer workers, from the beginning is vital to address their need for personalized and customized interventions and their choice in how interventions are delivered. Further implementation-effectiveness piloting of MyPREP in real-world mental health service settings is a critical next step. %M 38393768 %R 10.2196/49110 %U https://formative.jmir.org/2024/1/e49110 %U https://doi.org/10.2196/49110 %U http://www.ncbi.nlm.nih.gov/pubmed/38393768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49494 %T Help-Seeking, Support, and Engagement in Gestational Diabetes Mellitus Online Communities on Facebook: Content Analysis %A Pham,Sheila %A Churruca,Kate %A Ellis,Louise A %A Braithwaite,Jeffrey %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, 2113, Australia, 61 423078104, sheila.pham@mq.edu.au %K clinical management %K communication %K content analysis %K engagement %K Facebook %K gestational diabetes %K health communication %K help-seeking behavior %K mental distress %K online communities %K peer-support %K self-disclosure %K self-management %K support %D 2024 %7 26.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of gestational diabetes mellitus (GDM) has drastically risen in recent years. For some, self-management includes the use of GDM online communities on Facebook. Such communities can fill gaps in information and support that participants are not able to access elsewhere to address unmet needs. Given the popularity of sharing information about pregnancy on Facebook and the documented benefits of diabetes online communities, the same may be true of GDM online communities. Objective: This study aimed to categorize and quantify what is being discussed in GDM Facebook groups, including informational and emotional help-seeking behavior, and how this support and engagement may be demonstrated by peers through comments and reactions. Methods: We sourced the data from the 2 largest Facebook groups focused on GDM in Australia. A summative content analysis was conducted on original posts across the 2 groups and coded for topics as well as help-seeking types. The coding scheme was based on the previous work of Liang and Scammon. Visible indicators of engagement, including the number of comments and “reactions,” were tabled and manually evaluated. Results: There were 388 original posts, and the analysis produced 6 topics: GDM self-management (199/388, 51.3%), GDM clinical management (120/388, 30.9%), preparing for birth (40/388, 10.3%), mental distress (35/388, 9%), birth announcement (29/388, 7.5%), and GDM journey reflections (21/388, 5.4%). Secondary coding of help-seeking type revealed more than half of the posts were informational help-seeking (224/388, 57.7%), while a small proportion were both informational and emotional help-seeking (44/388, 11.3%), and some (12/388, 3.1%) were emotional help-seeking only. Self-disclosure was identified as a fourth category, comprising almost a quarter of all posts (90/388, 23.2%). A total of 6022 comments were posted in response to the original posts, and there were 4452 reactions across all posts. Emotional help-seeking attracted the most comments per thread (mean 21.5, SD 19.8), followed by informational and emotional help-seeking (mean 20.2, SD 14.7), informational help-seeking (mean 15.6, SD 14.6), and self-disclosure (mean 14.3, SD 21.8). Across all help-seeking categories, few reactions occurred compared to comments; in contrast, self-disclosure attracted a large number of reactions (mean 9.4, SD 45.3). Conclusions: This is one of the first studies to examine peer support in a GDM online community on Facebook. Our findings suggest that active participants’ needs around information and support in relation to GDM are being somewhat met by peer-led online communities. Given the practical limitations of formal health care, including the provision of ongoing social support, it is important to recognize how GDM online communities can complement formal health care and help address unmet needs. %M 38407949 %R 10.2196/49494 %U https://formative.jmir.org/2024/1/e49494 %U https://doi.org/10.2196/49494 %U http://www.ncbi.nlm.nih.gov/pubmed/38407949 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47570 %T How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study %A Ma,Shaoying %A Kaareen,Aadeeba %A Park,Hojin %A He,Yanyun %A Jiang,Shuning %A Qiu,Zefeng %A Xie,Zidian %A Li,Dongmei %A Chen,Jian %A O’Connor,Richard J %A Fong,Geoffrey T %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Wexner Medical Center, 3650 Olentangy River Road, 1st Floor, Suite 110, Columbus, OH, 43214, United States, 1 6148976063, shaoying.ma@osumc.edu %K tobacco %K electronic cigarette %K e-cigarette %K electronic nicotine delivery systems %K electronic nicotine delivery system %K vaping %K market surveillance %K tobacco marketing %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. Objective: To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. Methods: In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. Results: As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. Conclusions: As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers’ marketing behaviors, and identify regulatory impacts. %M 38416562 %R 10.2196/47570 %U https://formative.jmir.org/2024/1/e47570 %U https://doi.org/10.2196/47570 %U http://www.ncbi.nlm.nih.gov/pubmed/38416562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47458 %T Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences %A Patel,Priya %A Brown,Susan %A Guo,Boliang %A Holmes,Emily A %A Iyadurai,Lalitha %A Kingslake,Jonathan %A Highfield,Julie %A Morriss,Richard %+ NIHR ARC East Midlands, University of Nottingham, Innovation Park Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 7790988203, Priya.Patel1@nottingham.ac.uk %K intensive care %K posttraumatic stress disorder %K PTSD %K qualitative research %K intervention study %K health care professionals %K digital intervention %K staff well-being %K pandemic %K intrusive memories %K work-related trauma %K mobile phone %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. Objective: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. Methods: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. Results: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. Conclusions: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial. %M 38421698 %R 10.2196/47458 %U https://formative.jmir.org/2024/1/e47458 %U https://doi.org/10.2196/47458 %U http://www.ncbi.nlm.nih.gov/pubmed/38421698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50528 %T A Mobile Applet for Assessing Medication Adherence and Managing Adverse Drug Reactions Among Patients With Cancer: Usability and Utility Study %A Ni,Chenxu %A Wang,Yi-fu %A Zhang,Yun-ting %A Yuan,Min %A Xu,Qing %A Shen,Fu-ming %A Li,Dong-Jie %A Huang,Fang %+ Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, China, 86 66302570, hazel_huang@126.com %K WeChat applet %K usability testing %K utility testing %K cancer patients %K patients %K cancer %K qualitative study %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication adherence and the management of adverse drug reactions (ADRs) are crucial to the efficacy of antitumor drugs. A WeChat applet, also known as a “Mini Program,” is similar to the app but has marked advantages. The development and use of a WeChat applet makes follow-up convenient for patients with cancer. Objective: This study aimed to assess the usability and utility of a newly developed WeChat applet, “DolphinCare,” among patients with cancer in Shanghai. Methods: A qualitative methodology was used to obtain an in-depth understanding of the experiences of patients with cancer when using DolphinCare from the usability and utility aspects. The development phase consisted of 2 parts: alpha and beta testing. Alpha testing combined the theory of the Fogg Behavior Model and the usability model. Alpha testing also involved testing the design of DolphinCare using a conceptual framework, which included factors that could affect medication adherence and ADRs. Beta testing was conducted using in-depth interviews. In-depth interviews allowed us to assist the patients in using DolphinCare and understand whether they liked or disliked DolphinCare and found it useful. Results: We included participants who had an eHealth Literacy Scale (eHEALS) score of ≥50%, and a total of 20 participants were interviewed consecutively. The key positive motivators described by interviewers were to be reminded to take their medications and to alleviate their ADRs. The majority of the patients were able to activate and use DolphinCare by themselves. Most patients indicated that their trigger to follow-up DolphinCare was the recommendation of their known and trusted health care professionals. All participants found that labels containing the generic names of their medication and the medication reminders were useful, including timed pop-up push notifications and text alerts. The applet presented the corresponding information collection forms of ADRs to the patient to fill out. The web-based consultation system enables patients to consult pharmacists or physicians in time when they have doubts about medications or have ADRs. The applet had usabilities and utilities that could improve medication adherence and the management of ADRs among patients with cancer. Conclusions: This study provides preliminary evidence regarding the usability and utility of this type of WeChat applet among patients with cancer, which is expected to be promoted for managing follow-up among other patients with other chronic disease. %M 38421700 %R 10.2196/50528 %U https://formative.jmir.org/2024/1/e50528 %U https://doi.org/10.2196/50528 %U http://www.ncbi.nlm.nih.gov/pubmed/38421700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49492 %T Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility %A Zheng,Amy %A Bergh,Marissa %A Patel Murali,Komal %A Sadarangani,Tina %+ New York University Rory Meyers College of Nursing, 433 First Avenue, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, msb7677@nyu.edu %K adult day services %K primary health care %K health communication %K dementia %K mobile health %K mHealth %K community-based %K health care %K older adults %K older adult %K chronic condition %K health information %K feasibility %K acceptability %K CareMOBI %K mixed methods design %K caregivers %K caregiver %K care workers %K nurses %K social workers %D 2024 %7 1.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users’ health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. %M 38427418 %R 10.2196/49492 %U https://formative.jmir.org/2024/1/e49492 %U https://doi.org/10.2196/49492 %U http://www.ncbi.nlm.nih.gov/pubmed/38427418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51141 %T The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study %A Al-Sbei,Rasha %A Ataya,Jawdat %A Jamous,Issam %A Dashash,Mayssoon %+ Medical Education Program, Syrian Virtual University, Al-Mazzeh Street, Damascus, 35329, Syrian Arab Republic, 963 992287487, dr.jawdat.ataya@gmail.com %K restorative dentistry %K online learning %K dental education %K dental graduates %K Syria %K education %K dental %K dentistry %K dental practice %K effectiveness %K educational program %K survey %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility. Objective: This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria. Methods: This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants’ knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course. Results: The results showed a significant improvement in the participants’ knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ω2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion. Conclusions: The findings indicated a notable enhancement in the participants’ understanding of restorative dentistry. The participants’ high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field. %M 38441921 %R 10.2196/51141 %U https://formative.jmir.org/2024/1/e51141 %U https://doi.org/10.2196/51141 %U http://www.ncbi.nlm.nih.gov/pubmed/38441921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46817 %T Comparison of the Discrimination Performance of AI Scoring and the Brixia Score in Predicting COVID-19 Severity on Chest X-Ray Imaging: Diagnostic Accuracy Study %A Tenda,Eric Daniel %A Yunus,Reyhan Eddy %A Zulkarnaen,Benny %A Yugo,Muhammad Reynalzi %A Pitoyo,Ceva Wicaksono %A Asaf,Moses Mazmur %A Islamiyati,Tiara Nur %A Pujitresnani,Arierta %A Setiadharma,Andry %A Henrina,Joshua %A Rumende,Cleopas Martin %A Wulani,Vally %A Harimurti,Kuntjoro %A Lydia,Aida %A Shatri,Hamzah %A Soewondo,Pradana %A Yusuf,Prasandhya Astagiri %+ Department of Medical Physiology and Biophysics/ Medical Technology Cluster IMERI, Faculty of Medicine, Universitas Indonesia, Jalan Salemba Raya No.6, Jakarta, 10430, Indonesia, 62 812 8459 4272, prasandhya.a.yusuf@ui.ac.id %K artificial intelligence %K Brixia %K chest x-ray %K COVID-19 %K CAD4COVID %K pneumonia %K radiograph %K artificial intelligence scoring system %K AI scoring system %K prediction %K disease severity %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The artificial intelligence (AI) analysis of chest x-rays can increase the precision of binary COVID-19 diagnosis. However, it is unknown if AI-based chest x-rays can predict who will develop severe COVID-19, especially in low- and middle-income countries. Objective: The study aims to compare the performance of human radiologist Brixia scores versus 2 AI scoring systems in predicting the severity of COVID-19 pneumonia. Methods: We performed a cross-sectional study of 300 patients suspected with and with confirmed COVID-19 infection in Jakarta, Indonesia. A total of 2 AI scores were generated using CAD4COVID x-ray software. Results: The AI probability score had slightly lower discrimination (area under the curve [AUC] 0.787, 95% CI 0.722-0.852). The AI score for the affected lung area (AUC 0.857, 95% CI 0.809-0.905) was almost as good as the human Brixia score (AUC 0.863, 95% CI 0.818-0.908). Conclusions: The AI score for the affected lung area and the human radiologist Brixia score had similar and good discrimination performance in predicting COVID-19 severity. Our study demonstrated that using AI-based diagnostic tools is possible, even in low-resource settings. However, before it is widely adopted in daily practice, more studies with a larger scale and that are prospective in nature are needed to confirm our findings. %M 38451633 %R 10.2196/46817 %U https://formative.jmir.org/2024/1/e46817 %U https://doi.org/10.2196/46817 %U http://www.ncbi.nlm.nih.gov/pubmed/38451633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52427 %T Developing a Novel Web-Based Self-Management Support Intervention for Polycystic Ovary Syndrome: Mixed Methods Study With Patients and Health Care Professionals %A Percy,Carol %A Turner,Andrew %A Orr,Charys %+ Centre for Intelligent Healthcare, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 2477 659 337, c.percy@coventry.ac.uk %K anxiety %K depression %K PCOS %K peer support %K polycystic ovary syndrome %K positive well-being %K psychoeducation %K self-management %K web-based health intervention %K women’s health %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Polycystic ovary syndrome (PCOS) represents a significant global health burden requiring urgent attention. This common chronic endocrine and cardiometabolic condition affects around 1 in 10 women and individuals assigned female at birth, with significant adverse effects on well-being, quality of life, and mental health, as well as serious and complex long-term health consequences. International guidelines for best health care practice recommend the provision of comprehensive cognitive behavioral interventions to support self-management and improve health outcomes for those living with PCOS. Web-based health interventions have the potential to meet this need in an accessible and scalable way. Objective: We aim to identify barriers to self-management and psychological well-being in women with PCOS and adapt a web-based self-management program to provide a prototype digital support intervention for them. Methods: We adapted an existing support program (HOPE) for PCOS using the antecedent target measure approach. We conducted qualitative interviews with 13 adult women living with PCOS, 3 trustees of a patients with PCOS advocacy charity, and 4 endocrinologists to identify “antecedents” (barriers) to self-management and psychological well-being. Framework analysis was used to identify potentially modifiable antecedents to be targeted by the novel intervention. At a national conference, 58 key stakeholders (patients and health professionals) voted for the antecedents they felt were most important to address. We used research evidence and relevant theory to design a prototype for the PCOS intervention. Results: Voting identified 32 potentially modifiable antecedents, relating to knowledge, understanding, emotions, motivation, and behaviors, as priorities to be targeted in the new intervention. A modular, web-based prototype HOPE PCOS intervention was developed to address these, covering six broad topic areas (instilling HOPE for PCOS; managing the stress of PCOS; feeding your mind and body well; body image, intimacy, and close relationships; staying healthy with PCOS; and keeping PCOS in its place). Conclusions: We identified barriers to self-management and psychological well-being in women with PCOS and used these to adapt a web-based self-management program, tailoring it for PCOS, which is a comprehensive group intervention combining education, empowerment, lifestyle management, peer support with cognitive behavioral tools, and goal-setting (to be delivered by peers or codelivered with health care professionals). The modular structure offers flexibility to adapt the program further as new clinical recommendations emerge. The intervention has the potential to be delivered, evaluated for feasibility, and, if effective, integrated into health care services. Self-management interventions are not designed to replace clinical care; rather, they serve as an additional source of support. The HOPE PCOS program conveys this message in its content and activities. Future research should evaluate the prototype intervention using primary outcomes such as measures of psychological well-being, self-management self-efficacy, depression, anxiety, and PCOS-related quality of life. They should also assess the intervention’s acceptability, scalability, and cost-effectiveness. %M 38451567 %R 10.2196/52427 %U https://formative.jmir.org/2024/1/e52427 %U https://doi.org/10.2196/52427 %U http://www.ncbi.nlm.nih.gov/pubmed/38451567 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45202 %T A Deep Learning–Based Approach for Prediction of Vancomycin Treatment Monitoring: Retrospective Study Among Patients With Critical Illness %A Kim,Dohyun %A Choi,Hyun-Soo %A Lee,DongHoon %A Kim,Minkyu %A Kim,Yoon %A Han,Seon-Sook %A Heo,Yeonjeong %A Park,Ju-Hee %A Park,Jinkyeong %+ Department of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea, 82 1027747808, pjk3318@gmail.com %K critically ill %K deep learning %K inflammation %K machine learning %K pharmacokinetic %K therapeutic drug monitoring %K vancomycin %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Vancomycin pharmacokinetics are highly variable in patients with critical illnesses, and clinicians commonly use population pharmacokinetic (PPK) models based on a Bayesian approach to dose. However, these models are population-dependent, may only sometimes meet the needs of individual patients, and are only used by experienced clinicians as a reference for making treatment decisions. To assist real-world clinicians, we developed a deep learning–based decision-making system that predicts vancomycin therapeutic drug monitoring (TDM) levels in patients in intensive care unit. Objective: This study aimed to establish joint multilayer perceptron (JointMLP), a new deep-learning model for predicting vancomycin TDM levels, and compare its performance with the PPK models, extreme gradient boosting (XGBoost), and TabNet. Methods: We used a 977-case data set split into training and testing groups in a 9:1 ratio. We performed external validation of the model using 1429 cases from Kangwon National University Hospital and 2394 cases from the Medical Information Mart for Intensive Care–IV (MIMIC-IV). In addition, we performed 10-fold cross-validation on the internal training data set and calculated the 95% CIs using the metric. Finally, we evaluated the generalization ability of the JointMLP model using the MIMIC-IV data set. Results: Our JointMLP model outperformed other models in predicting vancomycin TDM levels in internal and external data sets. Compared to PPK, the JointMLP model improved predictive power by up to 31% (mean absolute error [MAE] 6.68 vs 5.11) on the internal data set and 81% (MAE 11.87 vs 6.56) on the external data set. In addition, the JointMLP model significantly outperforms XGBoost and TabNet, with a 13% (MAE 5.75 vs 5.11) and 14% (MAE 5.85 vs 5.11) improvement in predictive accuracy on the inner data set, respectively. On both the internal and external data sets, our JointMLP model performed well compared to XGBoost and TabNet, achieving prediction accuracy improvements of 34% and 14%, respectively. Additionally, our JointMLP model showed higher robustness to outlier data than the other models, as evidenced by its higher root mean squared error performance across all data sets. The mean errors and variances of the JointMLP model were close to zero and smaller than those of the PPK model in internal and external data sets. Conclusions: Our JointMLP approach can help optimize treatment outcomes in patients with critical illnesses in an intensive care unit setting, reducing side effects associated with suboptimal vancomycin administration. These include increased risk of bacterial resistance, extended hospital stays, and increased health care costs. In addition, the superior performance of our model compared to existing models highlights its potential to help real-world clinicians. %M 38152042 %R 10.2196/45202 %U https://formative.jmir.org/2024/1/e45202 %U https://doi.org/10.2196/45202 %U http://www.ncbi.nlm.nih.gov/pubmed/38152042 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47803 %T Optimization of Using Multiple Machine Learning Approaches in Atrial Fibrillation Detection Based on a Large-Scale Data Set of 12-Lead Electrocardiograms: Cross-Sectional Study %A Chuang,Beau Bo-Sheng %A Yang,Albert C %+ Digital Medicine and Smart Healthcare Research Center, National Yang Ming Chiao Tung University, No 155, Li-Nong St, Sec.2, Beitou District, Taipei, 112304, Taiwan, 886 228267995, accyang@nycu.edu.tw %K machine learning %K atrial fibrillation %K light gradient boosting machine %K power spectral density %K digital health %K electrocardiogram %K machine learning algorithm %K atrial fibrillation detection %K real-time %K detection %K electrocardiography leads %K clinical outcome %D 2024 %7 11.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Atrial fibrillation (AF) represents a hazardous cardiac arrhythmia that significantly elevates the risk of stroke and heart failure. Despite its severity, its diagnosis largely relies on the proficiency of health care professionals. At present, the real-time identification of paroxysmal AF is hindered by the lack of automated techniques. Consequently, a highly effective machine learning algorithm specifically designed for AF detection could offer substantial clinical benefits. We hypothesized that machine learning algorithms have the potential to identify and extract features of AF with a high degree of accuracy, given the intricate and distinctive patterns present in electrocardiogram (ECG) recordings of AF. Objective: This study aims to develop a clinically valuable machine learning algorithm that can accurately detect AF and compare different leads’ performances of AF detection. Methods: We used 12-lead ECG recordings sourced from the 2020 PhysioNet Challenge data sets. The Welch method was used to extract power spectral features of the 12-lead ECGs within a frequency range of 0.083 to 24.92 Hz. Subsequently, various machine learning techniques were evaluated and optimized to classify sinus rhythm (SR) and AF based on these power spectral features. Furthermore, we compared the effects of different frequency subbands and different lead selections on machine learning performances. Results: The light gradient boosting machine (LightGBM) was found to be the most effective in classifying AF and SR, achieving an average F1-score of 0.988 across all ECG leads. Among the frequency subbands, the 0.083 to 4.92 Hz range yielded the highest F1-score of 0.985. In interlead comparisons, aVR had the highest performance (F1=0.993), with minimal differences observed between leads. Conclusions: In conclusion, this study successfully used machine learning methodologies, particularly the LightGBM model, to differentiate SR and AF based on power spectral features derived from 12-lead ECGs. The performance marked by an average F1-score of 0.988 and minimal interlead variation underscores the potential of machine learning algorithms to bolster real-time AF detection. This advancement could significantly improve patient care in intensive care units as well as facilitate remote monitoring through wearable devices, ultimately enhancing clinical outcomes. %M 38466973 %R 10.2196/47803 %U https://formative.jmir.org/2024/1/e47803 %U https://doi.org/10.2196/47803 %U http://www.ncbi.nlm.nih.gov/pubmed/38466973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55205 %T Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study %A Poudyal,Anubhuti %A Lewis,Delta-Marie %A Taha,Sarah %A Martinez,Alyssa J %A Magoun,Lauren %A Ho,Y Xian %A Carmio,Natali %A Naslund,John A %A Sanchez,Katherine %A Lesh,Neal %A Patel,Vikram %+ Department of Sociomedical Sciences, Columbia Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, United States, 1 (212) 305 2862, ap4150@cumc.columbia.edu %K digital technology %K mental health %K depression %K task sharing %K nonspecialist providers %K peer supervision %K therapy quality %D 2024 %7 11.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. Objective: We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. Methods: We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app’s overall usability. We also calculated the participants’ likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. Results: A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants’ likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs’ workloads. Conclusions: We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app’s use and efficacy in real-world settings to support task-shared mental health programs across the United States. %M 38466971 %R 10.2196/55205 %U https://formative.jmir.org/2024/1/e55205 %U https://doi.org/10.2196/55205 %U http://www.ncbi.nlm.nih.gov/pubmed/38466971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48080 %T Improving Behavioral-Based Safety Training in Using Verbal Commands Through a Theory-Driven and Feedback-Based Nonimmersive Virtual Reality Game: Development and Usability Study %A Atagbuzia,Chukwudiebube %A Ng,Ean H %A Natarajan,Ganapathy %+ Oregon State University, 204 Rogers Hall, Oregon State University, Corvallis, OR, 97331, United States, 1 15417370570, ean.ng@oregonstate.edu %K behavioral safety training %K SERES framework %K Reflection, Engagement, Choice, Information, Play, Exposition framework %K gamification %K gestalt laws of perception %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The construction, chemical, aviation, medical, and health care industries have used serious games for safety training. To our knowledge, serious games have not been developed focusing on behavioral change to improve safety through the use of verbal commands and instilling players with heightened awareness of their spatial proximity to other people in their surroundings. Objective: We aimed to develop a theory-driven serious game for improving safety behavior using verbal commands and validate the implementation of the theoretical frameworks used for game development. The game developed, KitchenSpeak, was a first-person character (FPC) game where users respond to in-game prompts to use loud verbal commands when they are approaching another employee’s blind spot. Methods: In addition to using the SERES framework in guiding the general game design and development, and the Reflection, Engagement, Choice, Information, Play, Exposition (RECIPE) framework to inform the design of the game mechanics, we also applied gestalt laws of perception for graphic design to guide the design of the game’s user interface. We conducted 2 evaluative tests (alpha and beta) to collect end user and stakeholder feedback on the implementation of the theoretical frameworks, as well as to collect relevant information for full-scale implementation and a future validation study. Results: The alpha and beta tests had 8 and 40 participants, respectively. The alpha test results revealed that the theoretical frameworks were adequately applied; however, suggestions were also made to modify and improve the game. The beta test results suggested further improvements for the game design and found no differences in the perception of ease of play between participants with and without previous FPC gaming experience (P=.47; Kruskal-Wallis). Results suggested that the game met its design and theoretical requirements, and it would be easily playable by all players regardless of their previous experience in FPC games. Conclusions: A theory-driven and evidence-based FPC game titled KitchenSpeak was developed to teach the use of kitchen-speak terms in commercial kitchens. Evaluative tests were conducted to validate the implementation of the theoretical frameworks. Our main contributions are creating and validating game-based training to improve behavioral-based safety in the workplace and the incorporation of gestalt laws of perception for graphic design in the game’s user interface. %M 38470470 %R 10.2196/48080 %U https://formative.jmir.org/2024/1/e48080 %U https://doi.org/10.2196/48080 %U http://www.ncbi.nlm.nih.gov/pubmed/38470470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50737 %T Implementing a Sodium-Glucose Cotransporter 2 Inhibitor Module With a Software Tool (Future Health Today): Qualitative Study %A Suen,Matthew %A Manski-Nankervis,Jo-Anne %A McBride,Caroline %A Lumsden,Natalie %A Hunter,Barbara %+ Department of General Practice and Primary Care, University of Melbourne, Level 3, North Wing, Building, 181 Grattan Street, Medical Building, Parkville, 3010, Australia, 61 383443369, matthew.suen@unimelb.edu.au %K type 2 diabetes %K CP-FIT %K electronic health %K clinical decision support tool %K primary care %K SGLT2 inhibitor %K complication %K tool %K digital health intervention %K thematic analysis %K decision support %K diabetes management %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Primary care plays a key role in the management of type 2 diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been demonstrated to reduce hospitalization and cardiac and renal complications. Tools that optimize management, including appropriate prescribing, are a priority for treating chronic diseases. Future Health Today (FHT) is software that facilitates clinical decision support and quality improvement. FHT applies algorithms to data stored in electronic medical records in general practice to identify patients who are at risk of a chronic disease or who have a chronic disease that may benefit from intensification of management. The platform continues to evolve because of rigorous evaluation, continuous improvement, and expansion of the conditions hosted on the platform. FHT currently displays recommendations for the identification and management of chronic kidney disease, cardiovascular disease, type 2 diabetes, and cancer risk. A new module will be introduced to FHT focusing on SGLT2 inhibitors in patients with type 2 diabetes who have chronic kidney diseases, cardiovascular diseases, or risk factors for cardiovascular disease. Objective: The study aims to explore the barriers and enablers to the implementation of an SGLT2 inhibitor module within the Future Health Today software. Methods: Clinic staff were recruited to participate in interviews on their experience in their use of a tool to improve prescribing behavior for SGLT2 inhibitors. Thematic analysis was guided by Clinical Performance Feedback Intervention Theory. Results: In total, 16 interviews were completed. Identified enablers of use included workflow alignment, clinical appropriateness, and active delivery of the module. Key barriers to use were competing priorities, staff engagement, and knowledge of the clinical topic. Conclusions: There is a recognized benefit to the use of a clinical decision support tool to support type 2 diabetes management, but barriers were identified that impeded the usability and actionability of the module. Successful and effective implementation of this tool could support the optimization of patient management of type 2 diabetes in primary care. %M 38477973 %R 10.2196/50737 %U https://formative.jmir.org/2024/1/e50737 %U https://doi.org/10.2196/50737 %U http://www.ncbi.nlm.nih.gov/pubmed/38477973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53555 %T Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study %A Snyder,Morgan %A Elkins,Gary R %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, United States, 1 254 710 2961, gary_elkins@baylor.edu %K hypnotherapy %K hot flashes %K smartphone app %K mHealth %K mobile health %K app %K apps %K applications %K hypnosis %K menopause %K menopausal %K gynecology %K usage %K women's health %K user %K users %K demographics %K demographic %K characteristic %K characteristics %K mental health %K alternative %K complementary %K mind body %K hypnotism %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. Objective: This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. Methods: This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. Results: Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=–0.09). Conclusions: This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app. %M 38483465 %R 10.2196/53555 %U https://formative.jmir.org/2024/1/e53555 %U https://doi.org/10.2196/53555 %U http://www.ncbi.nlm.nih.gov/pubmed/38483465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50056 %T Adapting the Number of Questions Based on Detected Psychological Distress for Cognitive Behavioral Therapy With an Embodied Conversational Agent: Comparative Study %A Shidara,Kazuhiro %A Tanaka,Hiroki %A Adachi,Hiroyoshi %A Kanayama,Daisuke %A Kudo,Takashi %A Nakamura,Satoshi %+ Nara Institute of Science and Technology, 8916-5, Takayama-cho, Ikoma, 630-0192, Japan, 81 80 4687 8116, shidara.kazuhiro.sc5@is.naist.jp %K cognitive behavioral therapy %K psychological distress detection %K embodied conversational agents %K automatic thoughts %K long short-term memory %K multitask learning %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The high prevalence of mental illness is a critical social problem. The limited availability of mental health services is a major factor that exacerbates this problem. One solution is to deliver cognitive behavioral therapy (CBT) using an embodied conversational agent (ECA). ECAs make it possible to provide health care without location or time constraints. One of the techniques used in CBT is Socratic questioning, which guides users to correct negative thoughts. The effectiveness of this approach depends on a therapist’s skill to adapt to the user’s mood or distress level. However, current ECAs do not possess this skill. Therefore, it is essential to implement this adaptation ability to the ECAs. Objective: This study aims to develop and evaluate a method that automatically adapts the number of Socratic questions based on the level of detected psychological distress during a CBT session with an ECA. We hypothesize that this adaptive approach to selecting the number of questions will lower psychological distress, reduce negative emotional states, and produce more substantial cognitive changes compared with a random number of questions. Methods: In this study, which envisions health care support in daily life, we recruited participants aged from 18 to 65 years for an experiment that involved 2 different conditions: an ECA that adapts a number of questions based on psychological distress detection or an ECA that only asked a random number of questions. The participants were assigned to 1 of the 2 conditions, experienced a single CBT session with an ECA, and completed questionnaires before and after the session. Results: The participants completed the experiment. There were slight differences in sex, age, and preexperimental psychological distress levels between the 2 conditions. The adapted number of questions condition showed significantly lower psychological distress than the random number of questions condition after the session. We also found a significant difference in the cognitive change when the number of questions was adapted based on the detected distress level, compared with when the number of questions was fewer than what was appropriate for the level of distress detected. Conclusions: The results show that an ECA adapting the number of Socratic questions based on detected distress levels increases the effectiveness of CBT. Participants who received an adaptive number of questions experienced greater reductions in distress than those who received a random number of questions. In addition, the participants showed a greater amount of cognitive change when the number of questions matched the detected distress level. This suggests that adapting the question quantity based on distress level detection can improve the results of CBT delivered by an ECA. These results illustrate the advantages of ECAs, paving the way for mental health care that is more tailored and effective. %M 38483464 %R 10.2196/50056 %U https://formative.jmir.org/2024/1/e50056 %U https://doi.org/10.2196/50056 %U http://www.ncbi.nlm.nih.gov/pubmed/38483464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52809 %T A Closed-Loop Digital Health Tool to Improve Depression Care in Multiple Sclerosis: Iterative Design and Cross-Sectional Pilot Randomized Controlled Trial and its Impact on Depression Care %A Henderson,Kyra %A Reihm,Jennifer %A Koshal,Kanishka %A Wijangco,Jaeleene %A Sara,Narender %A Miller,Nicolette %A Doyle,Marianne %A Mallory,Alicia %A Sheridan,Judith %A Guo,Chu-Yueh %A Oommen,Lauren %A Rankin,Katherine P %A Sanders,Stephan %A Feinstein,Anthony %A Mangurian,Christina %A Bove,Riley %+ Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, 1651 4th Street, San Francisco, CA, 94158, United States, 1 4155027209, riley.bove@ucsf.edu %K depression %K quality of life %K bring your own device %K mHealth %K closed-loop %K clinical trial %K multiple sclerosis %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated. Objective: This study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this study involved a proof-of-concept pilot randomized controlled trial (RCT) validation phase and a detailed human-centered design (HCD) phase. Methods: During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts. Results: MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75% vs 34.6%; χ21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians. Conclusions: Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on trial design features of a full year long Department of Defense–funded feasibility and efficacy trial, which is now underway. Trial Registration: ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x %M 38488827 %R 10.2196/52809 %U https://formative.jmir.org/2024/1/e52809 %U https://doi.org/10.2196/52809 %U http://www.ncbi.nlm.nih.gov/pubmed/38488827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46820 %T Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study %A Simmich,Joshua %A Andrews,Nicole Emma %A Claus,Andrew %A Murdoch,Megan %A Russell,Trevor Glen %+ RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, 296 Herston Road, Herston, Brisbane, 4029, Australia, 61 7 3365 5560, j.simmich@uq.edu.au %K GPS %K mobile apps %K exercise test %K pain %K chronic pain %K mobile phone %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance. Objective: The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods. Methods: People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test. Results: The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI −2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and −77.6 (95% CI −107.7 to −61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points. Conclusions: In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment. %M 38498031 %R 10.2196/46820 %U https://formative.jmir.org/2024/1/e46820 %U https://doi.org/10.2196/46820 %U http://www.ncbi.nlm.nih.gov/pubmed/38498031 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e33868 %T Using Principles of Digital Development for a Smartphone App to Support Data Collection in Patients With Acute Myocardial Infarction and Physical Activity Intolerance: Case Study %A Cáceres Rivera,Diana Isabel %A Rojas,Luz Mileyde Jaimes %A Rojas,Lyda Z %A Gomez,Diana Canon %A Castro Ruiz,David Andrés %A López Romero,Luis Alberto %+ Facultad de Enfermería, Universidad Cooperativa de Colombia, Torre 2 Apto 203, Bucaramanga, 64000, Colombia, 57 3014006658, dianacaceresrivera@gmail.com %K app %K applications of medical informatics %K coronary disease %K data collection %K development %K health care reform %K health data %K medical informatics %K medical informatics apps %K mobile app %K mobile applications %K nursing diagnosis %K nursing research %K research data %K software %K validation %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Advances in health have highlighted the need to implement technologies as a fundamental part of the diagnosis, treatment, and recovery of patients at risk of or with health alterations. For this purpose, digital platforms have demonstrated their applicability in the identification of care needs. Nursing is a fundamental component in the care of patients with cardiovascular disorders and plays a crucial role in diagnosing human responses to these health conditions. Consequently, the validation of nursing diagnoses through ongoing research processes has become a necessity that can significantly impact both patients and health care professionals. Objective: We aimed to describe the process of developing a mobile app to validate the nursing diagnosis “intolerance to physical activity” in patients with acute myocardial infarction. Methods: We describe the development and pilot-testing of a mobile system to support data collection for validating the nursing diagnosis of activity intolerance. This was a descriptive study conducted with 11 adults (aged ≥18 years) who attended a health institution for highly complex needs with a suspected diagnosis of coronary syndrome between August and September 2019 in Floridablanca, Colombia. An app for the clinical validation of activity intolerance (North American Nursing Diagnosis Association [NANDA] code 00092) in patients with acute coronary syndrome was developed in two steps: (1) operationalization of the nursing diagnosis and (2) the app development process, which included an evaluation of the initial requirements, development and digitization of the forms, and a pilot test. The agreement level between the 2 evaluating nurses was evaluated with the κ index. Results: We developed a form that included sociodemographic data, hospital admission data, medical history, current pharmacological treatment, and thrombolysis in myocardial infarction risk score (TIMI-RS) and GRACE (Global Registry of Acute Coronary Events) scores. To identify the defining characteristics, we included official guidelines, physiological measurements, and scales such as the Piper fatigue scale and Borg scale. Participants in the pilot test (n=11) had an average age of 63.2 (SD 4.0) years and were 82% (9/11) men; 18% (2/11) had incomplete primary schooling. The agreement between the evaluators was approximately 80% for most of the defining characteristics. The most prevalent characteristics were exercise discomfort (10/11, 91%), weakness (7/11, 64%), dyspnea (3/11, 27%), abnormal heart rate in response to exercise (2/10, 20%), electrocardiogram abnormalities (1/10, 9%), and abnormal blood pressure in response to activity (1/10, 10%). Conclusions: We developed a mobile app for validating the diagnosis of “activity intolerance.” Its use will guarantee not only optimal data collection, minimizing errors to perform validation, but will also allow the identification of individual care needs. %M 38498019 %R 10.2196/33868 %U https://formative.jmir.org/2024/1/e33868 %U https://doi.org/10.2196/33868 %U http://www.ncbi.nlm.nih.gov/pubmed/38498019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48050 %T Preliminary Efficacy of a Cognitive Behavioral Therapy–Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial %A Chen,Shanshan %A Tang,Jinsong %A Wu,Congyang %A Zhang,Ge %A Zhang,Jing %A Liao,Yanhui %+ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China, 86 18814898844, liaoyanhui@zju.edu.cn %K China %K cognitive behavioral therapy %K program acceptability %K randomized controlled trial %K smartphone app %K smoking cessation %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The overall prevalence of cigarette smokers in China is very high, and China’s total cigarette consumption makes up more than 40% of the world’s consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app–based smoking cessation trial in China. Objective: This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)–based smoking cessation smartphone app among smokers seeking treatment in China. Methods: We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a “thank you” message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability. Results: A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46. Conclusions: Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China. Trial Registration: ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041985 %M 38498030 %R 10.2196/48050 %U https://formative.jmir.org/2024/1/e48050 %U https://doi.org/10.2196/48050 %U http://www.ncbi.nlm.nih.gov/pubmed/38498030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50716 %T Use of Digital COVID-19 Exposure Notifications at a Large Gathering: Survey Analysis of Public Health Conference Attendees %A Drover,Caitlin M %A Elder,Adam S %A Guthrie,Brandon L %A Revere,Debra %A Briggs,Nicole L %A West,Laura M %A Higgins,Amanda %A Lober,William B %A Karras,Bryant T %A Baseman,Janet G %+ Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Seattle, WA, 98195-1616, United States, 1 5056159180, eldera3@uw.edu %K COVID-19 %K exposure notification %K digital public health tool %K survey analysis %K conference %K online survey %K digital tool %K public health %K contact tracing %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: WA Notify was Washington State’s smartphone-based COVID-19 digital exposure notification (EN) tool, which was used to help limit the spread of COVID-19 between November 30, 2020, and May 11, 2023. Following the 2022 Washington State Public Health Association Annual Conference, attendees who had WA Notify activated began receiving ENs alerting them to a possible COVID-19 exposure during the conference. A survey was emailed to all conference attendees to measure WA Notify adoption, mechanisms through which attendees received ENs, and self-reported engagement in protective behaviors postexposure. Objective: This study aimed to learn more about the experiences of WA Notify adopters and nonadopters who may have been exposed to COVID-19 at a large group gathering. Methods: A web-based survey administered through REDCap (Research Electronic Data Capture; Vanderbilt University) was sent to all attendees of the Washington State Public Health Association conference. Self-reported demographic information and characteristics of respondents were summarized. Regression models were used to estimate relative risks to compare WA Notify adoption and testing behaviors between groups. Results: Of the 464 total registered attendees who were sent the survey, 205 (44%) responses were received; 201 eligible attendees were included in this analysis. Of those, 149 (74%) respondents reported having WA Notify activated on their phones at the time of the conference. Among respondents with WA Notify activated, 54% (n=77) reported learning of their potential exposure from a WA Notify EN. Respondents who reported that they did not have WA Notify activated and learned of their potential exposure via the event-wide email from conference organizers were 39% less likely to test for COVID-19 compared to respondents with WA Notify activated who learned of their potential exposure from the email (relative risk 0.61, 95% CI 0.40-0.93; P=.02), and this gap was even larger when compared to respondents who learned of their exposure from a WA Notify EN. The most commonly cited reason for not having WA Notify activated was privacy concerns (n=17, 35%), followed by not wanting to receive ENs (n=6, 12%) and being unaware of WA Notify (n=5, 10%). Conclusions: Digital EN systems are an important tool to directly and anonymously notify close contacts of potential exposures and provide guidance on the next steps in a timely manner. Given the privacy concerns, there is still a need for increasing transparency surrounding EN technology to increase uptake by the public if this technology were to be used in the future to slow the spread of communicable diseases. %M 38498047 %R 10.2196/50716 %U https://formative.jmir.org/2024/1/e50716 %U https://doi.org/10.2196/50716 %U http://www.ncbi.nlm.nih.gov/pubmed/38498047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55041 %T Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study %A Aycock,Chase A %A Mallawaarachchi,Indika %A Wang,Xin-Qun %A Cassidy,Daniel G %A Ellis,Jordan M %A Klesges,Robert C %A Talcott,G Wayne %A Wiseman,Kara %+ Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22908, United States, 1 4342348126, kara.wiseman@virginia.edu %K text messaging %K alcohol reduction %K binge drinking %K US %K United States %K US military %K alcohol misuse %K military %K functioning %K readiness %K health %K career %K careers %K text message %K text messages %K short message service %K SMS %K SMS intervention %K drinking %K Air Force %K Airmen %K mixed methods approach %K message %K messages %K development study %K qualitative coding %K drinking alcohol %K alcohol consumption %K survey %K descriptive statistics %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations. Objective: We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force. Methods: We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library. Results: In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age. Conclusions: This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force. %M 38502165 %R 10.2196/55041 %U https://formative.jmir.org/2024/1/e55041 %U https://doi.org/10.2196/55041 %U http://www.ncbi.nlm.nih.gov/pubmed/38502165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50506 %T Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study %A Breuer-Asher,Inbar %A Ritholz,Marilyn D %A Horwitz,David L %A Manejwala,Omar %A Behar,Ephraim %A Fundoiano-Hershcovitz,Yifat %+ DarioHealth, Ofek 8, 5 Tarshish Street, Caesarea, 3079821, Israel, 972 525296979, yifat@dariohealth.com %K mental health %K perceived stress %K stress reduction %K digital health %K video sessions %K behavioral health %K relaxation %K breathing exercises %K CBT %K anxiety %K cognitive behavioral therapy %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app. Objective: This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy–based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants’ perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions. Methods: Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform–based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions. Results: Analysis revealed a significant decrease in stress symptoms (β=–.25; 95% CI –0.32 to –0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (β=–.07; 95% CI –0.13 to –0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items. Conclusions: This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy–based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective. %M 38502164 %R 10.2196/50506 %U https://formative.jmir.org/2024/1/e50506 %U https://doi.org/10.2196/50506 %U http://www.ncbi.nlm.nih.gov/pubmed/38502164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49857 %T An Ecological Mobile Momentary Intervention to Support Dynamic Goal Pursuit: Feasibility and Acceptability Study %A O'Driscoll,Ciarán %A Singh,Aneesha %A Chichua,Iya %A Clodic,Joachim %A Desai,Anjali %A Nikolova,Dara %A Yap,Alex Jie %A Zhou,Irene %A Pilling,Stephen %+ CORE Data Lab, Centre for Outcomes Research and Effectiveness, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 207679 1897, c.odriscoll@ucl.ac.uk %K goal pursuit %K ecological momentary intervention %K ecological momentary assessment %K mood %K dynamics %K network analysis %K MCII %K COM-B %K support %K pilot study %K training %K feasibility %K acceptability %K self-monitoring %K implementation %K psychological %K effectiveness %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals can experience difficulties pursuing their goals amid multiple competing priorities in their environment. Effective goal dynamics require flexible and generalizable pursuit skills. Supporting successful goal pursuit requires a perpetually adapting intervention responsive to internal states. Objective: The purpose of this study was to (1) develop a flexible intervention that can adapt to an individual’s changing short to medium-term goals and be applied to their daily life and (2) examine the feasibility and acceptability of the just-in-time adaptive intervention for goal pursuit. Methods: This study involved 3 iterations to test and systematically enhance all aspects of the intervention. During the pilot phase, 73 participants engaged in an ecological momentary assessment (EMA) over 1 month. After week 1, they attended an intervention training session and received just-in-time intervention prompts during the following 3 weeks. The training employed the Capability, Opportunity, Motivation, and Behavior (COM-B) framework for goal setting, along with mental contrasting with implementation intentions (MCII). Subsequent prompts, triggered by variability in goal pursuit, guided the participants to engage in MCII in relation to their current goal. We evaluated feasibility and acceptability, efficacy, and individual change processes by combining intensive (single-case experimental design) and extensive methods. Results: The results suggest that the digital intervention was feasible and acceptable to participants. Compliance with the intervention was high (n=63, 86%). The participants endorsed high acceptability ratings relating to both the study procedures and the intervention. All participants (N=73, 100%) demonstrated significant improvements in goal pursuit with an average difference of 0.495 units in the outcome (P<.001). The results of the dynamic network modeling suggest that self-monitoring behavior (EMA) and implementing the MCII strategy may aid in goal reprioritization, where goal pursuit itself is a driver of further goal pursuit. Conclusions: This pilot study demonstrated the feasibility and acceptability of a just-in-time adaptive intervention among a nonclinical adult sample. This intervention used self-monitoring of behavior, the COM-B framework, and MCII strategies to improve dynamic goal pursuit. It was delivered via an Ecological Momentary Intervention (EMI) procedure. Future research should consider the utility of this approach as an additional intervention element within psychological interventions to improve goal pursuit. Sustaining goal pursuit throughout interventions is central to their effectiveness and warrants further evaluation. %M 38506904 %R 10.2196/49857 %U https://formative.jmir.org/2024/1/e49857 %U https://doi.org/10.2196/49857 %U http://www.ncbi.nlm.nih.gov/pubmed/38506904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47960 %T Effectiveness of a Web-based and Mobile Therapy Chatbot on Anxiety and Depressive Symptoms in Subclinical Young Adults: Randomized Controlled Trial %A Karkosz,Stanisław %A Szymański,Robert %A Sanna,Katarzyna %A Michałowski,Jarosław %+ Laboratory of Affective Neuroscience in Poznan, SWPS University, Chodakowska 19/31, Warsaw, 03-815, Poland, 48 22 517 96 00, skarkosz@swps.edu.pl %K chatbots %K conversational agents %K chatbot %K conversational agent %K artificial intelligence %K mental health %K depression %K anxiety %K depressive %K cognitive distortions %K young adults %K randomized control trial %K RCT %K user experience %K CBT %K psychotherapy %K cognitive behavioral therapy %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an increased need to provide specialized help for people with depressive and anxiety symptoms, particularly teenagers and young adults. There is evidence from a 2-week intervention that chatbots (eg, Woebot) are effective in reducing depression and anxiety, an effect that was not detected in the control group that was provided self-help materials. Although chatbots are a promising solution, there is limited scientific evidence for the efficacy of agent-guided cognitive behavioral therapy (CBT) outside the English language, especially for highly inflected languages. Objective: This study aimed to measure the efficacy of Fido, a therapy chatbot that uses the Polish language. It targets depressive and anxiety symptoms using CBT techniques. We hypothesized that participants using Fido would show a greater reduction in anxiety and depressive symptoms than the control group. Methods: We conducted a 2-arm, open-label, randomized controlled trial with 81 participants with subclinical depression or anxiety who were recruited via social media. Participants were divided into experimental (interacted with a fully automated Fido chatbot) and control (received a self-help book) groups. Both intervention methods addressed topics such as general psychoeducation and cognitive distortion identification and modification via Socratic questioning. The chatbot also featured suicidal ideation identification and redirection to suicide hotlines. We used self-assessment scales to measure primary outcomes, including the levels of depression, anxiety, worry tendencies, satisfaction with life, and loneliness at baseline, after the 2-week intervention and at the 1-month follow-up. We also controlled for secondary outcomes, including engagement and frequency of use. Results: There were no differences in anxiety and depressive symptoms between the groups at enrollment and baseline. After the intervention, depressive and anxiety symptoms were reduced in both groups (chatbot: n=36; control: n=38), which remained stable at the 1-month follow-up. Loneliness was not significantly different between the groups after the intervention, but an exploratory analysis showed a decline in loneliness among participants who used Fido more frequently. Both groups used their intervention technique with similar frequency; however, the control group spent more time (mean 117.57, SD 72.40 minutes) on the intervention than the Fido group (mean 79.44, SD 42.96 minutes). Conclusions: We did not replicate the findings from previous (eg, Woebot) studies, as both arms yielded therapeutic effects. However, such results are in line with other research of Internet interventions. Nevertheless, Fido provided sufficient help to reduce anxiety and depressive symptoms and decreased perceived loneliness among high-frequency users, which is one of the first pieces of evidence of chatbot efficacy with agents that use a highly inflected language. Further research is needed to determine the long-term, real-world effectiveness of Fido and its efficacy in a clinical sample. Trial Registration: ClinicalTrials.gov NCT05762939; https://clinicaltrials.gov/study/NCT05762939; Open Science Foundation Registry 2cqt3; https://osf.io/2cqt3 %M 38506892 %R 10.2196/47960 %U https://formative.jmir.org/2024/1/e47960 %U https://doi.org/10.2196/47960 %U http://www.ncbi.nlm.nih.gov/pubmed/38506892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53593 %T Parents’ User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study %A Cyrkot,Samantha %A Hartling,Lisa %A Scott,Shannon D %A Elliott,Sarah A %+ Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, 4-474 Edmonton Clinical Health Academy, 11405-87 Avenue, Edmonton, AB, T6G1C9, Canada, 1 7804921241, se2@ualberta.ca %K awareness %K COVID-19 %K credibility %K credible %K descriptive %K guidelines %K health evidence %K information behavior %K information needs %K information seeking %K information-seeking behaviour %K interface %K internet %K interview %K knowledge mobilization %K parent %K parenting %K public health %K qualitative %K recommendation %K recommender %K SARS-CoV-2 %K think-aloud activity %K think-aloud %K trust %K trustworthy %K usability %K user experience %K web design %K website %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The eCOVID19 Recommendations Map & Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents’ experiences when accessing and using the RecMap website for COVID-19 health decision-making. Objective: To explore (1) where parents look for COVID-19 health information and why, (2) parents’ user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents’ awareness, use, and engagement with the RecMap website. Methods: We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to “think aloud” as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis. Results: A total of 21 participants (13/21, 62% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants’ information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often. Conclusions: Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public. %M 38506915 %R 10.2196/53593 %U https://formative.jmir.org/2024/1/e53593 %U https://doi.org/10.2196/53593 %U http://www.ncbi.nlm.nih.gov/pubmed/38506915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50931 %T Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis %A Gnant,Michael %A Abdullah,Khatijah Lim %A Boyle,Frances %A Huang,Chiun-Sheng %A Bickford,Katie %A Neunie,Sola %A Noble,Alexander %A Nunn,Anne %A Sproat,Caroline %A Harbeck,Nadia %A Barrios,Carlos %+ Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, BT86/E01, Vienna, 1090, Austria, 43 1 40160 35602, mgnant@icloud.com %K continuing medical education %K early breast cancer %K performance %K risk stratification %K shared decision-making %D 2024 %7 21.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. Objective: This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. Methods: We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Results: Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Conclusions: Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities. %M 38512328 %R 10.2196/50931 %U https://formative.jmir.org/2024/1/e50931 %U https://doi.org/10.2196/50931 %U http://www.ncbi.nlm.nih.gov/pubmed/38512328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49133 %T Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study %A O'Kane,Kiarah M K %A Otamendi,Thalia %A Silverberg,Noah D %A Choi,Esther %A Sicard,Veronik %A Zemek,Roger %A Healey,Katherine %A Brown,Olivier %A Butterfield,Lauren %A Smith,Andra %A Goldfield,Gary %A Kardish,Rachel %A Saab,Bechara J %A Ledoux,Andrée-Anne %A Cairncross,Molly %+ Department of Psychology, Simon Fraser University, Robert C. Brown Hall 7321, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 778 782 7458, molly_cairncross@sfu.ca %K adolescent %K concussion %K digital therapeutics %K eHealth %K mHealth %K mindfulness %K mobile health %K social presence %K working alliance %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence—the extent to which digital encounters feel like they are occurring in person—may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. Objective: This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents’ development of therapeutic alliance and social presence with the intervention. Methods: Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. Results: Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by “developing a genuine connection” with their mindfulness guides and “sensing real people.” Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides’ “personal backgrounds and voices,” such that participants felt more connected to the guides by knowing information about them and through the guides’ calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants’ average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. Conclusions: Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents’ development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment. %M 38517472 %R 10.2196/49133 %U https://formative.jmir.org/2024/1/e49133 %U https://doi.org/10.2196/49133 %U http://www.ncbi.nlm.nih.gov/pubmed/38517472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53402 %T Low-Fidelity Prototype of a Sensor-Dependent Interaction Platform: Formative Evaluation With Informal Caregivers of Older Adults With Cognitive Impairment %A Sharma,Nikita %A Grotenhuijs,Karen %A Gemert-Pijnen,J E W C van %A Oinas-Kukkonen,Harri %A Braakman-Jansen,L M A %+ Faculty of Behavioural, Management and Social Sciences, University of Twente, Zilverling, Hallenweg 19,, Enschede, 7522 NH, Netherlands, 31 534899111, n.sharma@utwente.nl %K older adult care %K informal caregivers %K cognitive impairment %K sensing solutions %K information communication platform %K low-fidelity %K lo-fi prototype %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Unobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. Objective: For the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. Methods: Overall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. Results: The results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. Conclusions: In conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users’ needs and privacy. %M 38517461 %R 10.2196/53402 %U https://formative.jmir.org/2024/1/e53402 %U https://doi.org/10.2196/53402 %U http://www.ncbi.nlm.nih.gov/pubmed/38517461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55517 %T Community Members’ Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis %A Heilemann,MarySue V %A Lai,Jianchao %A Cadiz,Madonna P %A Meza,Jocelyn I %A Flores Romero,Daniela %A Wells,Kenneth B %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Box 956919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K adaptation %K humans %K pandemics %K mental health %K COVID-19 %K health resources %K California %K psychological %K stigma %K digital %K prevention %K public health %K emotions %K website %K qualitative research %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma. %M 38526558 %R 10.2196/55517 %U https://formative.jmir.org/2024/1/e55517 %U https://doi.org/10.2196/55517 %U http://www.ncbi.nlm.nih.gov/pubmed/38526558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47248 %T Best Practices in Evolving Privacy Frameworks for Patient Age Data: Census Data Study %A Moffatt,Colin %A Leshin,Jonah %+ Datavant, 44 Montgomery St 3rd floor, San Francisco, CA, 94104, United States, 1 415 520 1171, jonah@datavant.com %K census %K date of birth %K deidentification %K HIPAA %K Health Insurance Portability and Accountability Act %K k-anonymity %K patient privacy %K policy %K reidentification risk %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the previous 4 decennial censuses, the population of the United States has grown older, with the proportion of individuals aged at least 90 years old in the 2010 census being more than 2 and a half times what it was in the 1980 census. This suggests that the threshold for constraining age introduced in the Safe Harbor method of the HIPAA (Health Insurance Portability and Accountability Act) in 1996 may be increased without exceeding the original levels of risk. This is desirable to maintain or even increase the utility of affected data sets without compromising privacy. Objective: In light of the upcoming release of 2020 census data, this study presents a straightforward recipe for updating age-constrained thresholds in the context of new census data and derives recommendations for new thresholds from the 2010 census. Methods: Using census data dating back to 1980, we used group size considerations to analyze the risk associated with various maximum age thresholds over time. We inferred the level of risk of the age cutoff of 90 years at the time of HIPAA’s inception in 1996 and used this as a baseline from which to recommend updated cutoffs. Results: The maximum age threshold may be increased by at least 2 years without exceeding the levels of risk conferred in HIPAA’s original recommendations. Moreover, in the presence of additional information that restricts the population in question to a known subgroup with increased longevity (for example, restricting to female patients), the threshold may be increased further. Conclusions: Increasing the maximum age threshold would enable the data user to gain more utility from the data without introducing risk beyond what was originally envisioned with the enactment of HIPAA. Going forward, a recurring update of such thresholds is advised, in line with the considerations detailed in the paper. %M 38526530 %R 10.2196/47248 %U https://formative.jmir.org/2024/1/e47248 %U https://doi.org/10.2196/47248 %U http://www.ncbi.nlm.nih.gov/pubmed/38526530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54073 %T Adapting mHealth Interventions (PrEPmate and DOT Diary) to Support PrEP Retention in Care and Adherence Among English and Spanish-Speaking Men Who Have Sex With Men and Transgender Women in the United States: Formative Work and Pilot Randomized Trial %A Liu,Albert Y %A Alleyne,Cat-Dancing %A Doblecki-Lewis,Susanne %A Koester,Kimberly A %A Gonzalez,Rafael %A Vinson,Janie %A Scott,Hyman %A Buchbinder,Susan %A Torres,Thiago S %+ Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, United States, 1 628 217 7408, albert.liu@sfdph.org %K preexposure prophylaxis %K PrEP %K Spanish-speaking %K Latino %K transgender %K men who have sex with men %K mobile health %K mHealth %K HIV prevention %K HIV %K technology %K formative %K development %K mobile technology, mobile app %K text-messaging %K SMS %K app %K application %K USA %K United States %K health equity %K mHealth tool %K tool %K acceptability %K self-management %K pilot %K support %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of mobile health (mHealth) technologies are being developed to support HIV preexposure prophylaxis (PrEP) adherence and persistence; however, most tools have focused on men who have sex with men (MSM), and few are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to Spanish-speaking people and transgender women are critically needed. Objective: The aim of this study is to adapt and tailor 2 mHealth technologies, PrEPmate and DOT Diary, to support daily PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools. Methods: PrEPmate, an interactive, bidirectional, text messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English- and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and optimize the functionality of these tools. Results: Participants in focus groups liked the “human touch” of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended changes to tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback and thought the calendar functions were easy to use. Based on participant recommendations, we tailored language within the app for Spanish-speaking MSM and transgender women, simplified the sexual diary, and added motivational badges. In the technical pilot of the refined tools, mean System Usability Scale scores were 81.2/100 for PrEPmate and 76.4/100 for DOT Diary (P=.48), falling in the “good” to “excellent” range, and mean Client Satisfaction Questionnaire scores were 28.6 and 28.3 for PrEPmate and DOT Diary, respectively (maximum possible score=32). Use of both tools was high over the 1-month pilot (average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the DOT Diary app), indicating good feasibility for both tools. Conclusions: Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support daily PrEP use among Spanish-speaking MSM and English- and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial. %M 38536232 %R 10.2196/54073 %U https://formative.jmir.org/2024/1/e54073 %U https://doi.org/10.2196/54073 %U http://www.ncbi.nlm.nih.gov/pubmed/38536232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55742 %T User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial %A Gerbutavicius,Rokas %A Merle,David A %A Wolf,Armin %A Dimopoulos,Spyridon %A Kortuem,Karsten Ulrich %A Kortuem,Friederike Charlotte %+ Department for Ophthalmology, University of Tuebingen, Elfriede-Aulhorn-Str.7, Tuebingen, 72076, Germany, 49 70712988088, rokas.gerbutavicius@med.uni-tuebingen.de %K mHealth %K mobile health %K workflow optimization %K patient satisfaction %K health education %K educational background %K phacoemulsification %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. Objective: This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. Methods: All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the “Patient Journey” app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. Results: Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. Conclusions: The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally. %M 38551619 %R 10.2196/55742 %U https://formative.jmir.org/2024/1/e55742 %U https://doi.org/10.2196/55742 %U http://www.ncbi.nlm.nih.gov/pubmed/38551619 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50036 %T Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis %A Zhang,Chunyu %A Hu,Ning %A Li,Rui %A Zhu,Aiping %A Yu,Zhongguang %+ Respiratory Centre, China-Japan Friendship Hospital, Yinghua Road 2#, Beijing, 100013, China, 86 84206468, yzg081892@163.com %K web-based consultation %K Andersen Behavioral Model %K qualitative comparative analysis %K perceived convenience %K complementary role %K user's confidence %K China %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic. Objective: This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users’ perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages. Methods: We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors. Results: In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user’s confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user’s confidence. Conclusions: Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user’s confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations’ application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations. %M 38551645 %R 10.2196/50036 %U https://formative.jmir.org/2024/1/e50036 %U https://doi.org/10.2196/50036 %U http://www.ncbi.nlm.nih.gov/pubmed/38551645 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52920 %T A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study %A Acharya,Harshdeep %A Sykes,Kevin J %A Neira,Ton Mirás %A Scott,Angela %A Pacheco,Christina M %A Sanner,Matthew %A Ablah,Elizabeth %A Oyowe,Kevin %A Ellerbeck,Edward F %A Greiner,K Allen %A Corriveau,Erin A %A Finocchario-Kessler,Sarah %+ Health and Wellness Center, Baylor Scott and White Health, 4500 Spring Avenue, Dallas, TX, 75210, United States, 1 820 0111 ext 214, Kevin.Sykes@bswhealth.org %K public health %K database %K community health worker %K social determinants of health %K health worker %K health workers %K CHW %K CHWs %K community-based %K data collection %K functionality %K develop %K development %K EHR %K EHRs %K EMR %K EMRs %K dashboard %K dashboards %K health record %K health records %K documentation %K medical record %K medical records %K equity %K inequity %K inequities %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. Objective: We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. Methods: The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. Results: At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act–compliant record system, improved client engagement, enrollment processes, and identification of resources. Conclusions: Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings. %M 38557671 %R 10.2196/52920 %U https://formative.jmir.org/2024/1/e52920 %U https://doi.org/10.2196/52920 %U http://www.ncbi.nlm.nih.gov/pubmed/38557671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50850 %T Web-Based Emotion Regulation Training for Sexual Health: Randomized Controlled Trial %A Jobim Fischer,Vinicius %A Rossato Holz,Maila %A Billieux,Joël %A Andersson,Gerhard %A Vögele,Claus %+ Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 9740, viniciusjfischer@gmail.com %K emotion regulation %K internet %K sexual health %K FSFI %K randomized controlled trial %K intervention %K psychosexual intervention %K sexual disorder %K sexual dysfunction %K internet-based %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective emotional regulation (ER) skills are important for sexual function, as they impact emotional awareness and expression during sexual activity, and therefore, satisfaction and distress. Emotion regulation interventions may offer a promising approach to improve sexual health. Web-based emotion regulation may be a therapeutic strategy for men and women with sexual health concerns. Nevertheless, there is a scarcity of intervention trials investigating its effects in this context, much less using the internet. Objective: This study aims to investigate the effects of a web-based emotion regulation training program for sexual function in both men and women. Methods: The participants were recruited based on their self-reported sexual problems, which for men was defined by a score of <25 on the International Index Erectile Function (IIEF) and for women by a score of <26.55 on the Female Sexual Function Index (FSFI). The final sample included 60 participants who were randomized to either a web-based emotion regulation training for sexual function or to a waitlist control group. The treatment consisted of an 8-week web-based emotion regulation training for sexual function. The participants were assessed at baseline, post intervention, and the 3-month follow-up. Results: Of the 60 participants included, only 6 completed all 3 assessment points (n=5, 20% in the treatment group and n=1, 5% in the waitlist control group) after receiving the intervention. At follow-up, there were no significant differences between groups in any measure. Among the intervention completers, large-to-moderate within-group effect sizes were observed between the assessment points on measures of emotion regulation, depression, lubrication, orgasm, thoughts of sexual failure, and abuse during sexual activity. The adherence rate was very low, limiting the generalizability of the findings. Conclusions: Participants who completed the intervention showed improvements in both sexual function domains and emotion regulation. Nonetheless, due to a high dropout rate, this trial failed to collect sufficient data to allow for any conclusions to be drawn on treatment effects. Trial Registration: ClinicalTrials.gov NCT04792177; https://clinicaltrials.gov/study/NCT04792177 %M 38568720 %R 10.2196/50850 %U https://formative.jmir.org/2024/1/e50850 %U https://doi.org/10.2196/50850 %U http://www.ncbi.nlm.nih.gov/pubmed/38568720 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55270 %T Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study %A Wang,Zheng %A Kempen,John %A Luo,Gang %+ Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, United States, 1 6179122529, gang_luo@meei.harvard.edu %K vision screening %K refractive error %K strabismus %K smartphone %K visual acuity %K vision %K visual %K eye %K eyes %K screening %K mHealth %K mobile health %K app %K apps %K application %K applications %K feasibility %K optometry %K ophthalmology %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. Objective: We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. Methods: A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. Results: A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72–prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). Conclusions: The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. %M 38573757 %R 10.2196/55270 %U https://formative.jmir.org/2024/1/e55270 %U https://doi.org/10.2196/55270 %U http://www.ncbi.nlm.nih.gov/pubmed/38573757 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50018 %T The Role of Mental Health Stigma in University Students’ Satisfaction With Web-Based Stress Management Resources: Intervention Study %A Cho,Sohyun %A Bastien,Laurianne %A Petrovic,Julia %A Böke,Bilun Naz %A Heath,Nancy L %+ Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, QC, H3A 1Y2, Canada, 1 514 398 4242, sohyun.cho@mail.mcgill.ca %K help-seeking behavior %K help-seeking %K mental health services %K mental health stigma %K mental health %K university students %K web-based workshop %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: University students frequently report elevated levels of stress and mental health difficulties. Thus, the need to build coping capacity on university campuses has been highlighted as critical to mitigating the negative effects of prolonged stress and distress among students. Since the COVID-19 pandemic, web-based stress management resources such as infographics and web-based workshops have been central to supporting university students’ mental health and well-being. However, there is a lack of research on students’ satisfaction with and uptake of these approaches. Furthermore, mental health stigma has been suggested to have not only fueled the emergence of these web-based approaches to stress management but may also influence students’ help-seeking behaviors and their satisfaction with and uptake of these resources. Objective: This study explored potential differences in students’ satisfaction and strategy use in response to an interactive infographic (an emerging resource delivery modality) presenting stress management strategies and a web-based workshop (a more common modality) presenting identical strategies. This study also examined the relative contribution of students’ strategy use and family-based mental health stigma in predicting their sustained satisfaction with the 2 web-based stress management approaches. Methods: University students (N=113; mean age 20.93, SD 1.53 years; 100/113, 88.5% women) completed our web-based self-report measure of family-based mental health stigma at baseline and were randomly assigned to either independently review an interactive infographic (n=60) or attend a synchronous web-based workshop (n=53). All participants reported their satisfaction with their assigned modality at postintervention (T1) and follow-up (T2) and their strategy use at T2. Results: Interestingly, a 2-way mixed ANOVA revealed no significant group × time interaction or main effect of group on satisfaction. However, there was a significant decrease in satisfaction from T1 to T2, despite relatively high levels of satisfaction being reported at both time points. In addition, a 1-way ANOVA revealed no significant difference in strategy use between groups. Results from a hierarchical multiple regression revealed that students’ strategy use positively predicted T2 satisfaction in both groups. However, only in the web-based workshop group did family-based mental health stigma predict T2 satisfaction over and above strategy use. Conclusions: While both approaches were highly satisfactory over time, findings highlight the potential utility of interactive infographics since they are less resource-intensive than web-based workshops and students’ satisfaction with them is not impacted by family-based mental health stigma. Moreover, although numerous intervention studies measure satisfaction at a single time point, this study highlights the need for tracking satisfaction over time following intervention delivery. These findings have implications for student service units in the higher education context, emphasizing the need to consider student perceptions of family-based mental health stigma and preferences regarding delivery format when designing programming aimed at bolstering students’ coping capacity. %M 38573758 %R 10.2196/50018 %U https://formative.jmir.org/2024/1/e50018 %U https://doi.org/10.2196/50018 %U http://www.ncbi.nlm.nih.gov/pubmed/38573758 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54168 %T Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach %A McLaren,Jaye E %A Hoang-Gia,Dat %A Dorisca,Eugenia %A Hartz,Stephanie %A Dang,Stuti %A Moo,Lauren %+ New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Health Care System, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 687 2000, Jaye.McLaren@va.gov %K Alzheimer disease %K caregiver education %K dementia %K interdisciplinary %K older adults %K virtual resources %K website development %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. Objective: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. Methods: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. Results: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were “general dementia information,” “activities of daily living,” and “self-care and support.” Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. Conclusions: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care. %M 38573761 %R 10.2196/54168 %U https://formative.jmir.org/2024/1/e54168 %U https://doi.org/10.2196/54168 %U http://www.ncbi.nlm.nih.gov/pubmed/38573761 %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 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 e54109 %T Fast Healthcare Interoperability Resources–Based Support System for Predicting Delivery Type: Model Development and Evaluation Study %A Coutinho-Almeida,João %A Cardoso,Alexandrina %A Cruz-Correia,Ricardo %A Pereira-Rodrigues,Pedro %+ Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal, 351 225513600, joaofilipe90@gmail.com %K obstetrics %K machine-learning %K clinical decision support %K interoperability %K interoperable %K obstetric %K cesarean delivery %K cesarean %K cesarean deliveries %K decision support %K pregnant %K pregnancy %K maternal %K algorithm %K algorithms %K simulation %K simulations %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The escalating prevalence of cesarean delivery globally poses significant health impacts on mothers and newborns. Despite this trend, the underlying reasons for increased cesarean delivery rates, which have risen to 36.3% in Portugal as of 2020, remain unclear. This study delves into these issues within the Portuguese health care context, where national efforts are underway to reduce cesarean delivery occurrences. Objective: This paper aims to introduce a machine learning, algorithm-based support system designed to assist clinical teams in identifying potentially unnecessary cesarean deliveries. Key objectives include developing clinical decision support systems for cesarean deliveries using interoperability standards, identifying predictive factors influencing delivery type, assessing the economic impact of implementing this tool, and comparing system outputs with clinicians’ decisions. Methods: This study used retrospective data collected from 9 public Portuguese hospitals, encompassing maternal and fetal data and delivery methods from 2019 to 2020. We used various machine learning algorithms for model development, with light gradient-boosting machine (LightGBM) selected for deployment due to its efficiency. The model’s performance was compared with clinician assessments through questionnaires. Additionally, an economic simulation was conducted to evaluate the financial impact on Portuguese public hospitals. Results: The deployed model, based on LightGBM, achieved an area under the receiver operating characteristic curve of 88%. In the trial deployment phase at a single hospital, 3.8% (123/3231) of cases triggered alarms for potentially unnecessary cesarean deliveries. Financial simulation results indicated potential benefits for 30% (15/48) of Portuguese public hospitals with the implementation of our tool. However, this study acknowledges biases in the model, such as combining different vaginal delivery types and focusing on potentially unwarranted cesarean deliveries. Conclusions: This study presents a promising system capable of identifying potentially incorrect cesarean delivery decisions, with potentially positive implications for medical practice and health care economics. However, it also highlights the challenges and considerations necessary for real-world application, including further evaluation of clinical decision-making impacts and understanding the diverse reasons behind delivery type choices. This study underscores the need for careful implementation and further robust analysis to realize the full potential and real-world applicability of such clinical support systems. %M 38587885 %R 10.2196/54109 %U https://formative.jmir.org/2024/1/e54109 %U https://doi.org/10.2196/54109 %U http://www.ncbi.nlm.nih.gov/pubmed/38587885 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48144 %T Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study %A Mabetha,Khuthala %A Soepnel,Larske M %A Mabena,Gugulethu %A Motlhatlhedi,Molebogeng %A Nyati,Lukhanyo %A Norris,Shane A %A Draper,Catherine E %+ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa, 27 011 717 2382, khuthala.mabetha@wits.ac.za %K mobile technologies %K health promotion %K mixed methods %K clinical practice %K mobile phone %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. %M 38588527 %R 10.2196/48144 %U https://formative.jmir.org/2024/1/e48144 %U https://doi.org/10.2196/48144 %U http://www.ncbi.nlm.nih.gov/pubmed/38588527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49574 %T Development and Implementation of an eHealth Oncohematonootric Program: Descriptive, Observational, Prospective Cohort Pilot Study %A Sánchez-Quiñones,Beatriz %A Antón-Maldonado,Cristina %A Ibarra Vega,Nataly %A Martorell Mariné,Isabel %A Santamaria,Amparo %+ Hybrid Hematology Department, University Hospital Vinalopó, Calle Tonico Sansano Mora, 14, Alicante, Elche, 03293, Spain, 34 658981769, masantamaria@vinaloposalud.com %K Nootric app %K oncohematology patient %K physical-nutritional well-being %K multidisciplinary team %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In oncohematology, both the development of the disease and the side effects of antineoplastic treatment often take a toll on patients’ physical and nutritional well-being. In this era of digital transformation, we launched a pioneering project for oncohematologic patients to promote adherence to a healthy lifestyle and improve their physical and nutritional well-being. We aim to achieve this goal by involving doctors and nutritionists through the Nootric app. Objective: This study aims to assess the impact of the use of eHealth tools to facilitate nutrition and well-being in oncohematologic patients. We also aim to determine the usefulness of physical-nutritional management in improving tolerance to chemotherapy treatments within routine clinical practice. Methods: We designed a descriptive, observational, longitudinal, prospective cohort pilot study that included a total of 22 patients from March to May 2022 in the Vinalopó University Hospital. The inclusion criteria were adults over 18 years of age diagnosed with oncohematological pathology in active chemotherapy treatment. An action plan was created to generate alerts between the doctor and the nutritionist. In the beginning, the patients were trained to use the app and received education highlighting the importance of nutrition and physical exercise. Sociodemographic, clinical-biological-analytical (eg, malnutrition index), health care impact, usability, and patient adherence data were collected. Tolerance to chemotherapy treatment and its health care impact were evaluated. Results: We included 22 patients, 11 (50%) female and 11 (50%) male, ranging between 42 and 84 years of age. Among them, 13 (59%) were adherents to the program. The most frequent diseases were lymphoproliferative syndromes (13/22, 59%) and multiple myeloma (4/22, 18%). Moreover, 15 (68%) out of 22 patients received immunochemotherapy, while 7 (32%) out of 22 patients received biological treatment. No worsening of clinical-biological parameters was observed. Excluding dropouts and abandonments (n=9/22, 41%), the adherence rate was 81%, established by calculating the arithmetic mean of the adherence rates of 13 patients. No admission was observed due to gastrointestinal toxicity or discontinuation of treatment related to alterations in physical and nutritional well-being. In addition, only 5.5% of unscheduled consultations were increased due to incidents in well-being, mostly telematic (n=6/103 consultation are unscheduled). Additionally, 92% of patients reported an improvement in their nutritional habits (n=12/13), and up to 45% required adjustment of medical supportive treatment (n=5/11). There were no cases of grade 3 or greater gastrointestinal toxicity. All of this reflects improved tolerance to treatments. Patients reported a satisfaction score of 4.3 out of 5, while professionals rated their satisfaction at 4.8 out of 5. Conclusions: We demonstrated the usefulness of integrating new technologies through a multidisciplinary approach. The Nootric app facilitated collaboration among the medical team, nutritionists, and patients. It enabled us to detect health issues related to physical-nutritional well-being, anticipate major complications, and mitigate potentially avoidable risks. Consequently, there was a decrease in unscheduled visits and admissions related to this condition. %M 38588522 %R 10.2196/49574 %U https://formative.jmir.org/2024/1/e49574 %U https://doi.org/10.2196/49574 %U http://www.ncbi.nlm.nih.gov/pubmed/38588522 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52830 %T Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study %A Der-Martirosian,Claudia %A Hou,Cynthia %A Hovsepian,Sona %A Diarra Carter,Maia %A Heyworth,Leonie %A Dobalian,Aram %A Leung,Lucinda %+ Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, 16111 Plummer St, Los Angeles, CA, 91343, United States, 1 818 984 4596, claudia.der-martirosian@va.gov %K interdisciplinary primary care team members %K NASSS framework %K nonadoption, abandonment, scale-up, spread, and sustainability %K primary care %K telehealth %K video-based care %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. Objective: The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. Methods: We applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. Results: The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic—visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology—key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system—changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver’s role (eg, participation of caregivers during video visits); (4) health care organization—leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time—capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). Conclusions: This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes. %M 38592760 %R 10.2196/52830 %U https://formative.jmir.org/2024/1/e52830 %U https://doi.org/10.2196/52830 %U http://www.ncbi.nlm.nih.gov/pubmed/38592760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52558 %T Nudges and Prompts Increase Engagement in Self-Guided Digital Health Treatment for Depression and Anxiety: Results From a 3-Arm Randomized Controlled Trial %A van Mierlo,Trevor %A Rondina,Renante %A Fournier,Rachel %+ Evolution Health, 206-90 Eglinton Avenue East, Toronto, ON, M4P 2Y3, Canada, 1 4166448476, tvanmierlo@evolutionhealth.care %K behavioral economics %K digital health %K attrition %K engagement %K nudges %K depression %K anxiety %K mood disorders %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accessible and effective approaches to mental health treatment are important because of common barriers such as cost, stigma, and provider shortage. The effectiveness of self-guided treatment is well established, and its use has intensified because of the COVID-19 pandemic. Engagement remains important as dose-response relationships have been observed. Platforms such as Facebook (Meta Platform, Inc), LinkedIn (Microsoft Corp), and X Corp (formerly known as Twitter, Inc) use principles of behavioral economics to increase engagement. We hypothesized that similar concepts would increase engagement in self-guided digital health. Objective: This 3-arm randomized controlled trial aimed to test whether members of 2 digital self-health courses for anxiety and depression would engage with behavioral nudges and prompts. Our primary hypothesis was that members would click on 2 features: tips and a to-do checklist. Our secondary hypothesis was that members would prefer to engage with directive tips in arm 2 versus social proof and present bias tips in arm 3. Our tertiary hypothesis was that rotating tips and a to-do checklist would increase completion rates. The results of this study will form a baseline for future artificial intelligence–directed research. Methods: Overall, 13,224 new members registered between November 2021 and May 2022 for Evolution Health’s self-guided treatment courses for anxiety and depression. The control arm featured a member home page without nudges or prompts. Arm 2 featured a home page with a tip-of-the-day section. Arm 3 featured a home page with a tip-of-the-day section and a to-do checklist. The research protocol for this study was published in JMIR Research Protocols on August 15, 2022. Results: Arm 3 had significantly younger members (F2,4564=40.97; P<.001) and significantly more female members (χ24=92.2; P<.001) than the other 2 arms. Control arm members (1788/13,224, 13.52%) completed an average of 1.5 course components. Arm 2 members (865/13,224, 6.54%) clicked on 5% of tips and completed an average of 1.8 course components. Arm 3 members (1914/13,224, 14.47%) clicked on 5% of tips, completed 2.7 of 8 to-do checklist items, and completed an average of 2.11 course components. Completion rates in arm 2 were greater than those in arm 1 (z score=3.37; P<.001), and completion rates in arm 3 were greater than those in arm 1 (z score=12.23; P<.001). Engagement in all 8 components in arm 3 was higher than that in arm 2 (z score=1.31; P<.001). Conclusions: Members engaged with behavioral nudges and prompts. The results of this study may be important because efficacy is related to increased engagement. Due to its novel approach, the outcomes of this study should be interpreted with caution and used as a guideline for future research in this nascent field. International Registered Report Identifier (IRRID): RR2-10.2196/37231 %M 38592752 %R 10.2196/52558 %U https://formative.jmir.org/2024/1/e52558 %U https://doi.org/10.2196/52558 %U http://www.ncbi.nlm.nih.gov/pubmed/38592752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56143 %T Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study %A Detsomboonrat,Palinee %A Pisarnturakit,Pagaporn Pantuwadee %+ Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Road, Patumwan, Bangkok, 10330, Thailand, 66 22188545, pagaporn.p@chula.ac.th %K capability %K health survey %K oral health %K mobile apps %K personal health information %K PHI %K satisfaction %K tooth %K teeth %K oral %K dental %K dentist %K dentistry %K data entry %K data collection %K mHealth %K mobile health %K app %K apps %K applications %K periodontal %K survey %K questionnaire %K questionnaires %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. Objective: This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. Methods: There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients’ information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. Results: Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). Conclusions: The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app. %M 38598287 %R 10.2196/56143 %U https://formative.jmir.org/2024/1/e56143 %U https://doi.org/10.2196/56143 %U http://www.ncbi.nlm.nih.gov/pubmed/38598287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49780 %T Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study %A Lorenzo-Luaces,Lorenzo %A Wasil,Akash %A Kacmarek,Corinne N %A DeRubeis,Robert %+ Indiana University-Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 8128560866, lolorenz@indiana.edu %K digital mental health %K ethnicity %K health disparities %K internet-based CBT %K cognitive behavioral therapy %K intervention %K mental health %K mental health care %K race %K therapy %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants’ willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one’s income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. %M 38602769 %R 10.2196/49780 %U https://formative.jmir.org/2024/1/e49780 %U https://doi.org/10.2196/49780 %U http://www.ncbi.nlm.nih.gov/pubmed/38602769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50968 %T Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study %A O'Brien,Niki %A Fernandez Crespo,Roberto %A O'Driscoll,Fiona %A Prendergast,Mabel %A Chana,Deeph %A Darzi,Ara %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary’s Campus, London, W21NY, United Kingdom, 44 (0)20 3312 1310, n.obrien@imperial.ac.uk %K acceptability %K cross sectional %K cybersecurity %K digital health %K digital transformation %K education %K feasibility %K framework %K frameworks %K global health %K health systems %K implementation %K organization %K organizational %K organizations %K patient safety %K SWOT %K TAM %K usability %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care–specific resources to help organizations at different levels of maturity develop their cybersecurity practices. Objective: This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. Methods: A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams’ networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. Results: A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. Conclusions: The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone’s responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed. %M 38603777 %R 10.2196/50968 %U https://formative.jmir.org/2024/1/e50968 %U https://doi.org/10.2196/50968 %U http://www.ncbi.nlm.nih.gov/pubmed/38603777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45959 %T Mental Distress, Label Avoidance, and Use of a Mental Health Chatbot: Results From a US Survey %A Kosyluk,Kristin %A Baeder,Tanner %A Greene,Karah Yeona %A Tran,Jennifer T %A Bolton,Cassidy %A Loecher,Nele %A DiEva,Daniel %A Galea,Jerome T %+ Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 2735, Tampa, FL, 33612, United States, 1 8139746019, kkosyluk@usf.edu %K chatbots %K conversational agents %K mental health %K resources %K screening %K resource referral %K stigma %K label avoidance %K survey %K training %K behavioral %K COVID-19 %K pilot test %K design %K users %K psychological distress %K symptoms %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians’ responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral. Objective: We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users’ demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users. Methods: We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot. Results: We found that mental health screening using a chatbot was feasible, with 168 (75.7%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress. Conclusions: Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma. %M 38607665 %R 10.2196/45959 %U https://formative.jmir.org/2024/1/e45959 %U https://doi.org/10.2196/45959 %U http://www.ncbi.nlm.nih.gov/pubmed/38607665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53726 %T Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool %A Louch,Gemma %A Berzins,Kathryn %A Walker,Lauren %A Wormald,Gemma %A Blackwell,Kirstin %A Stephens,Michael %A Brown,Mark %A Baker,John %+ School of Healthcare, University of Leeds, Baines Wing, Leeds, LS2 9JT, United Kingdom, 44 0113343 ext 7173, g.e.louch@leeds.ac.uk %K patient safety %K mental health %K patient involvement %K qualitative %K digital innovation %K real time %K monitoring %K safety %K develop %K development %K design %K perception %K perceptions %K prototype %K evidence scan %K interview %K interviews %K logic model %K programme theory %K dashboard %K dashboards %K interface %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. Objective: This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. Methods: The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. Results: We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, “getting worse” or “getting better”; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. Conclusions: Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively. %M 38607663 %R 10.2196/53726 %U https://formative.jmir.org/2024/1/e53726 %U https://doi.org/10.2196/53726 %U http://www.ncbi.nlm.nih.gov/pubmed/38607663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48525 %T The Effects of a Single-Session Virtual Rumination Intervention to Enhance Cognitive Functioning in Veterans With Subjective Cognitive Symptoms: Multimethod Pilot Study %A Austin,Tara %A Smith,Jennifer %A Rabin,Borsika %A Lindamer,Laurie %A Pittman,James %A Justice,Staley %A Twamley,Elizabeth W %A Lantrip,Crystal %+ Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, 92161, United States, 1 8585528585, tara.austin@va.gov %K army %K cognition %K cognitive %K emotion regulation %K memory symptoms %K memory %K military %K rumination %K subjective cognitive decline %K telehealth %K telemedicine %K veteran %K worry %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Subjective cognitive concerns (SCCs) entail perceived difficulties in thinking or memory, often reported without substantial objective evidence of cognitive impairment. These concerns are prevalent among individuals with a history of brain injuries, neurological conditions, or chronic illnesses, contributing to both psychological distress and functional limitations. They are increasingly considered to be a risk factor for future objective decline. A considerable number of individuals reporting SCCs also exhibit mental health symptoms, such as a history of trauma, depression, or anxiety. Interventions that address modifiable emotional and cognitive factors related to SCC could improve functioning and quality of life. Therefore, the use of emotion regulation strategies, especially those directed at minimizing rumination, could serve as a promising focus for interventions aimed at mitigating subjective cognitive concerns in veteran populations. Objective: This pilot study explored the feasibility, acceptability, and preliminary efficacy of a brief, 1-session emotion regulation intervention called “Worry Less, Remember More.” The Worry Less, Remember More intervention was designed to reduce rumination and improve subjective cognitive functioning in veterans with subjective cognitive changes (N=15). Methods: We randomized 15 veterans to either the active telehealth condition or waitlist control and completed the intervention. Participants were aged between 31 and 67 (mean 49.5, SD 10.1) years, and the sample was primarily male (12/15, 83%) and White (10/15, 67%). The most common diagnoses were posttraumatic stress disorder and depression. Following the intervention, veteran input was sought through semistructured interviews with a subset of 12 participants, examining feasibility, acceptability, and perceived efficacy. Preliminary efficacy was also measured using pre- and postintervention self-report measures. Results: Veterans reported that this intervention was acceptable, with 92% (11/12) of the sample reporting that they benefited from the intervention and would recommend the intervention to others with similar difficulties. Semistructured interviews revealed difficulties with feasibility, including problems with the remote consenting process, forgetting appointments, and needing additional strategies to remember to consistently use the interventions. The intervention improved self-reported cognitive symptoms on quantitative measures but did not improve self-reported rumination. Conclusions: This pilot study establishes the preliminary feasibility, acceptability, and efficacy of the Worry Less, Remember More intervention for veterans with subjective cognitive symptoms. Future iterations of the intervention may benefit from simplifying the electronic consent process, providing reminders for appointments, and incorporating compensatory cognitive strategies to assist with using the telehealth system, as well as applying the strategies learned in the intervention. While future research is needed with larger samples, including nonveteran populations, the intervention may also be a useful clinical tool to bridge care between neuropsychology clinics and mental health treatment. %M 38608264 %R 10.2196/48525 %U https://formative.jmir.org/2024/1/e48525 %U https://doi.org/10.2196/48525 %U http://www.ncbi.nlm.nih.gov/pubmed/38608264 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52412 %T Novel Approach for Detecting Respiratory Syncytial Virus in Pediatric Patients Using Machine Learning Models Based on Patient-Reported Symptoms: Model Development and Validation Study %A Kawamoto,Shota %A Morikawa,Yoshihiko %A Yahagi,Naohisa %+ Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, 252-0882, Japan, 81 466 49 3404, yahagin@sfc.keio.ac.jp %K respiratory syncytial virus %K machine learning %K self-reported information %K clinical decision support system %K decision support %K decision-making %K artificial intelligence %K model development %K evaluation study %K detection %K respiratory %K respiratory virus %K virus %K machine learning model %K pediatric %K Japan %K detection model %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Respiratory syncytial virus (RSV) affects children, causing serious infections, particularly in high-risk groups. Given the seasonality of RSV and the importance of rapid isolation of infected individuals, there is an urgent need for more efficient diagnostic methods to expedite this process. Objective: This study aimed to investigate the performance of a machine learning model that leverages the temporal diversity of symptom onset for detecting RSV infections and elucidate its discriminatory ability. Methods: The study was conducted in pediatric and emergency outpatient settings in Japan. We developed a detection model that remotely confirms RSV infection based on patient-reported symptom information obtained using a structured electronic template incorporating the differential points of skilled pediatricians. An extreme gradient boosting–based machine learning model was developed using the data of 4174 patients aged ≤24 months who underwent RSV rapid antigen testing. These patients visited either the pediatric or emergency department of Yokohama City Municipal Hospital between January 1, 2009, and December 31, 2015. The primary outcome was the diagnostic accuracy of the machine learning model for RSV infection, as determined by rapid antigen testing, measured using the area under the receiver operating characteristic curve. The clinical efficacy was evaluated by calculating the discriminative performance based on the number of days elapsed since the onset of the first symptom and exclusion rates based on thresholds of reasonable sensitivity and specificity. Results: Our model demonstrated an area under the receiver operating characteristic curve of 0.811 (95% CI 0.784-0.833) with good calibration and 0.746 (95% CI 0.694-0.794) for patients within 3 days of onset. It accurately captured the temporal evolution of symptoms; based on adjusted thresholds equivalent to those of a rapid antigen test, our model predicted that 6.9% (95% CI 5.4%-8.5%) of patients in the entire cohort would be positive and 68.7% (95% CI 65.4%-71.9%) would be negative. Our model could eliminate the need for additional testing in approximately three-quarters of all patients. Conclusions: Our model may facilitate the immediate detection of RSV infection in outpatient settings and, potentially, in home environments. This approach could streamline the diagnostic process, reduce discomfort caused by invasive tests in children, and allow rapid implementation of appropriate treatments and isolation at home. The findings underscore the potential of machine learning in augmenting clinical decision-making in the early detection of RSV infection. %M 38608268 %R 10.2196/52412 %U https://formative.jmir.org/2024/1/e52412 %U https://doi.org/10.2196/52412 %U http://www.ncbi.nlm.nih.gov/pubmed/38608268 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54214 %T Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach %A Sobrinho,Andressa Crystine da Silva %A Gomes,Grace Angelica de Oliveira %A Bueno Júnior,Carlos Roberto %+ Faculty of Medicine of the University of São Paulo, Bandeirantes Avenue 9000, Ribeirão Preto, 14055-230, Brazil, 55 16988155152, andressa.sobrinho@usp.br %K information and communications technologies %K ICTs %K health care %K digital inclusion %K focus groups %K health promotion %K user %K usability %K health literacy %K digital competencies %K digital skills %K mobile phone %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ≥60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. %M 38619865 %R 10.2196/54214 %U https://formative.jmir.org/2024/1/e54214 %U https://doi.org/10.2196/54214 %U http://www.ncbi.nlm.nih.gov/pubmed/38619865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53000 %T Clinical Decision Support System for Guidelines-Based Treatment of Gonococcal Infections, Screening for HIV, and Prescription of Pre-Exposure Prophylaxis: Design and Implementation Study %A Karki,Saugat %A Shaw,Sarah %A Lieberman,Michael %A Pérez,Alejandro %A Pincus,Jonathan %A Jakhmola,Priya %A Tailor,Amrita %A Ogunrinde,Oyinkansola Bukky %A Sill,Danielle %A Morgan,Shane %A Alvarez,Miguel %A Todd,Jonathan %A Smith,Dawn %A Mishra,Ninad %+ Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30333, United States, 1 4047187483, skarki@cdc.gov %K clinical decision support systems %K CDS %K gonorrhea %K pre-exposure prophylaxis %K PrEP %K HIV %K sexually transmitted infections %K electronic health records %K guideline adherence %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfill this need and improve adherence to Centers for Disease Control and Prevention (CDC) treatment and screening guidelines for gonorrhea, HIV, and PrEP. Objective: The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record–based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic. Methods: We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name “X-Clinic.” We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods. Results: Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%). Conclusions: We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use. %M 38621237 %R 10.2196/53000 %U https://formative.jmir.org/2024/1/e53000 %U https://doi.org/10.2196/53000 %U http://www.ncbi.nlm.nih.gov/pubmed/38621237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55762 %T Assessing the Accuracy of Generative Conversational Artificial Intelligence in Debunking Sleep Health Myths: Mixed Methods Comparative Study With Expert Analysis %A Bragazzi,Nicola Luigi %A Garbarino,Sergio %+ Human Nutrition Unit, Department of Food and Drugs, University of Parma, Via Volturno 39, Parma, 43125, Italy, 39 0521 903121, nicolaluigi.bragazzi@unipr.it %K sleep %K sleep health %K sleep-related disbeliefs %K generative conversational artificial intelligence %K chatbot %K ChatGPT %K misinformation %K artificial intelligence %K comparative study %K expert analysis %K adequate sleep %K well-being %K sleep trackers %K sleep health education %K sleep-related %K chronic disease %K healthcare cost %K sleep timing %K sleep duration %K presleep behaviors %K sleep experts %K healthy behavior %K public health %K conversational agents %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adequate sleep is essential for maintaining individual and public health, positively affecting cognition and well-being, and reducing chronic disease risks. It plays a significant role in driving the economy, public safety, and managing health care costs. Digital tools, including websites, sleep trackers, and apps, are key in promoting sleep health education. Conversational artificial intelligence (AI) such as ChatGPT (OpenAI, Microsoft Corp) offers accessible, personalized advice on sleep health but raises concerns about potential misinformation. This underscores the importance of ensuring that AI-driven sleep health information is accurate, given its significant impact on individual and public health, and the spread of sleep-related myths. Objective: This study aims to examine ChatGPT’s capability to debunk sleep-related disbeliefs. Methods: A mixed methods design was leveraged. ChatGPT categorized 20 sleep-related myths identified by 10 sleep experts and rated them in terms of falseness and public health significance, on a 5-point Likert scale. Sensitivity, positive predictive value, and interrater agreement were also calculated. A qualitative comparative analysis was also conducted. Results: ChatGPT labeled a significant portion (n=17, 85%) of the statements as “false” (n=9, 45%) or “generally false” (n=8, 40%), with varying accuracy across different domains. For instance, it correctly identified most myths about “sleep timing,” “sleep duration,” and “behaviors during sleep,” while it had varying degrees of success with other categories such as “pre-sleep behaviors” and “brain function and sleep.” ChatGPT’s assessment of the degree of falseness and public health significance, on the 5-point Likert scale, revealed an average score of 3.45 (SD 0.87) and 3.15 (SD 0.99), respectively, indicating a good level of accuracy in identifying the falseness of statements and a good understanding of their impact on public health. The AI-based tool showed a sensitivity of 85% and a positive predictive value of 100%. Overall, this indicates that when ChatGPT labels a statement as false, it is highly reliable, but it may miss identifying some false statements. When comparing with expert ratings, high intraclass correlation coefficients (ICCs) between ChatGPT’s appraisals and expert opinions could be found, suggesting that the AI’s ratings were generally aligned with expert views on falseness (ICC=.83, P<.001) and public health significance (ICC=.79, P=.001) of sleep-related myths. Qualitatively, both ChatGPT and sleep experts refuted sleep-related misconceptions. However, ChatGPT adopted a more accessible style and provided a more generalized view, focusing on broad concepts, while experts sometimes used technical jargon, providing evidence-based explanations. Conclusions: ChatGPT-4 can accurately address sleep-related queries and debunk sleep-related myths, with a performance comparable to sleep experts, even if, given its limitations, the AI cannot completely replace expert opinions, especially in nuanced and complex fields such as sleep health, but can be a valuable complement in the dissemination of updated information and promotion of healthy behaviors. %M 38501898 %R 10.2196/55762 %U https://formative.jmir.org/2024/1/e55762 %U https://doi.org/10.2196/55762 %U http://www.ncbi.nlm.nih.gov/pubmed/38501898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50897 %T Experiences, Lessons, and Challenges With Adapting REDCap for COVID-19 Laboratory Data Management in a Resource-Limited Country: Descriptive Study %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Makhura,Onalenna %A Hu,Robin %A Motlogelwa,Nkwebi Peace %A Masizana,Audrey %A Lo,Emily %A Mphoyakgosi,Thongbotho %A Moyo,Sikhulile %+ Department of Computer Science, University of Botswana, Private Bag UB 0022, Gaborone, 00267, Botswana, 267 71786953, ndlovuk@ub.ac.bw %K REDCap %K DHIS2 %K COVID-19 %K National Health Laboratory %K eHealth %K interoperability %K data management %K Botswana %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic brought challenges requiring timely health data sharing to inform accurate decision-making at national levels. In Botswana, we adapted and integrated the Research Electronic Data Capture (REDCap) and the District Health Information System version 2 (DHIS2) platforms to support timely collection and reporting of COVID-19 cases. We focused on establishing an effective COVID-19 data flow at the national public health laboratory, being guided by the needs of health care professionals at the National Health Laboratory (NHL). This integration contributed to automated centralized reporting of COVID-19 results at the Ministry of Health (MOH). Objective: This paper reports the experiences, challenges, and lessons learned while designing, adapting, and implementing the REDCap and DHIS2 platforms to support COVID-19 data management at the NHL in Botswana. Methods: A participatory design approach was adopted to guide the design, customization, and implementation of the REDCap platform in support of COVID-19 data management at the NHL. Study participants included 29 NHL and 4 MOH personnel, and the study was conducted from March 2, 2020, to June 30, 2020. Participants’ requirements for an ideal COVID-19 data management system were established. NVivo 11 software supported thematic analysis of the challenges and resolutions identified during this study. These were categorized according to the 4 themes of infrastructure, capacity development, platform constraints, and interoperability. Results: Overall, REDCap supported the majority of perceived technical and nontechnical requirements for an ideal COVID-19 data management system at the NHL. Although some implementation challenges were identified, each had mitigation strategies such as procurement of mobile Internet routers, engagement of senior management to resolve conflicting policies, continuous REDCap training, and the development of a third-party web application to enhance REDCap’s capabilities. Lessons learned informed next steps and further refinement of the REDCap platform. Conclusions: Implementation of REDCap at the NHL to streamline COVID-19 data collection and integration with the DHIS2 platform was feasible despite the urgency of implementation during the pandemic. By implementing the REDCap platform at the NHL, we demonstrated the possibility of achieving a centralized reporting system of COVID-19 cases, hence enabling timely and informed decision-making at a national level. Challenges faced presented lessons learned to inform sustainable implementation of digital health innovations in Botswana and similar resource-limited countries. %M 38625736 %R 10.2196/50897 %U https://formative.jmir.org/2024/1/e50897 %U https://doi.org/10.2196/50897 %U http://www.ncbi.nlm.nih.gov/pubmed/38625736 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51859 %T Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis %A Allcock,Jake Alan %A Zhuang,Mengdie %A Li,Shuyang %A Zhao,Xin %+ Information School, University of Sheffield, The Wave, 2 Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 114 222 6339, m.zhuang@sheffield.ac.uk %K digital health %K healthcare service %K regional difference %K National Health Service %K NHS %K digital technology %K health equity %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. Objective: This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. Methods: We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes—inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. Results: We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients’ requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Conclusions: Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people’s fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements. %M 38639996 %R 10.2196/51859 %U https://formative.jmir.org/2024/1/e51859 %U https://doi.org/10.2196/51859 %U http://www.ncbi.nlm.nih.gov/pubmed/38639996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51858 %T AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation %A Chang,Christel Lynne %A Sinha,Chaitali %A Roy,Madhavi %A Wong,John Chee Meng %+ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 6772 3481, pcmwcmj@nus.edu.sg %K AI %K app %K application %K artificial intelligence %K COVID-19 %K digital %K health care workers %K mental health %K pandemic %K Wysa %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact that the COVID-19 pandemic has had on health care workers’ mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care. Objective: This study explores the feasibility of using Wysa, an artificial intelligence–led mental health app, among health care workers. Methods: A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated. Results: Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]). Conclusions: Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities. %M 38640476 %R 10.2196/51858 %U https://formative.jmir.org/2024/1/e51858 %U https://doi.org/10.2196/51858 %U http://www.ncbi.nlm.nih.gov/pubmed/38640476 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48173 %T Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial %A Grove,Birgith Engelst %A de Thurah,Annette %A Ivarsen,Per %A Kvisgaard,Ann Katrine %A Hjollund,Niels Henrik %A Grytnes,Regine %A Schougaard,Liv Marit Valen %+ AmbuFlex, Centre for Patient-Reported Outcomes, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark, 45 28904835, bigcri@rm.dk %K chronic kidney disease %K pragmatic randomized controlled trial %K process evaluation %K patient-reported outcome measures %K remote monitoring %K monitoring %K patient-reported outcome %K chronic kidney %K intervention %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. Objective: This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. Methods: A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. Results: Of the 320 patients invited, 152 (47.5%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82% (95% CI 76-87). The questionnaire response rate was 539/544 (99.1%). A minority of 13 (12.9%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5%) of the questionnaires. Contact was established in 417/539 (77.4%) of the cases, and 122/539 (22.6%) of the patients did not have contact. Physicians initiated 288/417 (69.1%) and patients requested 129/417 (30.9%) of all the contacts. The primary causes of contact were clinical data (242/417, 58%), PRO data (92/417, 22.1%), and medication concerns and precautionary reasons (83/417, 19.9%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient’s health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. Conclusions: This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their “clinical glance,” posing a potential risk of overlooking crucial patients‘ symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. Trial Registration: ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766 %M 38656781 %R 10.2196/48173 %U https://formative.jmir.org/2024/1/e48173 %U https://doi.org/10.2196/48173 %U http://www.ncbi.nlm.nih.gov/pubmed/38656781 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48371 %T Exploring the Use of Customized Links to Improve Electronic Engagement With Sexual and Reproductive Health Care Among Young African American Male Individuals: Web-Based Survey Study %A Arena,Sandy %A Adams,Mackenzie %A Burns,Jade %+ School of Nursing, University of Michigan, 400 N Ingalls, Room 3175, Ann Arbor, MI, 48109, United States, 1 734 936 5311, saarena@umich.edu %K African American %K engagement %K men’s health %K recruit %K recruitment %K reproductive health %K sexual behavior %K sexual health behavior %K sexual health %K sexual transmission %K sexually transmitted %K social media %K STIs %K young adult %K young adults %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research has shown that heterosexual African American male individuals aged 18-24 years have a higher prevalence of sexually transmitted infections (STIs) and are more likely to engage in risky sexual behavior. There is a critical need to promote sexual reproductive health (SRH) services among this population, especially in urban settings. Young African American male individuals use social media platforms to access health information, showcasing the potential of social media and web-based links as tools to leverage electronic engagement with this population to promote SRH care. Objective: This study aims to explore electronic engagement with young African American male individuals in discussions about SRH care. This paper focuses on the recruitment and social media marketing methods used to recruit young, heterosexual African American male individuals aged 18-24 years for the Stay Safe Project, a larger study that aims to promote SRH services among this population in Detroit, Michigan. We investigate the use of TinyURL, a URL shortener and customized tool, and culturally informed social media marketing strategies to promote electronic engagement within this population. Methods: Participants were recruited between December 2021 and February 2022 through various modes, including email listserves, Mailchimp, the UMHealthResearch website, X (formerly Twitter), Facebook, and Instagram. Images and vector graphics of African American male individuals were used to create social media advertisements that directed participants to click on a TinyURL that led to a recruitment survey for the study. Results: TinyURL metrics were used to monitor demographic and user data, analyzing the top countries, browsers, operating systems, and devices of individuals who engaged with the customized TinyURL links and the total human and unique clicks from various social media platforms. Mailchimp was the most successful platform for electronic engagement with human and unique clicks on the custom TinyURL link, followed by Instagram and Facebook. In contrast, X, traditional email, and research recruiting websites had the least engagement among our population. Success was determined based on the type of user and follower for each platform, whether gained in the community through sign-ups or promoted at peak user time and embedded and spotlighted on nontraditional media (eg, social media sites, blogs, and podcasts) for the user. Low engagement (eg, traditional email) from the target population, limited visibility, and fewer followers contributed to decreased engagement. Conclusions: This study provides insight into leveraging customized, shortened URLs, TinyURL metrics, and social media platforms to improve electronic engagement with young African American male individuals seeking information and resources about SRH care. The results of this study have been used to develop a pilot intervention for this population that will contribute to strategies for encouraging sexual well-being, clinic use, and appropriate linkage to SRH care services among young, heterosexual African American male individuals. %M 38656772 %R 10.2196/48371 %U https://formative.jmir.org/2024/1/e48371 %U https://doi.org/10.2196/48371 %U http://www.ncbi.nlm.nih.gov/pubmed/38656772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53668 %T Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Gusnowski,April %A Surood,Shireen %A Agyapong,Vincent %+ Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K Text4Hope Cancer Care %K COVID-19 %K cancer %K caregivers %K mental health %K anxiety %K depression %K cancer care %K Canada %K Canadian %K treatment %K stress %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging–based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy–based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05. Results: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%). Conclusions: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID): RR2-10.2196/20240 %M 38657234 %R 10.2196/53668 %U https://formative.jmir.org/2024/1/e53668 %U https://doi.org/10.2196/53668 %U http://www.ncbi.nlm.nih.gov/pubmed/38657234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51874 %T Objective Assessment of Physical Activity at Home Using a Novel Floor-Vibration Monitoring System: Validation and Comparison With Wearable Activity Trackers and Indirect Calorimetry Measurements %A Nakajima,Yuki %A Kitayama,Asami %A Ohta,Yuji %A Motooka,Nobuhisa %A Kuno-Mizumura,Mayumi %A Miyachi,Motohiko %A Tanaka,Shigeho %A Ishikawa-Takata,Kazuko %A Tripette,Julien %+ Center for Interdisciplinary AI and Data Science, Ochanomizu University, 2-1-1 Otsuka, Bunkyo, 112-8610, Japan, 81 03 5978 2032 ext 2032, tripette.julien@ocha.ac.jp %K smart home system %K physical behavior %K physical activity %K activity tracker %K floor vibration %K housework-related activity %K home-based activity %K mobile phone %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The self-monitoring of physical activity is an effective strategy for promoting active lifestyles. However, accurately assessing physical activity remains challenging in certain situations. This study evaluates a novel floor-vibration monitoring system to quantify housework-related physical activity. Objective: This study aims to assess the validity of step-count and physical behavior intensity predictions of a novel floor-vibration monitoring system in comparison with the actual number of steps and indirect calorimetry measurements. The accuracy of the predictions is also compared with that of research-grade devices (ActiGraph GT9X). Methods: The Ocha-House, located in Tokyo, serves as an independent experimental facility equipped with high-sensitivity accelerometers installed on the floor to monitor vibrations. Dedicated data processing software was developed to analyze floor-vibration signals and calculate 3 quantitative indices: floor-vibration quantity, step count, and moving distance. In total, 10 participants performed 4 different housework-related activities, wearing ActiGraph GT9X monitors on both the waist and wrist for 6 minutes each. Concurrently, floor-vibration data were collected, and the energy expenditure was measured using the Douglas bag method to determine the actual intensity of activities. Results: Significant correlations (P<.001) were found between the quantity of floor vibrations, the estimated step count, the estimated moving distance, and the actual activity intensities. The step-count parameter extracted from the floor-vibration signal emerged as the most robust predictor (r2=0.82; P<.001). Multiple regression models incorporating several floor-vibration–extracted parameters showed a strong association with actual activity intensities (r2=0.88; P<.001). Both the step-count and intensity predictions made by the floor-vibration monitoring system exhibited greater accuracy than those of the ActiGraph monitor. Conclusions: Floor-vibration monitoring systems seem able to produce valid quantitative assessments of physical activity for selected housework-related activities. In the future, connected smart home systems that integrate this type of technology could be used to perform continuous and accurate evaluations of physical behaviors throughout the day. %M 38662415 %R 10.2196/51874 %U https://formative.jmir.org/2024/1/e51874 %U https://doi.org/10.2196/51874 %U http://www.ncbi.nlm.nih.gov/pubmed/38662415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50234 %T Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study %A Kwok,Ian %A Lattie,Emily Gardiner %A Yang,Dershung %A Summers,Amanda %A Cotten,Paul %A Leong,Caroline Alina %A Moskowitz,Judith Tedlie %+ Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 323 364 1160, iankwok@u.northwestern.edu %K Alzheimer disease %K dementia %K caregiving %K eHealth %K web-based interventions %K positive emotion %K stress %K coping %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection. Objective: The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants. Methods: Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers. Results: Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished. Conclusions: Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers. %M 38662432 %R 10.2196/50234 %U https://formative.jmir.org/2024/1/e50234 %U https://doi.org/10.2196/50234 %U http://www.ncbi.nlm.nih.gov/pubmed/38662432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52687 %T Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study %A Hu,Lu %A Wyatt,Laura C %A Mohsin,Farhan %A Lim,Sahnah %A Zanowiak,Jennifer %A Mammen,Shinu %A Hussain,Sarah %A Ali,Shahmir H %A Onakomaiya,Deborah %A Belli,Hayley M %A Aifah,Angela %A Islam,Nadia S %+ Department of Population Health, Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 3438, lu.hu@nyulangone.org %K South Asian immigrants %K type 2 diabetes %K technology access %K technology use %K prediabetes %K health disparities %K mHealth %K health equity %K immigrant health %K mobile health %K smartphone %K diabetes %K diabetic %K DM %K diabetes mellitus %K immigrants %K prevention %K regression %K regression model %K logistic regression %K mobile health interventions %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth). Objective: This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access. Methods: We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response. Results: The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001). Conclusions: Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions. Trial Registration: ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3711-y %M 38669062 %R 10.2196/52687 %U https://formative.jmir.org/2024/1/e52687 %U https://doi.org/10.2196/52687 %U http://www.ncbi.nlm.nih.gov/pubmed/38669062 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53154 %T Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain %A Harnik,Michael Alexander %A Scheidegger,Alina %A Blättler,Larissa %A Nemecek,Zdenek %A Sauter,Thomas C %A Limacher,Andreas %A Reisig,Florian %A grosse Holtforth,Martin %A Streitberger,Konrad %+ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland, 41 31 632 39 65, michael.harnik@insel.ch %K acceptance %K satisfaction %K patient preferences %K COVID-19 pandemic %K health care providers %K phone consultations %K pain therapy %K eHealth services %K patient care %K health care delivery %K telemedicine %K chronic pain %K preference %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients’ preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients’ preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients’ preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually. %M 38684086 %R 10.2196/53154 %U https://formative.jmir.org/2024/1/e53154 %U https://doi.org/10.2196/53154 %U http://www.ncbi.nlm.nih.gov/pubmed/38684086 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51076 %T Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study %A Chen,Tzu Han %A Lee,Shin-Da %A Ma,Wei-Fen %+ PhD Program in Healthcare Science, School of Nursing, China Medical University, No 100, Sec 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, 886 4 22053366 ext 7107, lhdaisy@mail.cmu.edu.tw %K app quality %K caregiver %K dementia %K geriatrics %K aging %K technology %K digital health %K mHealth %K mobile health %K seniors %K mobile app %K patient %K adoption %K development %K management %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three– and bottom three–rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app’s perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. %M 38684083 %R 10.2196/51076 %U https://formative.jmir.org/2024/1/e51076 %U https://doi.org/10.2196/51076 %U http://www.ncbi.nlm.nih.gov/pubmed/38684083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53441 %T Precision Assessment of Real-World Associations Between Stress and Sleep Duration Using Actigraphy Data Collected Continuously for an Academic Year: Individual-Level Modeling Study %A Vidal Bustamante,Constanza M %A Coombs III,Garth %A Rahimi-Eichi,Habiballah %A Mair,Patrick %A Onnela,Jukka-Pekka %A Baker,Justin T %A Buckner,Randy L %+ Department of Psychology, Harvard University, 52 Oxford Street, Northwest Building, East Wing, Room 295.06, Cambridge, MA, 02138, United States, 1 617 384 8230, constanzavidalbustamante@gmail.com %K deep phenotyping %K individualized models %K intensive longitudinal data %K sleep %K stress %K actigraphy %K accelerometer %K wearable %K mobile phone %K digital health %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heightened stress and insufficient sleep are common in the transition to college, often co-occur, and have both been linked to negative health outcomes. A challenge concerns disentangling whether perceived stress precedes or succeeds changes in sleep. These day-to-day associations may vary across individuals, but short study periods and group-level analyses in prior research may have obscured person-specific phenotypes. Objective: This study aims to obtain stable estimates of lead-lag associations between perceived stress and objective sleep duration in the individual, unbiased by the group, by developing an individual-level linear model that can leverage intensive longitudinal data while remaining parsimonious. Methods: In total, 55 college students (n=6, 11% second-year students and n=49, 89% first-year students) volunteered to provide daily self-reports of perceived stress via a smartphone app and wore an actigraphy wristband for the estimation of daily sleep duration continuously throughout the academic year (median usable daily observations per participant: 178, IQR 65.5). The individual-level linear model, developed in a Bayesian framework, included the predictor and outcome of interest and a covariate for the day of the week to account for weekly patterns. We validated the model on the cohort of second-year students (n=6, used as a pilot sample) by applying it to variables expected to correlate positively within individuals: objective sleep duration and self-reported sleep quality. The model was then applied to the fully independent target sample of first-year students (n=49) for the examination of bidirectional associations between daily stress levels and sleep duration. Results: Proof-of-concept analyses captured expected associations between objective sleep duration and subjective sleep quality in every pilot participant. Target analyses revealed negative associations between sleep duration and perceived stress in most of the participants (45/49, 92%), but their temporal association varied. Of the 49 participants, 19 (39%) showed a significant association (probability of direction>0.975): 8 (16%) showed elevated stress in the day associated with shorter sleep later that night, 5 (10%) showed shorter sleep associated with elevated stress the next day, and 6 (12%) showed both directions of association. Of note, when analyzed using a group-based multilevel model, individual estimates were systematically attenuated, and some even reversed sign. Conclusions: The dynamic interplay of stress and sleep in daily life is likely person specific. Paired with intensive longitudinal data, our individual-level linear model provides a precision framework for the estimation of stable real-world behavioral and psychological dynamics and may support the personalized prioritization of intervention targets for health and well-being. %M 38687600 %R 10.2196/53441 %U https://formative.jmir.org/2024/1/e53441 %U https://doi.org/10.2196/53441 %U http://www.ncbi.nlm.nih.gov/pubmed/38687600 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48185 %T Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study %A Olsen,Christine %A Lungu,Daniel Adrian %+ Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, daniel.a.lungu@uis.no %K app %K BMI %K diet %K exercise %K health %K Heia Meg %K lifestyle change %K longitudinal %K mHealth %K mobile health %K motivation %K nutrition %K obese %K obesity %K overweight %K physical activity %K smartphone apps %K weight %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. Objective: This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. Methods: A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. Results: The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Conclusions: Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings. %M 38687565 %R 10.2196/48185 %U https://formative.jmir.org/2024/1/e48185 %U https://doi.org/10.2196/48185 %U http://www.ncbi.nlm.nih.gov/pubmed/38687565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54120 %T Community-Dwelling Older Adults’ Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study %A Ausserhofer,Dietmar %A Piccoliori,Giuliano %A Engl,Adolf %A Mahlknecht,Angelika %A Plagg,Barbara %A Barbieri,Verena %A Colletti,Nicoletta %A Lombardo,Stefano %A Gärtner,Timon %A Tappeiner,Waltraud %A Wieser,Heike %A Wiedermann,Christian Josef %+ Institute of General Medicine and Public Health, Lorenz-Böhler-Str. 13, Bolzano, 39100, Italy, 39 0471 067290, dietmar.ausserhofer@claudiana.bz.it %K frail older adults %K Italy %K Italian %K Europe %K European %K digital health %K health technologies %K health technology %K telemedicine %K telehealth %K eHealth %K e-health %K adoption %K readiness %K usage %K survey %K surveys %K questionnaire %K questionnaires %K robotics %K readiness %K adoption %K cross-sectional study %K population-based survey %K stratified probabilistic sampling %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults’ readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults’ readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ≥85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. %M 38687989 %R 10.2196/54120 %U https://formative.jmir.org/2024/1/e54120 %U https://doi.org/10.2196/54120 %U http://www.ncbi.nlm.nih.gov/pubmed/38687989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50385 %T An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups %A Donkin,Liesje %A Bidois-Putt,Marie-Claire %A Wilson,Holly %A Hayward,Penelope %A Chan,Amy Hai Yan %+ Department of Psychology and Neuroscience, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K Indigenous people %K Māori %K eHealth %K mental health %K web-based intervention %K digital intervention %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations’ world views. %M 38696236 %R 10.2196/50385 %U https://formative.jmir.org/2024/1/e50385 %U https://doi.org/10.2196/50385 %U http://www.ncbi.nlm.nih.gov/pubmed/38696236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49396 %T Assessment of Stress and Well-Being of Japanese Employees Using Wearable Devices for Sleep Monitoring Combined With Ecological Momentary Assessment: Pilot Observational Study %A Kinoshita,Shotaro %A Hanashiro,Sayaka %A Tsutsumi,Shiori %A Shiga,Kiko %A Kitazawa,Momoko %A Wada,Yasuyo %A Inaishi,Jun %A Kashiwagi,Kazuhiro %A Fukami,Toshikazu %A Mashimo,Yasumasa %A Minato,Kazumichi %A Kishimoto,Taishiro %+ Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, #7F Azabudai Hills Mori JP Tower, 1-3-1 Azabudai, Minato-Ku, Tokyo, 106-0041, Japan, 81 3 5363 3829, tkishimoto@keio.jp %K wearable device %K sleep feedback %K well-being %K stress %K ecological momentary assessment %K feasibility study %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor sleep quality can elevate stress levels and diminish overall well-being. Japanese individuals often experience sleep deprivation, and workers have high levels of stress. Nevertheless, research examining the connection between objective sleep assessments and stress levels, as well as overall well-being, among Japanese workers is lacking. Objective: This study aims to investigate the correlation between physiological data, including sleep duration and heart rate variability (HRV), objectively measured through wearable devices, and 3 states (sleepiness, mood, and energy) assessed through ecological momentary assessment (EMA) and use of rating scales for stress and well-being. Methods: A total of 40 office workers (female, 20/40, 50%; mean age 40.4 years, SD 11.8 years) participated in the study. Participants were asked to wear a wearable wristband device for 8 consecutive weeks. EMA regarding sleepiness, mood, and energy levels was conducted via email messages sent by participants 4 times daily, with each session spaced 3 hours apart. This assessment occurred on 8 designated days within the 8-week timeframe. Participants’ stress levels and perception of well-being were assessed using respective self-rating questionnaires. Subsequently, participants were categorized into quartiles based on their stress and well-being scores, and the sleep patterns and HRV indices recorded by the Fitbit Inspire 2 were compared among these groups. The Mann-Whitney U test was used to assess differences between the quartiles, with adjustments made for multiple comparisons using the Bonferroni correction. Furthermore, EMA results and the sleep and HRV indices were subjected to multilevel analysis for a comprehensive evaluation. Results: The EMA achieved a total response rate of 87.3%, while the Fitbit Inspire 2 wear rate reached 88.0%. When participants were grouped based on quartiles of well-being and stress-related scores, significant differences emerged. Specifically, individuals in the lowest stress quartile or highest subjective satisfaction quartile retired to bed earlier (P<.001 and P=.01, respectively), whereas those in the highest stress quartile exhibited greater variation in the midpoint of sleep (P<.001). A multilevel analysis unveiled notable relationships: intraindividual variability analysis indicated that higher energy levels were associated with lower deviation of heart rate during sleep on the preceding day (β=–.12, P<.001), and decreased sleepiness was observed on days following longer sleep durations (β=–.10, P<.001). Furthermore, interindividual variability analysis revealed that individuals with earlier midpoints of sleep tended to exhibit higher energy levels (β=–.26, P=.04). Conclusions: Increased sleep variabilities, characterized by unstable bedtime or midpoint of sleep, were correlated with elevated stress levels and diminished well-being. Conversely, improved sleep indices (eg, lower heart rate during sleep and earlier average bedtime) were associated with heightened daytime energy levels. Further research with a larger sample size using these methodologies, particularly focusing on specific phenomena such as social jet lag, has the potential to yield valuable insights. Trial Registration: UMIN-CTR UMIN000046858; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053392 %M 38696237 %R 10.2196/49396 %U https://formative.jmir.org/2024/1/e49396 %U https://doi.org/10.2196/49396 %U http://www.ncbi.nlm.nih.gov/pubmed/38696237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51694 %T Group Cohesion and Necessary Adaptations in Online Hearing Voices Peer Support Groups: Qualitative Study With Group Facilitators %A Branitsky,Alison %A Longden,Eleanor %A Bucci,Sandra %A Morrison,Anthony P %A Varese,Filippo %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 07936813441, alison.branitsky@postgrad.manchester.ac.uk %K peer support %K group cohesion %K web-based delivery %K hearing voices %K Hearing Voices Movement %K self-help groups %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative that enables individuals who hear voices to engage with the support of peers, have a long-standing history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing experiences and, in turn, reduces subjective distress. As such, group cohesion is assumed to be a central mechanism of change in HVGs. The rise of digital mental health support, coupled with the COVID-19 pandemic, has resulted in many HVGs adapting to online delivery. However, to date no studies have examined the implementation of these online groups and the adaptations necessary to foster cohesion. Objective: This study aims to understand the experience of group cohesion among HVG facilitators in online groups compared with face-to-face groups. Specifically, we examined the ways in which the medium through which groups run (online or face-to-face) impacts group cohesion and how facilitators adapted HVGs to foster group cohesion online. Methods: Semistructured qualitative interviews were conducted with 11 facilitators with varied experience of facilitating online and face-to-face HVGs. Data were analyzed using reflexive thematic analysis. Results: The findings are organized into 3 themes and associated subthemes: nonverbal challenges to cohesion (lack of differentiation, transitional space, inability to see the whole picture, and expressions of empathy); discursive challenges to cohesion (topic-based conversation and depth of disclosure); and necessary adaptations for online groups (fostering shared experience and using the unique context to demonstrate investment in others). Despite challenges in both the setting and content of online groups, facilitators felt that group cohesion was still possible to achieve online but that it had to be facilitated intentionally. Conclusions: This study is the first to specifically investigate group cohesion in online HVGs. Participants noted numerous challenges to group cohesion when adapting groups to run online, including the unnaturally linear narrative flow of dialogue in online settings; lack of transitional spaces, and associated small talk before and after the session; ease of disengagement online; inhibited sharing; and absence of shared physical presence online. Although these challenges were significant, facilitators nevertheless emphasized that the benefits provided by the accessibility of online groups outweighed these challenges. Necessary adaptations for cultivating group cohesion online are outlined and include capitalizing on moments of humor and spontaneity, using group activities, encouraging information sharing between participants using the chat and screen-sharing features, and using objects from participants’ environments to gain deeper insight into their subjective worlds. %M 38701439 %R 10.2196/51694 %U https://formative.jmir.org/2024/1/e51694 %U https://doi.org/10.2196/51694 %U http://www.ncbi.nlm.nih.gov/pubmed/38701439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52312 %T Accuracy of the Apple Watch Series 4 and Fitbit Versa for Assessing Energy Expenditure and Heart Rate of Wheelchair Users During Treadmill Wheelchair Propulsion: Cross-sectional Study %A Danielsson,Marius Lyng %A Vergeer,Melanie %A Plasqui,Guy %A Baumgart,Julia Kathrin %+ Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Smistadvegen 11, Trondheim, 7026, Norway, +47 47863154, mlyngd@gmail.com %K agreement %K validity %K accuracy %K cross sectional %K physiology %K disability %K disabled %K upper-body exercise %K upper body %K exercise %K physical activity %K ergospirometer %K fitness %K vital %K vitals %K energy %K expenditure %K mHealth %K wearable %K wearables %K mobile health %K smartwatch %K smartwatches %K apple watch %K fitbit %K digital health %K energy expenditure %K heart rate %K wheelchair %K wheelchairs %K fitness trackers %K tracker %K trackers %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Apple Watch (AW) Series 1 provides energy expenditure (EE) for wheelchair users but was found to be inaccurate with an error of approximately 30%, and the corresponding error for heart rate (HR) provided by the Fitbit Charge 2 was approximately 10% to 20%. Improved accuracy of estimated EE and HR is expected with newer editions of these smart watches (SWs). Objective: This study aims to assess the accuracy of the AW Series 4 (wheelchair-specific setting) and the Fitbit Versa (treadmill running mode) for estimating EE and HR during wheelchair propulsion at different intensities. Methods: Data from 20 manual wheelchair users (male: n=11, female: n=9; body mass: mean 75, SD 19 kg) and 20 people without a disability (male: n=11, female: n=9; body mass: mean 75, SD 11 kg) were included. Three 4-minute wheelchair propulsion stages at increasing speed were performed on 3 separate test days (0.5%, 2.5%, or 5% incline), while EE and HR were collected by criterion devices and the AW or Fitbit. The mean absolute percentage error (MAPE) was used to indicate the absolute agreement between the criterion device and SWs for EE and HR. Additionally, linear mixed model analyses assessed the effect of exercise intensity, sex, and group on the SW error. Interclass correlation coefficients were used to assess relative agreement between criterion devices and SWs. Results: The AW underestimated EE with MAPEs of 29.2% (SD 22%) in wheelchair users and 30% (SD 12%) in people without a disability. The Fitbit overestimated EE with MAPEs of 73.9% (SD 7%) in wheelchair users and 44.7% (SD 38%) in people without a disability. Both SWs underestimated HR. The device error for EE and HR increased with intensity for both SWs (all comparisons: P<.001), and the only significant difference between groups was found for HR in the AW (–5.27 beats/min for wheelchair users; P=.02). There was a significant effect of sex on the estimation error in EE, with worse accuracy for the AW (–0.69 kcal/min; P<.001) and better accuracy for the Fitbit (–2.08 kcal/min; P<.001) in female participants. For HR, sex differences were found only for the AW, with a smaller error in female participants (5.23 beats/min; P=.02). Interclass correlation coefficients showed poor to moderate relative agreement for both SWs apart from 2 stage-incline combinations (AW: 0.12-0.57 for EE and 0.11-0.86 for HR; Fitbit: 0.06-0.85 for EE and 0.03-0.29 for HR). Conclusions: Neither the AW nor Fitbit were sufficiently accurate for estimating EE or HR during wheelchair propulsion. The AW underestimated EE and the Fitbit overestimated EE, and both SWs underestimated HR. Caution is hence required when using SWs as a tool for training intensity regulation and energy balance or imbalance in wheelchair users. %M 38713497 %R 10.2196/52312 %U https://formative.jmir.org/2024/1/e52312 %U https://doi.org/10.2196/52312 %U http://www.ncbi.nlm.nih.gov/pubmed/38713497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50507 %T Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study %A Boudreau,Jacqueline Hannah %A Moo,Lauren R %A Kennedy,Meaghan A %A Conti,Jennifer %A Anwar,Chitra %A Pimentel,Camilla B %A Nearing,Kathryn A %A Hung,William W %A Dryden,Eileen M %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, 200 Springs Rd., Bedford, MA, 01730, United States, 1 6033059605, jacqueline.boudreau@va.gov %K caregivers %K geriatrics %K older adults %K rural veterans %K rural %K specialty care %K telehealth %K telemedicine %K veterans %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. Objective: In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. Methods: We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA’s videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. Results: From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. Conclusions: To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit. %M 38713503 %R 10.2196/50507 %U https://formative.jmir.org/2024/1/e50507 %U https://doi.org/10.2196/50507 %U http://www.ncbi.nlm.nih.gov/pubmed/38713503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52397 %T Patient and Provider Perspectives About the Use of Patient-Generated Health Data During Pregnancy: Qualitative Exploratory Study %A MacEwan,Sarah R %A Olvera,Ramona G %A Jonnalagadda,Pallavi %A Fareed,Naleef %A McAlearney,Ann Scheck %+ Division of General Internal Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, 43202, United States, 1 614 293 0164, Sarah.MacEwan@osumc.edu %K patient-generated health data %K patient-centered care %K obstetrics %K postpartum period %K qualitative methods %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is increasing interest in using patient-generated health data (PGHD) to improve patient-centered care during pregnancy. However, little research has examined the perspectives of patients and providers as they report, collect, and use PGHD to inform obstetric care. Objective: This study aims to explore the perspectives of patients and providers about the use of PGHD during pregnancy, including the benefits and challenges of reporting, collecting, and using these data, as well as considerations for expanding the use of PGHD to improve obstetric care. Methods: We conducted one-on-one interviews with 30 pregnant or postpartum patients and 14 health care providers from 2 obstetrics clinics associated with an academic medical center. Semistructured interview guides included questions for patients about their experience and preferences for sharing PGHD and questions for providers about current processes for collecting PGHD, opportunities to improve or expand the collection of PGHD, and challenges faced when collecting and using this information. Interviews were conducted by phone or videoconference and were audio recorded, transcribed verbatim, and deidentified. Interview transcripts were analyzed deductively and inductively to characterize and explore themes in the data. Results: Patients and providers described how PGHD, including physiologic measurements and experience of symptoms, were currently collected during and between in-person clinic visits for obstetric care. Both patients and providers reported positive perceptions about the collection and use of PGHD during pregnancy. Reported benefits of collecting PGHD included the potential to use data to directly inform patient care (eg, identify issues and adjust medication) and to encourage ongoing patient involvement in their care (eg, increase patient attention to their health). Patients and providers had suggestions for expanding the collection and use of PGHD during pregnancy, and providers also shared considerations about strategies that could be used to expand PGHD collection and use. These strategies included considering the roles of both patients and providers in reporting and interpreting PGHD. Providers also noted the need to consider the unintended consequences of using PGHD that should be anticipated and addressed. Conclusions: Acknowledging the challenges, suggestions, and considerations voiced by patients and providers can inform the development and implementation of strategies to effectively collect and use PGHD to support patient-centered care during pregnancy. %M 38718395 %R 10.2196/52397 %U https://formative.jmir.org/2024/1/e52397 %U https://doi.org/10.2196/52397 %U http://www.ncbi.nlm.nih.gov/pubmed/38718395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49276 %T Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model %A He,Yanyun %A Yang,Qian %A Alish,Yousef %A Ma,Shaoying %A Qiu,Zefeng %A Chen,Jian %A Wagener,Theodore %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Wexner Medical Center, 3650 Olentangy River Rd, Columbus, OH, 43214, United States, 1 9739607969, yanyun.he@osumc.edu %K e-cigarette devices %K price %K web-based vape shop %K battery capacity %K output wattage %K e-cigarette %K vape %K vaping %K consumers %K costs %K prices %K pricing %K feature %K features %K device %K devices %K consumer %K cost %K smoking products %K product safety %K consumer safety %K smoking %K smoker %K smokers %K tax %K taxes %K taxation %K economic %K economics %K regression %K regression model %K health economics %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. Objective: This study will examine how product features are associated with the prices of devices sold in web-based vape shops. Methods: We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container–only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. Results: EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device–only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. Conclusions: A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products. %M 38723251 %R 10.2196/49276 %U https://formative.jmir.org/2024/1/e49276 %U https://doi.org/10.2196/49276 %U http://www.ncbi.nlm.nih.gov/pubmed/38723251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44805 %T Decision Support for Managing Common Musculoskeletal Pain Disorders: Development of a Case-Based Reasoning Application %A Granviken,Fredrik %A Vasseljen,Ottar %A Bach,Kerstin %A Jaiswal,Amar %A Meisingset,Ingebrigt %+ Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, 7491, Norway, 47 93059497, fredrik.granviken@ntnu.no %K case-based reasoning %K musculoskeletal pain %K physiotherapy %K decision support %K primary care %K artificial intelligence %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Common interventions for musculoskeletal pain disorders either lack evidence to support their use or have small to modest or short-term effects. Given the heterogeneity of patients with musculoskeletal pain disorders, treatment guidelines and systematic reviews have limited transferability to clinical practice. A problem-solving method in artificial intelligence, case-based reasoning (CBR), where new problems are solved based on experiences from past similar problems, might offer guidance in such situations. Objective: This study aims to use CBR to build a decision support system for patients with musculoskeletal pain disorders seeking physiotherapy care. This study describes the development of the CBR system SupportPrim PT and demonstrates its ability to identify similar patients. Methods: Data from physiotherapy patients in primary care in Norway were collected to build a case base for SupportPrim PT. We used the local-global principle in CBR to identify similar patients. The global similarity measures are attributes used to identify similar patients and consisted of prognostic attributes. They were weighted in terms of prognostic importance and choice of treatment, where the weighting represents the relevance of the different attributes. For the local similarity measures, the degree of similarity within each attribute was based on minimal clinically important differences and expert knowledge. The SupportPrim PT’s ability to identify similar patients was assessed by comparing the similarity scores of all patients in the case base with the scores on an established screening tool (the short form Örebro Musculoskeletal Pain Screening Questionnaire [ÖMSPQ]) and an outcome measure (the Musculoskeletal Health Questionnaire [MSK-HQ]) used in musculoskeletal pain. We also assessed the same in a more extensive case base. Results: The original case base contained 105 patients with musculoskeletal pain (mean age 46, SD 15 years; 77/105, 73.3% women). The SupportPrim PT consisted of 29 weighted attributes with local similarities. When comparing the similarity scores for all patients in the case base, one at a time, with the ÖMSPQ and MSK-HQ, the most similar patients had a mean absolute difference from the query patient of 9.3 (95% CI 8.0-10.6) points on the ÖMSPQ and a mean absolute difference of 5.6 (95% CI 4.6-6.6) points on the MSK-HQ. For both ÖMSPQ and MSK-HQ, the absolute score difference increased as the rank of most similar patients decreased. Patients retrieved from a more extensive case base (N=486) had a higher mean similarity score and were slightly more similar to the query patients in ÖMSPQ and MSK-HQ compared with the original smaller case base. Conclusions: This study describes the development of a CBR system, SupportPrim PT, for musculoskeletal pain in primary care. The SupportPrim PT identified similar patients according to an established screening tool and an outcome measure for patients with musculoskeletal pain. %M 38728686 %R 10.2196/44805 %U https://formative.jmir.org/2024/1/e44805 %U https://doi.org/10.2196/44805 %U http://www.ncbi.nlm.nih.gov/pubmed/38728686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50679 %T Classifying Self-Reported Rheumatoid Arthritis Flares Using Daily Patient-Generated Data From a Smartphone App: Exploratory Analysis Applying Machine Learning Approaches %A Gandrup,Julie %A Selby,David A %A Dixon,William G %+ Centre for Epidemiology Versus Arthritis, University of Manchester, Oxford Rd, Stopford Building, Manchester, M13 9PT, United Kingdom, 44 1613066000, will.dixon@manchester.ac.uk %K rheumatoid arthritis %K flare %K patient-generated health data %K smartphone %K mobile health %K machine learning %K arthritis %K rheumatic %K rheumatism %K joint %K joints %K arthritic %K musculoskeletal %K flares %K classify %K classification %K symptom %K symptoms %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to predict rheumatoid arthritis (RA) flares between clinic visits based on real-time, longitudinal patient-generated data could potentially allow for timely interventions to avoid disease worsening. Objective: This exploratory study aims to investigate the feasibility of using machine learning methods to classify self-reported RA flares based on a small data set of daily symptom data collected on a smartphone app. Methods: Daily symptoms and weekly flares reported on the Remote Monitoring of Rheumatoid Arthritis (REMORA) smartphone app from 20 patients with RA over 3 months were used. Predictors were several summary features of the daily symptom scores (eg, pain and fatigue) collected in the week leading up to the flare question. We fitted 3 binary classifiers: logistic regression with and without elastic net regularization, a random forest, and naive Bayes. Performance was evaluated according to the area under the curve (AUC) of the receiver operating characteristic curve. For the best-performing model, we considered sensitivity and specificity for different thresholds in order to illustrate different ways in which the predictive model could behave in a clinical setting. Results: The data comprised an average of 60.6 daily reports and 10.5 weekly reports per participant. Participants reported a median of 2 (IQR 0.75-4.25) flares each over a median follow-up time of 81 (IQR 79-82) days. AUCs were broadly similar between models, but logistic regression with elastic net regularization had the highest AUC of 0.82. At a cutoff requiring specificity to be 0.80, the corresponding sensitivity to detect flares was 0.60 for this model. The positive predictive value (PPV) in this population was 53%, and the negative predictive value (NPV) was 85%. Given the prevalence of flares, the best PPV achieved meant only around 2 of every 3 positive predictions were correct (PPV 0.65). By prioritizing a higher NPV, the model correctly predicted over 9 in every 10 non-flare weeks, but the accuracy of predicted flares fell to only 1 in 2 being correct (NPV and PPV of 0.92 and 0.51, respectively). Conclusions: Predicting self-reported flares based on daily symptom scorings in the preceding week using machine learning methods was feasible. The observed predictive accuracy might improve as we obtain more data, and these exploratory results need to be validated in an external cohort. In the future, analysis of frequently collected patient-generated data may allow us to predict flares before they unfold, opening opportunities for just-in-time adaptative interventions. Depending on the nature and implication of an intervention, different cutoff values for an intervention decision need to be considered, as well as the level of predictive certainty required. %M 38743480 %R 10.2196/50679 %U https://formative.jmir.org/2024/1/e50679 %U https://doi.org/10.2196/50679 %U http://www.ncbi.nlm.nih.gov/pubmed/38743480 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49168 %T Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers’ Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study %A Morales-Cahuancama,Bladimir %A Verdezoto,Nervo %A Gonzales-Achuy,Elena %A Quispe-Gala,Cinthia %A Bautista-Olortegui,William %A Hinojosa-Mamani,Paul %A Aparco,Juan Pablo %+ Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Av Ricardo Tizón y Bueno 276, Jesús María, Lima, 15072, Peru, 51 7480000 ext 6626, bmorales@ins.gob.pe %K child %K children %K schoolchildren %K youth %K student %K students %K adolescent %K schoolchildren %K formative research %K digital media %K digital games %K serious game %K serious games %K nutrition %K obesity %K obese %K overweight %K mHealth %K caregivers’ perspectives %K perspective %K perspectives %K diet %K healthy eating %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren’s knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren’s homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren’s homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children’s knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers’ perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren’s nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. %M 38743472 %R 10.2196/49168 %U https://formative.jmir.org/2024/1/e49168 %U https://doi.org/10.2196/49168 %U http://www.ncbi.nlm.nih.gov/pubmed/38743472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50398 %T Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study %A Szkodny,Dominika %A Wróblewska-Czajka,Ewa %A Stryja,Mikołaj %A Gara,Filip %A Wylęgała,Edward %+ Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, Panewnicka 65, Katowice, 40-570, Poland, 48 32 605 35 55, dominikacholewa1@gmail.com %K eye donor %K corneal transplant %K donor shortage %K mHealth %K mobile health %K app %K apps %K applications %K application %K tissue procurement %K organ %K procurement %K donor %K donors %K donation %K transplant %K transplantation %K transplants %K usability %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K interview %K interviews %K survey %K surveys %K questionnaire %K questionnaires %K reporting %D 2024 %7 15.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. Objective: The primary objectives of this study were to assess health care professionals’ attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Methods: Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals’ perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application’s usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. Results: The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. Conclusions: The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis. %M 38748474 %R 10.2196/50398 %U https://formative.jmir.org/2024/1/e50398 %U https://doi.org/10.2196/50398 %U http://www.ncbi.nlm.nih.gov/pubmed/38748474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46151 %T Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study %A Lemos,Marta %A Henriques,Ana Rita %A Lopes,David Gil %A Mendonça,Nuno %A Victorino,André %A Costa,Andreia %A Arriaga,Miguel %A Gregório,Maria João %A de Sousa,Rute %A Canhão,Helena %A Rodrigues,Ana M %+ CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5 Edifício Amarelo, Lisboa, 1150-190, Portugal, 351 214956435 ext 27016, anarita.henriques@nms.unl.pt %K DigiAdherence %K mHealth %K mobile app %K technology %K utility %K usability %K ICT %K application %K patient-centered %K tool %K prevention %K falls %K treatment %K nutrition %K physical activity %K pilot study %K older adults %K adherence %K engagement %K compliance %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 %M 38758585 %R 10.2196/46151 %U https://formative.jmir.org/2024/1/e46151 %U https://doi.org/10.2196/46151 %U http://www.ncbi.nlm.nih.gov/pubmed/38758585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54595 %T Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study %A Soltero,Erica G %A Musaad,Salma M %A O’Connor,Teresia M %A Thompson,Debbe %A Norris,Keith %A Beech,Bettina M %+ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave, Houston, TX, 77030, United States, 1 602 496 0909, soltero@bcm.edu %K health disparities %K diabetes prevention %K Mexican youth %K physical activity %K sleep %K digital health %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. Objective: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. Methods: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. Results: Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. Conclusions: Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth’s desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations. %M 38758584 %R 10.2196/54595 %U https://formative.jmir.org/2024/1/e54595 %U https://doi.org/10.2196/54595 %U http://www.ncbi.nlm.nih.gov/pubmed/38758584 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53985 %T Longitudinal Changes in Diagnostic Accuracy of a Differential Diagnosis List Developed by an AI-Based Symptom Checker: Retrospective Observational Study %A Harada,Yukinori %A Sakamoto,Tetsu %A Sugimoto,Shu %A Shimizu,Taro %+ Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, 321-0293, Japan, 81 282 86 1111, yharada@dokkyomed.ac.jp %K atypical presentations %K diagnostic accuracy %K diagnosis %K diagnostics %K symptom checker %K uncommon diseases %K symptom checkers %K uncommon %K rare %K artificial intelligence %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) symptom checker models should be trained using real-world patient data to improve their diagnostic accuracy. Given that AI-based symptom checkers are currently used in clinical practice, their performance should improve over time. However, longitudinal evaluations of the diagnostic accuracy of these symptom checkers are limited. Objective: This study aimed to assess the longitudinal changes in the accuracy of differential diagnosis lists created by an AI-based symptom checker used in the real world. Methods: This was a single-center, retrospective, observational study. Patients who visited an outpatient clinic without an appointment between May 1, 2019, and April 30, 2022, and who were admitted to a community hospital in Japan within 30 days of their index visit were considered eligible. We only included patients who underwent an AI-based symptom checkup at the index visit, and the diagnosis was finally confirmed during follow-up. Final diagnoses were categorized as common or uncommon, and all cases were categorized as typical or atypical. The primary outcome measure was the accuracy of the differential diagnosis list created by the AI-based symptom checker, defined as the final diagnosis in a list of 10 differential diagnoses created by the symptom checker. To assess the change in the symptom checker’s diagnostic accuracy over 3 years, we used a chi-square test to compare the primary outcome over 3 periods: from May 1, 2019, to April 30, 2020 (first year); from May 1, 2020, to April 30, 2021 (second year); and from May 1, 2021, to April 30, 2022 (third year). Results: A total of 381 patients were included. Common diseases comprised 257 (67.5%) cases, and typical presentations were observed in 298 (78.2%) cases. Overall, the accuracy of the differential diagnosis list created by the AI-based symptom checker was 172 (45.1%), which did not differ across the 3 years (first year: 97/219, 44.3%; second year: 32/72, 44.4%; and third year: 43/90, 47.7%; P=.85). The accuracy of the differential diagnosis list created by the symptom checker was low in those with uncommon diseases (30/124, 24.2%) and atypical presentations (12/83, 14.5%). In the multivariate logistic regression model, common disease (P<.001; odds ratio 4.13, 95% CI 2.50-6.98) and typical presentation (P<.001; odds ratio 6.92, 95% CI 3.62-14.2) were significantly associated with the accuracy of the differential diagnosis list created by the symptom checker. Conclusions: A 3-year longitudinal survey of the diagnostic accuracy of differential diagnosis lists developed by an AI-based symptom checker, which has been implemented in real-world clinical practice settings, showed no improvement over time. Uncommon diseases and atypical presentations were independently associated with a lower diagnostic accuracy. In the future, symptom checkers should be trained to recognize uncommon conditions. %M 38758588 %R 10.2196/53985 %U https://formative.jmir.org/2024/1/e53985 %U https://doi.org/10.2196/53985 %U http://www.ncbi.nlm.nih.gov/pubmed/38758588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53204 %T Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study %A Amiot,Odile %A Sauvaget,Anne %A Alamome,Isabelle %A Bulteau,Samuel %A Charpeaud,Thomas %A Clair,Anne-Hélène %A Courtet,Philippe %A Drapier,Dominique %A Haffen,Emmanuel %A Fakra,Eric %A Gaudeau-Bosma,Christian %A Gaillard,Adeline %A Mouchabac,Stéphane %A Pineau,Fanny %A Narboni,Véronique %A Duburcq,Anne %A Lecardeur,Laurent %+ DueL, 8 Quai des Docks, Nice, 06300, France, 33 635568024, laurentlecardeur@gmail.com %K prospective acceptability %K digital health %K depression %K e-mental health %K deprexis %K psychotherapy %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Major depressive disorder is one of the leading causes of disability worldwide. Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains limited in France due to the limited availability of trained clinicians, high costs for patients in the context of nonreimbursement, and the fear of stigmatization. Therefore, online blended psychological treatment such as Deprexis could improve access to care for people with depression. It has several advantages, such as easy accessibility and scalability, and it is supported by evidence. Objective: This study aims to evaluate the real-life acceptability of Deprexis for people with depression in France outside of a reimbursement pathway. Methods: Deprexis Acceptability Study Measure in Real Life (DARE) was designed as a multicenter cross-sectional study in which Deprexis was offered to any patient meeting the inclusion criteria during the fixed inclusion period (June 2022-March 2023). Inclusion criteria were (1) depression, (2) age between 18 and 65 years, (3) sufficient French language skills, and (4) access to the internet with a device to connect to the Deprexis platform. Exclusion criteria were previous or current diagnoses of bipolar disorder, psychotic symptoms, and suicidal thoughts during the current episode. The primary objective was to measure the prospective acceptability of Deprexis, a new digital therapy. Secondary objectives were to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on Deprexis before enrollment to ensure that they all had the same level of information and understanding of the program. Results: A total of 245 patients were eligible (n=159, 64.9% were women and n=138, 56.3% were single). The mean age was 40.7 (SD 14.1) years. A total of 78% (n=191) of the patients had moderate to severe depression (according to the Patient Health Questionnaire-9 [PHQ-9]). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders, and suicidal ideation). A total of 33.9% (n=83) of patients accepted the idea of using Deprexis; the main reason for refusal was financial at 83.3% (n=135). Multivariate logistic regression identified factors that might favor the acceptability of Deprexis. Among these, being a couple, being treated with an antidepressant, or having a low severity level favored the acceptance of Deprexis. Conclusions: DARE is the first French study aiming at evaluating the prospective acceptability of digital therapy in the treatment of depression. The main reason for the refusal of Deprexis was financial. DARE will allow better identification of factors influencing acceptability in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use, and severity of depression. %M 38568139 %R 10.2196/53204 %U https://formative.jmir.org/2024/1/e53204 %U https://doi.org/10.2196/53204 %U http://www.ncbi.nlm.nih.gov/pubmed/38568139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50812 %T A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics %A Karuchit,Samart %A Thiengtham,Panupit %A Tanpradech,Suvimon %A Srinor,Watcharapol %A Yingyong,Thitipong %A Naiwatanakul,Thananda %A Northbrook,Sanny %A Hladik,Wolfgang %+ Informatics Section, Business Services Office, US Centers for Disease Control and Prevention, DDC7 Bldg, 3rd Fl. Ministry of Public Health, Tivanon Road, Nonthaburi, 11000, Thailand, 66 2 580 0669 ext 364, hqd5@cdc.gov %K online respondent-driven sampling %K web-based respondent-driven sampling %K virtual architecture %K men who have sex with men %K Thailand %K MSM %K Asia %K Asian %K gay %K homosexual %K homosexuality %K sexual minority %K sexual minorities %K biobehavioral %K surveillance %K respondent driven sampling %K survey %K surveys %K web app %K web application %K coding %K PHP %K web based %K automation %K automated %K design %K architecture %K information system %K information systems %K online sampling %K HIV %K sexually transmitted infection %K STI %K sexually transmitted disease %K STD %K sexual transmission %K sexually transmitted %K RDS %K webRDS %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Thailand’s HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys. Objective: We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM. Methods: We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants’ phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation. Results: Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using “borrowed” phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw. Conclusions: We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection. %M 38767946 %R 10.2196/50812 %U https://formative.jmir.org/2024/1/e50812 %U https://doi.org/10.2196/50812 %U http://www.ncbi.nlm.nih.gov/pubmed/38767946 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54101 %T Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study %A Teh,Pei-Lee %A Kwok,Andrei O J %A Cheong,Wing Loong %A Lee,Shaun %+ School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Malaysia, 60 355145890, shaun.lee@monash.edu %K digital health %K older adults %K digital divide %K aging %K pilot %K Malaysia %K coach %K digital access %K social barrier %K virtual %K virtual coach %K digital tool %K tool %K engagement %K gamification %K user experience %K app %K technology tool %K digital literacy %K user experience design %K decision support %K support %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. Objective: The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. Methods: We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Results: Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual’s health condition, and improvement in the user-experience design to accommodate older users’ specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. Conclusions: The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults’ digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults. %M 38772022 %R 10.2196/54101 %U https://formative.jmir.org/2024/1/e54101 %U https://doi.org/10.2196/54101 %U http://www.ncbi.nlm.nih.gov/pubmed/38772022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54586 %T A Web-Based Intervention to Support the Mental Well-Being of Sexual and Gender Minority Young People: Mixed Methods Co-Design of Oneself %A Brown,Katherine %A Lucassen,Mathijs F G %A Núñez-García,Alicia %A Rimes,Katharine A %A Wallace,Louise M %A Samra,Rajvinder %+ Centre for Research in Psychology and Sports Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL109AB, United Kingdom, 44 1707 284 615, k.brown25@herts.ac.uk %K sexual minority %K gender minority %K lesbian, gay, bisexual, transgender, queer %K LGBTQ+ %K mental well-being %K support %K intervention %K resilience %K digital %K co-design %K sexual and gender minority youth %K SGMY %K mobile phone %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority youth are at greater risk of compromised mental health than their heterosexual and cisgender peers. This is considered to be due to an increased burden of stigma, discrimination, or bullying resulting in a heightened experience of daily stress. Given the increasing digital accessibility and a strong preference for web-based support among sexual and gender minority youth, digital interventions are a key means to provide support to maintain their well-being. Objective: This paper aims to explicate the co-design processes and underpinning logic of Oneself, a bespoke web-based intervention for sexual and gender minority youth. Methods: This study followed a 6-stage process set out by Hagen et al (identify, define, position, concept, create, and use), incorporating a systematic scoping review of existing evidence, focus groups with 4 stakeholder groups (ie, sexual and gender minority youth, professionals who directly support them, parents, and UK public health service commissioners), a series of co-design workshops and web-based consultations with sexual and gender minority youth, the appointment of a digital development company, and young adult sexual and gender minority contributors to create content grounded in authentic experiences. Results: Oneself features a welcome and home page, including a free accessible to all animation explaining the importance of using appropriate pronouns and the opportunity to create a user account and log-in to access further free content. Creating an account provides an opportunity (for the user and the research team) to record engagement, assess users’ well-being, and track progress through the available content. There are three sections of content in Oneself focused on the priority topics identified through co-design: (1) coming out and doing so safely; (2) managing school, including homophobic, biphobic, or transphobic bullying or similar; and (3) dealing with parents and families, especially unsupportive family members, including parents or caregivers. Oneself’s content focuses on identifying these as topic areas and providing potential resources to assist sexual and gender minority youth in coping with these areas. For instance, Oneself drew on therapeutic concepts such as cognitive reframing, stress reduction, and problem-solving techniques. There is also a section containing relaxation exercises, a section with links to other recommended support and resources, and a downloads section with more detailed techniques and strategies for improving well-being. Conclusions: This study contributes to research by opening up the black box of intervention development. It shows how Oneself is underpinned by a logic that can support future development and evaluation and includes diverse co-designers. More interactive techniques to support well-being would be beneficial for further development. Additional content specific to a wider range of intersecting identities (such as care-experienced Asian sexual and gender minority youth from a minority faith background) would also be beneficial in future Oneself developments. International Registered Report Identifier (IRRID): RR2-10.2196/31036 %M 38772025 %R 10.2196/54586 %U https://formative.jmir.org/2024/1/e54586 %U https://doi.org/10.2196/54586 %U http://www.ncbi.nlm.nih.gov/pubmed/38772025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54996 %T Barriers to Implementing Registered Nurse–Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study %A Stevens,Elizabeth R %A Xu,Lynn %A Kwon,JaeEun %A Tasneem,Sumaiya %A Henning,Natalie %A Feldthouse,Dawn %A Kim,Eun Ji %A Hess,Rachel %A Dauber-Decker,Katherine L %A Smith,Paul D %A Halm,Wendy %A Gautam-Goyal,Pranisha %A Feldstein,David A %A Mann,Devin M %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, Room 17-13, New York, NY, 10016, United States, 1 6465012558, elizabeth.stevens@nyulangone.org %K integrated clinical prediction rules %K EHR %K electronic health record %K implementation %K barriers %K acute respiratory infections %K antibiotics %K CDS %K clinical decision support %K decision support %K antibiotic %K prescribe %K prescription %K acute respiratory infection %K barrier %K effectiveness %K registered nurse %K RN %K RN-driven intervention %K personnel availability %K workflow variability %K infrastructure %K infrastructures %K law %K laws %K policy %K policies %K clinical-care setting %K clinical setting %K electronic health records %K RN-driven %K antibiotic stewardship %K retrospective analysis %K Consolidated Framework for Implementation Research %K CFIR %K CDS-based intervention %K urgent care %K New York %K chart review %K interview %K interviews %K staff change %K staff changes %K RN shortage %K RN shortages %K turnover %K health system %K nurse %K nurses %K researcher %K researchers %D 2024 %7 23.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 50% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited. Objective: As a delegation protocol, we adapted a validated electronic health record–integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers. Methods: We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors. Results: Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties. Conclusions: Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels. Trial Registration: ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303 %M 38781006 %R 10.2196/54996 %U https://formative.jmir.org/2024/1/e54996 %U https://doi.org/10.2196/54996 %U http://www.ncbi.nlm.nih.gov/pubmed/38781006 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52185 %T Developing a Cost-Effective Surgical Scheduling System Applying Lean Thinking and Toyota’s Methods for Surgery-Related Big Data for Improved Data Use in Hospitals: User-Centered Design Approach %A Lin,Chien-Chung %A Shen,Jian-Hong %A Chen,Shu-Fang %A Chen,Hung-Ming %A Huang,Hung-Meng %+ Department of Orthopedic Surgery, Taipei City Hospital, Number 33, Section 2, Chung-Hwa Road, Taipei, 100, Taiwan, 886 223889595 ext 2102, ericdoctor@gmail.com %K algorithm %K process %K computational thinking %K continuous improvement %K customer needs %K lean principles %K problem solving %K Toyota Production System %K value stream map %K need %K needs %K operating room %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Surgical scheduling is pivotal in managing daily surgical sequences, impacting patient experience and hospital resources significantly. With operating rooms costing approximately US $36 per minute, efficient scheduling is vital. However, global practices in surgical scheduling vary, largely due to challenges in predicting individual surgeon times for diverse patient conditions. Inspired by the Toyota Production System’s efficiency in addressing similar logistical challenges, we applied its principles as detailed in the book “Lean Thinking” by Womack and Jones, which identifies processes that do not meet customer needs as wasteful. This insight is critical in health care, where waste can compromise patient safety and medical quality. Objective: This study aims to use lean thinking and Toyota methods to develop a more efficient surgical scheduling system that better aligns with user needs without additional financial burdens. Methods: We implemented the 5 principles of the Toyota system: specifying value, identifying the value stream, enabling flow, establishing pull, and pursuing perfection. Value was defined in terms of meeting the customer’s needs, which in this context involved developing a responsive and efficient scheduling system. Our approach included 2 subsystems: one handling presurgery patient data and another for intraoperative and postoperative data. We identified inefficiencies in the presurgery data subsystem and responded by creating a comprehensive value stream map of the surgical process. We developed 2 Excel (Microsoft Corporation) macros using Visual Basic for Applications. The first calculated average surgery times from intra- or postoperative historic data, while the second estimated surgery durations and generated concise, visually engaging scheduling reports from presurgery data. We assessed the effectiveness of the new system by comparing task completion times and user satisfaction between the old and new systems. Results: The implementation of the revised scheduling system significantly reduced the overall scheduling time from 301 seconds to 261 seconds (P=.02), with significant time reductions in the revised process from 99 seconds to 62 seconds (P<.001). Despite these improvements, approximately 21% of nurses preferred the older system for its familiarity. The new system protects patient data privacy and streamlines schedule dissemination through a secure LINE group (LY Corp), ensuring seamless flow. The design of the system allows for real-time updates and has been effectively monitoring surgical durations daily for over 3 years. The “pull” principle was demonstrated when an unplanned software issue prompted immediate, user-led troubleshooting, enhancing system reliability. Continuous improvement efforts are ongoing, except for the preoperative patient confirmation step, which requires further enhancement to ensure optimal patient safety. Conclusions: Lean principles and Toyota’s methods, combined with computer programming, can revitalize surgical scheduling processes. They offer effective solutions for surgical scheduling challenges and enable the creation of a novel surgical scheduling system without incurring additional costs. %M 38787610 %R 10.2196/52185 %U https://formative.jmir.org/2024/1/e52185 %U https://doi.org/10.2196/52185 %U http://www.ncbi.nlm.nih.gov/pubmed/38787610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54010 %T Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial %A Dinh,Mackenzie %A Lin,Chun Chieh %A Whitfield,Candace %A Farhan,Zahera %A Meurer,William J %A Bailey,Sarah %A Skolarus,Lesli E %+ Davee Department of Neurology, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, United States, 1 312 503 0399, lesli.skolarus@northwestern.edu %K hypertension %K cognition %K mobile health %K Bluetooth %K remote %K monitoring %K monitor %K low income %K mHealth %K hypertensive %K cardiology %K cardiovascular %K feasibility %K acceptability %K satisfaction %K RCT %K randomized controlled trial %K assessment %K blood pressure %K neurological %K mobile health %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease–related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health–based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message–linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 %M 38805251 %R 10.2196/54010 %U https://formative.jmir.org/2024/1/e54010 %U https://doi.org/10.2196/54010 %U http://www.ncbi.nlm.nih.gov/pubmed/38805251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54334 %T Exploring Consumers’ Negative Electronic Word-of-Mouth of 5 Military Hospitals in Taiwan Through SERVQUAL and Flower of Services: Web Scraping Analysis %A Huang,Ching-Yuan %A Lee,Po-Chun %A Chen,Long-Hui %+ Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung, 80284, Taiwan, 886 953332550, chyun0124@gmail.com %K electronic word-of-mouth %K eWOM %K service quality %K SERVQUAL scale %K Flower of Services %K health care service quality %K military hospitals %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, with the widespread use of the internet, the influence of electronic word-of-mouth (eWOM) has been increasingly recognized, particularly the significance of negative eWOM, which has surpassed positive eWOM in importance. Such reviews play a pivotal role in research related to service industry management, particularly in intangible service sectors such as hospitals, where they have become a reference point for improving service quality. Objective: This study comprehensively collected negative eWOM from 5 military hospitals in Taiwan that were at or above the level of regional teaching hospitals. It aimed to investigate service quality issues before and after the pandemic. The findings provide important references for formulating strategies to improve service quality. Methods: In this study, we used web scraping techniques to gather 1259 valid negative eWOM, covering the period from the inception of the first review to December 31, 2022. These reviews were categorized using content analysis based on the modified Parasuraman, Zeithaml, and Berry service quality (PZB SERVQUAL) scale and Flower of Services. Statistical data analysis was conducted to investigate the performance of service quality. Results: The annual count of negative reviews for each hospital has exhibited a consistent upward trajectory over the years, with a more pronounced increase following the onset of the pandemic. In the analysis, among the 5 dimensions of PZB SERVQUAL framework, the “Assurance” dimension yielded the least favorable results, registering a negative review rate as high as 58.3%. Closely trailing, the “Responsiveness” dimension recorded a negative review rate of 34.2%. When evaluating the service process, the subitem “In Service: Diagnosis/Examination/Medical/Hospitalization” exhibited the least satisfactory performance, with a negative review rate of 46.2%. This was followed by the subitem “In Service: Pre-diagnosis Waiting,” which had a negative review rate of 20.2%. To evaluate the average scores of negative reviews before and during the onset of the COVID-19 pandemic, independent sample t tests (2-tailed) were used. The analysis revealed statistically significant differences (P<.001). Furthermore, an ANOVA was conducted to investigate whether the length of the negative reviews impacted their ratings, which also showed significant differences (P=.01). Conclusions: Before and during the pandemic, there were significant differences in evaluating hospital services, and a higher word count in negative reviews indicated greater dissatisfaction with the service. Therefore, it is recommended that hospitals establish more comprehensive service quality management mechanisms, carefully respond to negative reviews, and categorize significant service deficiencies as critical events to prevent a decrease in overall service quality. Furthermore, during the service process, customers are particularly concerned about the attitude and responsiveness of health care personnel in the treatment process. Therefore, hospitals should enhance training and management in this area. %M 38809602 %R 10.2196/54334 %U https://formative.jmir.org/2024/1/e54334 %U https://doi.org/10.2196/54334 %U http://www.ncbi.nlm.nih.gov/pubmed/38809602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50857 %T Where Do I Go When My Doctor’s Office Is Closed? The Availability of Out-of-Hours Care Information on Primary Care Practitioners’ Websites %A Legg,David %A Napierala,Hendrik %A Holzinger,Felix %A Slagman,Anna %+ Health Services Research in Emergency and Acute Medicine, Charité - Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 553 037, david.legg@charite.de %K out of hours %K primary care %K telephone triage %K websites %K care information %D 2024 %7 29.5.2024 %9 Research Letter %J JMIR Form Res %G English %X %M 38809600 %R 10.2196/50857 %U https://formative.jmir.org/2024/1/e50857 %U https://doi.org/10.2196/50857 %U http://www.ncbi.nlm.nih.gov/pubmed/38809600 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51408 %T Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study %A Willemsen,Romy Fleur %A Chavannes,Niels Henrik %A Aardoom,Jiska Joëlle %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 615174812, r.f.willemsen@lumc.nl %K acceptability %K accessible %K adoption %K application %K design %K ehealth %K engagement %K evaluation study %K feasibility %K health app platform %K health apps %K health empowerment %K prevention %K public health %K uptake %K user-friendly %K users %K wellbeing %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform “FitKnip” was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. Objective: The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. Methods: This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire–8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one’s perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). Results: A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. Conclusions: A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users’ needs and preferences. This can help to increase uptake, engagement, and ultimately the platform’s adoption and effectiveness. %M 38809585 %R 10.2196/51408 %U https://formative.jmir.org/2024/1/e51408 %U https://doi.org/10.2196/51408 %U http://www.ncbi.nlm.nih.gov/pubmed/38809585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45561 %T The Development of a Text Messaging Platform to Enhance a Youth Diabetes Prevention Program: Observational Process Study %A Sapre,Manali %A Elaiho,Cordelia R %A Brar Prayaga,Rena %A Prayaga,Ram %A Constable,Jeremy %A Vangeepuram,Nita %+ Department of General Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1198, New York, NY, 10029, United States, 1 917 478 2106, nita.vangeepuram@mssm.edu %K community-based participatory research %K youth %K diabetes prevention %K peer education %K mobile health technology %K SMS text messaging %K mobile phone %K artificial intelligence %K AI %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritized youths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-person interventions are challenging because of barriers to access and engagement. Objective: We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messaging platform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes prevention workshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technology partner (mPulse Mobile) to develop and pilot-test the novel interactive platform. Methods: The technology subcommittee of our community action board (comprising youths and young adults) used the results from focus groups that we had previously conducted with youths from our community to develop 5 message types focused on healthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photo diary. We used an iterative process to develop and pilot the program with our internal study team, including youths from our community action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging program with 13 youths with prediabetes. Results: Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received an average of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; the remaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participant response to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5 (highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13) of the participants were still engaged with the program at week 12. During a focus group conducted after program completion, the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshops reflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, and tailored messages most highly and informed planned adaptations to the platform. Participants described the program as: “interactive, informative, enjoyable, very convenient, reliable, motivational, productive, and reflective.” Conclusions: We partnered with youths in the initial content development and pilot testing of a novel SMS text messaging platform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technology experts, and diverse youths to develop a mobile health platform to address diabetes-related disparities. %M 38809599 %R 10.2196/45561 %U https://formative.jmir.org/2024/1/e45561 %U https://doi.org/10.2196/45561 %U http://www.ncbi.nlm.nih.gov/pubmed/38809599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56916 %T Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study %A Albright,Liam %A Ko,Woojin %A Buvanesh,Meyhaa %A Haraldsson,Harald %A Polubriaginof,Fernanda %A Kuperman,Gilad J %A Levy,Michelle %A Sterling,Madeline R %A Dell,Nicola %A Estrin,Deborah %+ Department of Information Science, Jacobs Technion-Cornell Institute, Cornell Tech, 2 W Loop Rd, New York, NY, 10044, United States, 1 646 971 3777, nixdell@cornell.edu %K augmented reality %K extended reality %K family caregiver %K home care %K virtual care %K telemedicine %K telehealth %K oncology %K artificial intelligence %K mobile phone %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers’ unmet needs is via the design of digital technologies that support caregivers’ complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home. Objective: This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens. Methods: We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context. Results: We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians’ and caregivers’ perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers’ already significant burdens. Conclusions: These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery. %M 38814705 %R 10.2196/56916 %U https://formative.jmir.org/2024/1/e56916 %U https://doi.org/10.2196/56916 %U http://www.ncbi.nlm.nih.gov/pubmed/38814705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50025 %T Effectiveness of a Mental Health Chatbot for People With Chronic Diseases: Randomized Controlled Trial %A MacNeill,A Luke %A Doucet,Shelley %A Luke,Alison %+ Centre for Research in Integrated Care, University of New Brunswick, 355 Campus Ring Road, Saint John, NB, E2L 4L5, Canada, 1 506 648 5777, luke.macneill@unb.ca %K chatbot %K chronic disease %K arthritis %K diabetes %K mental health %K depression %K anxiety %K stress %K effectiveness %K application %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People with chronic diseases tend to experience more mental health issues than their peers without these health conditions. Mental health chatbots offer a potential source of mental health support for people with chronic diseases. Objective: The aim of this study was to determine whether a mental health chatbot can improve mental health in people with chronic diseases. We focused on 2 chronic diseases in particular: arthritis and diabetes. Methods: Individuals with arthritis or diabetes were recruited using various web-based methods. Participants were randomly assigned to 1 of 2 groups. Those in the treatment group used a mental health chatbot app (Wysa [Wysa Inc]) over a period of 4 weeks. Those in the control group received no intervention. Participants completed measures of depression (Patient Health Questionnaire–9), anxiety (Generalized Anxiety Disorder Scale–7), and stress (Perceived Stress Scale–10) at baseline, with follow-up testing 2 and 4 weeks later. Participants in the treatment group completed feedback questions on their experiences with the app at the final assessment point. Results: A total of 68 participants (n=47, 69% women; mean age 42.87, SD 11.27 years) were included in the analysis. Participants were divided evenly between the treatment and control groups. Those in the treatment group reported decreases in depression (P<.001) and anxiety (P<.001) severity over the study period. No such changes were found among participants in the control group. No changes in stress were reported by participants in either group. Participants with arthritis reported higher levels of depression (P=.004) and anxiety (P=.004) severity than participants with diabetes over the course of the study, as well as higher levels of stress (P=.01); otherwise, patterns of results were similar across these health conditions. In response to the feedback questions, participants in the treatment group said that they liked many of the functions and features of the app, the general design of the app, and the user experience. They also disliked some aspects of the app, with most of these reports focusing on the chatbot’s conversational abilities. Conclusions: The results of this study suggest that mental health chatbots can be an effective source of mental health support for people with chronic diseases such as arthritis and diabetes. Although cost-effective and accessible, these programs have limitations and may not be well suited for all individuals. Trial Registration: ClinicalTrials.gov NCT04620668; https://www.clinicaltrials.gov/study/NCT04620668 %M 38814681 %R 10.2196/50025 %U https://formative.jmir.org/2024/1/e50025 %U https://doi.org/10.2196/50025 %U http://www.ncbi.nlm.nih.gov/pubmed/38814681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52170 %T Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study %A Xu,Zidu %A Gu,Yaowen %A Xu,Xiaowei %A Topaz,Maxim %A Guo,Zhen %A Kang,Hongyu %A Sun,Lianglong %A Li,Jiao %+ Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, No 3. Yabao Road, Beijing, 10020, China, 86 1052328740, li.jiao@imicams.ac.cn %K knowledge graph %K personalized food recommendation %K geriatric nutrition %K community %K ubiquitous computing %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: China’s older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph–based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes. Objective: This study aims to develop a knowledge graph–based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing. Methods: We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo’s effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis. Results: Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35%) having and 62 (65%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo’s meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults’ own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo’s ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual’s health profile and dietary requirements. Conclusions: ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo’s performance in real-world settings, emphasizing the robust management of complex health data. The system’s scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults. %M 38814702 %R 10.2196/52170 %U https://formative.jmir.org/2024/1/e52170 %U https://doi.org/10.2196/52170 %U http://www.ncbi.nlm.nih.gov/pubmed/38814702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52726 %T Barriers to Postdischarge Smartphone App Use Among Patients With Traumatic Rib Fractures %A Berrigan,Margaret T %A Beaulieu-Jones,Brendin R %A Baines,Rachel %A Berkowitz,Seth %A Evans,Heather %A Brat,Gabriel A %+ Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 2G, Boston, MA, 02215, United States, 1 617 632 9922, gbrat@bidmc.harvard.edu %K mobile health %K smartphone app %K electronic health record %K postdischarge monitoring %K implementation science %K mHealth %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K mobile phone %D 2024 %7 31.5.2024 %9 Research Letter %J JMIR Form Res %G English %X Rib fractures commonly result from traumatic injury and often require hospitalization for pain control and supportive pulmonary care. Although the use of mobile health technology to share patient-generated health data has increased, it remains limited in patients with traumatic injuries. We sought to assess the feasibility of mobile health tracking in patients with rib fractures by using a smartphone app to monitor postdischarge recovery. We encountered patient, institutional, and process-related obstacles that limited app use. The success of future work requires the acknowledgment of these limitations and the use of an implementation science framework to effectively integrate technological tools for personalized trauma care. %M 38820574 %R 10.2196/52726 %U https://formative.jmir.org/2024/1/e52726 %U https://doi.org/10.2196/52726 %U http://www.ncbi.nlm.nih.gov/pubmed/38820574 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e40275 %T The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis %A Walters,Clarice %A Gratzer,David %A Dang,Kevin %A Laposa,Judith %A Knyahnytska,Yuliya %A Ortiz,Abigail %A Gonzalez-Torres,Christina %A Moore,Lindsay P %A Chen,Sheng %A Ma,Clement %A Daskalakis,Zafiris %A Ritvo,Paul %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 4165808021, paul.ritvo@gmail.com %K online intervention %K randomized controlled trial %K major depressive disorder %K text message %K online %K cognitive %K behavior therapy %K treatment %K depression %K disorder %K symptoms %K young adults %K wellness %K procedure %K anxiety %K model %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. Objective: This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. Methods: Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). Results: Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=–0.029, 95% CI –0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=–0.096, 95% CI –0.80 to 0.61), alliance building disclosures (β=–0.098, 95% CI –0.28 to 0.084), and agreement confirmation (β=–0.076, 95% CI –0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. Conclusions: The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 %M 38820586 %R 10.2196/40275 %U https://formative.jmir.org/2024/1/e40275 %U https://doi.org/10.2196/40275 %U http://www.ncbi.nlm.nih.gov/pubmed/38820586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50024 %T A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program %A Burn,Anne-Marie %A Hall,Poppy %A Anderson,Joanna %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 1223336961, amb278@cam.ac.uk %K self-harm %K schools %K young people %K youth %K school staff %K training %K coproduction %K qualitative %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person’s self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program’s effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. %M 38833286 %R 10.2196/50024 %U https://formative.jmir.org/2024/1/e50024 %U https://doi.org/10.2196/50024 %U http://www.ncbi.nlm.nih.gov/pubmed/38833286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55798 %T Using the Natural Language Processing System Medical Named Entity Recognition-Japanese to Analyze Pharmaceutical Care Records: Natural Language Processing Analysis %A Ohno,Yukiko %A Kato,Riri %A Ishikawa,Haruki %A Nishiyama,Tomohiro %A Isawa,Minae %A Mochizuki,Mayumi %A Aramaki,Eiji %A Aomori,Tohru %+ Faculty of Pharmacy, Takasaki University of Health and Welfare, 37-1 Nakaorui-machi, Takasaki-shi, Gunma, 370-0033, Japan, 81 273521290, aomori-t@takasaki-u.ac.jp %K natural language processing %K NLP %K named entity recognition %K pharmaceutical care records %K machine learning %K cefazolin sodium %K electronic medical record %K EMR %K extraction %K Japanese %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Large language models have propelled recent advances in artificial intelligence technology, facilitating the extraction of medical information from unstructured data such as medical records. Although named entity recognition (NER) is used to extract data from physicians’ records, it has yet to be widely applied to pharmaceutical care records. Objective: In this study, we aimed to investigate the feasibility of automatic extraction of the information regarding patients’ diseases and symptoms from pharmaceutical care records. The verification was performed using Medical Named Entity Recognition-Japanese (MedNER-J), a Japanese disease-extraction system designed for physicians’ records. Methods: MedNER-J was applied to subjective, objective, assessment, and plan data from the care records of 49 patients who received cefazolin sodium injection at Keio University Hospital between April 2018 and March 2019. The performance of MedNER-J was evaluated in terms of precision, recall, and F1-score. Results: The F1-scores of NER for subjective, objective, assessment, and plan data were 0.46, 0.70, 0.76, and 0.35, respectively. In NER and positive-negative classification, the F1-scores were 0.28, 0.39, 0.64, and 0.077, respectively. The F1-scores of NER for objective (0.70) and assessment data (0.76) were higher than those for subjective and plan data, which supported the superiority of NER performance for objective and assessment data. This might be because objective and assessment data contained many technical terms, similar to the training data for MedNER-J. Meanwhile, the F1-score of NER and positive-negative classification was high for assessment data alone (F1-score=0.64), which was attributed to the similarity of its description format and contents to those of the training data. Conclusions: MedNER-J successfully read pharmaceutical care records and showed the best performance for assessment data. However, challenges remain in analyzing records other than assessment data. Therefore, it will be necessary to reinforce the training data for subjective data in order to apply the system to pharmaceutical care records. %M 38833694 %R 10.2196/55798 %U https://formative.jmir.org/2024/1/e55798 %U https://doi.org/10.2196/55798 %U http://www.ncbi.nlm.nih.gov/pubmed/38833694 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53918 %T Chinese Oncologists’ Perspectives on Integrating AI into Clinical Practice: Cross-Sectional Survey Study %A Li,Ming %A Xiong,XiaoMin %A Xu,Bo %A Dickson,Conan %+ Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3543, cdickso1@jh.edu %K artificial intelligence %K AI %K machine learning %K oncologist %K concern %K clinical practice %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid development of artificial intelligence (AI) has brought significant interest to its potential applications in oncology. Although AI-powered tools are already being implemented in some Chinese hospitals, their integration into clinical practice raises several concerns for Chinese oncologists. Objective: This study aims to explore the concerns of Chinese oncologists regarding the integration of AI into clinical practice and to identify the factors influencing these concerns. Methods: A total of 228 Chinese oncologists participated in a cross-sectional web-based survey from April to June in 2023 in mainland China. The survey gauged their worries about AI with multiple-choice questions. The survey evaluated their views on the statements of “The impact of AI on the doctor-patient relationship” and “AI will replace doctors.” The data were analyzed using descriptive statistics, and variate analyses were used to find correlations between the oncologists’ backgrounds and their concerns. Results: The study revealed that the most prominent concerns were the potential for AI to mislead diagnosis and treatment (163/228, 71.5%); an overreliance on AI (162/228, 71%); data and algorithm bias (123/228, 54%); issues with data security and patient privacy (123/228, 54%); and a lag in the adaptation of laws, regulations, and policies in keeping up with AI’s development (115/228, 50.4%). Oncologists with a bachelor’s degree expressed heightened concerns related to data and algorithm bias (34/49, 69%; P=.03) and the lagging nature of legal, regulatory, and policy issues (32/49, 65%; P=.046). Regarding AI’s impact on doctor-patient relationships, 53.1% (121/228) saw a positive impact, whereas 35.5% (81/228) found it difficult to judge, 9.2% (21/228) feared increased disputes, and 2.2% (5/228) believed that there is no impact. Although sex differences were not significant (P=.08), perceptions varied—male oncologists tended to be more positive than female oncologists (74/135, 54.8% vs 47/93, 50%). Oncologists with a bachelor’s degree (26/49, 53%; P=.03) and experienced clinicians (≥21 years; 28/56, 50%; P=.054). found it the hardest to judge. Those with IT experience were significantly more positive (25/35, 71%) than those without (96/193, 49.7%; P=.02). Opinions regarding the possibility of AI replacing doctors were diverse, with 23.2% (53/228) strongly disagreeing, 14% (32/228) disagreeing, 29.8% (68/228) being neutral, 16.2% (37/228) agreeing, and 16.7% (38/228) strongly agreeing. There were no significant correlations with demographic and professional factors (all P>.05). Conclusions: Addressing oncologists’ concerns about AI requires collaborative efforts from policy makers, developers, health care professionals, and legal experts. Emphasizing transparency, human-centered design, bias mitigation, and education about AI’s potential and limitations is crucial. Through close collaboration and a multidisciplinary strategy, AI can be effectively integrated into oncology, balancing benefits with ethical considerations and enhancing patient care. %M 38838307 %R 10.2196/53918 %U https://formative.jmir.org/2024/1/e53918 %U https://doi.org/10.2196/53918 %U http://www.ncbi.nlm.nih.gov/pubmed/38838307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54256 %T Performance of a Wearable Ring in Controlled Hypoxia: A Prospective Observational Study %A Mastrototaro,John J %A Leabman,Michael %A Shumate,Joe %A Tompkins,Kim L %+ Movano Inc dba Movano Health, 6800 Koll Center Pkwy, Suite 160, Pleasanton, CA, 94566, United States, 1 408 981 4889, ktompkins@movano.com %K pulse oximetry %K SpO2 %K pulse oximeter %K hypoxia %K hypoxemia %K clinical trial %K accuracy %K digital health %K wearable %K smart ring %K ISO 80601-2-61 %K racial bias %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Over recent years, technological advances in wearables have allowed for continuous home monitoring of heart rate and oxygen saturation. These devices have primarily been used for sports and general wellness and may not be suitable for medical decision-making, especially in saturations below 90% and in patients with dark skin color. Wearable clinical-grade saturation of peripheral oxygen (SpO2) monitoring can be of great value to patients with chronic diseases, enabling them and their clinicians to better manage their condition with reliable real-time and trend data. Objective: This study aimed to determine the SpO2 accuracy of a wearable ring pulse oximeter compared with arterial oxygen saturation (SaO2) in a controlled hypoxia study based on the International Organization for Standardization (ISO) 80601-2-61:2019 standard over the range of 70%-100% SaO2 in volunteers with a broad range of skin color (Fitzpatrick I to VI) during nonmotion conditions. In parallel, accuracy was compared with a calibrated clinical-grade reference pulse oximeter (Masimo Radical-7). Acceptable medical device accuracy was defined as a maximum of 4% root mean square error (RMSE) per the ISO 80601-2-61 standard and a maximum of 3.5% RMSE per the US Food and Drug Administration guidance. Methods: We performed a single-center, blinded hypoxia study of the test device in 11 healthy volunteers at the Hypoxia Research Laboratory, University of California at San Francisco, under the direction of Philip Bickler, MD, PhD, and John Feiner, MD. Each volunteer was connected to a breathing apparatus for the administration of a hypoxic gas mixture. To facilitate frequent blood gas sampling, a radial arterial cannula was placed on either wrist of each participant. One test device was placed on the index finger and another test device was placed on the fingertip. SaO2 analysis was performed using an ABL-90 multi-wavelength oximeter. Results: For the 11 participants included in the analysis, there were 236, 258, and 313 SaO2-SpO2 data pairs for the test device placed on the finger, the test device placed on the fingertip, and the reference device, respectively. The RMSE of the test device for all participants was 2.1% for either finger or fingertip placement, while the Masimo Radical-7 reference pulse oximeter RMSE was 2.8%, exceeding the standard (4% or less) and the Food and Drug Administration guidance (3.5% or less). Accuracy of SaO2-SpO2 paired data from the 4 participants with dark skin in the study was separately analyzed for both test device placements and the reference device. The test and reference devices exceeded the minimum accuracy requirements for a medical device with RMSE at 1.8% (finger) and 1.6% (fingertip) and for the reference device at 2.9%. Conclusions: The wearable ring meets an acceptable standard of accuracy for clinical-grade SpO2 under nonmotion conditions without regard to skin color. Trial Registration: ClinicalTrials.gov NCT05920278; https://clinicaltrials.gov/study/NCT05920278 %M 38838332 %R 10.2196/54256 %U https://formative.jmir.org/2024/1/e54256 %U https://doi.org/10.2196/54256 %U http://www.ncbi.nlm.nih.gov/pubmed/38838332 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52251 %T Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study %A Narang,Gaurav %A Chen,Yaozhu J %A Wedel,Nicole %A Wu,Melody %A Luo,Michelle %A Atreja,Ashish %+ Rx.Health, 21 Penn Plaza, 368 9th Avenue, New York, NY, 10001, United States, 1 6469699939, gnarang@commure.com %K cyclic vomiting syndrome %K vomiting %K vomit %K emetic %K emesis %K gut %K GI %K gastrointestinal %K internal medicine %K prototype %K prototypes %K iterative %K self-management %K disease management %K gut-brain interaction %K gut-brain %K artificial intelligence %K digital patient assistant %K assistant %K assistants %K design thinking %K design %K patient-centric %K patient centred %K patient centered %K patient-centric approach %K System Usability Scale %K symptom tracking %K digital health solution %K user experience %K usability %K symptom %K symptoms %K tracking %K monitoring %K participatory %K co-design digital health technology %K patient assistance %K patient experience %K mobile phone %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients’ quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. Objective: We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. Methods: The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA’s effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. Results: The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA’s potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA’s role in enhancing patient engagement and disease management through a patient-centered digital solution. Conclusions: The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios. %M 38842924 %R 10.2196/52251 %U https://formative.jmir.org/2024/1/e52251 %U https://doi.org/10.2196/52251 %U http://www.ncbi.nlm.nih.gov/pubmed/38842924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50087 %T YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study %A van Dijk,Merle R %A van der Marel,Anne-Fleur %A van Rheenen-Flach,Leonie E %A Ganzevoort,Wessel %A Moll,Etelka %A Scheele,Fedde %A Velzel,Joost %+ Department of Obstetrics and Gynecology, Onze Lieve Vrouwen Gasthuis, Oosterpark 9, Amsterdam, 1061AC, Netherlands, 31 0205999111, m.r.vandijk@olvg.nl %K YouTube %K ECV %K external cephalic version %K breech %K education %K video %K cesarean %K health education %K childbirth %K patient information %K cross-sectional study %K cesarean delivery %K implementation %K usefulness %K medical information %K pregnancy %K pregnant women %K engagement %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making. Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos. Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV. Results: Among the 70 videos, only 14% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers. Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term. %M 38843520 %R 10.2196/50087 %U https://formative.jmir.org/2024/1/e50087 %U https://doi.org/10.2196/50087 %U http://www.ncbi.nlm.nih.gov/pubmed/38843520 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46300 %T Clinicians’ Decision-Making Regarding Telehealth Services: Focus Group Study in Pediatric Allied Health %A Thomas,Donna Claire %A Litherland,Eva Frances %A Masso,Sarah %A Raymundo,Gianina %A Keep,Melanie %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Avenue, Camperdown, 2006, Australia, 61 2 93519539, donna.thomas@sydney.edu.au %K telehealth %K pediatric %K allied health %K focus group %K decision-making %K community-based %K counseling %K speech pathology %K occupational therapy %K clinical services %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. Objective: The aim of this study is to explore clinicians’ decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians’ perceptions of telehealth utility beyond COVID-19 lockdowns. Methods: We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community–based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. Results: The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: “flexible telehealth use,” “telehealth can be superior to in-person therapy,” and “fear that in-person services may be replaced.” Conclusions: The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience. %M 38848121 %R 10.2196/46300 %U https://formative.jmir.org/2024/1/e46300 %U https://doi.org/10.2196/46300 %U http://www.ncbi.nlm.nih.gov/pubmed/38848121 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48520 %T mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study %A Tran,Dieu-My %A Dingley,Catherine %A Bonilla,Roger %+ School of Nursing, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 453018, Las Vegas, NV, 89154, United States, 1 7028951220, dieu-my.tran@unlv.edu %K blood pressure %K mHealth %K self-management %K students %K intervention %K elevated blood pressure %K college %K hypertension %K young adult %K mobile app %K smartphone %K monitoring %K text messaging %K text mining %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. Objective: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Methods: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant’s BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. Results: The participants’ (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. Conclusions: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research. %M 38848120 %R 10.2196/48520 %U https://formative.jmir.org/2024/1/e48520 %U https://doi.org/10.2196/48520 %U http://www.ncbi.nlm.nih.gov/pubmed/38848120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56493 %T Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment %A Philpot,Lindsey M %A Ramar,Priya %A Roellinger,Daniel L %A Njeru,Jane W %A Ebbert,Jon O %+ Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 538 1882, Philpot.Lindsey@mayo.edu %K electronic health records %K digital determinants of health %K patient portals %K eHealth %K digital health %K technology acceptance model %K digital health literacy %K digital inclusion %K mobile phone %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide. Objective: This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal. Methods: We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported. Results: This study included 1850 respondents (11,424 invited, 16.2% response rate), who were mostly female (1048/1850, 56.6%) and White (1240/1850, 67%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95% CI 1.8-6.6), portal ease of use (aOR 2.8, 95% CI 1.6-5), and portal usefulness (aOR 2.4, 95% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc). Conclusions: Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities. %M 38695754 %R 10.2196/56493 %U https://formative.jmir.org/2024/1/e56493 %U https://doi.org/10.2196/56493 %U http://www.ncbi.nlm.nih.gov/pubmed/38695754 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53806 %T Defining Activity Thresholds Triggering a “Stand Hour” for Apple Watch Users: Cross-Sectional Study %A Lyons,Katy %A Hei Man,Alison Hau %A Booth,David %A Rena,Graham %+ Division of Cellular and Systems Medicine, Ninewells Hospital and Medical School, University of Dundee, Jacqui Wood Centre, James Arrott Drive, Dundee, DD1 9SY, United Kingdom, 44 660111, k.m.lyons@dundee.ac.uk %K stand hour %K Apple Watch %K sedentary behavior %K light physical activity %K cardiovascular disease %K type 2 diabetes %K data collection %K wearable %K wearables %K watch %K smartwatch %K stand %K standing %K sedentary %K physical activity %K exercise %K movement %K algorithm %K algorithms %K predict %K predictive %K predictor %K predictors %K prediction %K machine learning %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sedentary behavior (SB) is one of the largest contributing factors increasing the risk of developing noncommunicable diseases, including cardiovascular disease and type 2 diabetes. Guidelines from the World Health Organization for physical activity suggest the substitution of SB with light physical activity. The Apple Watch contains a health metric known as the stand hour (SH). The SH is intended to record standing with movement for at least 1 minute per hour; however, the activity measured during the determination of the SH is unclear. Objective: In this cross-sectional study, we analyzed the algorithm used to determine time spent standing per hour. To do this, we investigated activity measurements also recorded on Apple Watches that influence the recording of an SH. We also aimed to estimate the values of any significant SH predictors in the recording of a SH. Methods: The cross-sectional study used anonymized data obtained in August 2022 from 20 healthy individuals gathered via convenience sampling. Apple Watch data were extracted from the Apple Health app through the use of a third-party app. Appropriate statistical models were fitted to analyze SH predictors. Results: Our findings show that active energy (AE) and step count (SC) measurements influence the recording of an SH. Comparing when an SH is recorded with when an SH is not recorded, we found a significant difference in the mean and median AE and SC. Above a threshold of 97.5 steps or 100 kJ of energy, it became much more likely that an SH would be recorded when each predictor was analyzed as a separate entity. Conclusions: The findings of this study reveal the pivotal role of AE and SC measurements in the algorithm underlying the SH recording; however, our findings also suggest that a recording of an SH is influenced by more than one factor. Irrespective of the internal validity of the SH metric, it is representative of light physical activity and might, therefore, have use in encouraging individuals through various means, for example, notifications, to reduce their levels of SB. %M 38857078 %R 10.2196/53806 %U https://formative.jmir.org/2024/1/e53806 %U https://doi.org/10.2196/53806 %U http://www.ncbi.nlm.nih.gov/pubmed/38857078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54207 %T Leveraging Ecological Momentary Assessment Data to Characterize Individual Mobility: Exploratory Pilot Study in Rural Uganda %A Khalifa,Aleya %A Beres,Laura K %A Anok,Aggrey %A Mbabali,Ismail %A Katabalwa,Charles %A Mulamba,Jeremiah %A Thomas,Alvin G %A Bugos,Eva %A Nakigozi,Gertrude %A Chang,Larry W %A Grabowski,M Kate %+ Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, United States, 1 212 305 2862, ak4598@cumc.columbia.edu %K ecological momentary assessment %K spatial analysis %K geographic mobility %K global positioning system %K health behaviors %K Uganda %K mobility %K pilot study %K smartphone %K alcohol %K cigarette %K smoking %K promoting %K promotion %K alcohol use %K cigarette smoking %K mobile phone %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The geographical environments within which individuals conduct their daily activities may influence health behaviors, yet little is known about individual-level geographic mobility and specific, linked behaviors in rural low- and middle-income settings. Objective: Nested in a 3-month ecological momentary assessment intervention pilot trial, this study aims to leverage mobile health app user GPS data to examine activity space through individual spatial mobility and locations of reported health behaviors in relation to their homes. Methods: Pilot trial participants were recruited from the Rakai Community Cohort Study—an ongoing population-based cohort study in rural south-central Uganda. Participants used a smartphone app that logged their GPS coordinates every 1-2 hours for approximately 90 days. They also reported specific health behaviors (alcohol use, cigarette smoking, and having condomless sex with a non–long-term partner) via the app that were both location and time stamped. In this substudy, we characterized participant mobility using 3 measures: average distance (kilometers) traveled per week, number of unique locations visited (deduplicated points within 25 m of one another), and the percentage of GPS points recorded away from home. The latter measure was calculated using home buffer regions of 100 m, 400 m, and 800 m. We also evaluated the number of unique locations visited for each specific health behavior, and whether those locations were within or outside the home buffer regions. Sociodemographic information, mobility measures, and locations of health behaviors were summarized across the sample using descriptive statistics. Results: Of the 46 participants with complete GPS data, 24 (52%) participants were men, 30 (65%) participants were younger than 35 years, and 33 (72%) participants were in the top 2 socioeconomic status quartiles. On median, participants traveled 303 (IQR 152-585) km per week. Over the study period, participants on median recorded 1292 (IQR 963-2137) GPS points—76% (IQR 58%-86%) of which were outside their 400-m home buffer regions. Of the participants reporting drinking alcohol, cigarette smoking, and engaging in condomless sex, respectively, 19 (83%), 8 (89%), and 12 (86%) reported that behavior at least once outside their 400-m home neighborhood and across a median of 3.0 (IQR 1.5-5.5), 3.0 (IQR 1.0-3.0), and 3.5 (IQR 1.0-7.0) unique locations, respectively. Conclusions: Among residents in rural Uganda, an ecological momentary assessment app successfully captured high mobility and health-related behaviors across multiple locations. Our findings suggest that future mobile health interventions in similar settings can benefit from integrating spatial data collection using the GPS technology in mobile phones. Leveraging such individual-level GPS data can inform place-based strategies within these interventions for promoting healthy behavior change. %M 38857493 %R 10.2196/54207 %U https://formative.jmir.org/2024/1/e54207 %U https://doi.org/10.2196/54207 %U http://www.ncbi.nlm.nih.gov/pubmed/38857493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48605 %T Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach %A Shen,Hongxia %A van der Kleij,Rianne %A van der Boog,Paul J M %A Chavannes,Niels H %+ School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, 510000, China, 86 13937118104, H.Shen@lumc.nl %K eHealth %K self-management %K intervention mapping %K chronic kidney disease %K intervention development %K mobile phone %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. Objective: This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. Methods: We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR–Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. Results: An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including “knowledge and beliefs” in the domain “individual characteristics,” “quality and advantage of eHealth intervention” in the domain “intervention characteristics,” “compatibility” in the domain “inner setting,” and “cultural context” in the domain “outer setting.” To ensure the effectiveness of the Dutch MD–based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention’s appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. Conclusions: Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, our study’s research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. Trial Registration: ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923 %M 38869943 %R 10.2196/48605 %U https://formative.jmir.org/2024/1/e48605 %U https://doi.org/10.2196/48605 %U http://www.ncbi.nlm.nih.gov/pubmed/38869943 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50557 %T Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study %A Li,Catherine Yan Hei %A Platkin,Charles %A Chin,Jonathan %A Khan,Asia %A Bennett,Jaleel %A Speck,Anna %A Nielsen,Annette %A Leung,May May %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 617 636 3676, maymay.leung@tufts.edu %K SNAP %K SNAP eligibility screening %K food insecurity %K college students %K web-based tool %K think-aloud %K system usability %K user experience %K student %K college %K chronic health %K stress %K anxiety %K barrier %K technology %K tool %K Supplemental Nutrition Assistance Program %K usability %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. Objective: The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. Methods: College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. Results: A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). Conclusions: Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses. %M 38869926 %R 10.2196/50557 %U https://formative.jmir.org/2024/1/e50557 %U https://doi.org/10.2196/50557 %U http://www.ncbi.nlm.nih.gov/pubmed/38869926 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55000 %T Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study %A Casella Jean-Baptiste,Meredith %A Vital Julmiste,Thamar Monide %A Ball,Ellen %+ Hôpital Universitaire de Mirebalais, Sante Fanm, Rue Chatulee, Mirebalais, HT 5210, Haiti, 509 4892 3626, mjeanbaptiste@pih.org %K maternal health %K health informatics %K quality improvement %K Plan-Do-Study-Act %K PDSA %K maternal %K neonatal %K data collection %K prenatal %K outpatient %K electronic data %K nursing %K nursing staff %K nursing leadership %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. %M 38875702 %R 10.2196/55000 %U https://formative.jmir.org/2024/1/e55000 %U https://doi.org/10.2196/55000 %U http://www.ncbi.nlm.nih.gov/pubmed/38875702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56687 %T The Relationship Between Static Characteristics of Physicians and Patient Consultation Volume in Internet Hospitals: Quantitative Analysis %A Wang,Ye %A Shi,Changjing %A Wang,Xinyun %A Meng,Hua %A Chen,Junqiang %+ Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Qingxiu District, Nanning, 530021, China, 86 07715347234, chenjunqiang@gxmu.edu.cn %K static characteristics of physicians %K internet hospitals %K telemedicine %K statistical analysis %K online consultation %K web-based consultation %K teleconsultation %K physician %K patient %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor’s clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor’s credentials and accomplishments patients prioritize during their selection process. Objective: Our primary aim is to delve deeper into the correlation between physicians’ static characteristics—such as their qualifications, experiences, and profiles on the internet—and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction. Methods: We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors’ internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice. Results: The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data (ρ=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001). Conclusions: Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction. %M 38885498 %R 10.2196/56687 %U https://formative.jmir.org/2024/1/e56687 %U https://doi.org/10.2196/56687 %U http://www.ncbi.nlm.nih.gov/pubmed/38885498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50452 %T Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study %A Siste,Kristiana %A Ophinni,Youdiil %A Hanafi,Enjeline %A Yamada,Chika %A Novalino,Reza %A Limawan,Albert P %A Beatrice,Evania %A Rafelia,Vania %A Alison,Peter %A Matsumoto,Toshihiko %A Sakamoto,Ryota %+ Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, 46 Yoshidashimoadachicho, Sakyo Ward, Kyoto, 606-8304, Japan, 81 757537351, chika128@cseas.kyoto-u.ac.jp %K substance use disorder %K cognitive behavioral therapy %K telemedicine %K peer involvement %K Indonesia %K substance use disorders %K digital intervention %K COVID-19 %K psychotherapy %K drug %K mobile phone %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. Objective: This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. Methods: Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. Results: In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. Conclusions: Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia. %M 38888959 %R 10.2196/50452 %U https://formative.jmir.org/2024/1/e50452 %U https://doi.org/10.2196/50452 %U http://www.ncbi.nlm.nih.gov/pubmed/38888959 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55751 %T Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study %A Porta,Xènia %A Nieto,Rubén %A Serrat,Mayte %A Bourdin Kreitz,Pierre %+ eHealthLab, Faculty of Psychology and Education, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 933263538, xeniaporta@uoc.edu %K fibromyalgia %K chronic pain %K pain management %K information and communication technologies %K use %K satisfaction %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. %M 38888943 %R 10.2196/55751 %U https://formative.jmir.org/2024/1/e55751 %U https://doi.org/10.2196/55751 %U http://www.ncbi.nlm.nih.gov/pubmed/38888943 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56074 %T Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study %A Podda,Jessica %A Tacchino,Andrea %A Ponzio,Michela %A Di Antonio,Federica %A Susini,Alessia %A Pedullà,Ludovico %A Battaglia,Mario Alberto %A Brichetto,Giampaolo %+ Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, 16149, Italy, 39 0102713306, jessica.podda@aism.it %K cognitive assessment %K cognitive impairment %K digital health %K mHealth app %K multiple sclerosis %K self-management %K usability %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43% to 70% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. Objective: This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. Methods: DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app’s reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. Results: The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74%), followed by secondary progressive (15/92, 16%) and primary progressive (9/92, 10%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. Conclusions: The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice. %M 38900535 %R 10.2196/56074 %U https://formative.jmir.org/2024/1/e56074 %U https://doi.org/10.2196/56074 %U http://www.ncbi.nlm.nih.gov/pubmed/38900535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52248 %T User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study %A Adam,Esmee %A Meiland,Franka %A Frielink,Noud %A Meinders,Erwin %A Smits,Reon %A Embregts,Petri %A Smaling,Hanneke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 071 526 84 44, e.adam@lumc.nl %K stress detection %K sensor system %K garment integrated %K wearable %K user requirements %K dementia %K intellectual disability %K intellectual disabilities %K long-term care %K perceptions %K wearables %K qualitative study %K residents %K communication impairment %K impairments %K garment sensor %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. Objective: This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. Methods: A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. Results: The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. Conclusions: The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice. %R 10.2196/52248 %U https://formative.jmir.org/2024/1/e52248 %U https://doi.org/10.2196/52248 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55722 %T Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study %A Hooker,Stephanie A %A Crain,A Lauren %A Muegge,Jule %A Rossom,Rebecca C %A Pronk,Nicolaas P %A Pasumarthi,Dhavan Prasad %A Kunisetty,Gopikrishna %A Masters,Kevin S %+ Division of Research and Evaluation, HealthPartners Institute, 8170 33rd Ave S MS21112R, Minneapolis, MN, 55425, United States, 1 9529675056, stephanie.a.hooker@healthpartners.com %K physical activity %K midlife %K digital health %K SMS text messaging %K theory-based %K meaning in life %K mobile phone %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions. Objective: This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults. Methods: Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (−4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data. Results: Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ≥5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement. Conclusions: MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition. %M 38917457 %R 10.2196/55722 %U https://formative.jmir.org/2024/1/e55722 %U https://doi.org/10.2196/55722 %U http://www.ncbi.nlm.nih.gov/pubmed/38917457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59267 %T Evaluating ChatGPT-4’s Accuracy in Identifying Final Diagnoses Within Differential Diagnoses Compared With Those of Physicians: Experimental Study for Diagnostic Cases %A Hirosawa,Takanobu %A Harada,Yukinori %A Mizuta,Kazuya %A Sakamoto,Tetsu %A Tokumasu,Kazuki %A Shimizu,Taro %+ Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-cho, Shimotsuga, Tochigi, 321-0293, Japan, 81 282861111, hirosawa@dokkyomed.ac.jp %K decision support system %K diagnostic errors %K diagnostic excellence %K diagnosis %K large language model %K LLM %K natural language processing %K GPT-4 %K ChatGPT %K diagnoses %K physicians %K artificial intelligence %K AI %K chatbots %K medical diagnosis %K assessment %K decision-making support %K application %K applications %K app %K apps %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of artificial intelligence (AI) chatbots, particularly ChatGPT with GPT-4 (OpenAI), in assisting with medical diagnosis is an emerging research area. However, it is not yet clear how well AI chatbots can evaluate whether the final diagnosis is included in differential diagnosis lists. Objective: This study aims to assess the capability of GPT-4 in identifying the final diagnosis from differential-diagnosis lists and to compare its performance with that of physicians for case report series. Methods: We used a database of differential-diagnosis lists from case reports in the American Journal of Case Reports, corresponding to final diagnoses. These lists were generated by 3 AI systems: GPT-4, Google Bard (currently Google Gemini), and Large Language Models by Meta AI 2 (LLaMA2). The primary outcome was focused on whether GPT-4’s evaluations identified the final diagnosis within these lists. None of these AIs received additional medical training or reinforcement. For comparison, 2 independent physicians also evaluated the lists, with any inconsistencies resolved by another physician. Results: The 3 AIs generated a total of 1176 differential diagnosis lists from 392 case descriptions. GPT-4’s evaluations concurred with those of the physicians in 966 out of 1176 lists (82.1%). The Cohen κ coefficient was 0.63 (95% CI 0.56-0.69), indicating a fair to good agreement between GPT-4 and the physicians’ evaluations. Conclusions: GPT-4 demonstrated a fair to good agreement in identifying the final diagnosis from differential-diagnosis lists, comparable to physicians for case report series. Its ability to compare differential diagnosis lists with final diagnoses suggests its potential to aid clinical decision-making support through diagnostic feedback. While GPT-4 showed a fair to good agreement for evaluation, its application in real-world scenarios and further validation in diverse clinical environments are essential to fully understand its utility in the diagnostic process. %M 38924784 %R 10.2196/59267 %U https://formative.jmir.org/2024/1/e59267 %U https://doi.org/10.2196/59267 %U http://www.ncbi.nlm.nih.gov/pubmed/38924784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58501 %T Improving the Acceptability and Implementation of Information and Communication Technology–Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders %A Ahmed,Mona %A Marín,Mayca %A Gangas,Pilar %A Bentlage,Ellen %A Louro,Claudia %A Brach,Michael %+ Institute of Sport and Exercise Sciences, University of Münster, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 8334812, mona.ahmad@uni-muenster.de %K acceptability %K implementation %K neurodegenerative diseases %K Parkinson disease %K dementia %K chronic diseases %K health care technologies %K older people %K stakeholders %K information and communication technology %K ICT %K user-centered design %K co-design %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups. Objective: Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union–funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs. Methods: The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied. Results: This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users’ needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future. International Registered Report Identifier (IRRID): RR2-10.2196/22463 %M 38935424 %R 10.2196/58501 %U https://formative.jmir.org/2024/1/e58501 %U https://doi.org/10.2196/58501 %U http://www.ncbi.nlm.nih.gov/pubmed/38935424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55855 %T Using Automated Machine Learning to Predict Necessary Upcoming Therapy Changes in Patients With Psoriasis Vulgaris and Psoriatic Arthritis and Uncover New Influences on Disease Progression: Retrospective Study %A Schaffert,Daniel %A Bibi,Igor %A Blauth,Mara %A Lull,Christian %A von Ahnen,Jan Alwin %A Gross,Georg %A Schulze-Hagen,Theresa %A Knitza,Johannes %A Kuhn,Sebastian %A Benecke,Johannes %A Schmieder,Astrid %A Leipe,Jan %A Olsavszky,Victor %+ Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 2280, victor.olsavszky@medma.uni-heidelberg.de %K psoriasis vulgaris %K psoriatic arthritis %K automated machine learning %K therapy change %K Psoriasis Area and Severity Index %K PASI score change %K Bath Ankylosing Spondylitis Disease Activity Index %K BASDAI classification %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) are complex, multifactorial diseases significantly impacting health and quality of life. Predicting treatment response and disease progression is crucial for optimizing therapeutic interventions, yet challenging. Automated machine learning (AutoML) technology shows promise for rapidly creating accurate predictive models based on patient features and treatment data. Objective: This study aims to develop highly accurate machine learning (ML) models using AutoML to address key clinical questions for PsV and PsA patients, including predicting therapy changes, identifying reasons for therapy changes, and factors influencing skin lesion progression or an abnormal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. Methods: Clinical study data from 309 PsV and PsA patients were extensively prepared and analyzed using AutoML to build and select the most accurate predictive models for each variable of interest. Results: Therapy change at 24 weeks follow-up was modeled using the extreme gradient boosted trees classifier with early stopping (area under the receiver operating characteristic curve [AUC] of 0.9078 and logarithmic loss [LogLoss] of 0.3955 for the holdout partition). Key influencing factors included the initial systemic therapeutic agent, the Classification Criteria for Psoriatic Arthritis score at baseline, and changes in quality of life. An average blender incorporating three models (gradient boosted trees classifier, ExtraTrees classifier, and Eureqa generalized additive model classifier) with an AUC of 0.8750 and LogLoss of 0.4603 was used to predict therapy changes for 2 hypothetical patients, highlighting the significance of these factors. Treatments such as methotrexate or specific biologicals showed a lower propensity for change. An average blender of a random forest classifier, an extreme gradient boosted trees classifier, and a Eureqa classifier (AUC of 0.9241 and LogLoss of 0.4498) was used to estimate PASI (Psoriasis Area and Severity Index) change after 24 weeks. Primary predictors included the initial PASI score, change in pruritus levels, and change in therapy. A lower initial PASI score and consistently low pruritus were associated with better outcomes. BASDAI classification at onset was analyzed using an average blender of a Eureqa generalized additive model classifier, an extreme gradient boosted trees classifier with early stopping, and a dropout additive regression trees classifier with an AUC of 0.8274 and LogLoss of 0.5037. Influential factors included initial pain, disease activity, and Hospital Anxiety and Depression Scale scores for depression and anxiety. Increased pain, disease activity, and psychological distress generally led to higher BASDAI scores. Conclusions: The practical implications of these models for clinical decision-making in PsV and PsA can guide early investigation and treatment, contributing to improved patient outcomes. %M 38738977 %R 10.2196/55855 %U https://formative.jmir.org/2024/1/e55855 %U https://doi.org/10.2196/55855 %U http://www.ncbi.nlm.nih.gov/pubmed/38738977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58503 %T Clinicians’ Perspectives on the Telehealth Serious Illness Care Program for Older Adults With Myeloid Malignancies: Single-Arm Pilot Study %A LoCastro,Marissa %A Wang,Ying %A Yu,Tristan %A Mortaz-Hedjri,Soroush %A Mendler,Jason %A Norton,Sally %A Bernacki,Rachelle %A Carroll,Thomas %A Klepin,Heidi %A Wedow,Lucy %A Goonan,Sean %A Erdos,Hannah %A Bagnato,Brenda %A Liesveld,Jane %A Huselton,Eric %A Kluger,Benzi %A Loh,Kah Poh %+ Division of Hematology Oncology, Department of Medicine, James P. Wilmot Cancer Institute, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, United States, 1 585 276 4353, Kahpoh_Loh@urmc.rochester.edu %K serious illness conversations %K serious illness conversation %K SIC %K Serious Illness Care Program %K SICP %K hematologic malignancy %K geriatric oncology %K acute myeloid leukemia %K AML %K myelodysplastic syndrome %K MDS %K cancer %K oncology %K oncologist %K oncologists %K metastases %K telemedicine %K telehealth %K tele-medicine %K tele-health %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. Objective: In this study, we aimed to understand the experience of the telehealth SICP from the clinician’s perspective. Methods: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at α=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. Results: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective in understanding their patients’ values about end-of-life care (7/7, 100%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. Conclusions: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial Registration: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676 %M 38935428 %R 10.2196/58503 %U https://formative.jmir.org/2024/1/e58503 %U https://doi.org/10.2196/58503 %U http://www.ncbi.nlm.nih.gov/pubmed/38935428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58551 %T Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design %A Hall,Evelyn %A Keyser,Laura %A McKinney,Jessica %A Pulliam,Samantha %A Weinstein,Milena %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Ste 400, San Francisco, CA, 94158, United States, 1 866 657 5382, laura.keyser@ucsf.edu %K urinary incontinence %K digital health %K pelvic floor muscle training %K real-world %K evidence %K user-centered design %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women’s access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. Objective: The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. Methods: This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Results: Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. Conclusions: This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes. %R 10.2196/58551 %U https://formative.jmir.org/2024/1/e58551 %U https://doi.org/10.2196/58551 %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 e54892 %T A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology %A Hodson,Nathan %A Woods,Peter %A Sobolev,Michael %A Giacco,Domenico %+ Price School of Public Policy, University of Southern California, 650 Childs Way, Los Angeles, CA, 90089, United States, 1 2133480086, nathan.hodson@warwick.ac.uk %K parenting %K child behavior %K mental health %K app development %K digital %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. Objective: We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. Methods: The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. Results: Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. Conclusions: We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non–English speakers and individuals who participate in parenting programs in settings outside the United Kingdom. %M 38941594 %R 10.2196/54892 %U https://formative.jmir.org/2024/1/e54892 %U https://doi.org/10.2196/54892 %U http://www.ncbi.nlm.nih.gov/pubmed/38941594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55013 %T Nonrepresentativeness of Human Mobility Data and its Impact on Modeling Dynamics of the COVID-19 Pandemic: Systematic Evaluation %A Liu,Chuchu %A Holme,Petter %A Lehmann,Sune %A Yang,Wenchuan %A Lu,Xin %+ College of Systems Engineering, National University of Defense Technology, No 137 Yanwachi Street, Changsha, 410073, China, 86 18627561577, xin.lu.lab@outlook.com %K human mobility %K data representativeness %K population composition %K COVID-19 %K epidemiological modeling %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near–real-time basis. These data have been used, for example, to perform traffic forecasting and epidemic modeling. During the COVID-19 pandemic in particular, human travel behavior has been considered a key component of epidemiological modeling to provide more reliable estimates about the volumes of the pandemic’s importation and transmission routes, or to identify hot spots. However, nearly universally in the literature, the representativeness of these data, how they relate to the underlying real-world human mobility, has been overlooked. This disconnect between data and reality is especially relevant in the case of socially disadvantaged minorities. Objective: The objective of this study is to illustrate the nonrepresentativeness of data on human mobility and the impact of this nonrepresentativeness on modeling dynamics of the epidemic. This study systematically evaluates how real-world travel flows differ from census-based estimations, especially in the case of socially disadvantaged minorities, such as older adults and women, and further measures biases introduced by this difference in epidemiological studies. Methods: To understand the demographic composition of population movements, a nationwide mobility data set from 318 million mobile phone users in China from January 1 to February 29, 2020, was curated. Specifically, we quantified the disparity in the population composition between actual migrations and resident composition according to census data, and shows how this nonrepresentativeness impacts epidemiological modeling by constructing an age-structured SEIR (Susceptible-Exposed-Infected- Recovered) model of COVID-19 transmission. Results: We found a significant difference in the demographic composition between those who travel and the overall population. In the population flows, 59% (n=20,067,526) of travelers are young and 36% (n=12,210,565) of them are middle-aged (P<.001), which is completely different from the overall adult population composition of China (where 36% of individuals are young and 40% of them are middle-aged). This difference would introduce a striking bias in epidemiological studies: the estimation of maximum daily infections differs nearly 3 times, and the peak time has a large gap of 46 days. Conclusions: The difference between actual migrations and resident composition strongly impacts outcomes of epidemiological forecasts, which typically assume that flows represent underlying demographics. Our findings imply that it is necessary to measure and quantify the inherent biases related to nonrepresentativeness for accurate epidemiological surveillance and forecasting. %M 38941609 %R 10.2196/55013 %U https://formative.jmir.org/2024/1/e55013 %U https://doi.org/10.2196/55013 %U http://www.ncbi.nlm.nih.gov/pubmed/38941609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55361 %T The Accuracy of Pulse Oxygen Saturation, Heart Rate, Blood Pressure, and Respiratory Rate Raised by a Contactless Telehealth Portal: Validation Study %A Gerald Dcruz,Julian %A Yeh,Paichang %+ Docsun Biomedical Holdings, Inc, 6763 32ND Ave N, Saint Petersburg, FL, 33710, United States, 1 (813) 4380045, jan.yeh@docsun.health %K medical devices %K mHealth %K vital signs %K measurements validity %K validation %K validity %K device %K devices %K vital %K vitals %K accuracy %K pulse %K oxygen %K saturation %K heart rate %K blood pressure %K respiration %K respiratory %K telehealth %K telemedicine %K eHealth %K e-health %K self-check %K self-checker %K breathing %K portal %K portals %K self-checking %K self-monitor %K self-monitoring %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The traditional measurement of heart rate (HR), oxygen saturation (SpO2), blood pressure (BP), and respiratory rate (RR) via physical examination can be challenging, and the recent pandemic has accelerated trends toward telehealth and remote monitoring. Instead of going to the physician to check these vital signs, measuring them at home would be more convenient. Vital sign monitors, also known as physiological parameter monitors, are electronic devices that measure and display biological information about patients under constant monitoring. Objective: The purpose of this study was to validate the accuracy of the pulse SpO2, HR, BP, and RR raised by Docsun Telehealth Portal by comparing it with approved medical devices. Methods: This is a noninvasive, self-check, system-based study conducted to validate the detection of vital signs (SpO2, HR, BP, and RR) raised by Docsun Telehealth Portal. The input for software processing involves facial screening without any accessories on the face, scanning directly through the software application portal. The participant’s facial features are detected and screened for the extraction of necessary readings. Results: For the validation of HR, SpO2, BP, and RR measurements, the main outcomes were the mean of the absolute difference between the respective investigational devices and the reference values as well as the absolute percentage difference between the respective investigational devices and the reference values. If the HR was within ±10% of the reference standard or 5 beats per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 1.41 (SD 1.14) beats per minute. The mean absolute percentage difference was 1.69% (SD 1.37). Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for HR measurements. If the RR was within ±10% of the reference standard or 3 breaths per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 0.86 breaths per minute. The mean absolute percentage difference was 4.72%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for RR measurements. SpO2 levels were considered acceptable if the average absolute difference between the Docsun Telehealth Portal and the reference values was ±3%. The mean absolute percentage difference was 0.59%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for SpO2 measurements. The Docsun Telehealth Portal predicted systolic BP with an accuracy of 94.81% and diastolic BP with an accuracy of 95.71%. Conclusions: The results of the study show that the accuracy of the HR, BP, SpO2, and RR values raised by the Docsun Telehealth Portal, compared against the clinically approved medical devices, proved to be accurate by meeting predefined accuracy guidelines. %M 38598698 %R 10.2196/55361 %U https://formative.jmir.org/2024/1/e55361 %U https://doi.org/10.2196/55361 %U http://www.ncbi.nlm.nih.gov/pubmed/38598698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56118 %T Motivational Variables as Moderating Effects of a Web-Based Mental Health Program for University Students: Secondary Analysis of a Randomized Controlled Trial %A Hanano,Maria %A Rith-Najarian,Leslie %A Gong-Guy,Elizabeth %A Chavira,Denise %+ University of California, Los Angeles, 405 Hilgard Ave, Los Angeles, CA, 90095, United States, 1 9493501523, mariahanano@g.ucla.edu %K web-based intervention %K internal motivation %K depression %K anxiety %K self-determination theory %K mental health %K university students %K university %K students %K web-based %K analysis %K randomized controlled trial %K self-guided %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interventions. Previous studies examining motivation as a moderator or predictor of improvement on web-based interventions have defined and measured motivation variably, producing conflicting results. Objective: This secondary analysis of data from a randomized controlled trial aimed to examine constructs of motivation as moderators of improvement for a self-guided 8-week web-based intervention in university students (N=1607). Methods: Tested moderators included internal motivation, external motivation, and confidence in treatment derived from the Treatment Motivation Questionnaire. The primary outcome was an improvement in depression and anxiety measured by the Depression Anxiety Stress Scale-21. Results: Piecewise linear mixed effects models showed that internal motivation significantly moderated symptom change for the intervention group (t1504=–2.94; P=.003) at average and high (+1 SD) motivation levels (t1507=–2.28; P=.02 and t1507=–4.05; P<.001, respectively). Significant results remained even after controlling for baseline severity. The results showed that confidence in treatment did not significantly moderate symptom change for the intervention group (t1504=1.44; P=.15). In this sample, only internal motivation was positively correlated with service initiation, intervention adherence, and intervention satisfaction. Conclusions: The combination of a web-based intervention and high or moderate internal motivation resulted in greater improvement in the total Depression Anxiety Stress Scale-21 score. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. The results suggest that the combination of a web-based intervention and high or moderate internal motivation results in greater improvement. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. To better understand the moderating role of internal motivation, future research is encouraged to replicate these findings in diverse samples as well as to examine related constructs such as baseline severity and adherence. Understanding these characteristics informs treatment strategies to maximize adherence and improvement when developing web-based interventions as well as allows services to be targeted to individuals likely to benefit from such interventions. Trial Registration: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/study/NCT04361045 %M 38959024 %R 10.2196/56118 %U https://formative.jmir.org/2024/1/e56118 %U https://doi.org/10.2196/56118 %U http://www.ncbi.nlm.nih.gov/pubmed/38959024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55342 %T A Deep Learning–Based Rotten Food Recognition App for Older Adults: Development and Usability Study %A Chun,Minki %A Yu,Ha-Jin %A Jung,Hyunggu %+ Department of Computer Science and Engineering, University of Seoul, Information and Technology Building, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea, 82 2 6490 2455, hjung@uos.ac.kr %K digital health %K mobile health %K mHealth %K app %K apps %K application %K applications %K smartphone %K smartphones %K classification %K digital sensor %K deep learning %K artificial intelligence %K machine learning %K food %K foods %K fruit %K fruits %K experience %K experiences %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %K acceptance %K adoption %K usability %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %K camera %K image %K imaging %K photo %K photos %K photograph %K photographs %K recognition %K picture %K pictures %K sensor %K sensors %K develop %K development %K design %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults are at greater risk of eating rotten fruits and of getting food poisoning because cognitive function declines as they age, making it difficult to distinguish rotten fruits. To address this problem, researchers have developed and evaluated various tools to detect rotten food items in various ways. Nevertheless, little is known about how to create an app to detect rotten food items to support older adults at a risk of health problems from eating rotten food items. Objective: This study aimed to (1) create a smartphone app that enables older adults to take a picture of food items with a camera and classifies the fruit as rotten or not rotten for older adults and (2) evaluate the usability of the app and the perceptions of older adults about the app. Methods: We developed a smartphone app that supports older adults in determining whether the 3 fruits selected for this study (apple, banana, and orange) were fresh enough to eat. We used several residual deep networks to check whether the fruit photos collected were of fresh fruit. We recruited healthy older adults aged over 65 years (n=15, 57.7%, males and n=11, 42.3%, females) as participants. We evaluated the usability of the app and the participants’ perceptions about the app through surveys and interviews. We analyzed the survey responses, including an after-scenario questionnaire, as evaluation indicators of the usability of the app and collected qualitative data from the interviewees for in-depth analysis of the survey responses. Results: The participants were satisfied with using an app to determine whether a fruit is fresh by taking a picture of the fruit but are reluctant to use the paid version of the app. The survey results revealed that the participants tended to use the app efficiently to take pictures of fruits and determine their freshness. The qualitative data analysis on app usability and participants’ perceptions about the app revealed that they found the app simple and easy to use, they had no difficulty taking pictures, and they found the app interface visually satisfactory. Conclusions: This study suggests the possibility of developing an app that supports older adults in identifying rotten food items effectively and efficiently. Future work to make the app distinguish the freshness of various food items other than the 3 fruits selected still remains. %M 38959501 %R 10.2196/55342 %U https://formative.jmir.org/2024/1/e55342 %U https://doi.org/10.2196/55342 %U http://www.ncbi.nlm.nih.gov/pubmed/38959501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53289 %T Capturing Home Care Information Management and Communication Processes Among Caregivers of Older Adults: Qualitative Study to Inform Technology Design %A Tennant,Ryan %A Allana,Sana %A Mercer,Kate %A Burns,Catherine M %+ Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567, drtennan@uwaterloo.ca %K aged %K caregivers %K patient safety %K communication %K patient care team %K information management %K digital technology %K human-centered design %K mobile phone %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The demand for complex home care is increasing with the growing aging population and the ongoing COVID-19 pandemic. Family and hired caregivers play a critical role in providing care for individuals with complex home care needs. However, there are significant gaps in research informing the design of complex home care technologies that consider the experiences of family and hired caregivers collectively. Objective: The objective of this study was to explore the health documentation and communication experiences of family and hired caregivers to inform the design and adoption of new technologies for complex home care. Methods: The research involved semistructured interviews with 15 caregivers, including family and hired caregivers, each of whom was caring for an older adult with complex medical needs in their home in Ontario, Canada. Due to COVID-19–related protection measures, the interviews were conducted via Teams (Microsoft Corp). The interview guide was informed by the cognitive work analysis framework, and the interview was conducted using storytelling principles of narrative medicine to enhance knowledge. Inductive thematic analysis was used to code the data and develop themes. Results: Three main themes were developed. The first theme described how participants were continually updating the caregiver team, which captured how health information, including their communication motivations and intentions, was shared among family and hired caregiver participants. The subthemes included binder-based health documentation, digital health documentation, and communication practices beyond the binder. The second theme described how participants were learning to improve care and decision-making, which captured how they acted on information from various sources to provide care. The subthemes included developing expertise as a family caregiver and tailoring expertise as a hired caregiver. The third theme described how participants experienced conflicts within caregiver teams, which captured the different struggles arising from, and the causes of, breakdowns in communication and coordination between family and hired caregiver participants. The subthemes included 2-way communication and trusting the caregiver team. Conclusions: This study highlights the health information communication and coordination challenges and experiences that family and hired caregivers face in complex home care settings for older adults. Given the challenges of this work domain, there is an opportunity for appropriate digital technology design to improve complex home care. When designing complex home care technologies, it will be critical to include the overlapping and disparate perspectives of family and hired caregivers collectively providing home care for older adults with complex needs to support all caregivers in their vital roles. %M 38963695 %R 10.2196/53289 %U https://formative.jmir.org/2024/1/e53289 %U https://doi.org/10.2196/53289 %U http://www.ncbi.nlm.nih.gov/pubmed/38963695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55834 %T Novel Methodology for Identifying the Occurrence of Ovulation by Estimating Core Body Temperature During Sleeping: Validity and Effectiveness Study %A Sato,Daisuke %A Ikarashi,Koyuki %A Nakajima,Fumiko %A Fujimoto,Tomomi %+ Sports Physiology Laboratory, Department of Health and Sports, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan, 81 25 257 4624, daisuke@nuhw.ac.jp %K menstrual cycle %K ovulation %K biphasic temperature shift %K estimation method %K women %D 2024 %7 5.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Body temperature is the most-used noninvasive biomarker to determine menstrual cycle and ovulation. However, issues related to its low accuracy are still under discussion. Objective: This study aimed to improve the accuracy of identifying the presence or absence of ovulation within a menstrual cycle. We investigated whether core body temperature (CBT) estimation can improve the accuracy of temperature biphasic shift discrimination in the menstrual cycle. The study consisted of 2 parts: experiment 1 assessed the validity of the CBT estimation method, while experiment 2 focused on the effectiveness of the method in discriminating biphasic temperature shifts. Methods: In experiment 1, healthy women aged between 18 and 40 years had their true CBT measured using an ingestible thermometer and their CBT estimated from skin temperature and ambient temperature measured during sleep in both the follicular and luteal phases of their menstrual cycles. This study analyzed the differences between these 2 measurements, the variations in temperature between the 2 phases, and the repeated measures correlation between the true and estimated CBT. Experiment 2 followed a similar methodology, but focused on evaluating the diagnostic accuracy of these 2 temperature measurement approaches (estimated CBT and traditional oral basal body temperature [BBT]) for identifying ovulatory cycles. This was performed using urine luteinizing hormone (LH) as the reference standard. Menstrual cycles were categorized based on the results of the LH tests, and a temperature shift was identified using a specific criterion called the “three-over-six rule.” This rule and the nested design of the study facilitated the assessment of diagnostic measures, such as sensitivity and specificity. Results: The main findings showed that CBT estimated from skin temperature and ambient temperature during sleep was consistently lower than directly measured CBT in both the follicular and luteal phases of the menstrual cycle. Despite this, the pattern of temperature variation between these phases was comparable for both the estimated and true CBT measurements, suggesting that the estimated CBT accurately reflected the cyclical variations in the true CBT. Significantly, the CBT estimation method showed higher sensitivity and specificity for detecting the occurrence of ovulation than traditional oral BBT measurements, highlighting its potential as an effective tool for reproductive health monitoring. The current method for estimating the CBT provides a practical and noninvasive method for monitoring CBT, which is essential for identifying biphasic shifts in the BBT throughout the menstrual cycle. Conclusions: This study demonstrated that the estimated CBT derived from skin temperature and ambient temperature during sleep accurately captures variations in true CBT and is more accurate in determining the presence or absence of ovulation than traditional oral BBT measurements. This method holds promise for improving reproductive health monitoring and understanding of menstrual cycle dynamics. %M 38967967 %R 10.2196/55834 %U https://formative.jmir.org/2024/1/e55834 %U https://doi.org/10.2196/55834 %U http://www.ncbi.nlm.nih.gov/pubmed/38967967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58063 %T A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study %A McClure,Jennifer B %A Heffner,Jaimee L %A Krakauer,Chloe %A Mun,Sophia %A Catz,Sheryl L %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K HIV %K tobacco %K nicotine %K smoking cessation %K mobile health %K mHealth %K motivation %K ambivalence %K app %K mobile phone %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. Objective: This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. Methods: In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants’ willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). Results: Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. Conclusions: On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health–based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. Trial Registration: ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659 %M 38976321 %R 10.2196/58063 %U https://formative.jmir.org/2024/1/e58063 %U https://doi.org/10.2196/58063 %U http://www.ncbi.nlm.nih.gov/pubmed/38976321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55732 %T Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design %A Gunn,Rose %A Watkins,Shelby L %A Boston,Dave %A Rosales,A Gabriela %A Massimino,Stefan %A Navale,Suparna %A Fitzpatrick,Stephanie L %A Dickerson,John %A Gold,Rachel %A Lee,George %A McMullen,Carmit K %+ OCHIN, Inc, PO Box 5426, Portland, OR, 97228, United States, 1 503 943 2500, gunnr@ochin.org %K Patient-generated health data %K telemedicine %K telehealth %K diabetes mellitus %K hypertension %K self-management %K patient portal %K implementation science %K COVID-19: pandemic %K community health center %K chronic condition %K remote patient monitoring %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic. Objective: The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic. Methods: This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC’s implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record–extracted health outcomes data and semistructured interviews with the CHC’s staff and patients participating in the RPM program. Results: The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology. Conclusions: While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance. %M 38980716 %R 10.2196/55732 %U https://formative.jmir.org/2024/1/e55732 %U https://doi.org/10.2196/55732 %U http://www.ncbi.nlm.nih.gov/pubmed/38980716 %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 e54044 %T Predictive Model for Extended-Spectrum β-Lactamase–Producing Bacterial Infections Using Natural Language Processing Technique and Open Data in Intensive Care Unit Environment: Retrospective Observational Study %A Ito,Genta %A Yada,Shuntaro %A Wakamiya,Shoko %A Aramaki,Eiji %+ Department of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma City, 8916-5, Japan, 81 0743725204, aramaki@is.naist.jp %K predictive modeling %K MIMIC-3 dataset %K natural language processing %K NLP %K QuickUMLS %K named entity recognition %K ESBL-producing bacterial infections %D 2024 %7 10.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Machine learning has advanced medical event prediction, mostly using private data. The public MIMIC-3 (Medical Information Mart for Intensive Care III) data set, which contains detailed data on over 40,000 intensive care unit patients, stands out as it can help develop better models including structured and textual data. Objective: This study aimed to build and test a machine learning model using the MIMIC-3 data set to determine the effectiveness of information extracted from electronic medical record text using a named entity recognition, specifically QuickUMLS, for predicting important medical events. Using the prediction of extended-spectrum β-lactamase (ESBL)–producing bacterial infections as an example, this study shows how open data sources and simple technology can be useful for making clinically meaningful predictions. Methods: The MIMIC-3 data set, including demographics, vital signs, laboratory results, and textual data, such as discharge summaries, was used. This study specifically targeted patients diagnosed with Klebsiella pneumoniae or Escherichia coli infection. Predictions were based on ESBL-producing bacterial standards and the minimum inhibitory concentration criteria. Both the structured data and extracted patient histories were used as predictors. In total, 2 models, an L1-regularized logistic regression model and a LightGBM model, were evaluated using the receiver operating characteristic area under the curve (ROC-AUC) and the precision-recall curve area under the curve (PR-AUC). Results: Of 46,520 MIMIC-3 patients, 4046 were identified with bacterial cultures, indicating the presence of K pneumoniae or E coli. After excluding patients who lacked discharge summary text, 3614 patients remained. The L1-penalized model, with variables from only the structured data, displayed a ROC-AUC of 0.646 and a PR-AUC of 0.307. The LightGBM model, combining structured and textual data, achieved a ROC-AUC of 0.707 and a PR-AUC of 0.369. Key contributors to the LightGBM model included patient age, duration since hospital admission, and specific medical history such as diabetes. The structured data-based model showed improved performance compared to the reference models. Performance was further improved when textual medical history was included. Compared to other models predicting drug-resistant bacteria, the results of this study ranked in the middle. Some misidentifications, potentially due to the limitations of QuickUMLS, may have affected the accuracy of the model. Conclusions: This study successfully developed a predictive model for ESBL-producing bacterial infections using the MIMIC-3 data set, yielding results consistent with existing literature. This model stands out for its transparency and reliance on open data and open-named entity recognition technology. The performance of the model was enhanced using textual information. With advancements in natural language processing tools such as BERT and GPT, the extraction of medical data from text holds substantial potential for future model optimization. %M 38986131 %R 10.2196/54044 %U https://formative.jmir.org/2024/1/e54044 %U https://doi.org/10.2196/54044 %U http://www.ncbi.nlm.nih.gov/pubmed/38986131 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52842 %T Adaptation and Reach of a Pre-Exposure Prophylaxis Social Marketing Campaign for Latino, Latina, and Latinx Populations: Development Study %A Shah,Harita S %A Serrano,Pedro Alonso %A Phillips II,Gregory %+ Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC 3051, Chicago, IL, 60637, United States, 1 773 702 4581, harita@uchicago.edu %K Latino %K Latinx %K Latina %K social marketing %K social media %K PrEP %K pre-exposure prophylaxis %K HIV prevention %K community %K CBPR %K community-based participatory research %K campaign %K transgender %K MSM %K reach %K HIV %K prevention %K formative research %K men who have sex with men %K treatment %K intervention %K biomedical %K awareness %K Latino/x/a %K Latina/x/o %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Latino, Latina, and Latinx (Latino/a/x) individuals remain disproportionately impacted by HIV, particularly sexual minority men and transgender women. Pre-exposure prophylaxis (PrEP) is an effective means of biomedical HIV prevention, but awareness and uptake remain low among marginalized Latino/a/x populations. Social marketing campaigns have demonstrated promise in promoting PrEP in other populations but are poorly studied in Latino/a/x sexual minority men and transgender women. Objective: This study aims to (1) adapt and pilot a PrEP social marketing campaign tailored to Latino/a/x populations with a focus on sexual minority men and transgender women through community-based participatory research (CBPR) and (2) evaluate the reach and ad performance of the adapted PrEP social marketing campaign. Methods: We used the ADAPT-ITT (assessment, decision, adaptation, production, topical experts-integration, training, and testing) framework for adapting evidence-based interventions for new settings or populations. This paper presents how each phase of the ADAPT-ITT framework was applied via CBPR to create the PrEPárate (“Be PrEPared”) campaign. Key community engagement strategies included shared ownership with community partners, focus groups to guide content, crowdsourcing to name the campaign, design by local Latino/a/x artists, and featuring local influencers as the faces of PrEPárate. We evaluated campaign reach and advertisement performance using social media platform metrics (paid and organic reach, impressions, unique clicks, and click-through rates [CTR]) and website use statistics from Google Analytics. Results: The PrEPárate campaign ran in Cook County, Illinois, from April to September 2022. The campaign reached over 118,750 people on social media (55,750 on Facebook and Instagram [Meta Platforms Inc] and 63,000 on TikTok [ByteDance Ltd]). The Meta ads performed over the industry benchmark with ads featuring local transgender women (2% CTR) and cisgender sexual minority men (1.4% CTR). Of the different Grindr (Grindr Inc) ad formats piloted, the interstitial Grindr ads were the highest performing (1183/55,479, 2.13% CTR). YouTube (Google) ads were low performing at 0.11% (153/138,337) CTR and were stopped prematurely, given limits on sexual education–related content. In the first year, there were 5006 visitors to the website. Conclusions: Adaptation of an existing evidence-based intervention served as an effective method for developing a PrEP social marketing campaign for Latino/a/x audiences. CBPR and strong community partnerships were essential to tailor materials and provide avenues to systematically address barriers to PrEP access. Social marketing is a promising strategy to promote PrEP among underserved Latino/a/x populations. %M 39018099 %R 10.2196/52842 %U https://formative.jmir.org/2024/1/e52842 %U https://doi.org/10.2196/52842 %U http://www.ncbi.nlm.nih.gov/pubmed/39018099 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53716 %T Detection of Common Respiratory Infections, Including COVID-19, Using Consumer Wearable Devices in Health Care Workers: Prospective Model Validation Study %A Esmaeilpour,Zeinab %A Natarajan,Aravind %A Su,Hao-Wei %A Faranesh,Anthony %A Friel,Ciaran %A Zanos,Theodoros P %A D’Angelo,Stefani %A Heneghan,Conor %+ Google LLC, 199 Fremont Street, San Francisco, CA, 94105, United States, 1 9293047065, znb.esmailpoor@gmail.com %K COVID detection %K wearable %K respiratory virus detection %K algorithm %K respiratory infection %K respiratory virus %K COVID-19 %K wearable device %K well-being %K health %K physiology %K health care worker %K prediction %K infection %K physical stress %K emotional stress %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The early detection of respiratory infections could improve responses against outbreaks. Wearable devices can provide insights into health and well-being using longitudinal physiological signals. Objective: The purpose of this study was to prospectively evaluate the performance of a consumer wearable physiology-based respiratory infection detection algorithm in health care workers. Methods: In this study, we evaluated the performance of a previously developed system to predict the presence of COVID-19 or other upper respiratory infections. The system generates real-time alerts using physiological signals recorded from a smartwatch. Resting heart rate, respiratory rate, and heart rate variability measured during the sleeping period were used for prediction. After baseline recordings, when participants received a notification from the system, they were required to undergo testing at a Northwell Health System site. Participants were asked to self-report any positive tests during the study. The accuracy of model prediction was evaluated using respiratory infection results (laboratory results or self-reports), and postnotification surveys were used to evaluate potential confounding factors. Results: A total of 577 participants from Northwell Health in New York were enrolled in the study between January 6, 2022, and July 20, 2022. Of these, 470 successfully completed the study, 89 did not provide sufficient physiological data to receive any prediction from the model, and 18 dropped out. Out of the 470 participants who completed the study and wore the smartwatch as required for the 16-week study duration, the algorithm generated 665 positive alerts, of which 153 (23.0%) were not acted upon to undergo testing for respiratory viruses. Across the 512 instances of positive alerts that involved a respiratory viral panel test, 63 had confirmed respiratory infection results (ie, COVID-19 or other respiratory infections detected using a polymerase chain reaction or home test) and the remaining 449 had negative upper respiratory infection test results. Across all cases, the estimated false-positive rate based on predictions per day was 2%, and the positive-predictive value ranged from 4% to 10% in this specific population, with an observed incidence rate of 198 cases per week per 100,000. Detailed examination of questionnaires filled out after receiving a positive alert revealed that physical or emotional stress events, such as intense exercise, poor sleep, stress, and excessive alcohol consumption, could cause a false-positive result. Conclusions: The real-time alerting system provides advance warning on respiratory viral infections as well as other physical or emotional stress events that could lead to physiological signal changes. This study showed the potential of wearables with embedded alerting systems to provide information on wellness measures. %M 39018555 %R 10.2196/53716 %U https://formative.jmir.org/2024/1/e53716 %U https://doi.org/10.2196/53716 %U http://www.ncbi.nlm.nih.gov/pubmed/39018555 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55575 %T Prediction of Mild Cognitive Impairment Status: Pilot Study of Machine Learning Models Based on Longitudinal Data From Fitness Trackers %A Xu,Qidi %A Kim,Yejin %A Chung,Karen %A Schulz,Paul %A Gottlieb,Assaf %+ McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States, 1 7135003698, assaf.gottlieb@uth.tmc.edu %K mild cognitive impairment %K Fitbits %K fitness trackers %K sleep %K physical activity %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Early signs of Alzheimer disease (AD) are difficult to detect, causing diagnoses to be significantly delayed to time points when brain damage has already occurred and current experimental treatments have little effect on slowing disease progression. Tracking cognitive decline at early stages is critical for patients to make lifestyle changes and consider new and experimental therapies. Frequently studied biomarkers are invasive and costly and are limited for predicting conversion from normal to mild cognitive impairment (MCI). Objective: This study aimed to use data collected from fitness trackers to predict MCI status. Methods: In this pilot study, fitness trackers were worn by 20 participants: 12 patients with MCI and 8 age-matched controls. We collected physical activity, heart rate, and sleep data from each participant for up to 1 month and further developed a machine learning model to predict MCI status. Results: Our machine learning model was able to perfectly separate between MCI and controls (area under the curve=1.0). The top predictive features from the model included peak, cardio, and fat burn heart rate zones; resting heart rate; average deep sleep time; and total light activity time. Conclusions: Our results suggest that a longitudinal digital biomarker differentiates between controls and patients with MCI in a very cost-effective and noninvasive way and hence may be very useful for identifying patients with very early AD who can benefit from clinical trials and new, disease-modifying therapies. %M 39024003 %R 10.2196/55575 %U https://formative.jmir.org/2024/1/e55575 %U https://doi.org/10.2196/55575 %U http://www.ncbi.nlm.nih.gov/pubmed/39024003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51943 %T Algorithmic Spaced Retrieval Enhances Long-Term Memory in Alzheimer Disease: Case-Control Pilot Study %A Smith,Amy M %A Marin,Anna %A DeCaro,Renee E %A Feinn,Richard %A Wack,Audrey %A Hughes,Gregory I %A Rivard,Nathaniel %A Umashankar,Akshay %A Turk,Katherine W %A Budson,Andrew E %+ Blank Slate Technologies, LLC, 4075 Wilson Blvd, Arlington, VA, 22203, United States, 1 2034018923, smitham192@gmail.com %K Alzheimer disease %K spaced retrieval %K mobile app %K assistive technology %K episodic memory %K semantic memory %K mobile phone %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Spaced retrieval is a learning technique that involves engaging in repeated memory testing after increasingly lengthy intervals of time. Spaced retrieval has been shown to improve long-term memory in Alzheimer disease (AD), but it has historically been difficult to implement in the everyday lives of individuals with AD. Objective: This research aims to determine, in people with mild cognitive impairment (MCI) due to AD, the efficacy and feasibility of a mobile app that combines spaced retrieval with a machine learning algorithm to enhance memory retention. Specifically, the app prompts users to answer questions during brief daily sessions, and a machine learning algorithm tracks each user’s rate of forgetting to determine the optimal spacing schedule to prevent anticipated forgetting. Methods: In this pilot study, 61 participants (young adults: n=21, 34%; healthy older adults: n=20, 33%; people with MCI due to AD: n=20, 33%) used the app for 4 weeks to learn new facts and relearn forgotten name-face associations. Participation during the 4-week period was characterized by using the app once per day to answer 15 questions about the facts and names. After the 4-week learning phase, participants completed 2 recognition memory tests approximately 1 week apart, which tested memory for information they had studied using the app as well as information they had not studied. Results: After using the mobile app for 1 month, every person with MCI due to AD demonstrated improvements in memory for new facts that they had studied via the app compared to baseline (P<.001). All but one person with MCI due to AD (19/20, 95%) showed improvements of more than 10 percentage points, comparable to the improvements shown by young adults and healthy older adults. Memory for name-face associations was similarly improved for all participant groups after using the app but to a lesser degree. Furthermore, for both new facts and name-face associations, we found no memory decay for any participant group after they took a break of approximately 1 week from using the app at the end of the study. Regarding usability, of the 20 people with MCI due to AD, 16 (80%) self-adhered to the app’s automated practice schedule, and half of them (n=10, 50%) expressed an interest in continuing to use it. Conclusions: These results demonstrate early evidence that spaced retrieval mobile apps are both feasible for people with early-stage AD to use in their everyday lives and effective for supporting memory retention of recently learned facts and name-face associations. %M 39028554 %R 10.2196/51943 %U https://formative.jmir.org/2024/1/e51943 %U https://doi.org/10.2196/51943 %U http://www.ncbi.nlm.nih.gov/pubmed/39028554 %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 e56312 %T Telemedicine and Patient Experience Ratings at an Academic Integrative Medicine Practice: Retrospective Examination %A Meltzer,Ellen %A Wilshusen,Laurie %A Abdulwadood,Isra %A Yee,Claire %A Sherman,Amy %A Strader,Kelli %A Thomley,Barbara %A Millstine,Denise %A Tilburt,Jon %A Fields,Heather %A Bergstrom,Larry %A Patchett,David %A Camoriano,John %A Bauer,Brent %+ Division of General Internal Medicine, Department of Medicine, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, United States, 1 4803016200, meltzer.ellen@mayo.edu %K telemedicine %K TELE %K patient experience %K communication skills %K integrative medicine %K face-to-face %K F2F %K encounters %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. Objective: The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. Methods: A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage “top box” scores (ie, the percentage of respondents who selected the most positive response category on the survey, “very good”), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Results: Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions: Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine. %M 39037767 %R 10.2196/56312 %U https://formative.jmir.org/2024/1/e56312 %U https://doi.org/10.2196/56312 %U http://www.ncbi.nlm.nih.gov/pubmed/39037767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57529 %T Measuring Engagement in Provider-Guided Digital Health Interventions With a Conceptual and Analytical Framework Using Nurse WRITE as an Exemplar: Exploratory Study With an Iterative Approach %A Wang,Yan %A DeVito Dabbs,Annette %A Thomas,Teresa Hagan %A Campbell,Grace %A Donovan,Heidi %+ Department of Health & Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building, Pittsburgh, PA, 15261, United States, 1 14126261172, yaw75@pitt.edu %K engagement %K digital health intervention %K framework %K symptom management %K eHealth %K gynecological cancer %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited guidance exists for analyzing participant engagement in provider-guided digital health interventions (DHIs). System usage is commonly assessed, with acknowledged limitations in measuring socio-affective and cognitive aspects of engagement. Nurse WRITE, an 8-week web-based nurse-guided DHI for managing symptoms among women with recurrent ovarian cancer, offers an opportunity to develop a framework for assessing multidimensional engagement. Objective: This study aims to develop a conceptual and analytic framework to measure socio-affective, cognitive, and behavioral engagement with provider-guided DHIs. We then illustrate the framework’s ability to describe and categorize engagement using Nurse WRITE as an example. Methods: A sample of 68 participants from Nurse WRITE who posted on the message boards were included. We adapted a prior framework for conceptualizing and operationalizing engagement across 3 dimensions and finalized a set of 6 distinct measures. Using patients' posts, we created 2 socio-affective engagement measures—total count of socio-affective engagement classes (eg, sharing personal experience) and total word count—and 2 cognitive engagement measures—total count of cognitive engagement classes (eg, asking information-seeking questions) and average question completion percentage. Additionally, we devised behavioral engagement measures using website data—the total count of symptom care plans and plan reviews. k-Means clustering categorized the participants into distinct groups based on levels of engagement across 3 dimensions. Descriptive statistics and narratives were used to describe engagement in 3 dimensions. Results: On average, participants displayed socio-affective engagement 34.7 times, writing 14,851 words. They showed cognitive engagement 19.4 times, with an average of 78.3% completion of nurses' inquiries. Participants also submitted an average of 1.6 symptom care plans and 0.7 plan reviews. Participants were clustered into high (n=13), moderate (n=17), and low engagers (n=38) based on the 6 measures. High engagers wrote a median of 36,956 (IQR 26,199-46,265) words. They demonstrated socio-affective engagement approximately 81 times and cognitive engagement around 46 times, approximately 6 times that of the low engagers and twice that of the moderate engagers. High engagers had a median of 91.7% (IQR 82.2%-93.7%) completion of the nurses’ queries, whereas moderate engagers had 86.4% (IQR 80%-96.4%), and low engagers had 68.3% (IQR 60.1%-79.6%). High engagers completed a median of 3 symptom care plans and 2 reviews, while moderate engagers completed 2 plans and 1 review. Low engagers completed a median of 1 plan with no reviews. Conclusions: This study developed and reported an engagement framework to guide behavioral intervention scientists in understanding and analyzing participants’ engagement with provider-guided DHIs. Significant variations in engagement levels across 3 dimensions highlight the importance of measuring engagement with provider-guided DHIs in socio-affective, cognitive, and behavioral dimensions. Future studies should validate the framework with other DHIs, explore the influence of patient and provider factors on engagement, and investigate how engagement influences intervention efficacy. %M 39037757 %R 10.2196/57529 %U https://formative.jmir.org/2024/1/e57529 %U https://doi.org/10.2196/57529 %U http://www.ncbi.nlm.nih.gov/pubmed/39037757 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51400 %T Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis %A Myers,Jennifer Rae %A Bryk,Kelsey N %A Madero,Erica N %A McFarlane,Jacob %A Campitelli,Anthony %A Gills,Joshua %A Jones,Megan %A Paulson,Sally %A Gray,Michelle %A Glenn,Jordan M %+ Neurotrack Technologies, 399 Bradford St #101, Redwood City, CA, 94063, United States, 1 6505498566, jennifer.r.myers@outlook.com %K Alzheimer disease %K cognition %K intervention %K rural issues %K digital health %K geriatric %K geriatrics %K elder %K elderly %K diabetes %K diabetes mellitus %K dementia %K digital cognitive health coaching %K rural %K countryside %K qualitative study %K thematic analysis %K mHealth %K telehealth %K health informatics %K mental health %K behavioral change %K healthy lifestyle %K coach support %K self-awareness %K prevention %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. Objective: The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. Methods: This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant’s goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, “What were your top 1 or 2 takeaways from your recent Health Coaching session?” and “Is there anything you would change about our Health Coaching sessions?” A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). Results: The following four themes emerged from participants’ feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. Conclusions: Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): RR2-10.2196/31841 %M 39038282 %R 10.2196/51400 %U https://formative.jmir.org/2024/1/e51400 %U https://doi.org/10.2196/51400 %U http://www.ncbi.nlm.nih.gov/pubmed/39038282 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52734 %T Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link %A Avanceña,Anton L V %A Brody,Carinne %A Chhoun,Pheak %A Tuot,Sovannary %A Yi,Siyan %+ Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, 2409 University Ave, PHR 2.112, Austin, TX, 78712, United States, 1 5124713146, antonlv@utexas.edu %K female entertainment workers %K Cambodia %K mHealth %K mobile health %K economic evaluation %K stigmatized populations %K women's health %K sexual health %K STI %K sexually transmitted infection %K STD %K sexually transmitted disease %K economic %K cost %K costs %K affordable %K affordability %K budget %K finance %K financial %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile Link is a mobile phone–based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. Objective: This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. Methods: We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link’s messaging and outreach services to 70% of female entertainment workers in 5 years. Results: The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval –0.088 to 0.126) DALYs averted, Mobile Link’s cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year. Conclusions: This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. Trial Registration: ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842 %M 39052328 %R 10.2196/52734 %U https://formative.jmir.org/2024/1/e52734 %U https://doi.org/10.2196/52734 %U http://www.ncbi.nlm.nih.gov/pubmed/39052328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52878 %T Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game %A Noroozi,Mohammad %A St John,Ace %A Masino,Caterina %A Laplante,Simon %A Hunter,Jaryd %A Brudno,Michael %A Madani,Amin %A Kersten-Oertel,Marta %+ Applied Perception Lab, Department of Computer Science and Software Engineering, Concordia University, 2155 Guy Street ER923, Montreal, QC, H3G 1M8, Canada, 1 8482424 ext 5830, marta.kersten@concordia.ca %K gamification %K serious games %K surgery %K education %K laparoscopic cholecystectomy %K artificial intelligence %K AI %K laparoscope %K gallbladder %K cholecystectomy %K mobile game %K gamify %K educational game %K interactive %K decision-making %K mobile phone %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. Objective:  To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. Methods:  LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. Results:  Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. Conclusions:  LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees. %M 39052314 %R 10.2196/52878 %U https://formative.jmir.org/2024/1/e52878 %U https://doi.org/10.2196/52878 %U http://www.ncbi.nlm.nih.gov/pubmed/39052314 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57938 %T Changes in the Frequency of Actions Associated With Mental Health During Online Treatment: Analysis of Demographic and Clinical Factors %A Bisby,Madelyne %A Staples,Lauren %A Dear,Blake %A Titov,Nickolai %+ MindSpot Clinic, MQ Health, Macquarie University, 16 University Avenue, Sydney, 2109, Australia, 61 298508724, madelyne.bisby@mq.edu.au %K anxiety %K depression %K daily actions %K treatments %K personalization %K mental health %K digital treatment %K analysis %K clinical factors %K questionnaire %K depression symptoms %K anxiety symptoms %K patients %K Australian %K Australia %K digital psychology service %K psychology %K symptom severity %K severity %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Specific daily actions (eg, goal setting, meaningful activities) are associated with mental health. Performing specific daily actions at a higher frequency is associated with significantly lower baseline symptoms of depression and anxiety, as well as better psychological treatment outcomes for depression and anxiety. Objective: This study explored how the frequency of specific daily actions associated with mental health may differ prior to, during, and following treatment according to demographic and clinical characteristics. Methods: Using a sample of 448 patients from an Australian national digital psychology service, we examined baseline differences in daily action frequency and changes in daily action frequency during a digital psychological treatment according to demographic and clinical subgroups. A total of 5 specific types of daily actions were measured using the Things You Do Questionnaire: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Results: The frequency of daily actions differed according to employment status (largest P=.005) and educational level (largest P=.004). Daily action frequency was lower in those participants with more severe or chronic depression or anxiety symptoms (largest P=.004). Participants reported larger increases in how often they did these daily actions from baseline to midtreatment compared to mid- to posttreatment. Depression duration (P=.01) and severity (P<.001) were associated with differences in how daily action frequency changed during treatment. Conclusions: The findings of this study support continued research exploring the relationship between daily actions and mental health, how this relationship might differ between individuals, and the clinical potential of supporting individuals to increase the frequency of daily actions to improve mental health. %M 39052998 %R 10.2196/57938 %U https://formative.jmir.org/2024/1/e57938 %U https://doi.org/10.2196/57938 %U http://www.ncbi.nlm.nih.gov/pubmed/39052998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43119 %T Implementation of a Web-Based Chatbot to Guide Hospital Employees in Returning to Work During the COVID-19 Pandemic: Development and Before-and-After Evaluation %A Unlu,Ozan %A Pikcilingis,Aaron %A Letourneau,Jonathan %A Landman,Adam %A Patel,Rajesh %A Shenoy,Erica S %A Hashimoto,Dean %A Kim,Marvel %A Pellecer,Johnny %A Zhang,Haipeng %+ Division of Cardiovascular Medicine, Brigham and Women's Hospital, 70 Francis St, Boston, MA, 02115, United States, 1 857 407 4561, ounlu@bwh.harvard.edu %K chatbot %K return to work %K employee %K health care personnel %K COVID-19 %K conversational agent %K occupational health %K support service %K health care delivery %K agile methodology %K digital intervention %K digital support %K work policy %K hospital staff %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Throughout the COVID-19 pandemic, multiple policies and guidelines were issued and updated for health care personnel (HCP) for COVID-19 testing and returning to work after reporting symptoms, exposures, or infection. The high frequency of changes and complexity of the policies made it difficult for HCP to understand when they needed testing and were eligible to return to work (RTW), which increased calls to Occupational Health Services (OHS), creating a need for other tools to guide HCP. Chatbots have been used as novel tools to facilitate immediate responses to patients’ and employees’ queries about COVID-19, assess symptoms, and guide individuals to appropriate care resources. Objective: This study aims to describe the development of an RTW chatbot and report its impact on demand for OHS support services during the first Omicron variant surge. Methods: This study was conducted at Mass General Brigham, an integrated health care system with over 80,000 employees. The RTW chatbot was developed using an agile design methodology. We mapped the RTW policy into a unified flow diagram that included all required questions and recommendations, then built and tested the chatbot using the Microsoft Azure Healthbot Framework. Using chatbot data and OHS call data from December 10, 2021, to February 17, 2022, we compared OHS resource use before and after the deployment of the RTW chatbot, including the number of calls to the OHS hotline, wait times, call length, and time OHS hotline staff spent on the phone. We also assessed Centers for Disease Control and Prevention data for COVID-19 case trends during the study period. Results: In the 5 weeks post deployment, 5575 users used the RTW chatbot with a mean interaction time of 1 minute and 17 seconds. The highest engagement was on January 25, 2022, with 368 users, which was 2 weeks after the peak of the first Omicron surge in Massachusetts. Among users who completed all the chatbot questions, 461 (71.6%) met the RTW criteria. During the 10 weeks, the median (IQR) number of daily calls that OHS received before and after deployment of the chatbot were 633 (251-934) and 115 (62-167), respectively (U=163; P<.001). The median time from dialing the OHS phone number to hanging up decreased from 28 minutes and 22 seconds (IQR 25:14-31:05) to 6 minutes and 25 seconds (IQR 5:32-7:08) after chatbot deployment (U=169; P<.001). Over the 10 weeks, the median time OHS hotline staff spent on the phone declined from 3 hours and 11 minutes (IQR 2:32-4:15) per day to 47 (IQR 42-54) minutes (U=193; P<.001), saving approximately 16.8 hours per OHS staff member per week. Conclusions: Using the agile methodology, a chatbot can be rapidly designed and deployed for employees to efficiently receive guidance regarding RTW that complies with the complex and shifting RTW policies, which may reduce use of OHS resources. %M 39052994 %R 10.2196/43119 %U https://formative.jmir.org/2024/1/e43119 %U https://doi.org/10.2196/43119 %U http://www.ncbi.nlm.nih.gov/pubmed/39052994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54458 %T Complex Hospital-Based Electronic Prescribing–Based Intervention to Support Antimicrobial Stewardship: Qualitative Study %A Cresswell,Kathrin %A Hinder,Susan %A Sheikh,Aziz %A Watson,Neil %A Price,David %A Heed,Andrew %A Pontefract,Sarah Katie %A Coleman,Jamie %A Beggs,Jillian %A Chuter,Antony %A Slee,Ann %A Williams,Robin %+ Usher Institute, University of Edinburgh, Usher Building, 5‒7 Little France Road, Edinburgh, EH16 4UX, United Kingdom, 44 (0)131 651 4151, Kathrin.Cresswell@ed.ac.uk %K antimicrobial stewardship %K electronic prescribing %K evaluation %K healthcare %K qualitative study %K hospital-based %K electronic prescribing %K e-prescribing %K prescribing %K prescription %K ePAMS+ %K antimicrobial resistance %K AMR %K complex intervention %K complex interventions %K educational %K behavioral %K technological %K public health %K implementation %K AMS %K hospital %K hospitals %K development %K in-depth %K interview %K interviews %K observation %K observations %K prescriber %K prescribers %K nurse %K nurses %K pharmacist %K pharmacists %K microbiologist %K microbiologists %K thematic analysis %K antimicrobial %K antimicrobials %D 2024 %7 26.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Antimicrobial resistance (AMR) represents a growing concern for public health. Objective: We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals. Methods: We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital. At 2 weeks and 7 weeks after initiating the intervention, we interviewed 25 users of the intervention, including senior and junior prescribers, a senior nurse, a pharmacist, and a microbiologist. Topics discussed included perceived impacts of different elements of the intervention and facilitators and barriers to effective use. Interviews were supplemented by 2 observations of ward rounds to gain insights into AMS practices. Data were audio-recorded, transcribed, and inductively and deductively analyzed thematically using NVivo12. Results: Tracing the adoption and impact of the various components of the intervention was difficult, as it had been introduced into a setting with competing pressures. These particularly affected behavioral and educational components (eg, training, awareness-building activities), which were often delivered ad hoc. We found that the participatory intervention design had addressed typical use cases but had not catered for edge cases that only became visible when the intervention was delivered in real-world settings (eg, variations in prescribing workflows across different specialties and conditions). Conclusions: Effective user-focused design of complex interventions to promote AMS can support acceptance and use. However, not all requirements and potential barriers to use can be fully anticipated or tested in advance of full implementation in real-world settings. %M 39059001 %R 10.2196/54458 %U https://formative.jmir.org/2024/1/e54458 %U https://doi.org/10.2196/54458 %U http://www.ncbi.nlm.nih.gov/pubmed/39059001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54577 %T Use of Machine Learning Models to Differentiate Neurodevelopment Conditions Through Digitally Collected Data: Cross-Sectional Questionnaire Study %A Grazioli,Silvia %A Crippa,Alessandro %A Buo,Noemi %A Busti Ceccarelli,Silvia %A Molteni,Massimo %A Nobile,Maria %A Salandi,Antonio %A Trabattoni,Sara %A Caselli,Gabriele %A Colombo,Paola %+ Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Via Don Luigi Monza, 20, Bosisio Parini, 23842, Italy, 39 031877593, alessandro.crippa@lanostrafamiglia.it %K digital-aided clinical assessment %K machine learning %K random forest %K logistic regression %K computational psychometrics %K telemedicine %K neurodevelopmental conditions %K parent-report questionnaires %K attention-deficit/hyperactivity disorder %K autism spectrum disorder %K ASD %K autism %K autistic %K attention deficit %K hyperactivity %K classification %D 2024 %7 29.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diagnosis of child and adolescent psychopathologies involves a multifaceted approach, integrating clinical observations, behavioral assessments, medical history, cognitive testing, and familial context information. Digital technologies, especially internet-based platforms for administering caregiver-rated questionnaires, are increasingly used in this field, particularly during the screening phase. The ascent of digital platforms for data collection has propelled advanced psychopathology classification methods such as supervised machine learning (ML) into the forefront of both research and clinical environments. This shift, recently called psycho-informatics, has been facilitated by gradually incorporating computational devices into clinical workflows. However, an actual integration between telemedicine and the ML approach has yet to be fulfilled. Objective: Under these premises, exploring the potential of ML applications for analyzing digitally collected data may have significant implications for supporting the clinical practice of diagnosing early psychopathology. The purpose of this study was, therefore, to exploit ML models for the classification of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using internet-based parent-reported socio-anamnestic data, aiming at obtaining accurate predictive models for new help-seeking families. Methods: In this retrospective, single-center observational study, socio-anamnestic data were collected from 1688 children and adolescents referred for suspected neurodevelopmental conditions. The data included sociodemographic, clinical, environmental, and developmental factors, collected remotely through the first Italian internet-based screening tool for neurodevelopmental disorders, the Medea Information and Clinical Assessment On-Line (MedicalBIT). Random forest (RF), decision tree, and logistic regression models were developed and evaluated using classification accuracy, sensitivity, specificity, and importance of independent variables. Results: The RF model demonstrated robust accuracy, achieving 84% (95% CI 82-85; P<.001) for ADHD and 86% (95% CI 84-87; P<.001) for ASD classifications. Sensitivities were also high, with 93% for ADHD and 95% for ASD. In contrast, the DT and LR models exhibited lower accuracy (DT 74%, 95% CI 71-77; P<.001 for ADHD; DT 79%, 95% CI 77-82; P<.001 for ASD; LR 61%, 95% CI 57-64; P<.001 for ADHD; LR 63%, 95% CI 60-67; P<.001 for ASD) and sensitivities (DT: 82% for ADHD and 88% for ASD; LR: 62% for ADHD and 68% for ASD). The independent variables considered for classification differed in importance between the 2 models, reflecting the distinct characteristics of the 3 ML approaches. Conclusions: This study highlights the potential of ML models, particularly RF, in enhancing the diagnostic process of child and adolescent psychopathology. Altogether, the current findings underscore the significance of leveraging digital platforms and computational techniques in the diagnostic process. While interpretability remains crucial, the developed approach might provide valuable screening tools for clinicians, highlighting the significance of embedding computational techniques in the diagnostic process. %M 39073858 %R 10.2196/54577 %U https://formative.jmir.org/2024/1/e54577 %U https://doi.org/10.2196/54577 %U http://www.ncbi.nlm.nih.gov/pubmed/39073858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56715 %T Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial %A Lowe,Cabella %A Sephton,Ruth %A Marsh,William %A Morrissey,Dylan %+ Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Road, London, E1 4DG, United Kingdom, 44 7976315105, c.lowe@qmul.ac.uk %K mHealth %K eHealth %K digital health %K digital technology %K digital triage %K musculoskeletal %K triage %K physiotherapy triage %K validation %K acceptability %K physiotherapy %K primary care %K randomized controlled trial %K usability %K assess %K assessment %K triaging %K referrals %K crossover %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation. Such innovations are rarely rigorously tested in clinical trials—considered the gold standard for evaluating safety and efficacy. This pilot study is a precursor to a trial assessing DART performance with a physiotherapist-led triage assessment. Objective: The study aims to evaluate trial design, assess procedures, and collect exploratory data to establish the feasibility of delivering an adequately powered, definitive randomized trial, assessing DART safety and efficacy in an NHS primary care setting. Methods: A crossover, noninferiority pilot trial using an integrated knowledge translation approach within a National Health Service England primary care setting. Participants were patients seeking assessment for a musculoskeletal condition, completing a DART assessment and the history-taking element of a face-to-face physiotherapist-led triage in a randomized order. The primary outcome was agreement between DART and physiotherapist triage recommendation. Data allowed analysis of participant recruitment and retention, randomization, blinding, study burden, and potential barriers to intervention delivery. Participant satisfaction was measured using the System Usability Scale. Results: Over 8 weeks, 129 patients were invited to participate. Of these, 92% (119/129) proceeded to eligibility assessment, with 60% (78/129) meeting the inclusion criteria and being randomized into each intervention arm (39/39). There were no dropouts and data were analyzed for all 78 participants. Agreement between physiotherapist and DART across all participants and all primary triage outcomes was 41% (32/78; 95% CI 22-45), intraclass correlation coefficient 0.37 (95% CI 0.16-0.55), indicating that the reliability of DART was poor to moderate. Feedback from the clinical service team led to an adjusted analysis yielding of 78% (61/78; 95% CI 47-78) and an intraclass correlation coefficient of 0.57 (95% CI 0.40-0.70). Participant satisfaction was measured quantitively using amalgamated System Usability Scale scores (n=78; mean score 84.0; 90% CI +2.94 to –2.94), equating to an “excellent” system. There were no study incidents, and the trial burden was acceptable. Conclusions: Physiotherapist-DART agreement of 78%, with no adverse triage decisions and high patient satisfaction, was sufficient to conclude DART had the potential to improve the musculoskeletal pathway. Study validity was enhanced by the recruitment of real-world patients and using an integrated knowledge translation approach. Completion of a context-specific consensus process is recommended to provide definitive definitions of safety criteria, range of appropriateness, noninferiority margin, and sample size. This pilot demonstrated an adequately powered definitive trial is feasible, which would provide evidence of DART safety and efficacy, ultimately informing potential for DART implementation. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): RR2-10.2196/31541 %M 39078682 %R 10.2196/56715 %U https://formative.jmir.org/2024/1/e56715 %U https://doi.org/10.2196/56715 %U http://www.ncbi.nlm.nih.gov/pubmed/39078682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54633 %T A Reliable and Accessible Caregiving Language Model (CaLM) to Support Tools for Caregivers: Development and Evaluation Study %A Parmanto,Bambang %A Aryoyudanta,Bayu %A Soekinto,Timothius Wilbert %A Setiawan,I Made Agus %A Wang,Yuhan %A Hu,Haomin %A Saptono,Andi %A Choi,Yong Kyung %+ Department of Health Information Management, University of Pittsburgh, 6052 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K large language model %K caregiving %K caregiver %K informal care %K carer %K GPT %K language model %K LLM %K elderly %K aging %K ChatGPT %K machine learning %K natural language processing %K NLP %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, 1 in 5 adults currently serves as a family caregiver for an individual with a serious illness or disability. Unlike professional caregivers, family caregivers often assume this role without formal preparation or training. Thus, there is an urgent need to enhance the capacity of family caregivers to provide quality care. Leveraging technology as an educational tool or an adjunct to care is a promising approach that has the potential to enhance the learning and caregiving capabilities of family caregivers. Large language models (LLMs) can potentially be used as a foundation technology for supporting caregivers. An LLM can be categorized as a foundation model (FM), which is a large-scale model trained on a broad data set that can be adapted to a range of different domain tasks. Despite their potential, FMs have the critical weakness of “hallucination,” where the models generate information that can be misleading or inaccurate. Information reliability is essential when language models are deployed as front-line help tools for caregivers. Objective: This study aimed to (1) develop a reliable caregiving language model (CaLM) by using FMs and a caregiving knowledge base, (2) develop an accessible CaLM using a small FM that requires fewer computing resources, and (3) evaluate the model’s performance compared with a large FM. Methods: We developed a CaLM using the retrieval augmented generation (RAG) framework combined with FM fine-tuning for improving the quality of FM answers by grounding the model on a caregiving knowledge base. The key components of the CaLM are the caregiving knowledge base, a fine-tuned FM, and a retriever module. We used 2 small FMs as candidates for the foundation of the CaLM (LLaMA [large language model Meta AI] 2 and Falcon with 7 billion parameters) and adopted a large FM (GPT-3.5 with an estimated 175 billion parameters) as a benchmark. We developed the caregiving knowledge base by gathering various types of documents from the internet. We focused on caregivers of individuals with Alzheimer disease and related dementias. We evaluated the models’ performances using the benchmark metrics commonly used in evaluating language models and their reliability for providing accurate references with their answers. Results: The RAG framework improved the performance of all FMs used in this study across all measures. As expected, the large FM performed better than the small FMs across all metrics. Interestingly, the small fine-tuned FMs with RAG performed significantly better than GPT 3.5 across all metrics. The fine-tuned LLaMA 2 with a small FM performed better than GPT 3.5 (even with RAG) in returning references with the answers. Conclusions: The study shows that a reliable and accessible CaLM can be developed using small FMs with a knowledge base specific to the caregiving domain. %M 39083337 %R 10.2196/54633 %U https://formative.jmir.org/2024/1/e54633 %U https://doi.org/10.2196/54633 %U http://www.ncbi.nlm.nih.gov/pubmed/39083337 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54723 %T Impact of a Health Coach–Led, Text-Based Digital Behavior Change Intervention on Weight Loss and Psychological Well-Being in Patients Receiving a Procedureless Intragastric Balloon Program: Prospective Single-Arm Study %A Sacher,Paul M %A Fulton,Emily %A Rogers,Victoria %A Wilson,Julia %A Gramatica,Marco %A Dent,Jennifer E %A Aarts,Edo O %A Eccleston,David %A Greve,Jan Willem %A Palm-Meinders,Inge %A Chuttani,Ram %+ Allurion Technologies Inc, 11 Huron Dr, Natick, MA, 01760, United States, 1 508 647 4000, psacher@icloud.com %K intragastric balloon %K obesity %K behavior change %K health coaching %K digital health %K weight management %K well-being %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management. Objective: This study aims to assess whether a health coach–led, asynchronous, text-based digital behavior change coaching intervention (DBCCI) delivered to participants receiving an intragastric balloon and its aftercare program was feasible and acceptable to participants and supported improved outcomes, including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance. Methods: This 12-month, single-arm prospective study enrolled adults aged 21 to 65 years with BMI ≥27 kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received the DBCCI and the clinic-led PIGB aftercare program (remotely delivered) for 6 months after PIGB placement and then no intervention for an additional 6 months. The DBCCI was an evidence-based, personalized intervention wherein health coaches supported participants via exchanged asynchronous in-app text-based messages. Over the 12-month study, we assessed percentage of total body weight loss and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder Scale, Impact of Weight on Quality of Life–Lite–Clinical Trials Version, Loss of Control Over Eating Scale–Brief, Weight Efficacy Lifestyle Questionnaire–Short Form, and Barriers to Being Active Quiz). Participant engagement with and acceptability of the intervention were assessed via self-reported surveys. Results: Overall, 107 participants (n=96, 89.7% female; mean baseline BMI 35.4, SD 5.4 kg/m2) were included in the analysis. Mean total body weight loss was 13.5% (SEM 2.3%) at the end of the DBCCI and 11.22% (SEM 2.3%) at the 12-month follow-up (P<.001). Improvements were observed for all psychological well-being measures throughout the 12 months except for the Generalized Anxiety Disorder Scale (improvement at month 1) and Barriers to Being Active Quiz (improvements at months 3 and 6). Surveys showed high levels of engagement with and acceptability of the DBCCI. Conclusions: This study provides evidence that the health coach–led, asynchronous, text-based DBCCI was engaging and acceptable to participants with overweight and obesity. The DBCCI, delivered alongside the PIGB and its aftercare program, supported improved weight loss outcomes and psychological well-being versus baseline and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Follow-up findings suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging generative artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. Trial Registration: ClinicalTrials.gov NCT05884606; https://clinicaltrials.gov/study/NCT05884606 %M 39083340 %R 10.2196/54723 %U https://formative.jmir.org/2024/1/e54723 %U https://doi.org/10.2196/54723 %U http://www.ncbi.nlm.nih.gov/pubmed/39083340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56594 %T Quality of Chronic Obstructive Pulmonary Disease Information on the Chinese Internet: Website Evaluation Study %A Wang,Qinqin %A Liu,Lingjun %A Li,Hong %A Zhang,Qiao %A Ma,Qianli %+ Chronic Respiratory Disease Management and Rehabilitation Center, SongShan General Hospital, D Building, 1st FIoor, Chongqing, 401120, China, 86 19112955805, cqmql@163.com %K chronic obstructive pulmonary disease %K internet %K information quality %K DISCERN %K websites %K health information %K DISCERN instrument %K pulmonary disease %K chronic pulmonary disease %K cross-sectional study %K website information %K treatment %K COPD %K China %K evaluation %K pulmonary %K chronic %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of internet technology has greatly increased the ability of patients with chronic obstructive pulmonary disease (COPD) to obtain health information, giving patients more initiative in the patient-physician decision-making process. However, concerns about the quality of website health information will affect the enthusiasm of patients’ website search behavior. Therefore, it is necessary to evaluate the current situation of Chinese internet information on COPD. Objective: This study aims to evaluate the quality of COPD treatment information on the Chinese internet. Methods: Using the standard disease name “慢性阻塞性肺疾病” (“chronic obstructive pulmonary disease” in Chinese) and the commonly used public search terms “慢阻肺” (“COPD”) and “肺气肿” (“emphysema”) combined with the keyword “治疗” (“treatment”), we searched the PC client web page of Baidu, Sogou, and 360 search engines and screened the first 50 links of the website from July to August 2021. The language was restricted to Chinese for all the websites. The DISCERN tool was used to evaluate the websites. Results: A total of 96 websites were included and analyzed. The mean overall DISCERN score for all websites was 30.4 (SD 10.3; range 17.3-58.7; low quality), no website reached the maximum DISCERN score of 75, and the mean score for each item was 2.0 (SD 0.7; range 1.2-3.9). There were significant differences in mean DISCERN scores between terms, with “chronic obstructive pulmonary disease” having the highest mean score. Conclusions: The quality of COPD information on the Chinese internet is poor, which is mainly reflected in the low reliability and relevance of COPD treatment information, which can easily lead consumers to make inappropriate treatment choices. The term “chronic obstructive pulmonary disease” has the highest DISCERN score among commonly used disease search terms. It is recommended that consumers use standard disease names when searching for website information, as the information obtained is relatively reliable. %M 39088820 %R 10.2196/56594 %U https://formative.jmir.org/2024/1/e56594 %U https://doi.org/10.2196/56594 %U http://www.ncbi.nlm.nih.gov/pubmed/39088820 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54009 %T An App for Navigating Patient Transportation and Acute Stroke Care in Northwestern Ontario Using Machine Learning: Retrospective Study %A Hassan,Ayman %A Benlamri,Rachid %A Diner,Trina %A Cristofaro,Keli %A Dillistone,Lucas %A Khallouki,Hajar %A Ahghari,Mahvareh %A Littlefield,Shalyn %A Siddiqui,Rabail %A MacDonald,Russell %A Savage,David W %+ Thunder Bay Regional Health Research Institute, 980 Oliver Road, Thunder Bay, ON, P7B 6Z6, Canada, 1 8076847580, rabail.siddiqui@tbh.net %K stroke care %K acute stroke %K northwestern %K Ontario %K prediction %K models %K machine learning %K stroke %K cardiovascular %K brain %K neuroscience %K TIA %K transient ischemic attack %K coordinated care %K navigation %K navigating %K mHealth %K mobile health %K app %K apps %K applications %K geomapping %K geography %K geographical %K location %K spatial %K predict %K predictions %K predictive %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A coordinated care system helps provide timely access to treatment for suspected acute stroke. In Northwestern Ontario (NWO), Canada, communities are widespread with several hospitals offering various diagnostic equipment and services. Thus, resources are limited, and health care providers must often transfer patients with stroke to different hospital locations to ensure the most appropriate care access within recommended time frames. However, health care providers frequently situated temporarily (locum) in NWO or providing care remotely from other areas of Ontario may lack sufficient information and experience in the region to access care for a patient with a time-sensitive condition. Suboptimal decision-making may lead to multiple transfers before definitive stroke care is obtained, resulting in poor outcomes and additional health care system costs. Objective: We aimed to develop a tool to inform and assist NWO health care providers in determining the best transfer options for patients with stroke to provide the most efficient care access. We aimed to develop an app using a comprehensive geomapping navigation and estimation system based on machine learning algorithms. This app uses key stroke-related timelines including the last time the patient was known to be well, patient location, treatment options, and imaging availability at different health care facilities. Methods: Using historical data (2008-2020), an accurate prediction model using machine learning methods was developed and incorporated into a mobile app. These data contained parameters regarding air (Ornge) and land medical transport (3 services), which were preprocessed and cleaned. For cases in which Ornge air services and land ambulance medical transport were both involved in a patient transport process, data were merged and time intervals of the transport journey were determined. The data were distributed for training (35%), testing (35%), and validation (30%) of the prediction model. Results: In total, 70,623 records were collected in the data set from Ornge and land medical transport services to develop a prediction model. Various learning models were analyzed; all learning models perform better than the simple average of all points in predicting output variables. The decision tree model provided more accurate results than the other models. The decision tree model performed remarkably well, with the values from testing, validation, and the model within a close range. This model was used to develop the “NWO Navigate Stroke” system. The system provides accurate results and demonstrates that a mobile app can be a significant tool for health care providers navigating stroke care in NWO, potentially impacting patient care and outcomes. Conclusions: The NWO Navigate Stroke system uses a data-driven, reliable, accurate prediction model while considering all variations and is simultaneously linked to all required acute stroke management pathways and tools. It was tested using historical data, and the next step will to involve usability testing with end users. %R 10.2196/54009 %U https://formative.jmir.org/2024/1/e54009 %U https://doi.org/10.2196/54009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54999 %T A Remote Oral Self-Care Behaviors Assessment System in Vulnerable Populations: Usability and Feasibility Study %A LaVine,Danielle %A Greer,Zara %A Kim,Jiyun %A Kumar,Santosh %A Belin,Thomas %A Shetty,Vivek %+ Section of Oral & Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, 23-009 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1668, United States, 1 3108255170, vshetty@g.ucla.edu %K dental disease %K underserved populations %K mHealth %K usability testing %K feasibility testing, mobile phone %D 2024 %7 2.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Preventative self-care can reduce dental disease that disproportionately burdens vulnerable populations. Personalized digital oral self-care behavioral interventions offer a promising solution. However, the success of these digital interventions depends on toothbrushing data collection e-platforms attuned to the needs and preferences of vulnerable communities. Objective: The aim of this study is to assess the usability and feasibility of the Remote Oral Behaviors Assessment System (ROBAS), which has been adapted to address the unique requirements of socioeconomically disadvantaged minority individuals. Methods: A cohort of 53 community-clinic participants, including 31 (58%) Latino and 22 (42%) Black individuals with no prior experience using electric toothbrushes, were recruited to use ROBAS, with planned assessments at baseline, 2 months, and 4 months. Beyond evaluating ROBAS’s technical performance, extensive feedback was gathered to gauge users’ experiences, viewpoints, and overall contentment. The System Usability Scale (SUS) served as a primary metric for assessing user satisfaction and acceptability. Results: ROBAS exhibited largely reliable and consistent data-gathering capabilities. SUS scores (mean 75.6, SD 14.5) reflected participant contentment within a range of values for other commonly used digital devices and technologies. Among participants who answered questions about willingness to pay for ROBAS, 97% (30/31) indicated that they were willing to pay for ROBAS either as a one-time payment or as a subscription-based service. Additionally, 87.5% of participants expressed that they would endorse it to acquaintances. Most participants expressed no reservations about privacy; among those who expressed privacy concerns (n=20, 50%), the concerns included exposure of information (n=18, 45%), monitoring of brushing habits (n=12, 30%), and collection of information (n=14, 35%), although these concerns did not significantly correlate with specific participant traits. In qualitative terms, users valued ROBAS's ability to monitor brushing habits but called for refinements, especially in Wi-Fi and application connectivity. Recommendations for system improvements encompassed enhanced app functionality, individualized coaching, more comprehensive brushing data, and the addition of flossing activity tracking. Conclusions: The research highlights ROBAS's promise as a digital platform for unobtrusively tracking daily oral self-care activities in marginalized communities. The system proved to be both feasible, as evidenced by its stable and accurate data capture of brushing behaviors, and user-friendly, as reflected by strong SUS scores and positive user feedback. Influential factors for its uptake included ease of learning and operation, and the feedback provided. %M 39094107 %R 10.2196/54999 %U https://formative.jmir.org/2024/1/e54999 %U https://doi.org/10.2196/54999 %U http://www.ncbi.nlm.nih.gov/pubmed/39094107 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55759 %T The Double-Edged Sword of Online Learning for Ethnoracial Differences in Adolescent Mental Health During Late Period of the COVID-19 Pandemic in the United States: National Survey %A Campos-Castillo,Celeste %A Tamla Rai,Vijaya %A Laestadius,Linnea I %+ Department of Media and Information, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48823, United States, 1 5174325912, camposca@msu.edu %K mental health %K school modality %K race and ethnicity %K confidants %K sleep %K equity %K remote learning %K virtual learning %K racial justice %K anxiety %K depression %K depressive %K student %K students %K school %K schools %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K race %K racial %K eLearning %K online learning %K education %K equality %K inequality %K inequity %K disparity %K disparities %K teaching %K ethnic %K ethnicities %D 2024 %7 5.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts. Objective: This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health. Methods: We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model. Results: Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component (β=–.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety (β=–.121; P=.01) and depression (β=–.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts (β=–.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety (β=.601; P<.001) and depression (β=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant. Conclusions: The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic’s impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports. %M 39102274 %R 10.2196/55759 %U https://formative.jmir.org/2024/1/e55759 %U https://doi.org/10.2196/55759 %U http://www.ncbi.nlm.nih.gov/pubmed/39102274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59434 %T Use of Generative AI for Improving Health Literacy in Reproductive Health: Case Study %A Burns,Christina %A Bakaj,Angela %A Berishaj,Amonda %A Hristidis,Vagelis %A Deak,Pamela %A Equils,Ozlem %+ MiOra, 17328 Ventura Boulevard Number 190, Encino, CA, 91316, United States, 1 3105954094, oequils@yahoo.com %K ChatGPT %K chatGPT %K chat-GPT %K chatbots %K chat-bot %K chat-bots %K artificial intelligence %K AI %K machine learning %K ML %K large language model %K large language models %K LLM %K LLMs %K natural language processing %K NLP %K deep learning %K chatbot %K Google Search %K internet %K communication %K English proficiency %K readability %K health literacy %K health information %K health education %K health related questions %K health information seeking %K health access %K reproductive health %K oral contraceptive %K birth control %K emergency contraceptive %K comparison %K clinical %K patients %D 2024 %7 6.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients find technology tools to be more approachable for seeking sensitive health-related information, such as reproductive health information. The inventive conversational ability of artificial intelligence (AI) chatbots, such as ChatGPT (OpenAI Inc), offers a potential means for patients to effectively locate answers to their health-related questions digitally. Objective: A pilot study was conducted to compare the novel ChatGPT with the existing Google Search technology for their ability to offer accurate, effective, and current information regarding proceeding action after missing a dose of oral contraceptive pill. Methods: A sequence of 11 questions, mimicking a patient inquiring about the action to take after missing a dose of an oral contraceptive pill, were input into ChatGPT as a cascade, given the conversational ability of ChatGPT. The questions were input into 4 different ChatGPT accounts, with the account holders being of various demographics, to evaluate potential differences and biases in the responses given to different account holders. The leading question, “what should I do if I missed a day of my oral contraception birth control?” alone was then input into Google Search, given its nonconversational nature. The results from the ChatGPT questions and the Google Search results for the leading question were evaluated on their readability, accuracy, and effective delivery of information. Results: The ChatGPT results were determined to be at an overall higher-grade reading level, with a longer reading duration, less accurate, less current, and with a less effective delivery of information. In contrast, the Google Search resulting answer box and snippets were at a lower-grade reading level, shorter reading duration, more current, able to reference the origin of the information (transparent), and provided the information in various formats in addition to text. Conclusions: ChatGPT has room for improvement in accuracy, transparency, recency, and reliability before it can equitably be implemented into health care information delivery and provide the potential benefits it poses. However, AI may be used as a tool for providers to educate their patients in preferred, creative, and efficient ways, such as using AI to generate accessible short educational videos from health care provider-vetted information. Larger studies representing a diverse group of users are needed. %M 38986153 %R 10.2196/59434 %U https://formative.jmir.org/2024/1/e59434 %U https://doi.org/10.2196/59434 %U http://www.ncbi.nlm.nih.gov/pubmed/38986153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55650 %T Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study %A Idalski Carcone,April %A Holtz,Bree E %A Reardon,Madeleine %A Vesey,Dariane %A Ellis,Deborah A %A Parks,Michael %+ Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, 3128 Integrative Biosciences Bldg, 6135 Woodward, Detroit, MI, 48202, United States, 1 3135771057, acarcone@med.wayne.edu %K emerging adults %K type 1 diabetes %K intervention %K qualitative %K mHealth %K mobile phone %K smartphone %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. Objective: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. Methods: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs’ experiences living in a rural community with T1D and discussed EAs’ impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. Results: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (“everyone knows”) and community members’ lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. Conclusions: mHealth interventions aligned with EAs’ needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. Trial Registration: N/A, not a clinical trial %M 39110496 %R 10.2196/55650 %U https://formative.jmir.org/2024/1/e55650 %U https://doi.org/10.2196/55650 %U http://www.ncbi.nlm.nih.gov/pubmed/39110496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46823 %T Using Discrete-Event Simulation to Model Web-Based Crisis Counseling Service Operation: Evaluation Study %A Chiang,Byron %A Law,Yik Wa %A Yip,Paul Siu Fai %+ Centre of Suicide Research and Prevention, University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Rd, Pokfulam, Hong Kong, China (Hong Kong), 852 2831 5232, sfpyip@hku.hk %K discrete-event simulation %K community operational research %K queuing %K web-based counseling %K service management %K repeat users %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the Organisation for Economic Co-operation and Development, its member states experienced worsening mental health during the COVID-19 pandemic, leading to an increase of 60% to 1000% in digital counseling access. Hong Kong, too, witnessed a surge in demand for crisis intervention services during the pandemic, attracting both nonrepeat and repeat service users during the process. As a result of the continuing demand, platforms offering short-term emotional support are facing an efficiency challenge in managing caller responses. Objective: This aim of this paper was to assess the queuing performance of a 24-hour text-based web-based crisis counseling platform using a Python-based discrete-event simulation (DES) model. The model evaluates the staff combinations needed to meet demand and informs service priority decisions. It is able to account for unbalanced and overlapping shifts, unequal simultaneous serving capacities among custom worker types, time-dependent user arrivals, and the influence of user type (nonrepeat users vs repeat users) and suicide risk on service durations. Methods: Use and queue statistics by user type and staffing conditions were tabulated from past counseling platform database records. After calculating the data distributions, key parameters were incorporated into the DES model to determine the supply-demand equilibrium and identify potential service bottlenecks. An unobserved-components time-series model was fitted to make 30-day forecasts of the arrival rate, with the results piped back to the DES model to estimate the number of workers needed to staff each work shift, as well as the number of repeat service users encountered during a service operation. Results: The results showed a marked increase (from 3401/9202, 36.96% to 5042/9199, 54.81%) in the overall conversion rate after the strategic deployment of human resources according to the values set in the simulations, with an 85% chance of queuing users receiving counseling service within 10 minutes and releasing an extra 39.57% (3631/9175) capacity to serve nonrepeat users at potential risk. Conclusions: By exploiting scientifically informed data models with DES, nonprofit web-based counseling platforms, even those with limited resources, can optimize service capacity strategically to manage service bottlenecks and increase service uptake. %M 39110974 %R 10.2196/46823 %U https://formative.jmir.org/2024/1/e46823 %U https://doi.org/10.2196/46823 %U http://www.ncbi.nlm.nih.gov/pubmed/39110974 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46800 %T Assessing ChatGPT’s Capability for Multiple Choice Questions Using RaschOnline: Observational Study %A Chow,Julie Chi %A Cheng,Teng Yun %A Chien,Tsair-Wei %A Chou,Willy %+ Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, No. 901, Chung Hwa Road, Yung Kung District, Tainan, 710, Taiwan, 886 937399106, smilewilly@mail.chimei.org.tw %K RaschOnline %K ChatGPT %K multiple choice questions %K differential item functioning %K Wright map %K KIDMAP %K website tool %K evaluation tool %K tool %K application %K artificial intelligence %K scoring %K testing %K college %K students %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: ChatGPT (OpenAI), a state-of-the-art large language model, has exhibited remarkable performance in various specialized applications. Despite the growing popularity and efficacy of artificial intelligence, there is a scarcity of studies that assess ChatGPT’s competence in addressing multiple-choice questions (MCQs) using KIDMAP of Rasch analysis—a website tool used to evaluate ChatGPT’s performance in MCQ answering. Objective: This study aims to (1) showcase the utility of the website (Rasch analysis, specifically RaschOnline), and (2) determine the grade achieved by ChatGPT when compared to a normal sample. Methods: The capability of ChatGPT was evaluated using 10 items from the English tests conducted for Taiwan college entrance examinations in 2023. Under a Rasch model, 300 simulated students with normal distributions were simulated to compete with ChatGPT’s responses. RaschOnline was used to generate 5 visual presentations, including item difficulties, differential item functioning, item characteristic curve, Wright map, and KIDMAP, to address the research objectives. Results: The findings revealed the following: (1) the difficulty of the 10 items increased in a monotonous pattern from easier to harder, represented by logits (–2.43, –1.78, –1.48, –0.64, –0.1, 0.33, 0.59, 1.34, 1.7, and 2.47); (2) evidence of differential item functioning was observed between gender groups for item 5 (P=.04); (3) item 5 displayed a good fit to the Rasch model (P=.61); (4) all items demonstrated a satisfactory fit to the Rasch model, indicated by Infit mean square errors below the threshold of 1.5; (5) no significant difference was found in the measures obtained between gender groups (P=.83); (6) a significant difference was observed among ability grades (P<.001); and (7) ChatGPT’s capability was graded as A, surpassing grades B to E. Conclusions: By using RaschOnline, this study provides evidence that ChatGPT possesses the ability to achieve a grade A when compared to a normal sample. It exhibits excellent proficiency in answering MCQs from the English tests conducted in 2023 for the Taiwan college entrance examinations. %M 39115919 %R 10.2196/46800 %U https://formative.jmir.org/2024/1/e46800 %U https://doi.org/10.2196/46800 %U http://www.ncbi.nlm.nih.gov/pubmed/39115919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53508 %T Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study %A Bilal,Ayesha-Mae %A Pagoni,Konstantina %A Iliadis,Stavros I %A Papadopoulos,Fotios C %A Skalkidou,Alkistis %A Öster,Caisa %+ Department of Medical Sciences, Psychiatry, Uppsala University, Academic Hospital, Entrance 10, Floor 4, Uppsala, 751 85, Sweden, 46 737240915, ayesha.bilal@uu.se %K digital phenotyping %K smartphone app %K mHealth %K mobile health %K qualitative study %K user experience %K usability %K perinatal depression %K depression %K app %K user %K users %K qualitative %K perinatal %K mobile app %K clinical research %K acceptability %K behavioral data %K depressive symptoms %K interview %K pregnant %K postpartum %K women %K thematic analysis %K well-being %K monitor %K mobile phone %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area. %M 39115893 %R 10.2196/53508 %U https://formative.jmir.org/2024/1/e53508 %U https://doi.org/10.2196/53508 %U http://www.ncbi.nlm.nih.gov/pubmed/39115893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57038 %T Characterization of Psychopathology in Latin American Adolescents Using a Web-Based Screening Tool: Cross-Sectional Study %A Campos,Susana %A Nuñez,Daniel %A Pérez,J Carola %A Robinson,Jo %+ Center of Cognitive Sciences, Faculty of Psychology, University of Talca, Avenida Lircay s/n, Talca, 3460000, Chile, 56 712201782, dnunez@utalca.cl %K web-based screening %K adolescents %K psychopathology %K suicidal ideation %K early detection %K detection %K screening %K teens %K youths %K suicide %K mental health %K screening tool %K Latin American %K Latino %K psychiatric %K psychiatric symptoms %K psychological risk %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health–related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. Objective: The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. Methods: A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar χ2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. Results: Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles—one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. Conclusions: WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions. %M 39116425 %R 10.2196/57038 %U https://formative.jmir.org/2024/1/e57038 %U https://doi.org/10.2196/57038 %U http://www.ncbi.nlm.nih.gov/pubmed/39116425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52428 %T Feasibility and Acceptability of a Mobile Health Exercise Intervention for Inactive Adults: 3-Arm Randomized Controlled Pilot Trial %A Dawson,Jacqueline Kiwata %A Ede,Alison %A Phan,Madeleine %A Sequeira,Alec %A Teng,Hsiang-Ling %A Donlin,Ayla %+ Department of Physical Therapy, California State University, Long Beach, ET-130, 1250 Bellflower Boulevard, Long Beach, CA, 90840, United States, 1 5629857139, jacqueline.dawson@csulb.edu %K digital health %K physical activity %K user experience %K heart rate monitor %K group exercise %K mHealth %K wearable %K group exercise %K feasibility %K acceptability %K mobile health %K mobile health exercise %K exercise %K adults %K randomized controlled trial %K exercise program %K support %K wearables %K screening %K effectiveness %K videoconference %D 2024 %7 9.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Objective monitoring of self-directed physical activity (PA) is a common approach used in both fitness and health settings to promote exercise behavior, but adherence has been poor. Newer mobile health (mHealth) technologies could be a cost-effective approach to broadening accessibility and providing support for PA behavior change; yet, the optimal method of delivery of such interventions is still unclear. Objective: This study aimed to determine the feasibility and acceptability of an mHealth exercise intervention delivered in combination with objective monitoring in 3 ways: health education emails, asynchronous exercise videos, or synchronous videoconference exercise classes. Methods: Physically inactive (<30 min/wk) adults (cisgender women aged 31.5, SD 11.3 years, cisgender men aged 34.1, SD 28.9 years, and nonbinary individuals aged 22.0, SD 0 years) were randomized (1:1:1) to 8 weeks of increasing PA behavioral support: level 1 (health education+objective monitoring, n=26), level 2 (asynchronous contact, level 1+prerecorded exercise videos, n=30), or level 3 (synchronous contact, level 1+videoconference group exercise, n=28). Participants used a heart rate monitor during exercise and a mobile app for interaction. Primary outcomes were feasibility (accrual, retention, and adherence) and acceptability (user experience survey). Secondary outcomes assessed at baseline and 8 weeks included resting heart rate, self-reported PA, and quality of life. The exercise dose was evaluated throughout the intervention. Results: Between August 2020 and August 2021, 204 adults were screened for eligibility. Out of 135 eligible participants, 84 (62%) enrolled in the study. Retention was 50% (13/26) in level 1, 60% (18/30) in level 2 and 82% (23/28) in level 3, while adherence was 31% (8/26) in level 1, 40% (12/30) in level 2 and 75% (21/28) in level 3. A total of 83% (70/84) of the study sample completed the intervention, but low response rates (64%, 54/84) were observed postintervention at week-8 assessments. Program satisfaction was highest in participants receiving exercise videos (level 2, 80%, 8/10) or exercise classes (level 3, 80%, 12/15), while only 63% (5/8) of level 1 reported the program as enjoyable. Level 3 was most likely to recommend the program (87%, 13/15), compared to 80% (8/10) in level 2 and 46% (5/8) in level 1. Self-reported PA significantly increased from baseline to intervention in level 3 (P<.001) and level 2 (P=.003), with no change in level 1. Level 3 appeared to exercise at higher doses throughout the intervention. Conclusions: Only the videoconference exercise class intervention met feasibility criteria, although postintervention response rates were low across all groups. Both videoconference and prerecorded videos had good acceptability, while objective monitoring and health education alone were not feasible or acceptable. Future studies are needed to examine the effectiveness of videoconference exercise interventions on health-related outcomes during nonpandemic times and how asynchronous interventions might maximize adherence. Trial Registration: ClinicalTrials.gov NCT05192421; https://clinicaltrials.gov/study/NCT05192421 %R 10.2196/52428 %U https://formative.jmir.org/2024/1/e52428 %U https://doi.org/10.2196/52428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52884 %T Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method %A Maar,Marion %A Bourdon,Caleigh %A Berti,Joahnna %A Bisaillon,Emma %A Boesch,Lisa %A Boston,Alicia %A Chapdelaine,Justin %A Humphrey,Alison %A Kumar,Sandeep %A Maar-Jackson,Benjamin %A Martell,Robert %A Naokwegijig,Bruce %A Preet Kaur,Davinder %A Rice,Sarah %A Rickaby,Barbara %A Sutherland,Mariette %A Reade,Maurianne %+ Human Sciences Division, Northern Ontario School of Medicine (NOSM) University, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada, 1 705 662 7233, mmaar@nosm.ca %K ATKC consensus method %K community-based participatory research %K COVID-19 vaccines %K cultural competency %K electronic survey development %K Indigenous Peoples %K vaccine confidence %K vaccine hesitancy %K youth %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants’ vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey. Objective:  To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants. Methods:  Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items. Results:  The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants’ connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth. Conclusions:  Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities. %M 39133917 %R 10.2196/52884 %U https://formative.jmir.org/2024/1/e52884 %U https://doi.org/10.2196/52884 %U http://www.ncbi.nlm.nih.gov/pubmed/39133917 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54819 %T Charting Health Challenges for Digital Preventive Interventions Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: National Long-Term Follow-Up Survey of Self-Rated Health Outcomes %A Nygren,Jens M %A Aili,Katarina %A Arvidsson,Susann %A Olsson,Maria %A Jarfelt,Marianne %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K digital preventive interventions %K long-term follow-up %K self-rated health outcomes %K adult survivors %K childhood acute lymphoblastic leukemia %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood, but the prognosis has remarkably improved over the last 50 years in high-income countries, and thus, there is a focus on long-term health outcomes following survival and how to best provide health care support to adult long-term survivors of childhood ALL to prevent and handle potential health problems. Digital health interventions are promising to deliver feasible health promotion and prevention programs. This is particularly relevant for ensuring long-term follow-up in cases where continuous contact with oncology care may be disrupted. Moreover, these interventions are beneficial in reaching geographically dispersed target groups and overcoming the time constraints of everyday life that often hinder participation in such programs. Objective: This study aimed to fill the gaps in existing research on adult long-term survivors of childhood ALL and provide formative data that can inform the development of formalized follow-up services designed to meet the needs of these survivors in ways that align with their preferences for digital health interventions. Methods: In this cross-sectional national study, adult survivors (aged ≥18 years) of childhood ALL for over 10 years after diagnosis were compared to their siblings in terms of mental and physical health-related factors, including sleep, stress, anxiety, and depression (Depression Anxiety and Stress Scale 21 [DASS-21]); several dimensions of fatigue (Multidimensional Fatigue Inventory 20 [MFI-20]); work ability (Work Ability Index); chronic pain; and prevalences of diabetes, cardiovascular disease, headache or migraine, and rheumatic disease. Results: Overall, 426 of 855 eligible ALL survivors responded (mean age 30.9, SD 7.7 years), and they participated at an average of 24 (SD 6.9) years after ALL diagnosis. Siblings (n=135; mean age 31.5, SD 7.7 years) acted as controls. Sleep quality, sleep quantity, and mean work ability scores were significantly lower, and physical fatigue, reduced motivation, and reduced activity scores were higher in ALL survivors than in siblings. There were no significant differences between the groups in terms of BMI and prevalence of chronic pain, depression, anxiety, or stress. Physical and psychological complications were more frequent among adult ALL survivors who had received hematopoietic stem cell transplantation (HSCT) than among those who had not received HSCT. Conclusions: Our nationwide cross-sectional study addressed the scarcity of knowledge regarding the self-reported health outcomes of adult long-term survivors of childhood ALL. We highlighted significant disparities within this population and emphasized the potential of comprehensive digital interventions that target vitality, sleep quality, fatigue, and psychosocial well-being to enhance well-being and bolster the capacity for managing chronic health conditions in this target group. Such an intervention would align with the needs of this target group, which is a prerequisite for successfully incorporating technology into the daily lives of survivors of childhood ALL. %M 39133918 %R 10.2196/54819 %U https://formative.jmir.org/2024/1/e54819 %U https://doi.org/10.2196/54819 %U http://www.ncbi.nlm.nih.gov/pubmed/39133918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e39554 %T Exploring the Impact of a Sleep App on Sleep Quality in a General Population Sample: Pilot Randomized Controlled Trial %A Armitage,Bianca Tanya %A Potts,Henry W W %A Irwin,Michael R %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 020 7679 1722, abigail.fisher@ucl.ac.uk %K sleep %K mobile app %K app optimization %K intervention %K smartphone %K general population %K mindfulness %K cognitive behavioral therapy %K CBT %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A third of adults in Western countries have impaired sleep quality. A possible solution involves distributing sleep aids through smartphone apps, but most empirical studies are limited to small pilot trials in distinct populations (eg, soldiers) or individuals with clinical sleep disorders; therefore, general population data are required. Furthermore, recent research shows that sleep app users desire a personalized approach, offering an individually tailored choice of techniques. One such aid is Peak Sleep, a smartphone app based on scientifically validated principles for improving sleep quality, such as mindfulness meditation and cognitive behavioral therapy. Objective: We aimed to test the impact of the smartphone app Peak Sleep on sleep quality and collect user experience data to allow for future app development. Methods: This was a 2-arm pilot randomized controlled trial. Participants were general population adults in the United Kingdom (aged ≥18 years) who were interested in improving their sleep quality and were not undergoing clinical treatment for sleep disorder or using sleep medication ≥1 per week. Participants were individually randomized to receive the intervention (3 months of app use) versus a no-treatment control. The intervention involved free access to Peak Sleep, an app that offered a choice of behavioral techniques to support better sleep (mindfulness, cognitive behavioral therapy, and acceptance commitment therapy). The primary outcome was sleep quality assessed using the Insomnia Severity Index at baseline and 1-, 2-, and 3-month follow-ups. Assessments were remote using web-based questionnaires. Objective sleep data collection using the Oura Ring (Ōura Health Oy) was planned; however, because the COVID-19 pandemic lockdowns began just after recruitment started, this plan could not be realized. Participant engagement with the app was assessed using the Digital Behavior Change Intervention Engagement Scale and qualitative telephone interviews with a subsample. Results: A total of 101 participants were enrolled in the trial, and 21 (21%) were qualitatively interviewed. Sleep quality improved in both groups over time, with Insomnia Severity Index scores of the intervention group improving by a mean of 2.5 and the control group by a mean of 1.6 (between-group mean difference 0.9, 95% CI –2.0 to 3.8), with was no significant effect of group (P=.91). App users’ engagement was mixed, with qualitative interviews supporting the view of a polarized sample who either strongly liked or disliked the app. Conclusions: In this trial, self-reported sleep improved over time in both intervention and control arms, with no impact by group, suggesting no effect of the sleep app. Qualitative data suggested polarized views on liking or not liking the app, features that people engaged with, and areas for improvement. Future work could involve developing the app features and then testing the app using objective measures of sleep in a larger sample. Trial Registration: ClinicalTrials.gov NCT04487483; https://www.clinicaltrials.gov/study/NCT04487483 %M 39137016 %R 10.2196/39554 %U https://formative.jmir.org/2024/1/e39554 %U https://doi.org/10.2196/39554 %U http://www.ncbi.nlm.nih.gov/pubmed/39137016 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56250 %T Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study %A Gautam,Kamal %A Shrestha,Roman %A Dlamini,Sihlelelwe %A Razali,Belle %A Paudel,Kiran %A Azwa,Iskandar %A Saifi,Rumana %A Toh,YuHang %A Justin Lim,Hazriq %A Sutherland,Ryan %A Restar,Arjee %A Phanuphak,Nittaya %A Wickersham,Jeffrey A %+ Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, United States, 1 2037374158, jeffrey.wickersham@yale.edu %K HIV %K AIDS %K pre-exposure prophylaxis %K PrEP %K mobile health %K mHealth %K transgender women %K Malaysia %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women’s needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women’s uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62%) and 2 FG sessions with stakeholders (n=11, 38%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app’s features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. %M 39137407 %R 10.2196/56250 %U https://formative.jmir.org/2024/1/e56250 %U https://doi.org/10.2196/56250 %U http://www.ncbi.nlm.nih.gov/pubmed/39137407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58653 %T A Chatbot (Juno) Prototype to Deploy a Behavioral Activation Intervention to Pregnant Women: Qualitative Evaluation Using a Multiple Case Study %A Mancinelli,Elisa %A Magnolini,Simone %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K chatbot prototype %K co-design %K pregnancy %K prevention %K behavioral activation %K multiple case study %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increasing focus on perinatal care, preventive digital interventions are still scarce. Furthermore, the literature suggests that the design and development of these interventions are mainly conducted through a top-down approach that limitedly accounts for direct end user perspectives. Objective: Building from a previous co-design study, this study aimed to qualitatively evaluate pregnant women’s experiences with a chatbot (Juno) prototype designed to deploy a preventive behavioral activation intervention. Methods: Using a multiple–case study design, the research aims to uncover similarities and differences in participants’ perceptions of the chatbot while also exploring women’s desires for improvement and technological advancements in chatbot-based interventions in perinatal mental health. Five pregnant women interacted weekly with the chatbot, operationalized in Telegram, following a 6-week intervention. Self-report questionnaires were administered at baseline and postintervention time points. About 10-14 days after concluding interactions with Juno, women participated in a semistructured interview focused on (1) their personal experience with Juno, (2) user experience and user engagement, and (3) their opinions on future technological advancements. Interview transcripts, comprising 15 questions, were qualitatively evaluated and compared. Finally, a text-mining analysis of transcripts was performed. Results: Similarities and differences have emerged regarding women’s experiences with Juno, appreciating its esthetic but highlighting technical issues and desiring clearer guidance. They found the content useful and pertinent to pregnancy but differed on when they deemed it most helpful. Women expressed interest in receiving increasingly personalized responses and in future integration with existing health care systems for better support. Accordingly, they generally viewed Juno as an effective momentary support but emphasized the need for human interaction in mental health care, particularly if increasingly personalized. Further concerns included overreliance on chatbots when seeking psychological support and the importance of clearly educating users on the chatbot’s limitations. Conclusions: Overall, the results highlighted both the positive aspects and the shortcomings of the chatbot-based intervention, providing insight into its refinement and future developments. However, women stressed the need to balance technological support with human interactions, particularly when the intervention involves beyond preventive mental health context, to favor a greater and more reliable monitoring. %M 39140593 %R 10.2196/58653 %U https://formative.jmir.org/2024/1/e58653 %U https://doi.org/10.2196/58653 %U http://www.ncbi.nlm.nih.gov/pubmed/39140593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56043 %T Leveraging Feedback From Families of Children With Autism to Create Digital Support for Service Navigation: Descriptive Study %A Burke,Meghan %A Li,Chak %A Cheung,Waifong Catherine %A Terol,Adriana Kaori %A Johnston,Amanda %A Schueller,Stephen M %+ Department of Special Education, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, United States, 1 6155851420, meghan.burke@vanderbilt.edu %K human-centered design %K autism %K service access %K families %K digital support %K autistic children %K autistic %K children %K child %K app %K apps %K application %K applications %K digital tool %K tool %K tools %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It is difficult for families to navigate and access services for their children with autism. Barriers to service access are compounded among families from low-resourced backgrounds. Objective: The purpose of our study was to explore the development of an app to facilitate access to services among families of children with autism from low-resourced backgrounds. Our specific aims were to explore feedback from an advisory board about the app and to explore feedback from navigators about the app. Methods: Via a multistage codevelopment process, we elicited feedback from 5 key parties: the research team, a community organization, the app development team, the advisory board, and family navigators. Collectively, 36 individuals provided feedback about the development of the app via individual interviews, focus groups, observations, and surveys. The key features of the app included a dashboard showing the service needs of the family and related resources, a messaging feature between the family, the navigator, and the supervisor, and a fidelity checklist and evaluation feature. Results: The advisory board provided feedback about the app to increase its user-friendliness, include the ability to develop an action plan, improve the identification of needed services, and add information about service providers. Navigators suggested that the app should connect navigators to one another, have a clearer purpose for the notes section, and reflect an easier log-in process. Navigators also wanted training to role-play using the app. After participating in a role play using the app, navigators reported significantly more satisfaction with the app and greater usefulness (P<.001). Conclusions: Our work sheds light on the importance of eliciting feedback from end users, especially users who are often overlooked by the research community and app developers. Further, it is important to elicit feedback in multiple ways to improve the app. %M 39141412 %R 10.2196/56043 %U https://formative.jmir.org/2024/1/e56043 %U https://doi.org/10.2196/56043 %U http://www.ncbi.nlm.nih.gov/pubmed/39141412 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56189 %T The Internet-Based Intervention Strategies for Empowering Activities in Everyday Life: Qualitative Study of Experiences of Clients With Stroke %A Barcheus,Ida-Maria %A Ranner,Maria %A Månsson Lexell,Eva %A Jacobsson,Lars %A Larsson-Lund,Maria %+ Division of Health, Medicine and Rehabilitation-Occupational Therapy, Department of Health, Education and Technology, Luleå University of Technology, Luleå tekniska universitet, Luleå, 97187, Sweden, 46 0733379375, ida.maria.barcheus@ltu.se %K internet-based rehabilitation %K occupational therapy intervention %K rehabilitation %K self-management %K stroke %K active everyday life %K activity-based intervention %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need to enhance access to and support for self-management of activities in everyday life after a stroke. Internet-based solutions have the potential to contribute to this development. Consequently, an internet-based intervention called Strategies for Empowering Activities in Everyday Life (SEE) was developed. The intervention aims to assist clients in developing management strategies that promote a healthy distribution and balanced engagement in various activities performed in different places and with other people. To further support the development and feasibility of this intervention, more knowledge is needed about clients’ experiences during the intervention process. Objective: This study aims to explore and describe how clients with stroke experienced the SEE intervention process and whether participation in SEE influenced their experience of everyday life. Methods: Overall, 9 clients with stroke who received SEE participated in the study—4 (44%) women and 5 (56%) men aged 37 to 73 years. Qualitative interviews about experiences with SEE were conducted twice during the intervention process with each participant. The data were analyzed using the constant comparative method of grounded theory. Results: The participants’ experiences with the intervention process of SEE formed the core category, conceptualized as The relevance of and readiness for entering a change process in activities of everyday life differ among clients, constituting of two main categories: (1) an eye-opener providing agency for a change process and (2) never beginning a change process in activities in everyday life. The results showed that the relevance of and readiness for SEE differed between the participants. The experiences of 78% (7/9) of the participants reflected that the intervention process provided them with an agency to drive their own change process for activities in everyday life to promote health. Overall, 22% (2/9) of the participants refrained from entering a change process during SEE as they did not recognize any need for changes in their activities. When SEE was relevant and adopted as expected, the participants described it as an eye-opener for how they can alter their health based on how they distribute and spend their time on various activities. Conclusions: SEE has the potential to support clients’ development of self-management and to take an active role in influencing their engagement in activities in everyday life and health. This study identified necessary improvements in the educational program for professionals to enhance delivery and strengthen the therapeutic mechanisms of SEE for future research. To effectively implement internet-based interventions such as SEE, it is crucial to identify clients who express a need for self-management in activities and are ready to invest the effort required to adopt a change process. Furthermore, it is indicated that participants’ self-analysis of their everyday activities empowers them to adopt new self-management strategies, which can also benefit other interventions. %M 39146535 %R 10.2196/56189 %U https://formative.jmir.org/2024/1/e56189 %U https://doi.org/10.2196/56189 %U http://www.ncbi.nlm.nih.gov/pubmed/39146535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54816 %T Using a Digital Mental Health Intervention for Crisis Support and Mental Health Care Among Children and Adolescents With Self-Injurious Thoughts and Behaviors: Retrospective Study %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Beam,Aislinn Brenna %A McAlister,Kelsey %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A Huberty,Jennifer %+ Bend Health, Inc, Ste 200, 821 E Washington Ave, Madison, WI, 53703, United States, 1 8005160975, darian.lawrence@bendhealth.com %K suicide %K self-harm %K collaborative care %K behavioral health %K telehealth %K telemedicine %K eHealth %K collaborative %K collaboration %K suicidal %K self-injury %K crisis %K crises %K mental health %K self-injurious %K anxiety %K depression %K pediatric %K pediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K mobile phone %D 2024 %7 16.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. Objective: To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. Methods: This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). Results: Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ21=1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ21=0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t80.20=1.37; P=.28) and depressive (t83.75=–0.08; P=.99) symptoms. Conclusions: This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents. %M 39151166 %R 10.2196/54816 %U https://formative.jmir.org/2024/1/e54816 %U https://doi.org/10.2196/54816 %U http://www.ncbi.nlm.nih.gov/pubmed/39151166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56319 %T Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach %A Franco,Pamela %A Olhaberry,Marcia %A Muzard,Antonia %A Harismendy,Ángeles %A Kelders,Saskia %+ Centre for eHealth & Well-being Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0 534899180, s.m.kelders@utwente.nl %K internet-based intervention %K postpartum depression %K user-centered development %K perinatal mental health %K user-centered design %K mobile phone %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders’ openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype’s final version. The resulting intervention, named Mamá, te entiendo (“Mom, I get you”), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. %M 39159447 %R 10.2196/56319 %U https://formative.jmir.org/2024/1/e56319 %U https://doi.org/10.2196/56319 %U http://www.ncbi.nlm.nih.gov/pubmed/39159447 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49589 %T Effect of the Implementation of a Multiple-Behavior Self-Monitoring Intervention on Dietary Intake in Type 2 Diabetes: Secondary Data Analysis %A Ko,Jisook %A Wang,Jing %A Mbue,Ngozi %A Schembre,Susan %A Cron,Stanley %+ Florida State University, 98 Varsity Way, Tallahassee, FL, FL32306, United States, 1 850 644 3299, jingwang@nursing.fsu.edu %K electronic diary %K technology-assisted self-monitoring %K multiple-behavior intervention %K type 2 diabetes %K diabetes %K self-monitoring %K monitoring %K dietary intake %K monitor %K carbohydrate intake %K calories %K education %K diabetic %K e-diary %K e diary %K self-care %D 2024 %7 20.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An electronic diary embedded in a mobile device to monitor lifestyle can be as effective as traditional methods. However, the efficacy of self-monitoring multiple behaviors for dietary intake has not been well studied in people with diabetes. Objective: This study aimed to compare the effect of using technology-assisted self-monitoring versus paper diaries on changes in dietary intake. Methods: This is a secondary analysis of data collected from 39 people with type 2 diabetes as part of a 3-month pilot clinical trial. Changes in energy intake and the contribution of total fat intake and total carbohydrate intake to total calories (%) from baseline to after intervention (3 months) were evaluated. Results: In total, 26 (67%) of the 39 participants preferred mobile diaries over paper diaries. Participants in the mobile diary group showed slightly higher self-monitoring adherence. Linear mixed modeling results indicated a significant overall decrease in total energy intake (P=.005), dietary fat intake (P=.01), and carbohydrate intake (P=.08) from baseline to 3 months. No significant group differences were detected (P>.05). Conclusions: The implementation of a 3-month, multiple-behavior, self-monitoring intervention in Diabetes Self-Management Education programs has resulted in successful reduction in dietary intake (energy, fat, and carbohydrate), whichever self-monitoring method is chosen by participants according to their preferences. Long-term studies are needed to confirm our findings on dietary intake and examine other behavioral and disease outcomes that require monitoring. %M 39163595 %R 10.2196/49589 %U https://formative.jmir.org/2024/1/e49589 %U https://doi.org/10.2196/49589 %U http://www.ncbi.nlm.nih.gov/pubmed/39163595 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55641 %T Comparing the Output of an Artificial Intelligence Algorithm in Detecting Radiological Signs of Pulmonary Tuberculosis in Digital Chest X-Rays and Their Smartphone-Captured Photos of X-Ray Films: Retrospective Study %A Ridhi,Smriti %A Robert,Dennis %A Soren,Pitamber %A Kumar,Manish %A Pawar,Saniya %A Reddy,Bhargava %+ Qure.ai, 2nd floor, Prestige Summit, Halasuru, Bangalore, 560042, India, 91 9611981003, dennis.robert.nm@gmail.com %K artificial intelligence %K AI %K deep learning %K early detection %K tuberculosis %K TB %K computer-aided detection %K diagnostic accuracy %K chest x-ray %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) based computer-aided detection devices are recommended for screening and triaging of pulmonary tuberculosis (TB) using digital chest x-ray (CXR) images (soft copies). Most AI algorithms are trained using input data from digital CXR Digital Imaging and Communications in Medicine (DICOM) files. There can be scenarios when only digital CXR films (hard copies) are available for interpretation. A smartphone-captured photo of the digital CXR film may be used for AI to process in such a scenario. There is a gap in the literature investigating if there is a significant difference in the performance of AI algorithms when digital CXR DICOM files are used as input for AI to process as opposed to photos of the digital CXR films being used as input. Objective: The primary objective was to compare the agreement of AI in detecting radiological signs of TB when using DICOM files (denoted as CXRd) as input versus when using smartphone-captured photos of digital CXR films (denoted as CXRp) with human readers. Methods: Pairs of CXRd and CXRp images were obtained retrospectively from patients screened for TB. AI results were obtained using both the CXRd and CXRp files. The majority consensus on the presence or absence of TB in CXR pairs was obtained from a panel of 3 independent radiologists. The positive and negative percent agreement of AI in detecting radiological signs of TB in CXRd and CXRp were estimated by comparing with the majority consensus. The distribution of AI probability scores was also compared. Results: A total of 1278 CXR pairs were analyzed. The positive percent agreement of AI was found to be 92.22% (95% CI 89.94-94.12) and 90.75% (95% CI 88.32-92.82), respectively, for CXRd and CXRp images (P=.09). The negative percent agreement of AI was 82.08% (95% CI 78.76-85.07) and 79.23% (95% CI 75.75-82.42), respectively, for CXRd and CXRp images (P=.06). The median of the AI probability score was 0.72 (IQR 0.11-0.97) in CXRd and 0.72 (IQR 0.14-0.96) in CXRp images (P=.75). Conclusions: We did not observe any statistically significant differences in the output of AI in digital CXRs and photos of digital CXR films. %M 39167435 %R 10.2196/55641 %U https://formative.jmir.org/2024/1/e55641 %U https://doi.org/10.2196/55641 %U http://www.ncbi.nlm.nih.gov/pubmed/39167435 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54097 %T Machine Learning Model for Anesthetic Risk Stratification for Gynecologic and Obstetric Patients: Cross-Sectional Study Outlining a Novel Approach for Early Detection %A Tsai,Feng-Fang %A Chang,Yung-Chun %A Chiu,Yu-Wen %A Sheu,Bor-Ching %A Hsu,Min-Huei %A Yeh,Huei-Ming %+ Department of Anesthesiology, National Taiwan University Hospital, No 7, Chung Shan South Road (Zhongshan South Road), Zhongzheng District, Taipei, 100225, Taiwan, 886 223123456 ext 2662158, y.y.hhmm@hotmail.com %K gradient boosting machine %K comorbidity %K gynecological and obstetric procedure %K ASA classification %K American Society of Anesthesiologists %K preoperative evaluation %K machine learning %K machine learning model %K gynecology %K obstetrics %K early detection %K artificial intelligence %K physiological %K gestational %K anesthetic risk %K clinical laboratory data %K laboratory data %K risk %K risk classification %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Preoperative evaluation is important, and this study explored the application of machine learning methods for anesthetic risk classification and the evaluation of the contributions of various factors. To minimize the effects of confounding variables during model training, we used a homogenous group with similar physiological states and ages undergoing similar pelvic organ–related procedures not involving malignancies. Objective: Data on women of reproductive age (age 20-50 years) who underwent gestational or gynecological surgery between January 1, 2017, and December 31, 2021, were obtained from the National Taiwan University Hospital Integrated Medical Database. Methods: We first performed an exploratory analysis and selected key features. We then performed data preprocessing to acquire relevant features related to preoperative examination. To further enhance predictive performance, we used the log-likelihood ratio algorithm to generate comorbidity patterns. Finally, we input the processed features into the light gradient boosting machine (LightGBM) model for training and subsequent prediction. Results: A total of 10,892 patients were included. Within this data set, 9893 patients were classified as having low anesthetic risk (American Society of Anesthesiologists physical status score of 1-2), and 999 patients were classified as having high anesthetic risk (American Society of Anesthesiologists physical status score of >2). The area under the receiver operating characteristic curve of the proposed model was 0.6831. Conclusions: By combining comorbidity information and clinical laboratory data, our methodology based on the LightGBM model provides more accurate predictions for anesthetic risk classification. Trial Registration: Research Ethics Committee of the National Taiwan University Hospital 202204010RINB; https://www.ntuh.gov.tw/RECO/Index.action %M 38991090 %R 10.2196/54097 %U https://formative.jmir.org/2024/1/e54097 %U https://doi.org/10.2196/54097 %U http://www.ncbi.nlm.nih.gov/pubmed/38991090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59963 %T Development of an mHealth App by Experts for Queer Individuals’ Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study %A Seretlo,Raikane James %A Smuts,Hanlie %A Mokgatle,Mathildah Mpata %+ Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa, Tshwane, 0208, South Africa, 27 012 521 4111, Raikane.seretlo@smu.ac.za %K experts %K mobile health app %K mHealth app %K digital health care %K telemedicine %K digital innovation %K sexual-reproductive health care services and needs %K lesbian, gay, bisexual, transgender, queer, intersex, asexual individuals, and related identities %K LBQTQIA+ %K queer individuals %K nominal group technique %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. Objective: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. Methods: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. Results: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). Conclusions: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions. %M 39167434 %R 10.2196/59963 %U https://formative.jmir.org/2024/1/e59963 %U https://doi.org/10.2196/59963 %U http://www.ncbi.nlm.nih.gov/pubmed/39167434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50580 %T Capturing Patients’ and Clinicians’ Experiences of Using Video Consultations in Mental Health Outpatient Services: Qualitative Thematic Analysis %A Shaker,Ali Abbas %A Simonsen,Erik %A Tarp,Kristine %A Borisov,Radoslav Aleksandrov %A Sørensen,John Aasted %A Bechmann,Henrik %A Austin,Stephen F %+ Psychiatric Research Unit, Fælledvej 6, Bygning 3, 4. sal, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K telemedicine %K telepsychiatry %K video consultation %K mobile health %K mHealth %K COVID-19 %K synchronous technology %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice. Objective: The aim of this study was to investigate patients’ and clinicians’ experiences and attitudes toward using VCs in clinical practice. Methods: Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis. Results: Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians’ experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically. Conclusions: Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients’ and clinicians’ perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions. %M 39167796 %R 10.2196/50580 %U https://formative.jmir.org/2024/1/e50580 %U https://doi.org/10.2196/50580 %U http://www.ncbi.nlm.nih.gov/pubmed/39167796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50128 %T Live Streaming of the Professor’s Ward Rounds in Undergraduate Neurology Education: Usability Study %A Sekiguchi,Kenji %A Kawano,Seiji %A Chihara,Norio %A Satomi-Kobayashi,Seimi %A Maeda,Eiichi %A Matsumoto,Riki %+ Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, 6500017, Japan, 81 783825885, sekiguch@med.kobe-u.ac.jp %K live streaming %K ward round %K web conferencing software %K neurological examination %K undergraduate education %K medical student %K medical education %K rounds %K remote education %K video-conferencing %K residents %K live-stream %K neurology %K neuroscience %K web conferencing %K distance education %K technology enhanced learning %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited from contacting patients altogether during the COVID-19 pandemic. One possible solution is to use commercial videoconferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet. Objective: The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients’ personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning. Methods: We created an on-premises videoconferencing system using an open-source app. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person rounds and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live stream. In total, 112 of 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour in-person and remote rounds. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds. Results: The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The postexperience survey (82/112, 73% response rate) showed that the mean score of participants’ satisfaction was 3.94 (SD 0.83; excellent 5 and poor 1). No participant scoring 1 was noted. The proportion of students who observed 6 representative abnormal neurological findings (Babinski sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 22% (18/82, range 13-24) compared to in-person rounds alone. When self-rating the learning value, 43% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 32% (26/82) preferred remote rounds. Conclusions: Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning before entering a clinical clerkship. %M 39172503 %R 10.2196/50128 %U https://formative.jmir.org/2024/1/e50128 %U https://doi.org/10.2196/50128 %U http://www.ncbi.nlm.nih.gov/pubmed/39172503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56380 %T Exploring the Feasibility and Initial Impact of an mHealth-Based Disease Management Program for Chronic Ischemic Heart Disease: Formative Study %A Miki,Takahiro %A Yamada,Junya %A Ishida,Shinpei %A Sakui,Daisuke %A Kanai,Masashi %A Hagiwara,Yuta %+ PREVENT Inc, 1 Aoi, Higashi-ku, IKKO Shinsakae Building 9F, Aichi, 461-0004, Japan, 81 8092149725, miki.takahiro@prevent.co.jp %K mobile health %K chronic ischemic heart disease %K disease management program %K mobile phone %K behavior change %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, requiring innovative management strategies. Traditional disease management programs often struggle to maintain patient engagement and ensure long-term adherence to lifestyle modifications and treatment plans. Mobile health (mHealth) technologies have emerged as a promising approach to address these challenges by providing continuous, personalized support and monitoring. However, the reported use and effectiveness of mHealth in the management of chronic diseases, such as IHD, have not been fully explored. Objective: The primary aim of this study was to evaluate the feasibility and initial impact of an mHealth-based disease management program on coronary risk factors, specifically focusing on low-density lipoprotein cholesterol (LDL-C) levels, in individuals with chronic IHD. This formative study assessed changes in LDL-C and other metabolic health indicators over a 6-month period to determine the initial impact of the program on promoting cardiovascular health and lifestyle modification. Methods: This study was conducted using data from 266 individuals enrolled in an mHealth-based disease management program between December 2018 and October 2022. Eligibility was based on a documented history of IHD, with participants undergoing a comprehensive cardiac risk assessment before enrollment. The program included biweekly telephone sessions, health tracking via a smartphone app, and regular progress reports to physicians. The study measured change in LDL-C levels as the primary outcome, with secondary outcomes including body weight, triglyceride levels, and other metabolic health indicators. Statistical analysis used paired 2-tailed t tests and stratified analyses to assess the impact of the program. Results: Participants experienced a significant reduction in LDL-C, with LDL-C levels decreasing from a mean of 98.82 (SD 40.92) mg/dL to 86.62 (SD 39.86) mg/dL (P<.001). The intervention was particularly effective in individuals with high baseline LDL-C levels. Additional improvements were seen in body weight and triglyceride levels, suggesting a broader impact on metabolic health. Program adherence and engagement metrics suggested high participant satisfaction and compliance. Conclusions: The results of this study suggest that the mHealth-based disease management program is feasible and has an initial positive impact on reducing LDL-C levels and improving metabolic health in individuals with chronic IHD. However, the study design does not allow for a definitive conclusion regarding whether mHealth-based disease management programs are more effective than traditional face-to-face care. Future studies are needed to further validate these findings and to examine the comparative effectiveness of these interventions in more detail. %M 39173150 %R 10.2196/56380 %U https://formative.jmir.org/2024/1/e56380 %U https://doi.org/10.2196/56380 %U http://www.ncbi.nlm.nih.gov/pubmed/39173150 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58121 %T Beta Test of a Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FaithCore): Development and Usability Study %A Sharma,Pravesh %A Tranby,Brianna %A Kamath,Celia %A Brockman,Tabetha A %A Lenhart,Ned %A Quade,Brian %A Abuan,Nate %A Halom,Martin %A Staples,Jamie %A Young,Colleen %A Brewer,LaPrincess %A Patten,Christi %+ Department of Psychiatry and Psychology, Mayo Clinic Health System, 1221 Whipple St, Eau Claire, WI, 54703, United States, 1 715 838 5369, sharma.pravesh@mayo.edu %K social media %K Facebook %K rural %K smoking %K cessation %K quitline %K community-based participatory research %K CBPR %K FaithCore %K mobile phone %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals living in rural communities experience substantial geographic and infrastructure barriers to attaining health equity in accessing tobacco use cessation treatment. Social media and other digital platforms offer promising avenues to improve access and overcome engagement challenges in tobacco cessation efforts. Research has also shown a positive correlation between faith-based involvement and a lower likelihood of smoking, which can be used to engage rural communities in these interventions. Objective: This study aimed to develop and beta test a social intervention prototype using a Facebook (Meta Platforms, Inc) group specifically designed for rural smokers seeking evidence-based smoking cessation resources. Methods: We designed a culturally aligned and faith-aligned Facebook group intervention, FaithCore, tailored to engage rural people who smoke in smoking cessation resources. Both intervention content and engagement strategies were guided by community-based participatory research principles. Given the intervention’s focus on end users, that is, rural people who smoked, we conducted a beta test to assess any technical or usability issues of this intervention before any future trials for large-scale implementation. Results: No critical beta test technical and usability issues were noted. Besides, the FaithCore intervention was helpful, easy to understand, and achieved its intended goals. Notably, 90% (9/10) of the participants reported that they tried quitting smoking, while 90% (9/10) reported using or seeking cessation resources discussed within the group. Conclusions: This study shows that social media platform with culturally aligned and faith-aligned content and engagement strategies delivered by trained moderators are promising for smoking cessation interventions in rural communities. Our future step is to conduct a large pilot trial to evaluate the intervention’s effectiveness on smoking cessation outcomes. %M 39186365 %R 10.2196/58121 %U https://formative.jmir.org/2024/1/e58121 %U https://doi.org/10.2196/58121 %U http://www.ncbi.nlm.nih.gov/pubmed/39186365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55476 %T Recognition of Forward Head Posture Through 3D Human Pose Estimation With a Graph Convolutional Network: Development and Feasibility Study %A Lee,Haedeun %A Oh,Bumjo %A Kim,Seung-Chan %+ Machine Learning Systems Laboratory, School of Sports Science, Sungkyunkwan University, Seoburo 2066, Suwon, Gyunggi-do, 16419, Republic of Korea, 82 31 299 6918, seungchan@ieee.org %K posture correction %K injury prediction %K human pose estimation %K forward head posture %K machine learning %K graph convolutional networks %K posture %K graph neural network %K graph %K pose %K postural %K deep learning %K neural network %K neural networks %K upper %K algorithms %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Prolonged improper posture can lead to forward head posture (FHP), causing headaches, impaired respiratory function, and fatigue. This is especially relevant in sedentary scenarios, where individuals often maintain static postures for extended periods—a significant part of daily life for many. The development of a system capable of detecting FHP is crucial, as it would not only alert users to correct their posture but also serve the broader goal of contributing to public health by preventing the progression of chronic injuries associated with this condition. However, despite significant advancements in estimating human poses from standard 2D images, most computational pose models do not include measurements of the craniovertebral angle, which involves the C7 vertebra, crucial for diagnosing FHP. Objective: Accurate diagnosis of FHP typically requires dedicated devices, such as clinical postural assessments or specialized imaging equipment, but their use is impractical for continuous, real-time monitoring in everyday settings. Therefore, developing an accessible, efficient method for regular posture assessment that can be easily integrated into daily activities, providing real-time feedback, and promoting corrective action, is necessary. Methods: The system sequentially estimates 2D and 3D human anatomical key points from a provided 2D image, using the Detectron2D and VideoPose3D algorithms, respectively. It then uses a graph convolutional network (GCN), explicitly crafted to analyze the spatial configuration and alignment of the upper body’s anatomical key points in 3D space. This GCN aims to implicitly learn the intricate relationship between the estimated 3D key points and the correct posture, specifically to identify FHP. Results: The test accuracy was 78.27% when inputs included all joints corresponding to the upper body key points. The GCN model demonstrated slightly superior balanced performance across classes with an F1-score (macro) of 77.54%, compared to the baseline feedforward neural network (FFNN) model’s 75.88%. Specifically, the GCN model showed a more balanced precision and recall between the classes, suggesting its potential for better generalization in FHP detection across diverse postures. Meanwhile, the baseline FFNN model demonstrates a higher precision for FHP cases but at the cost of lower recall, indicating that while it is more accurate in confirming FHP when detected, it misses a significant number of actual FHP instances. This assertion is further substantiated by the examination of the latent feature space using t-distributed stochastic neighbor embedding, where the GCN model presented an isotropic distribution, unlike the FFNN model, which showed an anisotropic distribution. Conclusions: Based on 2D image input using 3D human pose estimation joint inputs, it was found that it is possible to learn FHP-related features using the proposed GCN-based network to develop a posture correction system. We conclude the paper by addressing the limitations of our current system and proposing potential avenues for future work in this area. %M 39186772 %R 10.2196/55476 %U https://formative.jmir.org/2024/1/e55476 %U https://doi.org/10.2196/55476 %U http://www.ncbi.nlm.nih.gov/pubmed/39186772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51690 %T Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study %A Vakili,Negar %A Curran,Janet A %A Walls,Roisin %A Phillips,Debbie %A Miller,Alanna %A Cassidy,Christine %A Wozney,Lori %+ Mental Health and Addictions, IWK Health, 5850/5980 University Avenue, Halifax, NS, PO Box 9700, Canada, 1 902 719 9285, lori.wozney@iwk.nshealth.ca %K patient satisfaction %K satisfaction %K cross-sectional %K survey %K surveys %K engagement %K usage %K technology use %K transitional %K transition %K coordinated care %K service %K services %K feature %K features %K need %K needs %K transitional care %K information science %K human-computer interaction %K health behavior %K text-messaging %K messaging %K text messages %K text message %K SMS %K mental health %K persuasive system design %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message–based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. Objective: This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. Methods: A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. Results: A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Conclusions: Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions. %M 39190437 %R 10.2196/51690 %U https://formative.jmir.org/2024/1/e51690 %U https://doi.org/10.2196/51690 %U http://www.ncbi.nlm.nih.gov/pubmed/39190437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56332 %T Leveraging an Electronic Health Record Patient Portal to Help Patients Formulate Their Health Care Goals: Mixed Methods Evaluation of Pilot Interventions %A Naimark,Jody %A Tinetti,Mary E %A Delbanco,Tom %A Dong,Zhiyong %A Harcourt,Kendall %A Esterson,Jessica %A Charpentier,Peter %A Walker,Jan %+ Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, HVMA Annex, Suite 2200, Boston, MA, 02215, United States, 1 6177541416, jwalker1@bidmc.harvard.edu %K electronic pre-visit questionnaire %K patient portal %K multimorbidity %K care priorities %K goal %K goals %K priority %K priorities %K care plan %K care plans %K questionnaire %K questionnaires %K previsit %K pre-visit %K portal %K portals %K electronic health record %K EHR %K records %K record %K engagement %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %D 2024 %7 29.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients’ priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption. Objective: The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians. Methods: The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website’s questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians. Results: In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care. Conclusions: Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care. %M 39207829 %R 10.2196/56332 %U https://formative.jmir.org/2024/1/e56332 %U https://doi.org/10.2196/56332 %U http://www.ncbi.nlm.nih.gov/pubmed/39207829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56962 %T A Clinician and Electronic Health Record Wearable Device Intervention to Increase Physical Activity in Patients With Obesity: Formative Qualitative Study %A Ayyaswami,Varun %A Subramanian,Jeevarathna %A Nickerson,Jenna %A Erban,Stephen %A Rosano,Nina %A McManus,David D %A Gerber,Ben S %A Faro,Jamie M %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 3898 ext 63898, varun.ayyaswami@umassmed.edu %K remote patient monitoring %K physical activity %K electronic health record %K wearable device %K patient monitoring %K health monitoring %K health monitor %K patient monitor %K remote patient monitor %K exercise %K exercises %K electronic health records %K patient record %K health record %K health records %K wearable devices %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease. Objective: This formative study aimed to assess the perceptions, needs, and challenges of implementation of an electronic health record (EHR)–integrated RPM program using wearable devices to promote patient PA at a large urban primary care practice to prepare for future intervention. Methods: Our team identified existing workflows to upload wearable data to the EHR (Epic Systems), which included direct Fitbit (Google) integration that allowed for patient PA data to be uploaded to the EHR. We identified pictorial job aids describing the clinical workflow to PCPs. We then performed semistructured interviews with PCPs (n=10) and patients with obesity (n=8) at a large urban primary care clinic regarding their preferences and barriers to the program. We presented previously developed pictorial aids with instructions for (1) providers to complete an order set, set step-count goals, and receive feedback and (2) patients to set up their wearable devices and connect them to their patient portal account. We used rapid qualitative analysis during and after the interviews to code and develop key themes for both patients and providers that addressed our research objective. Results: In total, 3 themes were identified from provider interviews: (1) providers’ knowledge of PA prescription is focused on general guidelines with limited knowledge on how to tailor guidance to patients, (2) providers were open to receiving PA data but were worried about being overburdened by additional patient data, and (3) providers were concerned about patients being able to equitably access and participate in digital health interventions. In addition, 3 themes were also identified from patient interviews: (1) patients received limited or nonspecific guidance regarding PA from providers and other resources, (2) patients want to share exercise metrics with the health care team and receive tailored PA guidance at regular intervals, and (3) patients need written resources to support setting up an RPM program with access to live assistance on an as-needed basis. Conclusions: Implementation of an EHR-based RPM program and associated workflow is acceptable to PCPs and patients but will require attention to provider concerns of added burdensome patient data and patient concerns of receiving tailored PA guidance. Our ongoing work will pilot the RPM program and evaluate feasibility and acceptability within a primary care setting. %M 39221852 %R 10.2196/56962 %U https://formative.jmir.org/2024/1/e56962 %U https://doi.org/10.2196/56962 %U http://www.ncbi.nlm.nih.gov/pubmed/39221852 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47246 %T Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study %A Barnes,Keely %A Sveistrup,Heidi %A Bayley,Mark %A Egan,Mary %A Bilodeau,Martin %A Rathbone,Michel %A Taljaard,Monica %A Marshall,Shawn %+ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada, 1 6136126127, kbarn076@uottawa.ca %K telehealth %K remote care %K concussion %K mTBI %K mild traumatic brain injury %K assessment %K examination %K telemedicine %K remote care %K TBI %K traumatic brain injury %K brain injury %K Delphi %K measure %K measures %K measurement %K mobile phone %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. Objective: This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. Methods: The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. Results: In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Conclusions: Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. International Registered Report Identifier (IRRID): RR2-10.2196/40446 %M 39222352 %R 10.2196/47246 %U https://formative.jmir.org/2024/1/e47246 %U https://doi.org/10.2196/47246 %U http://www.ncbi.nlm.nih.gov/pubmed/39222352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59088 %T Prescription Digital Therapeutics for Substance Use Disorder in Primary Care: Mixed Methods Evaluation of a Pilot Implementation Study %A Mogk,Jessica %A Idu,Abisola E %A Bobb,Jennifer F %A Key,Dustin %A Wong,Edwin S %A Palazzo,Lorella %A Stefanik-Guizlo,Kelsey %A King,Deborah %A Beatty,Tara %A Dorsey,Caitlin N %A Caldeiro,Ryan M %A Garza McWethy,Angela %A Glass,Joseph E %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1360, Seattle, WA, 98101, United States, 1 206 287 2900, jessica.m.mogk@kp.org %K implementation %K digital therapeutics %K substance use disorder %K practice facilitation %K health coaching %K primary care %K mobile phone %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delivering prescription digital therapeutics (ie, evidence-based interventions designed to treat, manage, or prevent disorders via websites or smartphone apps) in primary care could increase patient access to substance use disorder (SUD) treatments. However, the optimal approach to implementing prescription digital therapeutics in primary care remains unknown. Objective: This pilot study is a precursor to a larger trial designed to test whether implementation strategies (practice facilitation [PF] and health coaching [HC]) improve the delivery of prescription digital therapeutics for SUDs in primary care. This mixed methods study describes outcomes among patients in the 2 pilot clinics and presents qualitative findings on implementation. Methods: From February 10 to August 6, 2021, a total of 3 mental health specialists embedded in 2 primary care practices of the same integrated health system were tasked with offering app-based prescription digital therapeutics to patients with SUD. In the first half of the pilot, implementation activities included training and supportive tools. PF (at 1 clinic) and HC (at 2 clinics) were added in the second half. All study analyses relied on secondary data, including electronic health records and digital therapeutic vendor data. Primary outcomes were the proportion of patients reached by the prescription digital therapeutics and fidelity related to ideal use. We used qualitative methods to assess the adherence to planned activities and the barriers and facilitators to implementing prescription digital therapeutics. Results: Of all 18 patients prescribed the apps, 10 (56%) downloaded the app and activated their prescription, and 8 (44%) completed at least 1 module of content. Patients who activated the app completed 1 module per week on average. Ideal use (fidelity) was defined as completing 4 modules per week and having a monthly SUD-related visit; 1 (6%) patient met these criteria for 10 weeks (of the 12-week prescription period). A total of 5 (28%) patients had prescriptions while HC was available, 2 (11%) were successfully contacted, and both declined coaching. Clinicians reported competing clinical priorities, technical challenges, and logistically complex workflows in part because the apps required a prescription. Some pilot activities were impacted by staff turnover that coincided with the COVID-19 pandemic. The facilitators to implementation were high engagement and the perception that the apps could meet patient needs. Conclusions: The pilot study encountered the barriers to implementing prescription digital therapeutics in a real-world primary care setting, especially staffing shortages, turnover, and competing priorities for clinic teams. The larger randomized trial will clarify the extent to which PF and HC improve the implementation of digital therapeutics. Trial Registration: ClinicalTrials.gov NCT04907045; https://clinicaltrials.gov/study/NCT04907045 %M 39222348 %R 10.2196/59088 %U https://formative.jmir.org/2024/1/e59088 %U https://doi.org/10.2196/59088 %U http://www.ncbi.nlm.nih.gov/pubmed/39222348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57335 %T The Application of Mask Region-Based Convolutional Neural Networks in the Detection of Nasal Septal Deviation Using Cone Beam Computed Tomography Images: Proof-of-Concept Study %A Shetty,Shishir %A Mubarak,Auwalu Saleh %A R David,Leena %A Al Jouhari,Mhd Omar %A Talaat,Wael %A Al-Rawi,Natheer %A AlKawas,Sausan %A Shetty,Sunaina %A Uzun Ozsahin,Dilber %+ Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Building M31, Sharjah, 27272, United Arab Emirates, 971 556491740, dozsahin@sharjah.ac.ae %K convolutional neural networks %K nasal septal deviation %K cone beam computed tomography %K tomographic %K tomography %K nasal %K nose %K face %K facial %K image %K images %K imagery %K artificial intelligence %K CNN %K neural network %K neural networks %K ResNet %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) models are being increasingly studied for the detection of variations and pathologies in different imaging modalities. Nasal septal deviation (NSD) is an important anatomical structure with clinical implications. However, AI-based radiographic detection of NSD has not yet been studied. Objective: This research aimed to develop and evaluate a real-time model that can detect probable NSD using cone beam computed tomography (CBCT) images. Methods: Coronal section images were obtained from 204 full-volume CBCT scans. The scans were classified as normal and deviated by 2 maxillofacial radiologists. The images were then used to train and test the AI model. Mask region-based convolutional neural networks (Mask R-CNNs) comprising 3 different backbones—ResNet50, ResNet101, and MobileNet—were used to detect deviated nasal septum in 204 CBCT images. To further improve the detection, an image preprocessing technique (contrast enhancement [CEH]) was added. Results: The best-performing model—CEH-ResNet101—achieved a mean average precision of 0.911, with an area under the curve of 0.921. Conclusions: The performance of the model shows that the model is capable of detecting nasal septal deviation. Future research in this field should focus on additional preprocessing of images and detection of NSD based on multiple planes using 3D images. %M 39226096 %R 10.2196/57335 %U https://formative.jmir.org/2024/1/e57335 %U https://doi.org/10.2196/57335 %U http://www.ncbi.nlm.nih.gov/pubmed/39226096 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59690 %T Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study %A Dougherty,Kylie %A Gebremariam,Abebe %A Biza,Heran %A Belew,Mulusew %A Benda,Natalie %A Tesfaye,Yihenew %A Cranmer,John %A Bakken,Suzanne %+ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, kylie.dougherty@northwestern.edu %K basic emergency obstetric care needs %K BEmOC %K supply chain %K Ethiopia %K Sociotechnical Model %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)—the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. Objective: This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. Methods: Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the “Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems” to guide the deductive portion. Results: The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. Conclusions: As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study’s findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur. %M 39235860 %R 10.2196/59690 %U https://formative.jmir.org/2024/1/e59690 %U https://doi.org/10.2196/59690 %U http://www.ncbi.nlm.nih.gov/pubmed/39235860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54909 %T Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability %A Heinert,Sara W %A Guzman-Baez,Kelvin %A Aamir,Affan %A Penugonda,Ananya %A Crabtree,Benjamin F %A Greene,Kathryn %A Heckman,Carolyn J %A Levy,Phillip %A Strickland,Pamela Ohman %A Hudson,Shawna V %+ Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ, 08901, United States, 1 732 235 7872, sara.heinert@rutgers.edu %K hypertension %K adolescents %K adults %K emergency department %K digital health intervention %K dyad intervention %K intervention development %K qualitative research %K youth %K adolescent %K teen %K teens %K teenager %K teenagers %K adult %K youth-led %K digital health %K health education %K refinement %K acceptability %K USA %K United States %K care navigation %K effectiveness %K formative study %K prototype %K self-guided %K online module %K online modules %K engagement %K blood pressure %K health knowledge %K health promotion %K nutrition education %K support intervention %K support %K supports %D 2024 %7 6.9.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. Objective: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. Methods: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. Results: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention’s concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. Conclusions: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT. %M 39240662 %R 10.2196/54909 %U https://formative.jmir.org/2024/1/e54909 %U https://doi.org/10.2196/54909 %U http://www.ncbi.nlm.nih.gov/pubmed/39240662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59003 %T Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial %A Adu,Medard K %A Eboreime,Oghenekome %A Shalaby,Reham %A Eboreime,Ejemai %A Agyapong,Belinda %A da Luz Dias,Raquel %A Sapara,Adegboyega O %A Agyapong,Vincent I O %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 17802157771, vn602367@dal.ca %K major depressive disorder %K Text4Support %K SMS text messaging %K email messaging %K digital health %K mental health %K mobile phone %K depressive disorder %K health communication %K global health %K treatments %K patient %K text messaging-based %K cognitive behavioral therapy %K communication %K effectiveness %K mental health support %K digital intervention %K digital interventions %K mental health care %K well-being %K depression symptoms %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging–based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. Objective: This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. Methods: A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). Results: Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded “No” to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: –1.90, 95% CI –6.53 to 2.74; 5.78, 95% CI –1.94 to 13.50; and 11.85, 95% CI –3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. Conclusions: The study’s findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. Trial Registration: ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/ %M 39250182 %R 10.2196/59003 %U https://formative.jmir.org/2024/1/e59003 %U https://doi.org/10.2196/59003 %U http://www.ncbi.nlm.nih.gov/pubmed/39250182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46901 %T User Experiences of Transitioning From a Homegrown Electronic Health Record to a Vendor-Based Product in the Department of Veterans Affairs: Qualitative Findings From a Mixed Methods Evaluation %A Anderson,Ekaterina %A Moldestad,Megan %A Brunner,Julian %A Ball,Sherry %A Helfrich,Christian %A Orlander,Jay %A Rinne,Seppo %A Sayre,George %+ Center for Health Optimization and Implementation Research, Veterans Affairs Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 7816874936, Ekaterina.Anderson@va.gov %K electronic health records %K United States Department of Veterans Affairs %K Veterans Affairs %K organizational change %K delivery of health care %K integrated %K medical informatics %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Department of Veterans Affairs (VA), the largest nationally integrated health system in the United States, is transitioning from its homegrown electronic health record (EHR) to a new vendor-based EHR, Oracle Cerner. Experiences of the first VA site to transition have been widely discussed in the media, but in-depth accounts based on rigorous research are lacking. Objective: We sought to explore employee perspectives on the rationale for, and value of, transitioning from a VA-tailored EHR to a vendor-based product. Methods: As part of a larger mixed methods, multisite, formative evaluation of VA clinician and staff experiences with the EHR transition, we conducted semistructured interviews at the Mann-Grandstaff VA Medical Center before, during, and after going live in October 2020. In total, we completed 122 interviews with 26 participants across multiple departments. Results: Before the new vendor-based EHR went live, participants initially expressed cautious optimism about the transition. However, in subsequent interviews following the go-live, participants increasingly critiqued the vendor’s understanding of VA’s needs, values, and workflows, as well as what they perceived as an inadequate fit between the functionalities of the new vendor-based EHR system and VA’s characteristic approach to care. As much as a year after going live, participants reiterated these concerns while also expressing a desire for substantive changes to the transition process, with some questioning the value of continuing with the transition. Conclusions: VA’s transition from a homegrown EHR to a vendor-based EHR system has presented substantial challenges, both practical and cultural in nature. Consequently, it is a valuable case study for understanding the sociotechnical dimension of EHR-to-EHR transitions. These findings have implications for both VA leadership and the broader community of policy makers, vendors, informaticists, and others involved in large-scale health information technology implementations. %M 39255006 %R 10.2196/46901 %U https://formative.jmir.org/2024/1/e46901 %U https://doi.org/10.2196/46901 %U http://www.ncbi.nlm.nih.gov/pubmed/39255006 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48453 %T Evaluating the Impact of a Dutch Sexual Health Intervention for Adolescents: Think-Aloud and Semistructured Interview Study %A Metz,Gido %A Thielmann,Rosa R L C %A Roosjen,Hanneke %A Crutzen,Rik %+ Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882435, g.metz@maastrichtuniversity.nl %K web-based intervention %K eHealth %K engagement %K potential impact %K mixed methods %K evaluation %K acyclic behavior change diagram %K web analytics %K think-aloud method %K web-based %K user %K chlamydia %K behavior change %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engagement with and the potential impact of web-based interventions is often studied by tracking user behavior with web analytics. These metrics do provide insights into how users behave, but not why they behave as such. Objective: This paper demonstrates how a mixed methods approach consisting of (1) a theoretical analysis of intended use, (2) a subsequent analysis of actual use, and (3) an exploration of user perceptions can provide insights into engagement with and potential impact of web-based interventions. This paper focuses on the exploration of user perceptions, using the chlamydia page of the Dutch sexual health intervention, Sense.info, as a demonstration case. This prevention-focused platform serves as the main source of sexual and reproductive health information (and care if needed) for young people aged 12-25 years in the Netherlands. Methods: First, acyclic behavior change diagrams were used to theoretically analyze the intended use of the chlamydia page. Acyclic behavior change diagrams display how behavior change principles are applied in an intervention and which subbehaviors and target behaviors are (aimed to be) influenced. This analysis indicated that one of the main aims of the page is to motivate sexually transmitted infection (STI) testing. Second, the actual use of the chlamydia page was analyzed with the web analytics tool Matomo. Despite the page’s aim of promoting STI testing, a relatively small percentage (n=4948, 14%) of the 35,347 transfers from this page were to the STI testing page. Based on these two phases, preliminary assumptions about use and impact were formulated. Third, to further explore these assumptions, a study combining the think-aloud method and semistructured interviews was executed with 15 young individuals aged 16-25 (mean 20, SD 2.5) years. Template analysis was used to analyze interview transcripts. Results: Participants found the information on the Sense.info chlamydia page reliable and would visit it mostly for self-diagnosis purposes if they experienced potential STI symptoms. A perceived facilitator for STI testing was the possibility to learn about the symptoms and consequences of chlamydia through the page. Barriers included an easily overlooked link to the STI testing page and the use of language not meeting the needs of participants. Participants offered suggestions for lowering the threshold for STI testing. Conclusions: The mixed methods approach used provided detailed insights into the engagement with and potential impact of the Sense.info chlamydia page, as well as strategies to further engage end users and increase the potential impact of the page. We conclude that this approach, which triangulates findings from theoretical analysis with web analytics and a think-aloud study combined with semistructured interviews, may also have potential for the evaluation of web-based interventions in general. %M 39259573 %R 10.2196/48453 %U https://formative.jmir.org/2024/1/e48453 %U https://doi.org/10.2196/48453 %U http://www.ncbi.nlm.nih.gov/pubmed/39259573 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58791 %T Digital Interventions for Reducing Loneliness and Depression in Korean College Students: Mixed Methods Evaluation %A Kang,Boyoung %A Hong,Munpyo %+ Sungkyunkwan University, 25-2, Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 2 740 1770, bykang2015@gmail.com %K loneliness %K depression %K digital interventions %K college students %K mental health %K mixed methods evaluation %K Woebot %K Happify %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot (Woebot Health, Inc) and Happify (Twill Inc), have shown promise in alleviating these symptoms. Objective: This study aims to investigate the effectiveness and acceptability of Woebot and Happify in reducing loneliness and depression among college students after the COVID-19 pandemic. Methods: A mixed methods approach was used over 4 months. A total of 63 participants aged 18 to 27 years from Sungkyunkwan University in Seoul, South Korea, were initially recruited, with an inclusion criterion of University of California, Los Angeles (UCLA) Loneliness Scale score ≥34. The final sample consisted of 27 participants due to attrition. Participants were randomly assigned to Woebot (15/27, 55%); Happify (9/27, 33%); or a control group using Bondee (Metadream), a metaverse social network messenger app (3/27, 11%). Quantitative measures (UCLA Loneliness Scale and Patient Health Questionnaire-9) and qualitative assessments (user feedback and focused interviews) were used. Results: Although mean decreases in loneliness and depression were observed in the control and intervention groups after the intervention, the differences between the control and intervention groups were not statistically significant (UCLA Loneliness: P=.67; Patient Health Questionnaire-9: P=.35). Qualitative data indicated user satisfaction, with suggestions for improved app effectiveness and personalization. Conclusions: Despite limitations, this study highlights the potential of well-designed digital interventions in alleviating college students’ loneliness and depression. The findings contribute to the growing body of research on accessible digital mental health tools and underscore the importance of comprehensive support systems. Further research with larger and more diverse samples is needed to better understand the effectiveness and optimization of such interventions. Trial Registration: Clinical Research Information Service KCT0009449; https://bit.ly/4d2e4Bu %M 39264705 %R 10.2196/58791 %U https://formative.jmir.org/2024/1/e58791 %U https://doi.org/10.2196/58791 %U http://www.ncbi.nlm.nih.gov/pubmed/39264705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56797 %T ChatGPT Use Among Pediatric Health Care Providers: Cross-Sectional Survey Study %A Kisvarday,Susannah %A Yan,Adam %A Yarahuan,Julia %A Kats,Daniel J %A Ray,Mondira %A Kim,Eugene %A Hong,Peter %A Spector,Jacob %A Bickel,Jonathan %A Parsons,Chase %A Rabbani,Naveed %A Hron,Jonathan D %+ Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 5704283137, susannah.kisvarday@childrens.harvard.edu %K ChatGPT %K machine learning %K surveys and questionnaires %K medical informatics applications %K OpenAI %K large language model %K LLM %K machine learning %K pediatric %K chatbot %K artificial intelligence %K AI %K digital tools %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The public launch of OpenAI’s ChatGPT platform generated immediate interest in the use of large language models (LLMs). Health care institutions are now grappling with establishing policies and guidelines for the use of these technologies, yet little is known about how health care providers view LLMs in medical settings. Moreover, there are no studies assessing how pediatric providers are adopting these readily accessible tools. Objective: The aim of this study was to determine how pediatric providers are currently using LLMs in their work as well as their interest in using a Health Insurance Portability and Accountability Act (HIPAA)–compliant version of ChatGPT in the future. Methods: A survey instrument consisting of structured and unstructured questions was iteratively developed by a team of informaticians from various pediatric specialties. The survey was sent via Research Electronic Data Capture (REDCap) to all Boston Children’s Hospital pediatric providers. Participation was voluntary and uncompensated, and all survey responses were anonymous.  Results: Surveys were completed by 390 pediatric providers. Approximately 50% (197/390) of respondents had used an LLM; of these, almost 75% (142/197) were already using an LLM for nonclinical work and 27% (52/195) for clinical work. Providers detailed the various ways they are currently using an LLM in their clinical and nonclinical work. Only 29% (n=105) of 362 respondents indicated that ChatGPT should be used for patient care in its present state; however, 73.8% (273/368) reported they would use a HIPAA-compliant version of ChatGPT if one were available. Providers’ proposed future uses of LLMs in health care are described. Conclusions: Despite significant concerns and barriers to LLM use in health care, pediatric providers are already using LLMs at work. This study will give policy makers needed information about how providers are using LLMs clinically. %M 39265163 %R 10.2196/56797 %U https://formative.jmir.org/2024/1/e56797 %U https://doi.org/10.2196/56797 %U http://www.ncbi.nlm.nih.gov/pubmed/39265163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53455 %T Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study %A Po,Hui-Wen %A Chu,Ying-Chien %A Tsai,Hui-Chen %A Lin,Chen-Liang %A Chen,Chung-Yu %A Ma,Matthew Huei-Ming %+ Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, No.579. Sec 2,, Yunlin Rd, Douliou, Yunlin, 640, Taiwan, 886 055323911, c8101147@ms16.hinet.net %K telemonitoring %K discharge planning %K case manager %K hospital readmission %K telehealth %K remote healthcare %K high-risk %K post-discharge %K respiratory disease %K respiratory diseases %K cardiovascular disease %K cardiovascular diseases %K case management %K patient education %K readmission %K health status tracking %K care guidance %K medical advice %K male %K men %K older adult %K older adults %K elder %K elderly %K older person %K older people %K home monitoring %K physiological signal %K physiological signals %K mobile phone %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. Objective: This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. Methods: This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. Results: Among 41 eligible patients, 93% (n=38) were male, and 46% (n=19) were aged 41-60 years, while 46% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). Conclusions: By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management. %M 39269747 %R 10.2196/53455 %U https://formative.jmir.org/2024/1/e53455 %U https://doi.org/10.2196/53455 %U http://www.ncbi.nlm.nih.gov/pubmed/39269747 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57108 %T The Potential Use and Value of a Wearable Monitoring Bracelet for Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study Investigating the Patient and Health Care Professional Perspectives %A Debeij,Suzanne M %A Aardoom,Jiska J %A Haaksma,Miriam L %A Stoop,Wieteke A M %A van Dam van Isselt,Eléonore F %A Kasteleyn,Marise J %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 651306514, s.m.debeij@lumc.nl %K eHealth %K Chronic Obstructive Pulmonary Disease %K COPD %K wearable %K exacerbation %K self-management %K monitoring bracelet %K remote monitoring %K mobile phone %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The occurrence of exacerbations has major effects on the health of people with chronic obstructive pulmonary disease (COPD). Monitoring devices that measure (vital) parameters hold promise for timely identification and treatment of exacerbations. Stakeholders’ perspectives on the use of monitoring devices are of importance for the successful development and implementation of a device. Objective: This study aimed to explore the potential use and value of a wearable monitoring bracelet (MB) for patients with COPD at high risk for exacerbation. The perspectives of health care professionals as well as patients were examined, both immediately after hospitalization and over a longer period. Furthermore, potential facilitators and barriers to the use and implementation of an MB were explored. Methods: Data for this qualitative study were collected from January to April 2023. A total of 11 participants (eg, n=6 health care professionals [HCPs], 2 patients, and 3 additional patients) participated. In total, 2 semistructured focus groups were conducted via video calls; 1 with HCPs of various professional backgrounds and 1 with patients. In addition, 3 semistructured individual interviews were held with patients. The interviews and focus groups addressed attitudes, wishes, needs, as well as factors that could either support or impede the potential MB use. Data from interviews and focus groups were coded and analyzed according to the principles of the framework method. Results: HCPs and patients both predominantly emphasized the importance of an MB in terms of promptly identifying exacerbations by detecting deviations from normal (vital) parameters, and subsequently alerting users. According to HCPs, this is how an MB should support the self-management of patients. Most participants did not anticipate major differences in value and use of an MB between the short-term and the long-term periods after hospitalization. Facilitators of the potential use and implementation of an MB that participants highlighted were ease of use and some form of support for patients in using an MB and interpreting the data. HCPs as well as patients expressed concerns about potential costs as a barrier to use and implementation. Another barrier that HCPs mentioned, was the prerequisite of digital literacy for patients to be able to interpret and react to the data from an MB. Conclusions: HCPs and patients both recognize that an MB could be beneficial and valuable to patients with COPD at high risk for exacerbation, in the short as well as the long term. In particular, they perceived value in supporting self-management of patients with COPD. Stakeholders would be able to use the obtained insights in support of the effective implementation of MBs in COPD patient care, which can potentially improve health care and the overall well-being of patients with COPD. %M 39270210 %R 10.2196/57108 %U https://formative.jmir.org/2024/1/e57108 %U https://doi.org/10.2196/57108 %U http://www.ncbi.nlm.nih.gov/pubmed/39270210 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52293 %T A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety %A Dimeff,Linda A %A Koerner,Kelly %A Heard,Kandi %A Ruork,Allison K %A Kelley-Brimer,Angela %A Witterholt,Suzanne T %A Lardizabal,Mary Beth %A Clubb,Joseph R %A McComish,Julie %A Waghray,Arpan %A Dowdy,Roger %A Asad-Pursley,Sara %A Ilac,Maria %A Lawrence,Hannah %A Zhou,Frank %A Beadnell,Blair %+ Evidence-Based Practice Institute, 9450 SW Gemini Dr, PMB 68735, Beaverton, OR, 97008-7105, United States, 1 253 765 0455, linda.dimeff@jasprhealth.com %K suicide %K emergency department %K ED %K digital technology %K suicide prevention best practices %K individual %K particular %K suicide prevention %K evidence-based intervention %K Emergency department %K hospital %K vulnerable population %K Jaspr Health %K psychiatric %K psychiatrist %K care %K safety %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. Objective: This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr’s use would be associated with improved patient agitation and distress. Methods: Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. Results: The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. Conclusions: Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments. %M 39283664 %R 10.2196/52293 %U https://formative.jmir.org/2024/1/e52293 %U https://doi.org/10.2196/52293 %U http://www.ncbi.nlm.nih.gov/pubmed/39283664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56370 %T A Behavior-Based Model to Validate Electronic Systems Designed to Collect Patient-Reported Outcomes: Model Development and Application %A Attamimi,Sultan %A Marshman,Zoe %A Deery,Christopher %A Radley,Stephen %A Gilchrist,Fiona %+ Academic Unit of Oral Health Dentistry and Society, University of Sheffield, 19 Claremont Cres, Broomhall, Sheffield, S10 2TA, United Kingdom, 44 0114 2717990, su.altamimi@uoh.edu.sa %K patient-reported outcome %K PRO %K electronic PRO %K user acceptance testing %K system validation %K patient-reported outcomes %K electronic PROs %K user acceptance %K validation model %K paediatric dentistry %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The merits of technology have been adopted in capturing patient-reported outcomes (PROs) by incorporating PROs into electronic systems. Following the development of an electronic system, evaluation of system performance is crucial to ensuring the collection of meaningful data. In contemporary PRO literature, electronic system validation is overlooked, and evidence on validation methods is lacking. Objective: This study aims to introduce a generalized concept to guide electronic patient-reported outcome (ePRO) providers in planning for system-specific validation methods. Methods: Since electronic systems are essentially products of software engineering endeavors, electronic systems used to collect PRO should be viewed from a computer science perspective with consideration to the health care environment. On this basis, a testing model was blueprinted and applied to a newly developed ePRO system designed for clinical use in pediatric dentistry (electronic Personal Assessment Questionnaire-Paediatric Dentistry) to investigate its thoroughness. Results: A behavior-based model of ePRO system validation was developed based on the principles of user acceptance testing and patient-centered care. The model allows systematic inspection of system specifications and identification of technical errors through simulated positive and negative usage pathways in open and closed environments. The model was able to detect 15 positive errors with 1 unfavorable response when applied to electronic Personal Assessment Questionnaire-Paediatric Dentistry system testing. Conclusions: The application of the behavior-based model to a newly developed ePRO system showed a high ability for technical error detection in a systematic fashion. The proposed model will increase confidence in the validity of ePRO systems as data collection tools in future research and clinical practice. %M 39288407 %R 10.2196/56370 %U https://formative.jmir.org/2024/1/e56370 %U https://doi.org/10.2196/56370 %U http://www.ncbi.nlm.nih.gov/pubmed/39288407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56559 %T Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment %A Staras,Stephanie A S %A Tauscher,Justin %A Vinson,Michelle %A Thompson,Lindsay A %A Gerend,Mary A %A Shenkman,Elizabeth A %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Road, Room 7005, Gainesville, FL, 32611, United States, 1 (352)294 8299, sstaras@ufl.edu %K participatory design %K think-aloud %K implementation science %K adolescent vaccination %K human papillomavirus vaccine %K usability %K eHealth %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents’ vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app’s usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child’s vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents’ children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. %M 39298761 %R 10.2196/56559 %U https://formative.jmir.org/2024/1/e56559 %U https://doi.org/10.2196/56559 %U http://www.ncbi.nlm.nih.gov/pubmed/39298761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41093 %T Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study %A Yoo,In-jin %A Park,Do-Hyung %A Lee,Othelia EunKyoung %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte, 9201 University City Boulevard, Woodward 310H, Charlotte, NC, 28223-0001, United States, 1 7046878668, al.park@uncc.edu %K socially assistive robot %K older adults %K robot use pattern %K time series clustering %K profiling analysis %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. Objective: This study aims to examine the characteristics and use patterns of SARs. Methods: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Results: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. Conclusions: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions. %M 39298762 %R 10.2196/41093 %U https://formative.jmir.org/2024/1/e41093 %U https://doi.org/10.2196/41093 %U http://www.ncbi.nlm.nih.gov/pubmed/39298762 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57185 %T Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study %A Grube,Lara %A Petit,Pascal %A Vuillerme,Nicolas %A Nitschke,Marlies %A Nwosu,Obioma Bertrand %A Knitza,Johannes %A Krusche,Martin %A Seifer,Ann-Kristin %A Eskofier,Bjoern M %A Schett,Georg %A Morf,Harriet %+ Department of Internal Medicine 3- Rheumatology & Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 091318543023, harriet.morf@uk-erlangen.de %K DTx %K DHA %K usability %K Yoga %K YogiTherapy %K ankylosing spondylitis %K axial spondylarthritis %K digital health application %K eHealth %K self-assessment %K physical exercise %K patient acceptance %K therapy %K home exercise %K exercise %K patients %K patient %K spondyloarthritis %K usability study %K app %K apps %K rheumatic disease %K chronic %K spine %K adjacent joints %K joints %K joint %K correlation analysis %K digital therapeutics %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. Results: A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is –26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=–0.21, P<.001). Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. %M 39298754 %R 10.2196/57185 %U https://formative.jmir.org/2024/1/e57185 %U https://doi.org/10.2196/57185 %U http://www.ncbi.nlm.nih.gov/pubmed/39298754 %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 e60411 %T Exploring the User Acceptability and Feasibility of a Clinical Decision Support Tool Designed to Facilitate Timely Diagnosis of New-Onset Type 1 Diabetes in Children: Qualitative Interview Study Among General Practitioners %A Beccia,Chiara %A Hunter,Barbara %A Manski-Nankervis,Jo-Anne %A White,Mary %+ Department of General Practice and Primary Care, The University of Melbourne, Medical Building (181), , Melbourne, 3010, Australia, 61 0468480327, cbeccia@student.unimelb.edu.au %K type 1 diabetes %K digital health innovation %K clinical decision support tool %K diabetes %K acceptability %K feasibility %K diagnosis %K child %K children %K youth %K qualitative and simulation study %K hospital %K diabetic ketoacidosis %K diagnostic delay %K Australian %K Australia %K video recorded %K audio recorded %K screen recorded %K video %K videos %K patient %K patients %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to half of the children with new-onset type 1 diabetes present to the hospital with diabetic ketoacidosis, a life-threatening condition that can develop because of diagnostic delay. Three-quarters of Australian children visit their general practitioner (GP) the week before presenting to the hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM (Decision-Support for Integrated, Real-Time Evaluation and Clinical Treatment of Type 1 Diabetes Mellitus), is an electronic clinical decision support tool that promotes immediate point-of-care testing in general practice to confirm the suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay. Objective: In this investigation, we aimed to pilot and assess the feasibility and acceptability of our prototype to GP end users. We also explored the challenges of diagnosing type 1 diabetes in the Australian general practice context. Methods: In total, 4 GPs, a pediatric endocrinologist, and a PhD candidate were involved in conceptualizing the DIRECT-T1DM prototype, which was developed at the Department of General Practice and Primary Care at the University of Melbourne. Furthermore, 6 GPs were recruited via convenience sampling to evaluate the tool. The study involved 3 phases: a presimulation interview, simulated clinical scenarios, and a postsimulation interview. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) as a guide. All phases of the study were video, audio, and screen recorded. Audio recordings were transcribed by the investigating team. Analysis was carried out using CFIR as the underlying framework. Results: Major themes were identified among three domains and 7 constructs of the CFIR: (1) outer setting—time pressure, difficulty in diagnosing pediatric type 1 diabetes, and secondary care considerations influenced GPs’ needs regarding DIRECT-T1DM; (2) inner setting—DIRECT-T1DM fits within existing workflows, it has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change; and (3) innovation—design recommendations included altering coloring to reflect urgency, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets. Conclusions: End-user acceptability of DIRECT-T1DM was high. This was largely due to its implications for patient safety and its “real-time” nature. DIRECT-T1DM may assist in appropriate management of children with new-onset diabetes, which is an uncommon event in general practice, through safety netting. %M 39312767 %R 10.2196/60411 %U https://formative.jmir.org/2024/1/e60411 %U https://doi.org/10.2196/60411 %U http://www.ncbi.nlm.nih.gov/pubmed/39312767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53034 %T Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of ‘Zvatinoda!’ (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework %A Mackworth-Young,Constance Ruth Sina %A Charashika,Privillage %A , %A Larsson,Leyla %A Wilding-Davies,Olivia Jane %A Simpson,Nikita %A Kydd,Anna Sorrel %A Chinyanga,Theonevus Tinashe %A Ferrand,Rashida Abbas %A Mangombe,Aveneni %A Webb,Karen %A Doyle,Aoife Margaret %+ Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 20 7636 8636, constance.mackworth-young1@lshtm.ac.uk %K adolescents %K young people %K digital health %K mobile intervention %K HIV %K sexual and reproductive health %K Zimbabwe %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services. Objective: The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe. Methods: The intervention utilized mobile phone–based discussion groups, complemented by “ask the expert” sessions. Peer facilitators, supported by an “Auntie,” led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators’ debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance. Results: Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14% (4/28) for contraception to 86% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50% (14/28) preintervention to 86% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57% (16/28) preintervention to 89% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32% (9/28) preintervention to 86% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable “Auntie,” and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance). Conclusions: The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people’s knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers. %M 39316784 %R 10.2196/53034 %U https://formative.jmir.org/2024/1/e53034 %U https://doi.org/10.2196/53034 %U http://www.ncbi.nlm.nih.gov/pubmed/39316784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53759 %T Smartphone-Based Digital Peer Support for a Walking Intervention Among Public Officers in Kanagawa Prefecture: Single-Arm Pre- and Postintervention Evaluation %A Okamoto,Masumi %A Saito,Yoshinobu %A Nakamura,Sho %A Nagasawa,Makoto %A Shibuya,Megumi %A Nagasaka,Go %A Narimatsu,Hiroto %+ Graduate School of Health Innovation, Kanagawa University of Human Services, Research Gate Building Tonomachi 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki, 210-0821, Japan, 81 44 589 8100, hiroto-narimatsu@umin.org %K digital health %K mhealth %K ehealth %K smartphone app %K smartphone application %K peer support %K digital peer support %K social support %K group intervention %K physical activity %K health promotion %K behavior change %K apps %K step counting %K workplace health %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital peer support, defined as peer support delivered through technology such as smartphone apps, may be promising to promote activity in the form of step counts. Interactions among users have a positive impact on retention rates, and apps with social elements show significant improvements in daily step count. However, the feasibility of digital peer support in promoting physical activity (PA) is unknown; therefore, its effectiveness on step count and the clinical implications remain unconfirmed. Objective: This study aimed to assess the feasibility of digital peer support over a 3-month intervention period using the retention rate as the outcome. Moreover, changes in daily step count and physical measurements were compared between pre- and postintervention. Methods: The study design was a 3-month 1-arm intervention with participants from local government offices in Kanagawa, Japan. We used an available smartphone app, Minchalle, as the tool for the group intervention. Participants were required to report their daily step count to a maximum of 5 members composed exclusively of study participants. The primary outcome was the retention rate. Secondary outcomes included daily step count, the rate of achieving daily step goals, physical measurements, and lifestyle characteristics. Descriptive statistics and the Pearson coefficient were used to examine the relationship between goal achievement and step count, as well as changes in step count and various variables including physical measurements. Results: Of the 63 participants, 62 completed the intervention. The retention rate was 98% (62/63). The average daily step count during the intervention was 6993 (SD 2328) steps, an 1182-step increase compared with the count observed 1 week before the intervention began. The rate of achieving the daily step count during the intervention was 53.5% (SD 26.2%). There was a significant correlation (r=0.27, P=.05) between achieving daily step goals and increasing daily step count. Comparative analyses showed that changes in weight (68.56, SD 16.97 kg vs 67.30, SD 16.86 kg; P<.001), BMI (24.82, SD 4.80 kg/m2 vs 24.35, SD 4.73 kg/m2; P<.001), somatic fat rate (28.50%, SD 7.44% vs 26.58%, SD 7.90%; P=.005), systolic blood pressure (130.42, SD 17.92 mm Hg vs 122.00, SD 15.06 mm Hg; P<.001), and diastolic blood pressure (83.24, SD 13.27 mm Hg vs 77.92, SD 11.71 mm Hg; P=.002) were significantly different before and after the intervention. Similarly, the daily amount of PA significantly improved from 5.77 (SD 3.81) metabolic equivalent (MET)–hours per day to 9.85 (SD 7.84) MET-hours per day (P<.001). Conclusions: This study demonstrated that digital peer support is feasible for maintaining a high retention rate and can, therefore, effectively promote PA. It can be a promising tool to improve daily step count, subjective PA, and clinical outcomes, such as weight and somatic fat rate. Trial Registration: UMIN Clinical Trials Registry UMIN000042520; https://tinyurl.com/46c4nm8z %M 39316793 %R 10.2196/53759 %U https://formative.jmir.org/2024/1/e53759 %U https://doi.org/10.2196/53759 %U http://www.ncbi.nlm.nih.gov/pubmed/39316793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53224 %T The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing %A Savage,Leah C %A Soto-Cossio,Luz Estefhany %A Minardi,Francesca %A Beyrouty,Matthew %A Schoonover,Julie %A Musella,Jay %A Frazier,Michaela %A Villagra,Cristina N %A Sly,Jamilia R %A Erblich,Joel %A Itzkowitz,Steven H %A Jandorf,Lina H %A Calman,Neil S %A Atreja,Ashish %A Miller,Sarah J %+ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Box 1077, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 2128247783, sarah.miller@mssm.edu %K digital navigation %K digital health %K Federally Qualified Health Center %K colorectal cancer %K cancer screening %K mobile phone %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a “think aloud” exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website’s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website’s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool’s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. %M 39321451 %R 10.2196/53224 %U https://formative.jmir.org/2024/1/e53224 %U https://doi.org/10.2196/53224 %U http://www.ncbi.nlm.nih.gov/pubmed/39321451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56162 %T mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users %A Muehlensiepen,Felix %A Bruch,Dunja %A Seifert,Frances %A Wengemuth,Eileen %A Heinze,Martin %A Spethmann,Sebastian %A May,Susann %+ Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 151 191260 24, Felix.Muehlensiepen@mhb-fontane.de %K hypertension %K mobile health %K mHealth apps %K digital health %K patient perspective %K qualitative study %K cardiology %D 2024 %7 27.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence. Objective: This study aimed to explore patient-users’ perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany. Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis. Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users’ hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it. Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s %M 39331954 %R 10.2196/56162 %U https://formative.jmir.org/2024/1/e56162 %U https://doi.org/10.2196/56162 %U http://www.ncbi.nlm.nih.gov/pubmed/39331954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56355 %T Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study %A Iyer,Priya %A Iyer,Lina %A Carter,Nicole %A Iyer,Ranjani %A Stirling,Amy %A Priya,Lakshmi %A Sriraman,Ushma %+ Department of Education, Heartfulness Institute, 2200 Goldenrod Ln, San Ramon, CA, 94582, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness, anxiety, loneliness, high school, satisfaction with life %K self-care %K develop %K stress %K stress management %K effectiveness %K life satisfaction %K students %K student %K support %K web-based program %K time management %K educational %K mental health %K tool %K tools %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder—Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 %M 39047180 %R 10.2196/56355 %U https://formative.jmir.org/2024/1/e56355 %U https://doi.org/10.2196/56355 %U http://www.ncbi.nlm.nih.gov/pubmed/39047180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58241 %T Exploring Trade-Offs for Online Mental Health Matching: Agent-Based Modeling Study %A Liu,Yuhan %A Fang,Anna %A Moriarty,Glen %A Firman,Cristopher %A Kraut,Robert E %A Zhu,Haiyi %+ Human-Computer Interaction Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 (412) 268 2000, annadfang@gmail.com %K agent-based modeling %K mental health %K algorithmic matching %K social computing %K online communities %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online mental health communities (OMHCs) are an effective and accessible channel to give and receive social support for individuals with mental and emotional issues. However, a key challenge on these platforms is finding suitable partners to interact with given that mechanisms to match users are currently underdeveloped or highly naive. Objective: In this study, we collaborated with one of the world’s largest OMHCs; our contribution is to show the application of agent-based modeling for the design of online community matching algorithms. We developed an agent-based simulation framework and showcased how it can uncover trade-offs in different matching algorithms between people seeking support and volunteer counselors. Methods: We used a comprehensive data set spanning January 2020 to April 2022 to create a simulation framework based on agent-based modeling that replicates the current matching mechanisms of our research site. After validating the accuracy of this simulated replication, we used this simulation framework as a “sandbox” to test different matching algorithms based on the deferred acceptance algorithm. We compared trade-offs among these different matching algorithms based on various metrics of interest, such as chat ratings and matching success rates. Results: Our study suggests that various tensions emerge through different algorithmic choices for these communities. For example, our simulation uncovered that increased waiting time for support seekers was an inherent consequence on these sites when intelligent matching was used to find more suitable matches. Our simulation also verified some intuitive effects, such as that the greatest number of support seeker–counselor matches occurred using a “first come, first served” protocol, whereas relatively fewer matches occurred using a “last come, first served” protocol. We also discuss practical findings regarding matching for vulnerable versus overall populations. Results by demographic group revealed disparities—underaged and gender minority groups had lower average chat ratings and higher blocking rates on the site when compared to their majority counterparts, indicating the potential benefits of algorithmically matching them. We found that some protocols, such as a “filter”-based approach that matched vulnerable support seekers only with a counselor of their same demographic, led to improvements for these groups but resulted in lower satisfaction (–12%) among the overall population. However, this trade-off between minority and majority groups was not observed when using “topic” as a matching criterion. Topic-based matching actually outperformed the filter-based protocol among underaged people and led to significant improvements over the status quo among all minority and majority groups—specifically, a 6% average chat rating improvement and a decrease in blocking incidents from 5.86% to 4.26%. Conclusions: Agent-based modeling can reveal significant design considerations in the OMHC context, including trade-offs in various outcome metrics and the potential benefits of algorithmic matching for marginalized communities. %M 39352736 %R 10.2196/58241 %U https://formative.jmir.org/2024/1/e58241 %U https://doi.org/10.2196/58241 %U http://www.ncbi.nlm.nih.gov/pubmed/39352736 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51198 %T Harnessing the Power of Complementarity Between Smart Tracking Technology and Associated Health Information Technologies: Longitudinal Study %A Tao,Youyou %A Zhu,Ruilin %A Wu,Dezhi %+ Department of Management Science, Lancaster University, Bailrigg, Lancaster, LA1 4YX, United Kingdom, 44 1524592938, ruilin.zhu@lancaster.ac.uk %K health IT %K smart tracking technology %K mobile IT %K health information exchange %K electronic health record %K readmission risk %K complementarity effects %K mobile phone %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smart tracking technology (STT) that was applied for clinical use has the potential to reduce 30-day all-cause readmission risk through streamlining clinical workflows with improved accuracy, mobility, and efficiency. However, previously published literature has inadequately addressed the joint effects of STT for clinical use and its complementary health ITs (HITs) in this context. Furthermore, while previous studies have discussed the symbiotic and pooled complementarity effects among different HITs, there is a lack of evidence-based research specifically examining the complementarity effects between STT for clinical use and other relevant HITs. Objective: Through a complementarity theory lens, this study aims to examine the joint effects of STT for clinical use and 3 relevant HITs on 30-day all-cause readmission risk. These HITs are STT for supply chain management, mobile IT, and health information exchange (HIE). Specifically, this study examines whether the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and whether symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Methods: This study uses a longitudinal in-patient dataset, including 879,122 in-patient hospital admissions for 347,949 patients in 61 hospitals located in Florida and New York in the United States, from 2014 to 2015. Logistic regression was applied to assess the effect of HITs on readmission risks. Time and hospital fixed effects were controlled in the regression model. Robust standard errors (SEs) were used to account for potential heteroskedasticity. These errors were further clustered at the patient level to consider possible correlations within the patient groups. Results: The interaction between STT for clinical use and STT for supply chain management, mobile IT, and HIE was negatively associated with 30-day readmission risk, with coefficients of –0.0352 (P=.003), –0.0520 (P<.001), and –0.0216 (P=.04), respectively. These results indicate that the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Furthermore, the joint effects of these HITs varied depending on the hospital affiliation and patients’ disease types. Conclusions: Our results reveal that while individual HIT implementations have varying impacts on 30-day readmission risk, their joint effects are often associated with a reduction in 30-day readmission risk. This study substantially contributes to HIT value literature by quantifying the complementarity effects among 4 different types of HITs: STT for clinical use, STT for supply chain management, mobile IT, and HIE. It further offers practical implications for hospitals to maximize the benefits of their complementary HITs in reducing the 30-day readmission risk in their respective care scenarios. %M 39353192 %R 10.2196/51198 %U https://formative.jmir.org/2024/1/e51198 %U https://doi.org/10.2196/51198 %U http://www.ncbi.nlm.nih.gov/pubmed/39353192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51383 %T Optimizing ChatGPT’s Interpretation and Reporting of Delirium Assessment Outcomes: Exploratory Study %A Choi,Yong K %A Lin,Shih-Yin %A Fick,Donna Marie %A Shulman,Richard W %A Lee,Sangil %A Shrestha,Priyanka %A Santoso,Kate %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6051B Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 624 6442, yong.choi@pitt.edu %K generative artificial intelligence %K generative AI %K large language models %K ChatGPT %K delirium detection %K Sour Seven Questionnaire %K prompt engineering %K clinical vignettes %K medical education %K caregiver education %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Generative artificial intelligence (AI) and large language models, such as OpenAI’s ChatGPT, have shown promising potential in supporting medical education and clinical decision-making, given their vast knowledge base and natural language processing capabilities. As a general purpose AI system, ChatGPT can complete a wide range of tasks, including differential diagnosis without additional training. However, the specific application of ChatGPT in learning and applying a series of specialized, context-specific tasks mimicking the workflow of a human assessor, such as administering a standardized assessment questionnaire, followed by inputting assessment results in a standardized form, and interpretating assessment results strictly following credible, published scoring criteria, have not been thoroughly studied. Objective: This exploratory study aims to evaluate and optimize ChatGPT’s capabilities in administering and interpreting the Sour Seven Questionnaire, an informant-based delirium assessment tool. Specifically, the objectives were to train ChatGPT-3.5 and ChatGPT-4 to understand and correctly apply the Sour Seven Questionnaire to clinical vignettes using prompt engineering, assess the performance of these AI models in identifying and scoring delirium symptoms against scores from human experts, and refine and enhance the models’ interpretation and reporting accuracy through iterative prompt optimization. Methods: We used prompt engineering to train ChatGPT-3.5 and ChatGPT-4 models on the Sour Seven Questionnaire, a tool for assessing delirium through caregiver input. Prompt engineering is a methodology used to enhance the AI’s processing of inputs by meticulously structuring the prompts to improve accuracy and consistency in outputs. In this study, prompt engineering involved creating specific, structured commands that guided the AI models in understanding and applying the assessment tool’s criteria accurately to clinical vignettes. This approach also included designing prompts to explicitly instruct the AI on how to format its responses, ensuring they were consistent with clinical documentation standards. Results: Both ChatGPT models demonstrated promising proficiency in applying the Sour Seven Questionnaire to the vignettes, despite initial inconsistencies and errors. Performance notably improved through iterative prompt engineering, enhancing the models’ capacity to detect delirium symptoms and assign scores. Prompt optimizations included adjusting the scoring methodology to accept only definitive “Yes” or “No” responses, revising the evaluation prompt to mandate responses in a tabular format, and guiding the models to adhere to the 2 recommended actions specified in the Sour Seven Questionnaire. Conclusions: Our findings provide preliminary evidence supporting the potential utility of AI models such as ChatGPT in administering standardized clinical assessment tools. The results highlight the significance of context-specific training and prompt engineering in harnessing the full potential of these AI models for health care applications. Despite the encouraging results, broader generalizability and further validation in real-world settings warrant additional research. %M 39353189 %R 10.2196/51383 %U https://formative.jmir.org/2024/1/e51383 %U https://doi.org/10.2196/51383 %U http://www.ncbi.nlm.nih.gov/pubmed/39353189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57936 %T The WeThrive App and Its Impact on Adolescents Who Menstruate: Qualitative Study %A MacNeil,Nora %A Price,Victoria %A Pike,Meghan %+ Division of Hematology/Oncology, Department of Pediatrics, Izaak Walton Killam Health Centre, PO Box 9700, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 9024708643, meghan.pike@iwk.nshealth.ca %K heavy menstrual bleeding %K adolescents %K menorrhagia %K quality of life %K mobile applications %K mobile health application %K mobile phone %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heavy menstrual bleeding (HMB) affects up to 37% of adolescents. Without recognition, HMB can lead to other medical conditions resulting in diminished health-related quality of life. WeThrive, a new mobile health (mHealth) app, implements the pictorial bleeding assessment chart to identify HMB, and the adolescent Menstrual Bleeding Questionnaire to measure the effects of HMB on adolescents’ health-related quality of life. If HMB is identified, WeThrive will connect users to local clinics for further assessment of their menstrual bleeding with a health care provider. Objective: This study aimed to describe adolescents’ experiences using WeThrive app. Methods: This qualitative study was approved by the local Research Ethics Board in Halifax, Nova Scotia, and informed consent was provided by all participants. Individual semistructured interviews were held via videoconference with adolescents younger than 18 years, who had at least 1 menstrual period and had used WeThrive at least once. Interview transcripts were thematically analyzed by 2 investigators (MP and NMN) independently, and the κ statistic was calculated to determine the strength of correlation in themes. Results: Five adolescents (mean age 15.5, range 13-18 years), participated in the interviews. All participants stated that WeThrive helps them better understand their menstrual periods by predicting period onset, recognizing menstrual symptoms, and identifying HMB. Four themes were identified: (1) the importance of visual features and usability, (2) newly obtained knowledge using WeThrive, (3) feature use depends on menstrual health, and (4) trustworthiness. There was substantial agreement on the identified themes (κ=0.73). Conclusions: WeThrive is visually appealing, and trustworthy, and helps users better understand their menstrual periods, including identifying HMB. By identifying HMB early, WeThrive has the potential to improve the recognition of bleeding disorders and iron deficiency in adolescents. WeThrive is a useful tool to help adolescents better understand their menstrual periods. %M 39361373 %R 10.2196/57936 %U https://formative.jmir.org/2024/1/e57936 %U https://doi.org/10.2196/57936 %U http://www.ncbi.nlm.nih.gov/pubmed/39361373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55815 %T A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach %A Chernick,Lauren S. %A Bugaighis,Mona %A Daylor,Victoria %A Hochster,Daniel %A Rosen,Evan %A Schnall,Rebecca %A Stockwell,Melissa S %A Bell,David L. %+ Columbia University Irving Medical Center, 3959 Broadway, New York, NY, United States, 1 2123059825, lc2243@cumc.columbia.edu %K sexual health %K adolescent health %K sex education %K emergency medicine %K health planning %K sexual behavior %K SMS text messaging %K mHealth %K mobile app %K condom use %K user-centered design %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. Objective: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. Methods: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric’s content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen’s heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. Results: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. Conclusions: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions. %M 39365657 %R 10.2196/55815 %U https://formative.jmir.org/2024/1/e55815 %U https://doi.org/10.2196/55815 %U http://www.ncbi.nlm.nih.gov/pubmed/39365657 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56606 %T Assessing the Effectiveness of an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Single-Case and Pre-Post Experimental Design Study %A Herrijgers,Corinne %A Verboon,Peter %A Florence,Eric %A Vandebosch,Heidi %A Poels,Karolien %A Platteau,Tom %+ Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerpen, 2000, Belgium, 32 033455656, cherrijgers@itg.be %K mobile health %K chemsex %K men who have sex with men %K MSM %K harm reduction %K behavioral change %K self-efficacy %K risk behavior %K sexual health %K digital intervention %K health education %K mobile phone %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study focuses on the Budd app, a mobile health intervention designed for gay, bisexual, and other men who have sex with men who participate in chemsex. Chemsex, the use of psychoactive drugs in a sexual context, presents substantial health risks including increased HIV transmission and mental health issues. Addressing these risks requires innovative interventions tailored to the unique needs of this population. Objective: This study aims to evaluate the effectiveness of the Budd app in promoting drug harm reduction practices among its users, focusing on knowledge, behavioral intention, risk behavior awareness, and self-efficacy. Methods: The study used a mixed methods approach, combining a single-case experimental design and a pre-post study. A total of 10 participants from an outpatient clinic were recruited, and each attended the clinic 3 times. During the first visit, participants installed a restricted version of the Budd app, which allowed them to report daily mood and risk behavior after chemsex sessions. Phase A (baseline) lasted at least 2 weeks depending on chemsex participation. In the second visit, participants gained full access to the Budd app, initiating phase B (intervention). Phase B lasted at least 6 weeks, depending on chemsex participation, with identical data input as phase A. Participants completed pre- and postintervention surveys assessing behavioral determinants during the first and third visit. Results: The study observed an increased knowledge about chemsex substances postintervention, with a mean percentage improvement in knowledge scores of 20.59% (SD 13.3%) among participants. Behavioral intention and self-efficacy showed mixed results, with some participants improving while others experienced a decrease. There was also a variable impact on awareness of risk behavior, with half of the participants reporting a decrease postintervention. Despite these mixed results, the app was generally well-received, with participants engaging with the app’s features an average of 50 times during the study. Conclusions: The Budd app showed effectiveness in enhancing knowledge about chemsex substances among gay, bisexual, and other men who have sex with men. However, its impact on safe dosing behavior, behavioral intention, self-efficacy, and risk behavior awareness was inconsistent. These findings suggest that while educational interventions can increase knowledge, translating this into behavioral change is more complex and may require more participants, a longer follow-up period, and additional strategies and support mechanisms. %M 39365642 %R 10.2196/56606 %U https://formative.jmir.org/2024/1/e56606 %U https://doi.org/10.2196/56606 %U http://www.ncbi.nlm.nih.gov/pubmed/39365642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55921 %T Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment %A Vomhof,Markus %A Bau,Jessica Tabea %A Hüter,Pia %A Stehl,Stefan %A Haastert,Burkhard %A Loerbroks,Adrian %A Icks,Andrea %A Calo,Stella Teresa %A Schuster,Luca %A Pischke,Claudia R %A Kairies-Schwarz,Nadja %A Angerer,Peter %A Apolinário-Hagen,Jennifer %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany, 49 211 8106557, jessica.bau@hhu.de %K preferences %K digital mental health %K medical students %K innovation diffusion %K technology acceptance %K health information %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students’ information preferences regarding DMHIs. Objective: This study aims to explore information preferences for DMHIs for personal use among medical students in Germany. Methods: A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis. Results: Of 309 participants, 231 (74.8%) with reliable data were included in the main analysis (women: 217/309, 70.2%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies. Conclusions: Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students’ interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step. %M 39365652 %R 10.2196/55921 %U https://formative.jmir.org/2024/1/e55921 %U https://doi.org/10.2196/55921 %U http://www.ncbi.nlm.nih.gov/pubmed/39365652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45461 %T Impact of a Self-Autonomous Evaluation Station and Personalized Training Algorithm on Quality of Life and Physical Capacities in Sedentary Adults: Randomized Controlled Trial %A Le Mat,Yann %A Casali,Corentin %A Le Mat,Franck %A Féasson,Léonard %A Foschia,Clément %A Géry,Mathias %A Rossi,Jérémy %A Millet,Guillaume Y %+ Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, F-42023, 10 rue de Tréfilerie, Saint Etienne, 42100, France, 33 0477421875, yann.lemat@univ-st-etienne.fr %K physical activity %K sedentary behavior %K quality of life %K mobile health %K health-related interventions %K mobile app %K mobile phone %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is a major risk factor for noncommunicable diseases and a leading cause of premature death. The World Health Organization (WHO) recommends at least 150 minutes of moderate intensity physical activity (PA) weekly, regardless of age, gender, or personal habits. However, in both sports performance and clinical settings, personalized training (PT) regimens have shown superior efficacy over general guidelines. Objective: We hypothesized that an automatic PT program, informed by initial physical evaluations, would increase overall quality of life, quality of sleep, and physical capabilities and reduce fatigue and depression compared with adherence to WHO recommendations. Methods: This 5-month, randomized, single-blinded controlled trial involved 112 sedentary or minimally active participants, divided randomly into PT and free training (FT) groups. Physical capabilities and subjective measures such as quality of life, sleep, depression, and fatigue were evaluated for both groups. After 1 month, both groups were asked to perform 150 minutes of PA per week for 4 months; the PT group could either follow a “virtual coach” on a mobile app to follow some personalized PA or do what they would like, while the FT group was to follow the general PA recommendations of the WHO. Results: We did not find any group×time interaction for PA duration or intensity, physical qualities, and subjective measures. However, considering both groups together, there was a significant pretest and posttest time effect for duration of PA (18.2 vs 24.5 min/d of PA; P<.001), intensity (2.36 vs 3.11; P<.001), and workload (46.8 vs 80.5; P<.001). Almost all physical qualities were increased pretest and posttest (ie, estimated VO2max 26.8 vs 29 mL min–1 kg–1; P<.001; flexibility 25.9 vs 26.9 cm; P=.049; lower limb isometric forces 328 vs 347 N m; P=.002; reaction time 0.680 vs 0.633 s; P<.001; power output on cyclo-ergometer 7.63 vs 7.82 W; P<.003; and balance for the left and right leg 215 vs 163 mm2; P<.003 and 186 vs 162 mm2; P=.048, respectively). Finally, still considering the PT and FT groups together, there were significant pretest to posttest improvements in the mental component of quality of life using the 12-item Short Form Health Survey (41.9 vs 46.0; P<.006), well-being using the Warwick-Edinburgh Mental Well-Being Scale (48.3 vs 51.7; P<.002), depression using the Center for Epidemiologic Studies Depression Scale (15.5 vs 11.5; P=.02), and fatigue using the Functional Assessment of Chronic Illness Therapy–Fatigue (37.1 vs 39.5; P=.048). Conclusions: The individualized training was not more effective than the general recommendations. A slight increase in PA (from 18 to 24 min/d) in sedentary or poorly active people is enough for a significant increase in physical capabilities and a significant improvement in quality of life, well-being, depression, and fatigue. Trial Registration: ClinicalTrials.gov NCT04998266; https://clinicaltrials.gov/study/NCT04998266 %M 39365990 %R 10.2196/45461 %U https://formative.jmir.org/2024/1/e45461 %U https://doi.org/10.2196/45461 %U http://www.ncbi.nlm.nih.gov/pubmed/39365990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56674 %T Comparison of Analgesia Methods Through a Web Platform in Patients Undergoing Thoracic Surgery: Pilot Design, Implementation, and Validation Study %A Trò,Rosella %A Orecchia,Angelica %A Disma,Nicola %A Uva,Paolo %A Cavanna,Roberto %A Zanardi,Nicolò %A Torre,Michele %A Fato,Marco Massimo %+ Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Via all'Opera Pia 13, Genoa, 16145, Italy, 39 3408716911, rosella.tro@edu.unige.it %K pectus excavatum %K pain assessment %K web platform %K health care informatics %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. Objective: This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children’s Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. Methods: The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. Results: Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy. Conclusions: This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality. %M 39378419 %R 10.2196/56674 %U https://formative.jmir.org/2024/1/e56674 %U https://doi.org/10.2196/56674 %U http://www.ncbi.nlm.nih.gov/pubmed/39378419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60147 %T Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study %A Polivka,Barbara %A Krueger,Kathryn %A Bimbi,Olivia %A Huntington-Moskos,Luz %A Nyenhuis,Sharmilee %A Cramer,Emily %A Eldeirawi,Kamal %+ School of Nursing, University of Kansas, 3901 Rainbow Blvd., School of Nursing, Kansas City, KS, 66160, United States, 1 9135881630, bpolivka@kumc.edu %K indoor air quality %K asthma %K real-time assessment %K EMA %K ecological momentary assessment %K mobile phone %K monitoring %K air quality %K real time %K spirometry %K acceptability %K usability %K residential toxins %K volatile organic compounds %K VOC %K adult %K female %K women %K college student %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies. %M 39388233 %R 10.2196/60147 %U https://formative.jmir.org/2024/1/e60147 %U https://doi.org/10.2196/60147 %U http://www.ncbi.nlm.nih.gov/pubmed/39388233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58221 %T Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke %A Wakeman,Michael %A Tesfaye,Lydia %A Gregory,Tim %A Leahy,Erin %A Kendrick,Brandon %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, Rockville, MD, 20852, United States, 1 3015944743, sherine.el-toukhy@nih.gov %K smoking cessation %K social determinants of health %K mhealth %K apps %K qualitative research %K young adults %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users’ perceptions are important determinants of the adoption and use of new technologies. However, little is known about users’ perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke. Objective: This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. Methods: In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach. Results: Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants’ limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%). Conclusions: The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management. %M 39392684 %R 10.2196/58221 %U https://formative.jmir.org/2024/1/e58221 %U https://doi.org/10.2196/58221 %U http://www.ncbi.nlm.nih.gov/pubmed/39392684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53465 %T Automated Detection of Neurodevelopmental Disorders Using Face-to-Face Mobile Technology Among Typically Developing Greek Children: Randomized Controlled Trial %A Toki,Eugenia I %A Zakopoulou,Victoria %A Tatsis,Giorgos %A Pange,Jenny %+ Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Panepistimioupoli B, Rm 148, Ioannina, 45500, Greece, 30 2651050720, toki@uoi.gr %K main principles %K automated detection %K neurodevelopmental disorders %K principal component analysis %K early screening %K early intervention %K detection %K screening %K assessment %K digital tool %K serious game %K child %K Greece %K speech %K psychomotor %K cognitive %K psychoemotional %K hearing %K machine learning %K apps %K predictions %K screening %K prognosis %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurodevelopmental disorders (NDs) are characterized by heterogeneity, complexity, and interactions among multiple domains with long-lasting effects in adulthood. Early and accurate identification of children at risk for NDs is crucial for timely intervention, yet many cases remain undiagnosed, leading to missed opportunities for effective interventions. Digital tools can help clinicians assist and identify NDs. The concept of using serious games to enhance health care has gained attention among a growing group of scientists, entrepreneurs, and clinicians. Objective: This study aims to explore the core principles of automated mobile detection of NDs in typically developing Greek children, using a serious game developed within the SmartSpeech project, designed to evaluate multiple developmental domains through principal component analysis (PCA). Methods: A total of 229 typically developing children aged 4 to 12 years participated in the study. The recruitment process involved open calls through public and private health and educational institutions across Greece. Parents were thoroughly informed about the study’s objectives and procedures, and written consent was obtained. Children engaged under the clinician’s face-to-face supervision with the serious game “Apsou,” which assesses 18 developmental domains, including speech, language, psychomotor, cognitive, psychoemotional, and hearing abilities. Data from the children’s interactions were analyzed using PCA to identify key components and underlying principles of ND detection. Results: A sample of 229 typically developing preschoolers and early school-aged children played the Apsou mobile serious game for automated detection of NDs. Performing a PCA, the findings identified 5 main components accounting for about 80% of the data variability that potentially have significant prognostic implications for a safe diagnosis of NDs. Varimax rotation explained 61.44% of the total variance. The results underscore key theoretical principles crucial for the automated detection of NDs. These principles encompass communication skills, speech and language development, vocal processing, cognitive skills and sensory functions, and visual-spatial skills. These components align with the theoretical principles of child development and provide a robust framework for automated ND detection. Conclusions: The study highlights the feasibility and effectiveness of using serious games for early ND detection in children. The identified principal components offer valuable insights into critical developmental domains, paving the way for the development of advanced machine learning applications to support highly accurate predictions and classifications for automated screening, diagnosis, prognosis, or intervention planning in ND clinical decision-making. Future research should focus on validating these findings across diverse populations integrating additional features such as biometric data and longitudinal tracking to enhance the accuracy and reliability of automated detection systems. Trial Registration: ClinicalTrials.gov NCT06633874; https://clinicaltrials.gov/study/NCT06633874 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.3390/signals4020021 %M 39393054 %R 10.2196/53465 %U https://formative.jmir.org/2024/1/e53465 %U https://doi.org/10.2196/53465 %U http://www.ncbi.nlm.nih.gov/pubmed/39393054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57348 %T Decision Support Tool to Improve Decision-Making for HIV Pre-Exposure Prophylaxis (PrEP): Development Process and Alpha Testing %A Ajiboye,Wale %A Yusuf,Abban %A Pedersen,Cheryl %A Brown,Rebecca %A Dzonsons,Kristaps %A Nelson,LaRon %+ MAP Center for Urban Health Solution, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B1C9, Canada, 1 4165873178, wale.ajiboye@unityhealth.to %K HIV PrEP in black patients %K pre-exposure prophylaxis %K decision support tool to increase PrEP uptake and adherence %K HIV prevention in Black communities %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: African, Caribbean, and Black (Black) communities in Canada are disproportionately affected by the HIV epidemic. Pre-exposure prophylaxis (PrEP) is a highly effective option for the prevention of HIV. However, the use of PrEP for HIV prevention among eligible Black clients in Canada remains far below the thresholds necessary to achieve the goal of zero new HIV infections. In a recent study in Toronto, PrEP-eligible Black clients were found to have decisional conflict and unmet decisional needs, which affected the quality of their decision-making process regarding the initiation and adherence to PrEP. There is evidence that decision support tools (DSTs) can improve the quality of a decision, the quality of the decision-making process, the implementation or continuation of the chosen option, and the appropriate use of health services. Despite these benefits, there is currently no DST for PrEP-eligible Black clients being asked to consider PrEP for HIV prevention. Objective: Our study aimed to develop a DST to improve PrEP decision-making for Black clients and to evaluate the tool’s acceptability and usability. Methods: We developed and evaluated the PrEP DST for Black patients using the 7-step process outlined in the Ottawa Decision Support Group Guideline for the development and evaluation of DST. To facilitate the implementation of the Ottawa Decision Support Group guideline, we assembled a multidisciplinary team of primary health care providers, researchers, community members with lived experiences, and digital content designers to serve as the steering committee. First, we assessed patients’ and primary health care providers’ views on decisional support needs, after which we determined the content, design, and distribution plan for the DST. Subsequently, we conducted evidence synthesis, reviews, and appraisal before developing the PrEP DST prototype. The final tool was reviewed by steering committee members for completeness before acceptability and usability testing with potential Black clients and PrEP providers. Results: The web-based DST yielded 27 pages divided into 6 distinct sections. The six sections include (1) an introduction of the DST, (2) clarify your decision, (3) knowledge, (4) a value clarification exercise, (5) support system, and (6) next steps. Both Black clients and PrEP providers reported ease of task performance, general satisfaction, and usefulness of the tool to support decision-making for Black clients. Feedback on usability centered on the need to add a user guide to increase usability. All feedback was incorporated into the final tool. Conclusions: A PrEP DST for Black clients developed using a systematic process and a multidisciplinary steering committee was acceptable and usable by both Black clients and PrEP providers. Further study (eg, randomized controlled trials) may be needed to evaluate the efficacy of the PrEP DST. %M 39393055 %R 10.2196/57348 %U https://formative.jmir.org/2024/1/e57348 %U https://doi.org/10.2196/57348 %U http://www.ncbi.nlm.nih.gov/pubmed/39393055 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60712 %T Leveraging Chatbots to Combat Health Misinformation for Older Adults: Participatory Design Study %A Peng,Wei %A Lee,Hee Rin %A Lim,Sue %+ Department of Media and Information, Michigan State University, 404 Wilson Room 409, East Lansing, MI, 48824, United States, 1 5174328235, pengwei@msu.edu %K chatbot %K conversational agent %K older adults %K health misinformation %K participatory design %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults, a population particularly susceptible to misinformation, may experience attempts at health-related scams or defrauding, and they may unknowingly spread misinformation. Previous research has investigated managing misinformation through media literacy education or supporting users by fact-checking information and cautioning for potential misinformation content, yet studies focusing on older adults are limited. Chatbots have the potential to educate and support older adults in misinformation management. However, many studies focusing on designing technology for older adults use the needs-based approach and consider aging as a deficit, leading to issues in technology adoption. Instead, we adopted the asset-based approach, inviting older adults to be active collaborators in envisioning how intelligent technologies can enhance their misinformation management practices. Objective: This study aims to understand how older adults may use chatbots’ capabilities for misinformation management. Methods: We conducted 5 participatory design workshops with a total of 17 older adult participants to ideate ways in which chatbots can help them manage misinformation. The workshops included 3 stages: developing scenarios reflecting older adults’ encounters with misinformation in their lives, understanding existing chatbot platforms, and envisioning how chatbots can help intervene in the scenarios from stage 1. Results: We found that issues with older adults’ misinformation management arose more from interpersonal relationships than individuals’ ability to detect misinformation in pieces of information. This finding underscored the importance of chatbots to act as mediators that facilitate communication and help resolve conflict. In addition, participants emphasized the importance of autonomy. They desired chatbots to teach them to navigate the information landscape and come to conclusions about misinformation on their own. Finally, we found that older adults’ distrust in IT companies and governments’ ability to regulate the IT industry affected their trust in chatbots. Thus, chatbot designers should consider using well-trusted sources and practicing transparency to increase older adults’ trust in the chatbot-based tools. Overall, our results highlight the need for chatbot-based misinformation tools to go beyond fact checking. Conclusions: This study provides insights for how chatbots can be designed as part of technological systems for misinformation management among older adults. Our study underscores the importance of inviting older adults to be active co-designers of chatbot-based interventions. %M 39393065 %R 10.2196/60712 %U https://formative.jmir.org/2024/1/e60712 %U https://doi.org/10.2196/60712 %U http://www.ncbi.nlm.nih.gov/pubmed/39393065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57939 %T Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation %A Folk,Johanna B %A Valencia-Ayala,Cynthia %A Holloway,Evan D %A Anvar,Sarah %A Czopp,Alison %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building 5, 7M8, San Francisco, CA, 94110, United States, 1 4156029521, Johanna.folk@ucsf.edu %K family-based intervention %K affect management %K child welfare system %K telehealth %K formative evaluation %K trauma exposure %K substance misuse %K adverse childhood experiences %K trauma-informed care %K adolescent health %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. Objective: To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Methods: Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Results: Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. Conclusions: An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. Trial Registration: ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523 %M 39405104 %R 10.2196/57939 %U https://formative.jmir.org/2024/1/e57939 %U https://doi.org/10.2196/57939 %U http://www.ncbi.nlm.nih.gov/pubmed/39405104 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47251 %T Intervention to Improve Well-Being, Nutrition, and Physical Activity in Adults: Experimental Study %A Aubert,Morghane %A Clavel,Céline %A Le Scanff,Christine %A Martin,Jean-Claude %+ Laboratoire Interdisciplinaire des Sciences du Numérique, Campus Universitaire bâtiment 507, Rue du Belvédère, Orsay, 91400, France, 33 684216205, jean-claude.martin@lisn.fr %K mindfulness %K well-being %K affects %K nutrition %K physical activity %K intervention %K lifestyle habits %K mindfulness exercises %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mindfulness improves well-being, improves emotional regulation, reduces impulses to eat, and is linked to increased physical activity. Mindfulness interventions usually focus on 1 aspect but do not offer an approach to holistically improving lifestyle. Objective: This study aims to address this gap by designing and evaluating a holistic mindfulness intervention. Methods: Committing to a 12-week intervention with 2-hour sessions without knowing whether you will enjoy it can be a hindrance for someone completely unfamiliar with mindfulness. For this reason, we decided to design a mindfulness intervention with short sessions over a reduced number of weeks. The aim is to enable novices to discover different aspects of mindfulness while at the same time offering a satisfactory practice for people who are already practicing mindfulness. We designed and evaluated a web-based mindfulness intervention in 5 sessions of 5 to 10 minutes each on well-being, diet, and physical activity to support a healthier lifestyle. The first 2 sessions focus on formal mindfulness meditation to enable novices to discover mindfulness and its main principles. Then there are 2 sessions about food. The first session about food aims to develop a sense of satisfaction with the food we eat and to focus our attention on new sensations. The second session about food aims to develop the ability to resist the lure of unhealthy foods. Finally, there is a session on physical activity. The aim is to develop a particular awareness of the body during movement, to increase satisfaction with physical activity, and to develop regular exercise. Results: In total, 32 participants completed the intervention. After the intervention, we observed decreases in negative affect, anxiety, and emotional distress, and an increase in dispositional mindfulness. There was no effect on reported healthy eating habits and physical activity habits. Few participants repeated the exercises as recommended. The majority of our participants were new to mindfulness. The majority of our participants reported being satisfied with the different sessions. A few minor difficulties were mentioned, mainly related to the environment in which the participants carried out the sessions. Only 1 session was less satisfactory for one-third of the participants. The session on resistance to unhealthy foods was formulated too strictly and the idea of banning certain foods was a hindrance for one-third of the participants. A reformulation is needed. Conclusions: The mindfulness exercises were well accepted and promoted a state of mindfulness. It would be interesting to provide easier technical access to the exercises via a mobile app so that they can be repeated easily. %M 39405102 %R 10.2196/47251 %U https://formative.jmir.org/2024/1/e47251 %U https://doi.org/10.2196/47251 %U http://www.ncbi.nlm.nih.gov/pubmed/39405102 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55234 %T Examining the Effects of Cognitive Behavioral Therapy With a Virtual Agent on User Motivation and Improvement in Psychological Distress and Anxiety: Two-Session Experimental Study %A Frischholz,Katja %A Tanaka,Hiroki %A Shidara,Kazuhiro %A Onishi,Kazuyo %A Nakamura,Satoshi %+ Department of Psychology, University of Regensburg, Universitätsstraße 31, Regensburg, 93053, Germany, 49 941 943 4413, katja.frischholz@psychologie.uni-regensburg.de %K cognitive behavioral therapy %K cognitive restructuring %K motivation %K virtual agent %K automatic negative thoughts %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) is a valuable treatment for mood disorders and anxiety. CBT methods, such as cognitive restructuring, are employed to change automatic negative thoughts to more realistic ones. Objective: This study extends on previous research conducted by the authors, focused on the process of correcting automatic negative thoughts to realistic ones and reducing distress and anxiety via CBT with a virtual agent. It was aimed to investigate whether the previously applied virtual agent would achieve changes in automatic negative thoughts when modifications to the previous experimental paradigm are applied and when user motivation is taken into consideration. Furthermore, the potential effects of existing participant knowledge concerning CBT or automatic thoughts were explored. Methods: A single-group, 2-session experiment was conducted using a within-group design. The study recruited 35 participants from May 15, 2023, to June 2, 2023, via Inter Group Corporation, with data collection following from June 5 to June 20, 2023, at Nara Institute of Science and Technology, Japan. There were 19 male and 16 female participants (age range: 18-50 years; mean 33.66, SD 10.77 years). Participants answered multiple questionnaires covering depressive symptomatology and other cognitive variables before and after a CBT session. CBT was carried out using a virtual agent, who participants conversed with using a CBT dialogue scenario on the topic of automatic negative thoughts. Session 2 of the experiment took place 1 week after session 1. Changes in distress and state anxiety were analyzed using a Wilcoxon signed-rank test and t-test for paired samples. The relationships of motivation with cognitive changes and distress or anxiety changes were investigated via correlation analysis. Multiple linear regression was used to analyze the potential predictive qualities of previous knowledge of CBT and automatic negative thoughts regarding outcome measures. Results: Significant reductions in distress (all P<.001) and state anxiety (all P<.003) emerged throughout the first and second experimental sessions. The CBT intervention increased participants’ recognition of their negative thinking and their intention to change it, namely their motivation to change it. However, no clear correlations of motivation with changes in distress or anxiety were found (all P>.04). Participants reported moderate subjective changes in their cognition, which were in part positively correlated with their motivation (all P<.007). Lastly, existing knowledge of CBT did not predict reductions in distress during the first session of the experiment (P=.02). Conclusions: CBT using a virtual agent and a CBT dialogue scenario was successful in reducing distress and anxiety when talking about automatic negative thoughts. The promotion of client motivation needs to be critically considered when designing interventions using CBT with a virtual agent, and further experimental investigations on the causal influences between motivation and outcome measures need to be conducted. %M 39405101 %R 10.2196/55234 %U https://formative.jmir.org/2024/1/e55234 %U https://doi.org/10.2196/55234 %U http://www.ncbi.nlm.nih.gov/pubmed/39405101 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60434 %T Intention to Use a Mental Health App for Menopause: Health Belief Model Approach %A Martin-Key,Nayra A %A Funnell,Erin L %A Benacek,Jiri %A Spadaro,Benedetta %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K menopause %K menopause transition %K mental health %K perimenopause %K women’s health %K psychological framework %K symptom tracking %K app usage %K app %K Health Belief Model %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Menopause presents a period of heightened vulnerability for mental health issues. Despite this, mental health screening is not consistently integrated into menopausal health care, and access to psychological interventions is limited. Digital technologies, such as web and smartphone apps, may offer a way to facilitate and improve mental health care provision throughout menopause. However, little is known about potential users’ intention to use such technologies during this critical phase of life. Objective: To examine the factors that impact the intention of potential users to use a mental health app during menopause, we used the Health Belief Model (HBM), a psychological framework widely used to understand and predict individuals’ health-related behaviors. Methods: An online survey was generated. Convenience sampling was used, with participants recruited via social media and email, through relevant foundations and support groups, and by word of mouth. Structural equation modeling with maximum likelihood estimation was conducted to explore whether the factor structure of the HBM is a good fit for predicting the intention to use a mental health app for menopause. A Cronbach α value of .05 was used for determining statistical significance. Results: A total of 1154 participants commenced the survey, of which 82.49% (n=952) completed at least 97% of the survey. Of these, 86.76% (n=826) expressed that their menopausal symptoms had negatively affected their mental health, and went on to answer questions regarding their experiences and interest in using a web or smartphone app for mental health symptoms related to menopause. Data from this subgroup (N=826) were analyzed. In total, 74.09% (n=612) of respondents sought online help for mental health symptoms related to menopause. The most common topics searched for were symptom characteristics (n=435, 52.66%) and treatment or therapy options (n=210, 25.42%). Psychoeducation (n=514, 62.23%) was the most desired mental health app feature, followed by symptom tracking (n=499, 60.41%) and self-help tips (n=469, 56.78%). In terms of the intention to use a mental health app, the Satorra-Bentler–scaled fit statistics indicated a good fit for the model (χ2278=790.44, P<.001; comparative fit index=0.933, root mean square error of approximation=0.047, standardized root mean square residual=0.056), with cues to action emerging as the most significant predictor of intention (β=.48, P<.001). This was followed by perceived barriers (β=–.25, P<.001), perceived susceptibility (β=.15, P<.001), and perceived benefits (β=.13, P<.001). Perceived severity (β=.01, P=.869) and self-efficacy (β=.03, P=.286) were not significantly associated with behavioral intention. Conclusions: This study reveals important factors that influence the intention to use a mental health app during menopause. It emphasizes the need to address barriers to app usage, while highlighting the impact of credible endorsements and psychoeducation. Furthermore, the study underscores the significance of improving accessibility for users with lower digital literacy or limited resources. %M 39412868 %R 10.2196/60434 %U https://formative.jmir.org/2024/1/e60434 %U https://doi.org/10.2196/60434 %U http://www.ncbi.nlm.nih.gov/pubmed/39412868 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57294 %T A French-Language Web-Based Intervention Targeting Prolonged Grief Symptoms in People Who Are Bereaved and Separated: Randomized Controlled Trial %A Debrot,Anik %A Efinger,Liliane %A Kheyar,Maya %A Pomini,Valentino %A Berthoud,Laurent %+ Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Géopolis, Rue de la Mouline 11, Lausanne, 1015, Switzerland, 41 216923239, anik.debrot@unil.ch %K web-based interventions %K randomized controlled trial %K grief %K bereavement %K separation %K guidance %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Losing a loved one, through death or separation, counts among the most stressful life events and is detrimental to health and well-being. About 15% of people show clinically significant difficulties coping with such an event. Web-based interventions (WBIs) are effective for a variety of mental health disorders, including prolonged grief. However, no validated WBI is available in French for treating prolonged grief symptoms. Objective: This study aimed to compare the efficacy and adherence rates of 2 WBIs for prolonged grief symptoms following the loss of a loved one through death or romantic separation. Methods: LIVIA 2.0 was developed relying on theoretical and empirical findings on bereavement processes and WBIs, and is compared with LIVIA 1, which has already demonstrated its efficacy. We conducted a randomized controlled trial and provided on-demand guidance to participants. Outcomes were assessed through web-based questionnaires before the intervention, after the intervention (12 weeks later), and at follow-up (24 weeks later). Primary outcomes were grief symptoms, depressive symptoms, and well-being. Secondary outcomes were anxiety symptoms, grief coping strategies, aspects related to self-identity, and program satisfaction. Results: In total, 62 participants were randomized (intent-to-treat [ITT] sample), 29 (47%) in LIVIA 2.0 (active arm) and 33 (53%) in LIVIA 1 (control arm). The dropout rate was 40% (37/62), and 10 participants were removed due to exclusion criteria, leading to a final per-protocol sample of 27 (44%) completers who differed from noncompleters only based on reporting fewer anxiety symptoms (t60=3.03; P=.004). Participants who are separated reported more grief symptoms (t60=2.22; P=.03) and attachment anxiety (t60=2.26; P=.03), compared to participants who are bereaved. There were pre-post within-group differences for both programs in the ITT sample, with significant reductions in grief (Cohen d=−0.90), depressive symptoms (Cohen d=−0.31), and centrality of the loss (Cohen d=−0.45). The same pattern was observed in the per-protocol sample, with the exception that anxiety symptoms also significantly diminished (Cohen d=−0.45). No difference was found in efficacy between the 2 programs (all P>.33). Participants (ITT sample) reported overall high levels of program satisfaction (mean 3.18, SD 0.54; over a maximum of 4). Effect stability was confirmed at the 6-month follow-up for all outcomes, with an improvement in self-concept clarity. Conclusions: The 2 grief-related WBIs were effective in reducing grief, depressive and anxiety symptoms for participants who are bereaved or separated. The analyses did not reveal any pre-post between-group differences, suggesting that the innovations brought to LIVIA 2.0 did not significantly affect the outcome. However, caution is warranted with the interpretation of the results given the limited power of the sample, which only allows the detection of medium effect sizes. Trial Registration: ClinicalTrials.gov NCT05219760; https://clinicaltrials.gov/study/NCT05219760 International Registered Report Identifier (IRRID): RR2-10.2196/39026 %M 39412869 %R 10.2196/57294 %U https://formative.jmir.org/2024/1/e57294 %U https://doi.org/10.2196/57294 %U http://www.ncbi.nlm.nih.gov/pubmed/39412869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62762 %T WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice %A Fabens,Isabella %A Makhele,Calsile %A Igaba,Nelson Kibiribiri %A Hlongwane,Sizwe %A Phohole,Motshana %A Waweru,Evelyn %A Oni,Femi %A Khwepeya,Madalitso %A Sardini,Maria %A Moyo,Khumbulani %A Tweya,Hannock %A Wafula,Mourice Barasa %A Pienaar,Jacqueline %A Ndebele,Felex %A Setswe,Geoffrey %A Dong,Tracy Qi %A Feldacker,Caryl %+ International Training and Education Center for Health (I-TECH), Departments of Global Health and Medicine, University of Washington, 13th Floor, 908 Jefferson Street, Seattle, WA, 98104, United States, 1 206 221 4970, cfeld@uw.edu %K 2-way texting %K text messages %K WhatsApp %K digital health innovations %K male circumcision %K South Africa %K quality improvement %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. Objective: The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Methods: Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Results: Over a 2-month period—from August to October, 2023—337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33%) WhatsApp clients and 44 (28%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. Conclusions: When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting. %M 39412842 %R 10.2196/62762 %U https://formative.jmir.org/2024/1/e62762 %U https://doi.org/10.2196/62762 %U http://www.ncbi.nlm.nih.gov/pubmed/39412842 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54916 %T Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework %A Pack,Allison P %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 %+ Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 0274, allison.pack@northwestern.edu %K older adults %K polypharmacy %K medication adherence %K intervention development %K qualitative research %D 2024 %7 17.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. Objective: To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). Methods: We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. Results: In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Conclusions: Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults. %M 39418094 %R 10.2196/54916 %U https://formative.jmir.org/2024/1/e54916 %U https://doi.org/10.2196/54916 %U http://www.ncbi.nlm.nih.gov/pubmed/39418094 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47814 %T Fine-Tuned Bidirectional Encoder Representations From Transformers Versus ChatGPT for Text-Based Outpatient Department Recommendation: Comparative Study %A Jo,Eunbeen %A Yoo,Hakje %A Kim,Jong-Ho %A Kim,Young-Min %A Song,Sanghoun %A Joo,Hyung Joon %+ Department of Medical Informatics, Korea University College of Medicine, 73, Inchon-ro, Seoul, 02841, Republic of Korea, 82 2 920 5445, drjoohj@gmail.com %K natural language processing %K bidirectional encoder representations from transformers %K large language model %K generative pretrained transformer %K medical specialty prediction %K quality of care %K health care application %K ChatGPT %K BERT %K AI technology %K conversational agent %K AI %K artificial intelligence %K chatbot %K application %K health care %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients often struggle with determining which outpatient specialist to consult based on their symptoms. Natural language processing models in health care offer the potential to assist patients in making these decisions before visiting a hospital. Objective: This study aimed to evaluate the performance of ChatGPT in recommending medical specialties for medical questions. Methods: We used a dataset of 31,482 medical questions, each answered by doctors and labeled with the appropriate medical specialty from the health consultation board of NAVER (NAVER Corp), a major Korean portal. This dataset includes 27 distinct medical specialty labels. We compared the performance of the fine-tuned Korean Medical bidirectional encoder representations from transformers (KM-BERT) and ChatGPT models by analyzing their ability to accurately recommend medical specialties. We categorized responses from ChatGPT into those matching the 27 predefined specialties and those that did not. Both models were evaluated using performance metrics of accuracy, precision, recall, and F1-score. Results: ChatGPT demonstrated an answer avoidance rate of 6.2% but provided accurate medical specialty recommendations with explanations that elucidated the underlying pathophysiology of the patient’s symptoms. It achieved an accuracy of 0.939, precision of 0.219, recall of 0.168, and an F1-score of 0.134. In contrast, the KM-BERT model, fine-tuned for the same task, outperformed ChatGPT with an accuracy of 0.977, precision of 0.570, recall of 0.652, and an F1-score of 0.587. Conclusions: Although ChatGPT did not surpass the fine-tuned KM-BERT model in recommending the correct medical specialties, it showcased notable advantages as a conversational artificial intelligence model. By providing detailed, contextually appropriate explanations, ChatGPT has the potential to significantly enhance patient comprehension of medical information, thereby improving the medical referral process. %M 39423004 %R 10.2196/47814 %U https://formative.jmir.org/2024/1/e47814 %U https://doi.org/10.2196/47814 %U http://www.ncbi.nlm.nih.gov/pubmed/39423004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63823 %T Evaluating User Experiences and Preferred Features of a Web-Based 24-Hour Dietary Assessment Tool: Usability Study %A Follong,Berit %A Haliburton,Caitlin %A Mackay,Sally %A Maiquez,Maria %A Grey,Jacqueline %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599, berit.follong@auckland.ac.nz %K public health %K nutrition %K dietary assessment methods %K digital tools %K user experience %K qualitative data %K survey %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Intake24, a web-based 24-hour dietary recall tool developed in the United Kingdom, was adapted for use in New Zealand (Intake24-NZ) through the addition of a New Zealand food list, portion size images, and food composition database. Owing to the customizations made, a thorough evaluation of the tool’s usability was required. Detailed qualitative usability studies are well suited to investigate any challenges encountered while completing a web-based 24-hour recall and provide meaningful data to inform enhancements to the tool. Objective: This study aims to evaluate the usability of Intake24-NZ and identify improvements to enhance both the user experience and the quality of dietary intake data collected. Methods: We used a mixed methods approach comprising two components: (1) completion of a single 24-hour dietary recall using Intake24-NZ with both screen observation recordings and collation of verbal participant feedback on their experience and (2) a survey. Results: A total of 37 participants aged ≥11 years self-completed the dietary recall and usability survey (men and boys: 14/37, 38% and women and girls: 23/37, 62%; Māori: 10/37, 27% and non-Māori: 27/37, 73%). Although most (31/37, 84%) reported that Intake24-NZ was easy to use and navigate, data from the recorded observations and usability survey revealed challenges related to the correct use of search terms, search results obtained (eg, type and order of foods displayed), portion size estimation, and associated food prompts (eg, did you add milk to your tea?). Conclusions: This comprehensive usability study identified challenges experienced by users in completing a dietary recall in Intake24-NZ. The results informed a series of improvements to enhance user experience and the quality of dietary data collected with Intake24-NZ, including adding new foods to the food list, optimizing the search function and ordering of search results, creating new portion size images, and providing clearer instructions to the users. %M 39422998 %R 10.2196/63823 %U https://formative.jmir.org/2024/1/e63823 %U https://doi.org/10.2196/63823 %U http://www.ncbi.nlm.nih.gov/pubmed/39422998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60925 %T Intensive, Real-Time Data Collection of Psychological and Physiological Stress During a 96-Hour Field Training Exercise at a Senior Military College: Feasibility and Acceptability Cohort Study %A Pojednic,Rachele %A Welch,Amy %A Thornton,Margaret %A Garvey,Meghan %A Grogan,Tara %A Roberts,Walter %A Ash,Garrett %+ Stanford Lifestyle Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94303, United States, 1 617 833 7372, rpojedni@stanford.edu %K biomarker %K biometric %K heart rate variability %K saliva %K feasibility %K warfighter %K field training %K acceptability %K wearable biosensors %K real-time %K data collection %K physiological stress %K training exercise %K pilot study %K sweat sensors %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters. Objective: This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX). Methods: A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured. Results: A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ≥80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (≥80%) for all metrics and devices. Conclusions: This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery. %M 39422988 %R 10.2196/60925 %U https://formative.jmir.org/2024/1/e60925 %U https://doi.org/10.2196/60925 %U http://www.ncbi.nlm.nih.gov/pubmed/39422988 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54827 %T The Online Health Information–Seeking Behaviors of People Who Have Experienced Stroke: Qualitative Interview Study %A Clancy,Brigid %A Bonevski,Billie %A English,Coralie %A Guillaumier,Ashleigh %+ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 4055 3222, brigid.clancy@newcastle.edu.au %K stroke %K online health information seeking %K information-seeking behavior %K consumer health information %K digital health %K eHealth %K long-term care %K health-risk behaviors %K qualitative research %K mobile phone %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke. Objective: This study aims to explore the online health information–seeking behaviors of people who have experienced stroke and any related barriers or navigational needs. Methods: Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive–deductive approach. In the deductive analysis, responses were mapped to an online health information–seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework. Results: A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information–seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants’ online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports. Conclusions: People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support. %M 39423365 %R 10.2196/54827 %U https://formative.jmir.org/2024/1/e54827 %U https://doi.org/10.2196/54827 %U http://www.ncbi.nlm.nih.gov/pubmed/39423365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55679 %T Virtual Reality–Based Exposure With 360° Environments for Social Anxiety Disorder: Usability and Feasibility Study %A Ernst,Mathias %A Bouchard,Stéphane %A Andersen,Tonny %A Orskov,Per Trads %A Tarp,Kristine %A Lichtenstein,Mia Beck %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 26218846, mlichtenstein@health.sdu.dk %K anxiety %K exposure therapy %K social anxiety disorder %K virtual reality %K 360° %K mixed methods %K interactive %D 2024 %7 21.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social anxiety disorder (SAD) is a long-term and overwhelming fear of social situations that can affect work, school, and other daily activities. Although cognitive behavioral therapy is effective, few seek treatment, and many who do start often drop out. This may be due to the component of exposure inherent to cognitive behavioral therapy, where the patient confronts feared stimuli outside the therapist’s office, which they otherwise try to avoid. As an alternative, research has explored the effectiveness of virtual reality (VR)–based exposure therapy with promising results. However, few studies have investigated the feasibility of VR tools using mixed methodologies before assessing their efficacy. Objective: This study aims to assess the usability, feasibility, and presence of four 360° virtual environments and whether these were able to evoke anxiety in patients with SAD. Methods: A total of 10 adult participants with SAD and 10 healthy controls were recruited for 1 experimental session (age range 21-32 y; 12/20, 60% male participants). Questionnaire and interview data were collected and analyzed. A mixed methods triangulation design was applied to analyze and compare the data. Results: Participants with SAD experienced increased anxiety when exposed to VR, and environments were considered relevant and useful as an exposure tool. Participants with SAD reported significantly higher average anxiety levels (P=.01) and peak anxiety levels (P=.01) compared with controls during exposure; however, significant differences in anxiety when accounting for baseline anxiety levels were only found in 2 of 4 environments (P=.01, P=.01, P=.07, and P=.06). While presence scores were acceptable in both groups, participants with SAD scored significantly lower than controls. Qualitative analyses highlight this finding within the SAD group, where some participants experienced presence reduction due to being observed while in VR and in situations with reduced interaction in VR. Conclusions: VR exposure with 360° videos seems to be useful as a first step of exposure therapy for patients with SAD. Future exploration in the clinical application of VR-based exposure for SAD, as well as means of increasing presence within the virtual environments, may be useful. %M 39432344 %R 10.2196/55679 %U https://formative.jmir.org/2024/1/e55679 %U https://doi.org/10.2196/55679 %U http://www.ncbi.nlm.nih.gov/pubmed/39432344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56704 %T Influence of Avatar Identification on the Attraction of Virtual Reality Games: Survey Study %A Li,PengFei %A Qi,Fa %A Ye,Zhihai %+ Art College, Jinan University, No. 601 Huangpu Avenue West, Tianhe District, Guangzhou City, Guangdong Province, Guangzhou, 510632, China, 86 198 3289 9510, tlipengfei@jnu.edu.cn %K avatar identification %K self-differentiation theory %K immersion %K attractiveness %K virtual reality games %D 2024 %7 22.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In gaming, the embodied interaction experience of avatars serves as a key to emotional sublimation in artistic creation. This presents the emotional expression of art in a more vivid form, which is a critical factor in the high attractiveness of virtual reality (VR) games to players. Intertwined with players’ physiological and psychological responses, immersion is an essential element for enhancing gaming attractiveness. Objective: This study aims to explore how to help players establish a sense of identity with their embodied avatars in VR game environments and enhance the attractiveness of games to players through the mediating effect of immersion. Methods: We conducted a structured questionnaire survey refined through repeated validation. A total of 402 VR users were publicly recruited through the internet from March 22, 2024, to April 13, 2024. Statistical analysis was conducted using the SPSS and Amos tools, including correlation analysis, regression analysis, and mediation effect verification. We divided the self-differentiation theory into 4 dimensions to validate their impact on avatar identification. Subsequently, we correlated the effects of avatar identification, game immersion, and game attractiveness and proposed a hypothetical mediating model. Results: Regression analysis of the predictor variables and the dependent variable indicated a significant positive predictive effect (P<.001); the variance inflation factor values for each independent variable were all <5. In the hypothesis testing of the mediating effect, the total mediating effect was significant (P<.001). Regarding the direct impact, both the effect of avatar identification on immersion and the effect of immersion on game attractiveness were significant (P<.001). However, the direct effect of avatar identification on game attractiveness was not significant (P=.28). Regarding the indirect impact, the effect of avatar identification on game attractiveness was significant (P<.001). The results indicate a significant positive correlation between different dimensions of the self-differentiation theory and identification with avatars. Moreover, immersion in the game fully mediated the relationship between identification with avatars and game attractiveness. Conclusions: This study underscores that the embodiment of avatar identification is influenced by dimensions of self-differentiation, and the impact of identification with avatars on game attractiveness is contingent upon full mediation by immersion. These findings deepen our understanding of the role of avatar identification in VR gaming. %M 39437383 %R 10.2196/56704 %U https://formative.jmir.org/2024/1/e56704 %U https://doi.org/10.2196/56704 %U http://www.ncbi.nlm.nih.gov/pubmed/39437383 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60491 %T Exploring Contactless Vital Signs Collection in Video Telehealth Visits Among Veterans Affairs Providers and Patients: Pilot Usability Study %A Garvin,Lynn %A Richardson,Eric %A Heyworth,Leonie %A McInnes,D Keith %+ Center for Healthcare Optimization and Implementation Research, Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, United States, 1 617 390 4315, Lynn.Garvin@va.gov %K veteran %K provider %K video-based care %K vital statistics %K telemonitoring %K usability %K mobile health app %K telemedicine %K health care access %K vital sign %K video %K telehealth %K patient %K Veterans Affairs %K telehealth platform %K photoplethysmography %K camera %K web-based survey %K electronic medical record %K home-based biometric devices %K mHealth %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To expand veterans’ access to health care, the Veterans Affairs (VA) Office of Connected Care explored a novel software feature called “Vitals” on its VA Video Connect telehealth platform. Vitals uses contactless, video-based, remote photoplethysmography (rPPG) through the infrared camera on veterans’ smartphones (and other devices) to automatically scan their faces to provide real-time vital statistics on screen to both the provider and patient. Objective: This study aimed to assess VA clinical provider and veteran patient attitudes regarding the usability of Vitals. Methods: We conducted a mixed methods evaluation of Vitals among VA providers and patients, collecting data in July and August 2023 at the VA Boston Healthcare System and VA San Diego Healthcare System. We conducted analyses in October 2023. In-person usability testing sessions consisted of a think-aloud procedure while using the software, a semistructured interview, and a 26-item web-based survey. Results: Usability test sessions with 20 VA providers and 13 patients demonstrated that both groups found Vitals “useful” and “easy to use,” and they rated its usability highly (86 and 82 points, respectively, on a 100-point scale). Regarding acceptability or willingness/intent to use, providers and patients generally expressed confidence and trust in Vitals readings, with high ratings of 90 and 85 points, respectively. Providers and patients rated Vitals highly for its feasibility and appropriateness for context (90 and 90 points, respectively). Finally, providers noted that Vitals’ flexibility makes it appropriate and advantageous for implementation in a wide range of clinical contexts, particularly in specialty care. Providers believed that most clinical teams would readily integrate Vitals into their routine workflow because it saves time; delivers accurate, consistently collected vitals; and may reduce reporting errors. Providers and veterans suggested training and support materials that could improve Vitals adoption and implementation. Conclusions: While remote collection of vital readings has been described in the literature, this is one of the first accounts of testing a contactless vital signs measurement tool among providers and patients. If ongoing initiatives demonstrate accuracy in its readings, Vitals could enhance telemedicine by providing accurate and automatic reporting and recording of vitals; sending patients’ vital readings (pending provider approval) directly to their electronic medical record; saving provider and patient time; and potentially reducing necessity of some home-based biometric devices. Understanding usability issues before US Food and Drug Administration approval of Vitals and its implementation could contribute to a seamless introduction of Vitals to VA providers and patients. %M 39441645 %R 10.2196/60491 %U https://formative.jmir.org/2024/1/e60491 %U https://doi.org/10.2196/60491 %U http://www.ncbi.nlm.nih.gov/pubmed/39441645 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51322 %T A Person-Based Web-Based Sleep Intervention Aimed at Adolescents (SleepWise): Randomized Controlled Feasibility Study %A Moghadam,Shokraneh %A Husted,Margaret %A Aznar,Ana %A Gray,Debra %+ Department of Psychology, University of Winchester, Sparkford Rd, Winchester, SO22 4NR, United Kingdom, 44 01392 72 5950, s.oftadeh-moghadam@exeter.ac.uk %K web-based health interventions %K sleep %K adolescence %K behavior change %K person-based approach %K sleep intervention %K detrimental health outcome %K SleepWise %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents are advised to sleep 8-10 hours per night; however, most do not sleep for this recommended amount. Poor adolescent sleep is associated with detrimental health outcomes, including reduced physical activity, risk-taking behaviors, and increased depression and anxiety levels, making this an important public health concern. Existing interventions targeting adolescent sleep are often unsuccessful or their effectiveness unclear, as they are frequently noninteractive, time-consuming, and lack a strong theoretical foundation; highlighting an urgent need for innovative interventions deemed acceptable by adolescents. Objective: The main objective of this study was to determine the acceptability, feasibility, and preliminary impact of a web-based person-based sleep intervention (SleepWise) on adolescent sleep quality. Participant incentivization was also explored to understand its impact on engagement, acceptability, and sleep quality. Methods: A feasibility trial was conducted to test the feasibility, acceptability, and preliminary impact of SleepWise on adolescent sleep quality, developed based on the person-based approach to intervention development. In total, 90 participants (aged 13-17 years) from further education institutions and secondary schools were recruited for two 2-arm randomized controlled trials. One trial (trial 1) was incentivized to understand the impact of incentivization. Acceptability and sleep quality were assessed via questionnaires, and a mixed methods process evaluation was undertaken to assess participant engagement and experience with SleepWise. Engagement was automatically tracked by SleepWise, which collected data on the date and time, pages viewed, and the number of goals and sleep logs completed per participant. Semistructured interviews were carried out to gain participant feedback. Results: Participants in both trials reported high levels of acceptability (trial 1: mean 21.00, SD 2.74; trial 2: mean 20.82, SD 2.48) and demonstrated similar levels of engagement with SleepWise. Participants in trial 1 viewed slightly more pages of the intervention, and those in trial 2 achieved their set goals more frequently. Improvements in sleep quality were found in both trials 1 and 2, with medium (trial 1) and large (trial 2) effect sizes. A larger effect size for improvement in sleep quality was found in the nonincentivized trial (d=0.87), suggesting that incentivization may not impact engagement or sleep quality. Both trials achieved acceptable recruitment (trial 1, N=48; trial 2, N=42), and retention at 5 weeks (trial 1: N=30; trial 2: N=30). Qualitative findings showed that adolescents lead busy lifestyles, which may hinder engagement; however, participants deemed SleepWise acceptable in length and content, and made attempts at behavior change. Conclusions: SleepWise is an acceptable and potentially efficacious web-based sleep intervention aimed at adolescents. Findings from this study showed that incentivization did not greatly impact engagement, acceptability, or sleep quality. Subject to a full trial, SleepWise has the potential to address the urgent need for innovative, personalized, and acceptable sleep interventions for adolescents. Trial Registration: OSF Registries osf.io/yanb2; https://osf.io/yanb2 %M 39442165 %R 10.2196/51322 %U https://formative.jmir.org/2024/1/e51322 %U https://doi.org/10.2196/51322 %U http://www.ncbi.nlm.nih.gov/pubmed/39442165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55481 %T Exploring the Impact of an Interactive Electronic Pegboard on Manual Dexterity and Cognitive Skills of Patients With Stroke: Preliminary Analysis %A Chien,Shih-Ying %A Wu,Ching-Yi %A Wong,Alice May-Kuen %A Chen,Chih-Kuang %A Beckman,Sara L %+ Department of Industrial Design, Chang Gung University, No 259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, 886 3 211 8800 ext 5669, shihying@mail.cgu.edu.tw %K interactive electronic pegboard %K stroke %K hand dexterity %K cognitive rehabilitation %K system %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As individuals age, the incidence and mortality rates of cerebrovascular accidents significantly rise, leading to fine motor impairments and cognitive deficits that impact daily life. In modern occupational therapy, assessing manual dexterity and cognitive functions typically involves observation of patients interacting with physical objects. However, this pen-and-paper method is not only time-consuming, relying heavily on therapist involvement, but also often inaccurate. Digital assessment methods, therefore, have the potential to increase the accuracy of diagnosis, as well as decrease the workload of health care professionals. Objective: This study examined the feasibility of an interactive electronic pegboard for the assessment and rehabilitation of patients with stroke. Methods: We explored the pegboard’s clinical applicability by examining the relationship among stages, timing, and difficulty settings, as well as their alignment with patient capabilities. In total, 10 participants used a prototype of the pegboard for functional and task assessments; questionnaire interviews were conducted simultaneously to collect user feedback. Results: Patients with stroke consistently required more time to complete tasks than expected, significantly deviating from the initial time frames. Additionally, the participants exhibited a slight reduction in performance levels in both manual dexterity and cognitive abilities. Insights from questionnaire responses revealed that the majority of participants found the prototype interface easy and enjoyable to use, with good functionality. Conclusions: This preliminary investigation supports the efficacy of interactive electronic pegboards for the rehabilitation of the hand functions of patients with stroke, as well as training their attentional and cognitive abilities. This digital technology could potentially alleviate the burden of health care workers, positioning it as a valuable and intelligent precision health care tool. %M 39446480 %R 10.2196/55481 %U https://formative.jmir.org/2024/1/e55481 %U https://doi.org/10.2196/55481 %U http://www.ncbi.nlm.nih.gov/pubmed/39446480 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50131 %T Optimizing the Measurement of Information on the Context of Alcohol Consumption Within the Drink Less App Among People Drinking at Increasing and Higher Risk Levels: Mixed-Methods Usability Study %A Stevely,Abigail K %A Garnett,Claire %A Holmes,John %A Jones,Andrew %A Dinu,Larisa %A Oldham,Melissa %+ Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, 30 Regent St, Sheffield City Centre, Sheffield, S1 4DA, United Kingdom, 44 114 222 552, a.stevely@sheffield.ac.uk %K alcohol use disorder %K substance use disorder %K alcohol consumption %K mobile app %K mHealth %K mobile health %K diary %K health behavior change %K usability %K user engagement %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing public health evidence base focused on understanding the links between drinking contexts and alcohol consumption. However, the potential value of developing context-based interventions to help people drinking at increasing and higher risk levels to cut down remains underexplored. Digital interventions, such as apps, offer significant potential for delivering context-based interventions as they can collect contextual information and flexibly deliver personalized interventions while addressing barriers associated with face-to-face interventions, such as time constraints. Objective: This early phase study aimed to identify the best method for collecting information on the contexts of alcohol consumption among users of an alcohol reduction app by comparing 2 alternative drinking diaries in terms of user engagement, data quality, usability, and acceptability. Methods: Participants were recruited using the online platform Prolific and were randomly assigned to use 1 of the 2 adapted versions of the Drink Less app for 14 days. Tags (n=31) included tags for location, motivation, and company that participants added to drink records. Occasion type (n=31) included a list of occasion types that participants selected from when adding drink records. We assessed engagement and data quality with app data, usability with a validated questionnaire, and acceptability with semistructured interviews. Results: Quantitative findings on engagement, data quality, and app usability were good overall, with participants using the app on most days (tags: mean 12.23, SD 2.46 days; occasion type: mean 12.39, SD 2.12 days). However, around 40% of drinking records in tags did not include company and motivation tags. Mean usability scores were similar across app versions (tags: mean 72.39, SD 8.10; occasion type: mean 74.23, SD 6.76). Qualitative analysis found that both versions were acceptable to users and were relevant to their drinking occasions, and participants reported increased awareness of their drinking contexts. Several participants reported that the diary helped them to reduce alcohol consumption in some contexts (eg, home or lone drinking) more than others (eg, social drinking) and suggested that they felt less negative affect recording social drinking contexts out of their home. Participants also suggested the inclusion of “work drinks” in both versions and “habit” as a motivation in the tags version. Conclusions: There was no clearly better method for collecting data on alcohol consumption as both methods had good user engagement, usability, acceptability, and data quality. Participants recorded sufficient data on their drinking contexts to suggest that an adapted version of Drink Less could be used as the basis for context-specific interventions. The occasion type version may be preferable owing to lower participant burden. A more general consideration is to ensure that context-specific interventions are designed to minimize the risk of unintended positive reinforcement of drinking occasions that are seen as sociable by users. %M 39446464 %R 10.2196/50131 %U https://formative.jmir.org/2024/1/e50131 %U https://doi.org/10.2196/50131 %U http://www.ncbi.nlm.nih.gov/pubmed/39446464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55706 %T Evaluating a WeChat-Based Intervention to Enhance Influenza Vaccination Knowledge, Attitude, and Behavior Among Chinese University Students Residing in the United Kingdom: Controlled, Quasi-Experimental, Mixed Methods Study %A Li,Lan %A Wood,Caroline E %A Kostkova,Patty %+ Centre for Digital Public Health in Emergencies, Department for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E6BT, United Kingdom, 44 7529917633, lan.li.19@ucl.ac.uk %K influenza vaccination %K intervention study %K social media %K students %K health promotion %K mixed methods %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: University students, who often live in close quarters and engage in frequent social interaction, face a heightened risk of influenza morbidity. Still, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations. Objective: This study examines the effectiveness of a cocreated WeChat-based intervention that targets mainland Chinese university students in the United Kingdom, aiming to improve their knowledge, attitude, and behavior (KAB) toward seasonal influenza vaccination. Methods: A quasi-experimental mixed methods design was used, incorporating an intervention and comparison group, with baseline and follow-up self-reported surveys. The study was conducted from December 19, 2022, to January 16, 2023. The primary outcome is the KAB score, which was measured before and after the intervention phases. System-recorded data and user feedback were included in the analysis as secondary outcomes. A series of hypothesis testing methods were applied to test the primary outcomes, and path analysis was used to explore the relationships. Results: Our study included 596 students, of which 303 (50.8%) were in the intervention group and 293 (49.2%) were in the control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the 2 groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (63/303, 20.8%) compared to the control group (54/293, 18.4%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes, and both knowledge and attitudes significantly influenced intended behavior; and there was a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its use. Conclusions: This study demonstrates how a WeChat intervention effectively improves KAB related to seasonal influenza vaccination among Chinese students, highlighting the potential of social media interventions to drive vaccination behavior change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations. %M 39447171 %R 10.2196/55706 %U https://formative.jmir.org/2024/1/e55706 %U https://doi.org/10.2196/55706 %U http://www.ncbi.nlm.nih.gov/pubmed/39447171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58583 %T Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study %A Kim,Jae Heon %A Lee,Ui Cheol %A Jeong,Byeong Hun %A Kang,Byeong Uk %A Shim,Sung Ryul %A Jeong,In Gab %+ Department of Biomedical Informatics, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea, 82 6008661, sungryul.shim@gmail.com %K smart diaper %K urinary incontinence %K medical device %K voided volume %K urine output %K nursing home %K older adults %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. Objective: The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. Methods: From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user’s movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. Results: The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was –0.045 of the standardized mean difference, and all measurements were located within the 95% CI, so this confirms that the 2 test methods are equivalent. Conclusions: Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications. %M 39447169 %R 10.2196/58583 %U https://formative.jmir.org/2024/1/e58583 %U https://doi.org/10.2196/58583 %U http://www.ncbi.nlm.nih.gov/pubmed/39447169 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59501 %T Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study %A Dana,Zara %A Nagra,Harpreet %A Kilby,Kimberly %+ Supportiv, 2222 Harold Way, Berkeley, CA, 94704, United States, 1 800 845 0015, harpreet@supportiv.com %K digital peer support %K social loneliness %K chat-based interactions %K older adults %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users’ autonomy, competence, and relatedness. Objective: This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism. Methods: Participants were each prompted with a single question: “What’s your struggle?” Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts. Results: Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively. Conclusions: Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options. %M 39453688 %R 10.2196/59501 %U https://formative.jmir.org/2024/1/e59501 %U https://doi.org/10.2196/59501 %U http://www.ncbi.nlm.nih.gov/pubmed/39453688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64454 %T Client Perspectives of Case Stories in Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Study %A Price,Jill AB %A Gregory,Julia %A McCall,Hugh C %A Landry,Caeleigh A %A Beahm,Janine D %A Hadjistavropoulos,Heather D %+ Canadian Institute for Public Safety Research and Treatment, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada, 1 3063378418, jill.price@uregina.ca %K internet-delivered cognitive behavioral therapy %K case stories %K public safety personnel %K public safety %K mental health %K internet interventions %K digital mental health interventions %K first responders %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and convenient means of offering cognitive behavioral therapy to the general population. To increase access to ICBT among Canadian public safety personnel (PSP)—a group that experiences elevated rates of mental health concerns and barriers to mental health care—a clinical research unit called PSPNET has tailored ICBT to PSP, primarily through offering case stories and PSP-specific examples within an ICBT program. PSPNET’s first and most frequently used ICBT program, called the PSP Wellbeing Course, has been found to reduce symptoms of mental disorders (eg, anxiety, depression, and posttraumatic stress) among PSP. Little research, however, has investigated clients’ perceptions of the case stories in this course. Objective: This study was designed to expand the literature on the use and evaluation of case stories in ICBT among PSP. Specifically, this study investigated (1) PSP’s perceptions of the case stories using the theoretical model provided by Shaffer and Zikmund-Fisher and (2) PSP feedback on the case stories in the PSP Wellbeing Course. Methods: This study included 41 clients who completed the PSP Wellbeing Course. Of these, 27 clients completed a bespoke questionnaire called the Stories Questionnaire, 10 of whom also participated in a semistructured interview. Results: Findings show that perceptions of the case stories in the PSP Wellbeing Course were largely positive and that the case stories were generally successful in achieving the 5 purposes of case stories (ie, informing, comforting, modeling, engaging, and persuading) proposed by Shaffer and Zikmund-Fisher. Client feedback also identified 3 tangible areas for story improvement: characters, content, and delivery. Each area highlights the need for and potential benefits of story development. Not all PSP engaged with the case stories, though, so results must be interpreted with caution. Conclusions: Overall, this study adds to the growing body of research supporting the use of case stories in internet-delivered interventions among PSP. Trial Registration: ClinicalTrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032 %M 39453705 %R 10.2196/64454 %U https://formative.jmir.org/2024/1/e64454 %U https://doi.org/10.2196/64454 %U http://www.ncbi.nlm.nih.gov/pubmed/39453705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59087 %T eHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study %A Kim,Youlim %A Lee,Hyeonkyeong %A Park,Jeongok %A Kim,Yong-Chan %A Kim,Dong Hee %A Lee,Young-Me %+ College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3373, hlee39@yuhs.ac %K cervical cancer %K human papillomavirus %K vaccines %K health communication %K chatbot %K artificial intelligence %K adolescent %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As the age of initiating sexual intercourse has gradually decreased among South Korean adolescents, earlier vaccination of adolescents for human papillomavirus (HPV) is necessary before their exposure to HPV. Health communication includes “cues to action” that lead to preventive health behaviors, and recently, social networking services, which operate with fewer time and space constraints, have been used in various studies as a form of eHealth communication. Objective: This study aims to investigate the feasibility and usability of an eHealth communication intervention for HPV vaccination in middle-school girls aimed at the girls and their mothers. Methods: The eHealth communication intervention for HPV vaccination was developed using a 6-step intervention mapping process: needs assessments, setting program outcomes, selection of a theory-based method and practical strategies, development of the intervention, implementation plan, and testing the validity of the intervention. Results: A review of 10 studies identified effective health communication messages, delivery methods, and theories for HPV vaccination among adolescents. Barriers including low knowledge, perceived threat, and the inconvenience of taking 2 doses of the vaccine were identified through focus groups, suggesting a need for youth-friendly and easy-to-understand information for adolescents delivered via mobile phones. The expected outcomes and the performance objectives are specifically tailored to reflect the vaccination intention. Behavior change techniques were applied using trusted sources and a health belief model. Health messages delivered through a KakaoTalk chatbot improved awareness and self-efficacy. Quality control was ensured with the use of a log system. The experts’ chatbot usability average score was 80.13 (SD 8.15) and the average score of girls was 84.06 (SD 7.61). Conclusions: Future studies need to verify the effectiveness of health communication strategies in promoting HPV vaccination and the effectiveness of scientific intervention using a chatbot as a delivery method for the intervention. %M 39466304 %R 10.2196/59087 %U https://formative.jmir.org/2024/1/e59087 %U https://doi.org/10.2196/59087 %U http://www.ncbi.nlm.nih.gov/pubmed/39466304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57219 %T Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study %A Strandberg,Susanna %A Ekstedt,Mirjam %A Fagerström,Cecilia %A Backåberg,Sofia %+ Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 35195, Sweden, 46 725673309, susanna.strandberg@lnu.se %K chronic illness %K eHealth %K experience-based co-design %K older adults %K self-care %K video feedback %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. Objective: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. Methods: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. Results: The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, “Breathing exercises” and “Picking up from the floor,” revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. Conclusions: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support. %M 39466305 %R 10.2196/57219 %U https://formative.jmir.org/2024/1/e57219 %U https://doi.org/10.2196/57219 %U http://www.ncbi.nlm.nih.gov/pubmed/39466305 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51753 %T Home-Based Connected Devices Combined With Statistical Process Control for the Early Detection of Respiratory Exacerbations by Patients With Cystic Fibrosis: Pilot Interventional Study With a Pre-Post Design %A Le Roux,Enora %A Ursino,Moreno %A Milovanovic,Ivana %A Picq,Paul %A Haignere,Jeremie %A Rault,Gilles %A Pougheon Bertrand,Dominique %A Alberti,Corinne %+ Inserm, Hôpital Universitaire Robert Debré, Assistance publique – Hôpitaux de Paris.Nord - Université Paris Cité, 48 Boulevard Serurier, Paris, 75019, France, 33 679690998, enora.leroux@aphp.fr %K connected devices %K cystic fibrosis %K patient education %K self-management %K medical device %K home monitoring %K remote monitoring %K statistical process control %K connected health %K alerts %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, patients with cystic fibrosis do not routinely monitor their respiratory function at home. Objective: This study aims to assess the clinical validity of using different connected health devices at home to measure 5 physiological parameters to help prevent exacerbations on a personalized basis from the perspective of patient empowerment. Methods: A multicenter interventional pilot study including 36 patients was conducted. Statistical process control—the cumulative sum control chart (CUSUM)—was used with connected health device measures with the objective of sending patients alerts at a relevant time in order to identify their individual risk of exacerbations. Associated patient education was delivered. Quantitative and qualitative data were collected. Results: One-half (18/36) of the patients completed the protocol through the end of the study. During the 12-month intervention, 6162 measures were collected with connected health devices, 387 alerts were sent, and 33 exacerbations were reported. The precision of alerts to detect exacerbations was weak for all parameters, which may be partly related to the low compliance of patients with the measurements. However, a decrease in the median number of exacerbations from 12 months before the study to after the 12-month intervention was observed for patients. Conclusions: The use of connected health devices associated with statistical process control showed that it was not acceptable for all patients, especially because of the burden related to measurements. However, the results suggest that it may be promising, after adaptations, for early identification and better management of exacerbations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/study/NCT03304028 %M 39467550 %R 10.2196/51753 %U https://formative.jmir.org/2024/1/e51753 %U https://doi.org/10.2196/51753 %U http://www.ncbi.nlm.nih.gov/pubmed/39467550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57376 %T Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies, Inc, 1010 Commercial St, Suite C, San Carlos, CA, 94070, United States, 1 4082145545, marler@pivot.co %K app %K digital health %K mobile health %K mHealth %K mobile apps %K smartphone %K vaping %K vaping cessation %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app–based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data. Objective: This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design. Methods: American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback. Results: In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks—4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change –3.2, SD 3.9; P<.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day. Conclusions: In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements. %M 39331522 %R 10.2196/57376 %U https://formative.jmir.org/2024/1/e57376 %U https://doi.org/10.2196/57376 %U http://www.ncbi.nlm.nih.gov/pubmed/39331522 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58048 %T Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial %A Lin,Yu-Chih %A Wu,Chen-Ching %A Sung,Wan-Yu %A Yen,Jeng-Hsien %A Lin,Yi-Ching %+ Department of Laboratory Medicine, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist, Kaohsiung, 80756, Taiwan, 886 7 3121101 ext 7233, winterjeanne@gmail.com %K ankylosing spondylitis %K galvanic response %K home medical device %K rehabilitation %K transcutaneous electrical stimulation %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. Objective: This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. Methods: The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. Results: A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference –0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference –0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). Conclusions: The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients’ physical functions and spinal flexibility. %M 39467549 %R 10.2196/58048 %U https://formative.jmir.org/2024/1/e58048 %U https://doi.org/10.2196/58048 %U http://www.ncbi.nlm.nih.gov/pubmed/39467549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56898 %T Critical Success Factors and Acceptance of the Casemix System Implementation Within the Total Hospital Information System: Exploratory Factor Analysis of a Pilot Study %A Mustafa,Noor Khairiyah %A Ibrahim,Roszita %A Aizuddin,Azimatun Noor %A Aljunid,Syed Mohamed %A Awang,Zainudin %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 6th Floor, Pre-Clinical Block, Cheras, 56000, Malaysia, 60 391455887 ext 5888, roszita@ppukm.ukm.edu.my %K critical success factors %K exploratory factor analysis %K Casemix system %K acceptance %K Total Hospital Information System %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The health care landscape is evolving rapidly due to rising costs, an aging population, and the increasing prevalence of diseases. To address these challenges, the Ministry of Health of Malaysia implemented transformation strategies such as the Casemix system and hospital information system to enhance health care quality, resource allocation, and cost-effectiveness. However, successful implementation relies not just on the technology itself but on the acceptance and engagement of the users involved. Objective: This study aims to develop and refine items of a quantitative instrument measuring the critical success factors influencing acceptance of Casemix system implementation within the Ministry of Health’s Total Hospital Information System (THIS). Methods: A cross-sectional pilot study collected data from medical doctors at a hospital equipped with the THIS in the federal territory of Putrajaya, Malaysia. This pilot study’s minimum sample size was 125, achieved through proportionate stratified random sampling. Data were collected using a web-based questionnaire adapted from the human, organization, and technology-fit evaluation framework and the technology acceptance model. The pilot data were analyzed using exploratory factor analysis (EFA), and the Cronbach α assessed internal reliability. Both analyses were conducted in SPSS (version 25.0; IBM Corp). Results: This study obtained 106 valid responses, equivalent to an 84.8% (106/125) response rate. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.859, and the Bartlett test of sphericity yielded statistically significant results (P<.001). Principal component analysis identified 9 components explaining 84.07% of the total variance, surpassing the minimum requirement of 60%. In total, 9 unique slopes indicated the identification of 9 components through EFA. While no new components emerged from the other 7 constructs, only the organizational factors construct was divided into 2 components, later named organizational structure and organizational environment. In total, 98% (41/42) of the items had factor loadings of >0.6, leading to the removal of 1 item for the final instrument for the field study. EFA ultimately identified 8 main constructs influencing Casemix implementation within the THIS: system quality, information quality, service quality, organizational characteristics, perceived ease of use, perceived usefulness, intention to use, and acceptance. Internal reliability measured using the Cronbach α ranged from 0.914 to 0.969, demonstrating high reliability. Conclusions: This study provides insights into the complexities of EFA and the distinct dimensions underlying the constructs that influence Casemix system acceptance in the THIS. While the findings align with extensive technology acceptance literature, the results accentuate the necessity for further research to develop a consensus regarding the most critical factors for successful Casemix adoption. The developed instrument is a substantial step toward better understanding the multidimensional challenges of health care system transformations in Malaysia, postulating an underpinning for future fieldwork and broader application across other hospitals. %M 39470697 %R 10.2196/56898 %U https://formative.jmir.org/2024/1/e56898 %U https://doi.org/10.2196/56898 %U http://www.ncbi.nlm.nih.gov/pubmed/39470697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59016 %T Development of the Happy Hands Self-Management App for People with Hand Osteoarthritis: Feasibility Study %A Tveter,Anne Therese %A Varsi,Cecilie %A Maarnes,Marit Kristin %A Pedersen,Stein Jarle %A Christensen,Barbara S %A Blanck,Thale Beate %A Nyheim,Sissel B %A Pelle,Tim %A Kjeken,Ingvild %+ Health Service Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Diakonveien 12, Oslo, 0319, Norway, 47 22451500, a.t.tveter@medisin.uio.no %K Osteoarthritis %K hand exercises %K home exercise %K first-line treatment %K mHealth %K eHealth %K self-management %K app development %K design %K usefulness %K satisfaction %K activity performance %K social cognitive theory %K behavior change %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient education, hand exercises, and the use of assistive devices are recommended as first-line treatments for individuals with hand osteoarthritis (OA). However, the quality of care services for this patient group is suboptimal in primary care. Objective: The overarching goal was to develop and evaluate feasibility of an app-based self-management intervention for people with hand OA. This feasibility study aims to assess self-reported usability and satisfaction, change in outcomes and quality-of-care, exercise adherence and patients’ experiences using the app. Methods: The development and feasibility testing followed the first 2 phases of the Medical Research Council framework for the development and evaluation of complex interventions and were conducted in close collaboration with patient research partners (PRPs). A 3-month pre-post mixed methods design was used to evaluate feasibility. Men and women over 40 years of age diagnosed with painful, symptomatic hand OA were recruited. Usability was assessed using the System Usability Scale (0-100), while satisfaction, usefulness, pain, and stiffness were evaluated using a numeric rating scale (NRS score from 0 to 10). The activity performance of the hand was measured using the Measure of Activity Performance of the Hand (MAP-Hand) (1-4), grip strength was assessed with a Jamar dynamometer (kg), and self-reported quality of care was evaluated using the Osteoarthritis Quality Indicator questionnaire (0-100). Participants were deemed adherent if they completed at least 2 exercise sessions per week for a minimum of 8 weeks. Focus groups were conducted to explore participants’ experiences using the app. Changes were analyzed using a paired sample t test (mean change and 95% CI), with the significance level set at P<.05. Results: The first version of the Happy Hands app was developed based on the needs and requirements of the PRPs, evidence-based treatment recommendations, and the experiences of individuals living with hand OA. The app was designed to guide participants through a series of informational videos, exercise videos, questionnaires, quizzes, and customized feedback over a 3-month period. The feasibility study included 71 participants (mean age 64 years, SD 8; n=61, 86%, women), of whom 57 (80%) completed the assessment after 3 months. Usability (mean 91.5 points, SD 9.2 points), usefulness (median 8, IQR 7-10), and satisfaction (median 8, IQR 7-10) were high. Significant improvements were observed in self-reported quality of care (36.4 points, 95% CI 29.7-43.1, P<.001), grip strength (right: 2.9 kg, 95% CI 1.7-4.1; left: 3.2 kg, 95% CI 1.9-4.6, P<.001), activity performance (0.18 points, 95% CI 0.11-0.25, P<.001), pain (1.7 points, 95% CI 1.2-2.2, P<.001), and stiffness (1.9 points, 95% CI 1.3-2.4, P=.001) after 3 months. Of the 71 participants, 53 (75%) were adherent to the exercise program. The focus groups supported these results and led to the implementation of several enhancements in the second version of the app. Conclusions: The app-based self-management intervention was deemed highly usable and useful by patients. The results further indicated that the intervention may improve quality of care, grip strength, activity performance, pain, and stiffness. However, definitive conclusions need to be confirmed in a powered randomized controlled trial. Trial Registration: NCT05150171 %M 39470716 %R 10.2196/59016 %U https://formative.jmir.org/2024/1/e59016 %U https://doi.org/10.2196/59016 %U http://www.ncbi.nlm.nih.gov/pubmed/39470716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56390 %T An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use %A Preuhs,Katharina %A Bussink-Voorend,Daphne %A van Keulen,Hilde M %A Wildeman,Ilona %A Hautvast,Jeannine %A Hulscher,Marlies %A van Empelen,Pepijn %+ Netherlands Organization for Applied Scientific Research (TNO), Expertise Group Child Health, PO Box 2215, Leiden, 2301 CE, Netherlands, 31 615597505, katharina.preuhs@tno.nl %K COVID-19 %K COVID-19 vaccination %K informed decision-making %K user-centered design %K low literacy %K eHealth %K tailored decision aid %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since December 2019, COVID-19 led to a pandemic causing many hospitalizations and deaths. Vaccinations were developed and introduced to control viral transmission. In the Dutch context, the decision to accept vaccination is not mandatory. An informed decision is based on sufficient and reliable information, in line with one’s attitudes and values, and with consideration of pros and cons. To support people in informed decision-making, we developed an online COVID-19 vaccination decision aid (DA). Objective: This article aims to describe the development, dissemination, and use of the DA. Methods: Building on a previously developed DA, the COVID-19 vaccination DA was developed in 3 phases following a user-centered design approach: (1) definition phase, (2) concept testing, and (3) prototype testing. End users, individuals with low literacy, and experts (with relevant expertise on medical, behavioral, and low literacy aspects) were involved in the iterative development, design, and testing, with their feedback forming the basis for adaptations to the DA. Results: The DA was developed within 14 weeks. The DA consists of 3 modules, namely, Provide Information, Support Decision-Making, and Facilitate Actions Following a Decision. These modules are translated into various information tiles and diverse functionalities such as a knowledge test, a value clarification tool using a decisional balance, and a communication tool. The DA was disseminated for use in May 2021. Users varied greatly regarding age, gender, and location in the Netherlands. Conclusions: This paper elaborates on the development of the COVID-19 vaccination DA in a brief period and its dissemination for use among Dutch adults in the Netherlands. The evaluation of use showed that we were able to reach a large proportion and variety of people throughout the Netherlands. %M 39475719 %R 10.2196/56390 %U https://formative.jmir.org/2024/1/e56390 %U https://doi.org/10.2196/56390 %U http://www.ncbi.nlm.nih.gov/pubmed/39475719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59811 %T Perceptions Toward Using Artificial Intelligence and Technology for Asthma Attack Risk Prediction: Qualitative Exploration of Māori Views %A Jayamini,Widana Kankanamge Darsha %A Mirza,Farhaan %A Bidois-Putt,Marie-Claire %A Naeem,M Asif %A Chan,Amy Hai Yan %+ Department of Computer Science, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Building WZ, Level 8, 6th St Paul Street, Auckland, 1010, New Zealand, 64 210504680, darsha.jayamini@autuni.ac.nz %K asthma risk prediction %K artificial intelligence %K machine learning %K māori perceptions %K health system development %K mobile phone %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a significant global health issue, impacting over 500,000 individuals in New Zealand and disproportionately affecting Māori communities in New Zealand, who experience worse asthma symptoms and attacks. Digital technologies, including artificial intelligence (AI) and machine learning (ML) models, are increasingly popular for asthma risk prediction. However, these AI models may underrepresent minority ethnic groups and introduce bias, potentially exacerbating disparities. Objective: This study aimed to explore the views and perceptions that Māori have toward using AI and ML technologies for asthma self-management, identify key considerations for developing asthma attack risk prediction models, and ensure Māori are represented in ML models without worsening existing health inequities. Methods: Semistructured interviews were conducted with 20 Māori participants with asthma, 3 male and 17 female, aged 18-76 years. All the interviews were conducted one-on-one, except for 1 interview, which was conducted with 2 participants. Altogether, 10 web-based interviews were conducted, while the rest were kanohi ki te kanohi (face-to-face). A thematic analysis was conducted to identify the themes. Further, sentiment analysis was carried out to identify the sentiments using a pretrained Bidirectional Encoder Representations from Transformers model. Results: We identified four key themes: (1) concerns about AI use, (2) interest in using technology to support asthma, (3) desired characteristics of AI-based systems, and (4) experience with asthma management and opportunities for technology to improve care. AI was relatively unfamiliar to many participants, and some of them expressed concerns about whether AI technology could be trusted, kanohi ki te kanohi interaction, and inadequate knowledge of AI and technology. These concerns are exacerbated by the Māori experience of colonization. Most of the participants were interested in using technology to support their asthma management, and we gained insights into user preferences regarding computer-based health care applications. Participants discussed their experiences, highlighting problems with health care quality and limited access to resources. They also mentioned the factors that trigger their asthma control level. Conclusions: The exploration revealed that there is a need for greater information about AI and technology for Māori communities and a need to address trust issues relating to the use of technology. Expectations in relation to computer-based applications for health purposes were expressed. The research outcomes will inform future investigations on AI and technology to enhance the health of people with asthma, in particular those designed for Indigenous populations in New Zealand. %M 39475765 %R 10.2196/59811 %U https://formative.jmir.org/2024/1/e59811 %U https://doi.org/10.2196/59811 %U http://www.ncbi.nlm.nih.gov/pubmed/39475765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53491 %T Self-Reported Patient and Provider Satisfaction With Neurology Telemedicine Visits After Rapid Telemedicine Implementation in an Urban Academic Center: Cross-Sectional Survey %A Robertson,Noah %A Syed,Maryam J %A Song,Bowen %A Kaur,Arshdeep %A Patel,Janaki G %A Marawar,Rohit %A Basha,Maysaa %A Zutshi,Deepti %+ Department of Neurology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, United States, 1 (313) 577 1245, dzutshi@med.wayne.edu %K telemedicine %K telehealth %K neurology %K eHealth %K teleneurology %K patient experience %K patient satisfaction %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many clinics and health systems implemented telemedicine appointment services out of necessity due to the COVID-19 pandemic. Objective: Our objective was to evaluate patient and general provider satisfaction with neurology telemedicine implementation at an urban academic medical center. Methods: Patients who had completed 1 or more teleneurology visits from April 1 to December 31, 2020, were asked to complete a survey regarding their demographic information and satisfaction with teleneurology visits. Providers of all specialties within the same hospital system were given a different survey to gather their experiences of providing telemedicine care. Results: Of the estimated 1500 patients who had completed a teleneurology visit within the given timeframe, 117 (7.8%) consented to complete the survey. Of these 117 respondents, most appointments were regarding epilepsy (n=59, 50.4%), followed by multiple sclerosis (n=33, 28.2%) and neuroimmunology (n=7, 6%). Overall, 74.4% (n=87) of patients rated their experience as 8 out of 10 or higher, with 10 being the highest satisfaction. Furthermore, 75.2% (n=88) of patients reported missing an appointment in the previous year due to transportation issues and thought telemedicine was more convenient instead. A significant relationship between racial or ethnic group and comfort sharing private information was found (P<.001), with 52% (26/50) of Black patients reporting that an office visit is better, compared to 25% (14/52) of non-Black patients. The provider survey gathered 40 responses, with 75% (n=30) of providers agreeing that virtual visits are a valuable tool for patient care and 80% (n=32) reporting few to no technical issues. The majority of provider respondents were physicians on faculty or staff (n=21, 52%), followed by residents or fellows (n=15, 38%) and nurse practitioners or physician assistants (n=4, 10%). Of the specialties represented, 15 (38%) of the providers were in neurology. Conclusions: Our study found adequate satisfaction among patients and providers regarding telemedicine implementation and its utility for patient care in a diverse urban population. Additionally, while access to technology and technology literacy are barriers to telemedical care, a substantial majority of patients who responded to the survey had access to devices (101/117, 86.3%) and were able to connect with few to no technological difficulties (84/117, 71.8%). One area identified by patients in need of improvement was comfortability in communicating via telemedicine with their providers. Furthermore, while providers agreed that telemedicine is a useful tool for patient care, it limits their ability to perform physical exams. More research and quality studies are needed to further appreciate and support the expansion of telemedical care into underserved and rural populations, especially in the area of subspecialty neurological care. %M 39476368 %R 10.2196/53491 %U https://formative.jmir.org/2024/1/e53491 %U https://doi.org/10.2196/53491 %U http://www.ncbi.nlm.nih.gov/pubmed/39476368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57514 %T Person-Centered Web-Based Mobile Health System (Symptoms) for Reporting Symptoms in COVID-19 Vaccinated Individuals: Observational Study of System, Users, and Symptoms %A Gustafson Hedov,Emelie %A Nyberg,Fredrik %A Gustafsson,Stefan %A Li,Huiqi %A Gisslén,Magnus %A Sundström,Johan %+ Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Entrance 40, 5th floor, Uppsala, 75185, Sweden, 46 018 471 00 00, emelie.gustafson@medsci.uu.se %K mHealth %K mobile health %K patient-reported outcomes %K apps %K COVID-19 %K vaccination side effects %K web-based symptom reporting %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The full spectrum of side effects from COVID-19 vaccinations and infections, including milder symptoms or health effects that do not lead to health care visits, remains unknown. Person-centered self-reporting of symptoms may offer a solution. Monitoring patient-reported outcomes over time will vary in importance for different patients. Individuals have unique needs and preferences, in terms of both communication methods and how the collected information is used to support care. Objective: This study aims to describe how Symptoms, a system for person-centered self-reporting of symptoms and health-related quality of life, was utilized in investigating COVID-19 vaccine side effects. We illustrate this by presenting data from the Symptoms system in newly vaccinated individuals from the RECOVAC (Register-based large-scale national population study to monitor COVID-19 vaccination effectiveness and safety) study. Methods: During the COVID-19 pandemic, newly vaccinated individuals were identified as the ideal population to query for milder symptoms related to COVID-19 vaccinations and infections. To this end, we used posters in observation areas at 150 vaccination sites across the Västra Götaland region of Sweden, inviting newly vaccinated individuals to use a novel digital system, Symptoms. In the Symptoms system, users can track their symptoms, functioning, and quality of life as often as they wish, using evidence-based patient-reported outcome measures and short numeric rating scales. These scales cover a prespecified list of symptoms based on common COVID-19 symptoms and previously reported vaccine side effects. Participants could also use numeric rating scales for self-defined symptoms if their symptom was not included on the prespecified list. Results: A total of 731 people created user accounts and consented to share data for research between July 21, 2021, and September 27, 2022. The majority of users were female (444/731, 60.7%), with a median age of 38 (IQR 30-47) years. Most participants (498/702, 70.9%) did not report any of the comorbidities included in the questionnaire. Of the 731 participants, 563 (77.0%) reported experiencing 1 or more symptoms. The most common symptom was pain at the injection site (486/563, 86.3%), followed by fatigue (181/563, 32.1%) and headache (169/563, 30.0%). In total, 143 unique symptoms were reported. Of these, 29 were from the prespecified list, while the remaining 114 (79.7%) were self-defined entries in the symptom field. This suggests that the flexibility of the self-directed system—allowing individuals to decide which symptoms they consider worth tracking—may be an important feature. Conclusions: Self-reported symptoms in the Symptoms system appeared to align with previously observed post–COVID-19 vaccination symptoms. The system was relatively easy to use and successfully captured broad, longitudinal data. Its person-centered and self-directed design seemed crucial in capturing the full burden of symptoms experienced by users. %M 39476854 %R 10.2196/57514 %U https://formative.jmir.org/2024/1/e57514 %U https://doi.org/10.2196/57514 %U http://www.ncbi.nlm.nih.gov/pubmed/39476854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60317 %T Digital Youth and Family Engagement Program for Adolescents Who Receive Outpatient Mental Health Services: Qualitative Evaluation %A Ramirez,Ana %A Kramer,Justin %A Hazim,Katrina %A Roberge,Jason %+ Department of Anthropology, University of North Carolina at Chapel Hill, 207 E Cameron Aveue Chapel Hill, NC 27599-3115, Chapel Hill, NC, 27599, United States, 1 9199621243, ana_ramirez@unc.edu %K telemedicine %K telepsychiatry %K adolescents %K mental health %K psychiatry %K coaching %K qualitative assessment %K patient satisfaction %K family engagement %K depression %K anxiety %K suicidal ideation %D 2024 %7 31.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management (“Youth and Family Engagement” [YFE] program). Objective: This study aims to explore patients’ and parents’ perceptions of a mental health program and the factors that impact enrollment and sustained engagement. Methods: Semistructured interviews were conducted with adolescent patients (n=9, 56%), parents (n=11, 92%), and clinicians who placed patient referrals (n=6, 100%). Interviews were in English (participants: 19/26, 73%) or Spanish (parents: 7/11, 64%), depending upon participants’ preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis. Results: The YFE program’s structure was often mentioned as promoting engagement, with telephone appointments and health coaches’ ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents’ nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches’ ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program. Conclusions: Prioritizing convenient engagement for adolescents and families may be important for sustained program participation, as inflexible schedules and competing priorities pose barriers to traditional appointments. Future programs should carefully consider health coach–participant relationships, specifically cultural competency, providing services in native languages, and assisting families with wraparound care, as these may be crucial to sustained engagement. %M 39481102 %R 10.2196/60317 %U https://formative.jmir.org/2024/1/e60317 %U https://doi.org/10.2196/60317 %U http://www.ncbi.nlm.nih.gov/pubmed/39481102 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53744 %T Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study %A Paltell,Katherine C %A Duffecy,Jennifer %A Maki,Pauline M %A Edalatian Zakeri,Shiva %A Vujanovic,Anka A %A Berenz,Erin C %+ Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St, M/C 285, Chicago, IL, 60607, United States, 1 312 315 0808, kpaltell@uic.edu %K trauma %K posttraumatic stress disorder %K pregnancy %K perinatal %K web-based intervention %K stress %K postpartum %K depression %K child health %K treatment %K behavioral therapy %K SunnysideFlex %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. Objective: This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. Methods: The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). Results: All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Conclusions: Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period. %M 39485381 %R 10.2196/53744 %U https://formative.jmir.org/2024/1/e53744 %U https://doi.org/10.2196/53744 %U http://www.ncbi.nlm.nih.gov/pubmed/39485381 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52729 %T Understanding Users’ Engagement in a Provider-Created Mobile App for Training to Advance Hepatitis C Care: Knowledge Assessment Survey Study %A Wegener,Maximilian %A Sims,Katarzyna %A Brooks,Ralph %A Nichols,Lisa %A Sideleau,Robert %A McKay,Sharen %A Villanueva,Merceditas %+ Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, 135 College Street, Suite 323, New Haven, CT, 06510, United States, 1 2037857026, maximilian.wegener@yale.edu %K HIV %K HCV %K hepatitis C virus %K interactive digital interventions (IDI) %K education %K mobile application %K user engagement %K training %K awareness %K treatment %K testing %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization and the Centers for Disease Control and Prevention have set ambitious hepatitis C virus (HCV) elimination targets for 2030. Current estimates show that the United States is not on pace to meet elimination targets due to multiple patient, clinic, institutional, and societal level barriers that contribute to HCV testing and treatment gaps. Among these barriers are unawareness of testing and treatment needs, misinformation concerning adverse treatment reactions, need for substance use sobriety, and treatment efficacy. Strategies to improve viral hepatitis education are needed. Objective: We aim to provide a high-quality HCV educational app for patients and health care workers, particularly nonprescriber staff. The app was vetted by health care providers and designed to guide users through the HCV testing and treatment stages in a self-exploratory way to promote engagement and knowledge retention. The app is comprised of five learning modules: (1) Testing for Hep C (hepatitis C), (2) Tests for Hep C Positive Patients, (3) Treatments Available to You, (4) What to Expect During Treatment, and (5) What to Expect After Treatment. Methods: An HCV knowledge assessment survey was administered to providers and patients at the Yale School of Medicine and 11 Connecticut HIV clinics as part of a grant-funded activity. The survey findings and pilot testing feedback guided the app’s design and content development. Data on app usage from November 2019 to November 2022 were analyzed, focusing on user demographics, engagement metrics, and module usage patterns. Results: There were 561 app users; 216 (38.5%) accessed the training modules of which 151 (69.9%) used the app for up to 60 minutes. Of them, 65 (30.1%) users used it for >60 minutes with a median time spent of 5 (IQR 2-8) minutes; the median time between initial accession and last use was 39 (IQR 18-60) days. Users accessed one or more modules and followed a nonsequential pattern of use: module 1: 163 (75.4%) users; module 4: 82 (38%); module 5: 67 (31%); module 3: 49 (22.7%); module 2: 41 (19%). Conclusions: This app, created in an academic setting, is one of a few available in English and Spanish that provides content-vetted HCV education for patients and health care supportive staff. It offers the convenience of on-demand education, allowing users to access crucial information about HCV management and treatment in a self-directed fashion that acknowledges and promotes variable preferences in learning approaches. While app uptake was relatively limited, we propose that future efforts should focus on combined promotion efforts with marketing strategies experts aligned with academic experts. Incorporating ongoing user feedback and integrating personalized reminders and quizzes, will further enhance engagement, supporting the broader public health HCV elimination goals. %M 39486023 %R 10.2196/52729 %U https://formative.jmir.org/2024/1/e52729 %U https://doi.org/10.2196/52729 %U http://www.ncbi.nlm.nih.gov/pubmed/39486023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58622 %T Couple-Focused Smartphone Intervention to Reduce Problem Drinking: Pilot Randomized Control Trial %A Gustafson Sr,David H %A Gustafson Jr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Vjorn,Olivia J %A Curtin,John J %A Epstein,Elizabeth E %A Bailey,Genie L %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering, Room 4127, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K alcohol use disorder %K AUD %K mHealth %K mobile health %K mobile phone %K smartphone %K couple therapy %K Comprehensive Health Enhancement Support System %K A-CHESS %K Alcohol Behavioral Couple Therapy %K ABCT %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. Objective: This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. Methods: A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients’ percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. Results: At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=–17.4, 95% CI –36.1 to 1.4; P=.07; Hedges g=–0.53), while the percentage of drinking days was relatively equal between patient groups (β=–2.1, 95% CI –24.8 to 20.7; P=.85; Hedges g=–0.12). Conclusions: Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. Trial Registration: ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549 %M 39486022 %R 10.2196/58622 %U https://formative.jmir.org/2024/1/e58622 %U https://doi.org/10.2196/58622 %U http://www.ncbi.nlm.nih.gov/pubmed/39486022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55614 %T Claims-Based Algorithm to Identify Pre-Exposure Prophylaxis Indications for Tenofovir Disoproxil Fumarate and Emtricitabine Prescriptions (2012-2014): Validation Study %A Sullivan,Patrick Sean %A Mera-Giler,Robertino M %A Bush,Staci %A Shvachko,Valentina %A Sarkodie,Eleanor %A O'Farrell,Daniel %A Dubose,Stephanie %A Magnuson,David %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 2005, Atlanta, GA, 30322, United States, 1 40421016039, pssulli@emory.edu %K pre-exposure prophylaxis %K PrEP %K classification %K electronic medical record %K EMR %K algorithm %K electronic health record %K EHR %K drug %K pharmacology %K pharmacotherapy %K pharmaceutical %K medication %K monotherapy %K HIV %K prevention %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To monitor the use of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and related medicines for pre-exposure prophylaxis (PrEP) as HIV prevention using commercial pharmacy data, it is necessary to determine whether TDF/FTC prescriptions are used for PrEP or for some other clinical indication. Objective: This study aimed to validate an algorithm to distinguish the use of TDF/FTC for HIV prevention or infectious disease treatment. Methods: An algorithm was developed to identify whether TDF/FTC prescriptions were for PrEP or for other indications from large-scale administrative databases. The algorithm identifies TDF/FTC prescriptions and then excludes patients with International Classification of Diseases (ICD)–9 diagnostic codes, medications, or procedures that suggest indications other than for PrEP (eg, documentation of HIV infection, chronic hepatitis B, or use of TDF/FTC for postexposure prophylaxis). For evaluation, we collected data by clinician assessment of medical records for patients with TDF/FTC prescriptions and compared the assessed indication identified by the clinician review with the assessed indication identified by the algorithm. The algorithm was then applied and evaluated in a large, urban, community-based sexual health clinic. Results: The PrEP algorithm demonstrated high sensitivity and moderate specificity (99.6% and 49.6%) in the electronic medical record database and high sensitivity and specificity (99% and 87%) in data from the urban community health clinic. Conclusions: The PrEP algorithm classified the indication for PrEP in most patients treated with TDF/FTC with sufficient accuracy to be useful for surveillance purposes. The methods described can serve as a basis for developing a robust and evolving case definition for antiretroviral prescriptions for HIV prevention purposes. %M 39141024 %R 10.2196/55614 %U https://formative.jmir.org/2024/1/e55614 %U https://doi.org/10.2196/55614 %U http://www.ncbi.nlm.nih.gov/pubmed/39141024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54565 %T User Views on Online Sexual Health Symptom Checker Tool: Qualitative Research %A King,Alicia Jean %A Bilardi,Jade Elissa %A Towns,Janet Mary %A Maddaford,Kate %A Fairley,Christopher Kincaid %A Chow,Eric P F %A Phillips,Tiffany Renee %+ School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 580 Swanston Street, Carlton, Melbourne, 3053, Australia, 61 93416266, aking@mshc.org.au %K sexual health %K sexually transmitted diseases %K risk assessment %K risk factors %K smartphone apps %K help-seeking behavior %K health literacy %K information seeking behavior %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delayed diagnosis and treatment of sexually transmitted infections (STIs) contributes to poorer health outcomes and onward transmission to sexual partners. Access to best-practice sexual health care may be limited by barriers such as cost, distance to care providers, sexual stigma, and trust in health care providers. Online assessments of risk offer a novel means of supporting access to evidence-based sexual health information, testing, and treatment by providing more individualized sexual health information based on user inputs. Objective: This developmental evaluation aims to find potential users’ views and experiences in relation to an online assessment of risk, called iSpySTI (Melbourne Sexual Health Center), including the likely impacts of use. Methods: Individuals presenting with urogenital symptoms to a specialist sexual health clinic were given the opportunity to trial a web-based, Bayesian-powered tool that provides a list of 2 to 4 potential causes of their symptoms based on inputs of known STI risk factors and symptoms. Those who tried the tool were invited to participate in a once-off, semistructured research interview. Descriptive, action, and emotion coding informed the comparative analysis of individual cases. Results: Findings from interviews with 14 people who had used the iSpySTI tool support the superiority of the online assessment of STI risk compared to existing sources of sexual health information (eg, internet search engines) in providing trusted and probabilistic information to users. Additionally, potential users reported benefits to their emotional well-being in the intervening period between noticing symptoms and being able to access care. Differences in current and imagined urgency of health care seeking and emotional impacts were found based on clinical diagnosis (eg, non-STI, curable and incurable but treatable STIs) and whether participants were born in Australia or elsewhere. Conclusions: Online assessments of risk provide users experiencing urogenital symptoms with more individualized and evidence-based health information that can improve their health care–seeking and provide reassurance in the period before they can access care. %R 10.2196/54565 %U https://formative.jmir.org/2024/1/e54565 %U https://doi.org/10.2196/54565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58776 %T A Deep Learning Model to Predict Breast Implant Texture Types Using Ultrasonography Images: Feasibility Development Study %A Kim,Ho Heon %A Jeong,Won Chan %A Pi,Kyungran %A Lee,Angela Soeun %A Kim,Min Soo %A Kim,Hye Jin %A Kim,Jae Hong %+ The W Clinic, 9F Kukdong B/D, 596 Gangnam-daero, Gangnam-gu, Seoul, 06038, Republic of Korea, 82 2 517 7617, stenkaracin@gmail.com %K breast implants %K mammoplasty %K ultrasonography: AI-assisted diagnosis %K cshell surface topography %K artificial intelligence %K deep learning %K machine learning %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast implants, including textured variants, have been widely used in aesthetic and reconstructive mammoplasty. However, the textured type, which is one of the shell texture types of breast implants, has been identified as a possible etiologic factor for lymphoma, specifically breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Identifying the shell texture type of the implant is critical to diagnosing BIA-ALCL. However, distinguishing the shell texture type can be difficult due to the loss of human memory and medical history. An alternative approach is to use ultrasonography, but this method also has limitations in quantitative assessment. Objective: This study aims to determine the feasibility of using a deep learning model to classify the shell texture type of breast implants and make robust predictions from ultrasonography images from heterogeneous sources. Methods: A total of 19,502 breast implant images were retrospectively collected from heterogeneous sources, including images captured from both Canon and GE devices, images of ruptured implants, and images without implants, as well as publicly available images. The Canon images were trained using ResNet-50. The model’s performance on the Canon dataset was evaluated using stratified 5-fold cross-validation. Additionally, external validation was conducted using the GE and publicly available datasets. The area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (PRAUC) were calculated based on the contribution of the pixels with Gradient-weighted Class Activation Mapping (Grad-CAM). To identify the significant pixels for classification, we masked the pixels that contributed less than 10%, up to a maximum of 100%. To assess the model’s robustness to uncertainty, Shannon entropy was calculated for 4 image groups: Canon, GE, ruptured implants, and without implants. Results: The deep learning model achieved an average AUROC of 0.98 and a PRAUC of 0.88 in the Canon dataset. The model achieved an AUROC of 0.985 and a PRAUC of 0.748 for images captured with GE devices. Additionally, the model predicted an AUROC of 0.909 and a PRAUC of 0.958 for the publicly available dataset. This model maintained the PRAUC values for quantitative validation when masking up to 90% of the least-contributing pixels and the remnant pixels in breast shell layers. Furthermore, the prediction uncertainty increased in the following order: Canon (0.066), GE (0072), ruptured implants (0.371), and no implants (0.777). Conclusions: We have demonstrated the feasibility of using deep learning to predict the shell texture type of breast implants. This approach quantifies the shell texture types of breast implants, supporting the first step in the diagnosis of BIA-ALCL. %M 39499915 %R 10.2196/58776 %U https://formative.jmir.org/2024/1/e58776 %U https://doi.org/10.2196/58776 %U http://www.ncbi.nlm.nih.gov/pubmed/39499915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50456 %T Codesigning a Digital Type 2 Diabetes Risk Communication Tool in Singapore: Qualitative Participatory Action Research Approach %A Hashim,Jumana %A Luna Puerta,Lidia %A Foong,Pin Sym %A Tai,E Shyong %A Yi,Huso %A Smith,Helen Elizabeth %+ Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, 117549, Singapore, 65 66012499, jhashim@nus.edu.sg %K type 2 diabetes %K risk perception %K co-design %K risk communication tool %K diabetes prevention %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a serious public health concern worldwide. Despite public health efforts encouraging early screening and improving knowledge of effective interventions for those at increased risk of type 2 diabetes (T2D), the incorporation of preventative behaviors into an individual’s daily life remains suboptimal. Successfully and accurately increasing risk perception has been demonstrated to increase behavioral intention. Objective: The study aims to codesign a T2D risk communication tool by engaging public participants to (1) identify key characteristics that contribute to an effective risk communication tool and (2) test and iterate to develop a culturally sensitive and meaningful risk communication tool that can motivate T2D preventative behaviors. Methods: We adopted a novel methodology, “Patient and Public Involvement (PPI) Hawkers,” where we approached patrons at hawker centers and public eateries frequented by all local residents to evaluate and test 3 prototypes for the tool. The three prototypes were (1) “Diabetes Onset”—estimated age of diabetes onset of T2D based on one’s risk factors, (2) “Relative Risk”—the relative risk of T2D is presented in a 1-10 scale indicating where one’s risk score lie in relation to others, and (3) “Metabolic Age”—the median age of the risk category based on one’s risk factors, presented to be compared against their chronological age. We gathered reactions and feedback through rapid testing and iteration to understand which risk result presentation would be received the best. All the collected data were revisited and analyzed using an inductive thematic analysis to identify the key characteristics contributing to an effective risk communication tool. Results: We engaged with 112 participants (female: n=59, 56%) across 6 hawker centers. The key characteristics that were important to participants emerged in four main themes: (1) appeal and user experience, in terms of format and readability; (2) trust and validity of the institution providing the tool and the accuracy of the risk result; (3) threat appraisal: salience of risk information, which influenced their risk perception; and (4) coping appraisal: facilitators for behavior change, which impacted their intention for implementing T2D preventative behaviors. The predictive nature of the prototype entitled “Diabetes Onset” was poorly received and removed after the first iteration. The Relative Risk prototype was valued for being straightforward but feared to be boring. The Metabolic Age prototype was anticipated to be more motivating for behavior change, but there were some concerns that the terminology may not be understood by everyone. Conclusions: Participants were divided on which of the 2 prototypes, “Metabolic Age” or “Relative Risk,” they would favor adopting. Further testing is now required to determine which prototype will be more effective in motivating behavior change. This study’s insights on the design process and valued characteristics of a risk communication tool will inform future development of such interventions. %M 39500495 %R 10.2196/50456 %U https://formative.jmir.org/2024/1/e50456 %U https://doi.org/10.2196/50456 %U http://www.ncbi.nlm.nih.gov/pubmed/39500495 %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 e51832 %T Exploring Psychotherapists’ Attitudes on Internet- and Mobile-Based Interventions in Germany: Thematic Analysis %A Hildebrand,Anne Sophie %A Planert,Jari %A Machulska,Alla %A Margraf,Lena Maria %A Roesmann,Kati %A Klucken,Tim %+ Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, Siegen, 57072, Germany, 49 271 740 3688, Anne.Hildebrand@uni-siegen.de %K eHealth %K psychotherapy %K psychotherapists’ perspectives %K thematic analysis %K internet- and mobile-based intervention %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, internet- and mobile-based interventions (IMIs) have become increasingly relevant in mental health care and have sparked societal debates. Psychotherapists’ perspectives are essential for identifying potential opportunities for improvement, facilitating conditions, and barriers to the implementation of these interventions. Objective: This study aims to explore psychotherapists’ perspectives on opportunities for improvement, facilitating conditions, and barriers to using IMIs. Methods: The study used a qualitative research design, utilizing open-ended items in a cross-sectional survey. A total of 350 psychotherapists were asked to provide their written opinions on various aspects of IMIs. Thematic analysis was conducted to analyze the data and identify core themes. Results: The analysis revealed 11 core themes related to the use of IMIs, which were categorized into 4 superordinate categories: “Applicability,” “Treatment Resources,” “Technology,” and “Perceived Risks and Barriers.” While many psychotherapists viewed IMIs as a valuable support for conventional psychotherapy, they expressed skepticism about using IMIs as a substitute. Several factors were perceived as hindrances to the applicability of IMIs in clinical practice, including technological issues, subjective concerns about potential data protection risks, a lack of individualization due to the manualized nature of most IMIs, and the high time and financial costs for both psychotherapists and patients. They expressed a desire for easily accessible information on evidence and programs to reduce the time and effort required for training and advocated for this information to be integrated into the conceptualization of new IMIs. Conclusions: The findings of this study emphasize the importance of considering psychotherapists’ attitudes in the development, evaluation, and implementation of IMIs. This study revealed that psychotherapists recognized both the opportunities and risks associated with the use of IMIs, with most agreeing that IMIs serve as a tool to support traditional psychotherapy rather than as a substitute for it. Furthermore, it is essential to involve psychotherapists in discussions about IMIs specifically, as well as in the development of new methodologies in psychotherapy more broadly. Overall, this study can advance the use of IMIs in mental health care and contribute to the ongoing societal debate surrounding these interventions. %M 39510514 %R 10.2196/51832 %U https://formative.jmir.org/2024/1/e51832 %U https://doi.org/10.2196/51832 %U http://www.ncbi.nlm.nih.gov/pubmed/39510514 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51865 %T Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders %A Lange-Drenth,Lukas %A Schulz,Holger %A Suck,Isabell %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 07410 56811, l.lange-drenth@uke.de %K telerehabilitation %K rehabilitation %K eHealth development %K value specification %K stakeholder participation %K occupational injuries %K vocational rehabilitation %K aftercare %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients’ lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. %M 39514260 %R 10.2196/51865 %U https://formative.jmir.org/2024/1/e51865 %U https://doi.org/10.2196/51865 %U http://www.ncbi.nlm.nih.gov/pubmed/39514260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59158 %T A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study %A Straand,Ingjerd J %A Følstad,Asbjørn %A Wünsche,Burkhard C %+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no %K web-based intervention %K positive psychology %K mental health %K user experience %K persuasive design %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users’ motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. %M 39514255 %R 10.2196/59158 %U https://formative.jmir.org/2024/1/e59158 %U https://doi.org/10.2196/59158 %U http://www.ncbi.nlm.nih.gov/pubmed/39514255 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e13723 %T Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process %A de Vette,Frederiek %A Ruiz-Rodriguez,Aurora %A Tabak,Monique %A Oude Nijeweme-d'Hollosy,Wendy %A Hermens,Hermie %A Vollenbroek-Hutten,Miriam %+ Biomechanical Engineering Group, Faculty of Engineering Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 5798, a.ruizrodriguez@utwente.nl %K game based %K gamification %K game %K eHealth %K telemedicine %K development %K design %K engagement %K game preferences %K older adults %K self-management %K prototyping %K evaluations %K creative %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform’s training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game “Stranded!” The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. %M 39514861 %R 10.2196/13723 %U https://formative.jmir.org/2024/1/e13723 %U https://doi.org/10.2196/13723 %U http://www.ncbi.nlm.nih.gov/pubmed/39514861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53299 %T Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study %A Perme,Natalie %A Reid,Endia %A Eluagu,Macdonald Chinwenwa %A Thompson,John %A Hebert,Courtney %A Gabbe,Steven %A Swoboda,Christine Marie %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Suite 4101, 700 Ackerman Rd., Columbus, OH, 43210, United States, 1 13157612701, swoboda.2@osu.edu %K health resources %K pregnancy %K patient engagement %K mHealth %K maternal %K mobile health %K app %K focus group %K landscape analysis %K birth %K preterm %K premature %K mortality %K death %K pediatric %K infant %K neonatal %K design %K development %K obstetric %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app’s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. %M 39514852 %R 10.2196/53299 %U https://formative.jmir.org/2024/1/e53299 %U https://doi.org/10.2196/53299 %U http://www.ncbi.nlm.nih.gov/pubmed/39514852 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58363 %T A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study %A Oliveira,Ashleigh %A Wolff,John %A Alfouzan,Nouf %A Yu,Jin %A Yahya,Asma %A Lammy,Kayla %A Nakamura,Manabu T %+ Division of Nutritional Sciences, University of Illinois at Urbana Champaign, 905 S Goodwin Ave, Urbana, IL, 61801, United States, 1 217 333 1267, oliveira.ashleigh@gmail.com %K health application %K weight loss %K behavior change technique %K BCT %K online weight loss program %K weight monitoring %K meal planning %K sustainable weight loss %K dietary fiber %K mHealth %K mobile health %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. Objective: This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. Methods: The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. Results: The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. Conclusions: The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial. %M 39527795 %R 10.2196/58363 %U https://formative.jmir.org/2024/1/e58363 %U https://doi.org/10.2196/58363 %U http://www.ncbi.nlm.nih.gov/pubmed/39527795 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59395 %T Trends in Exercise-Related Internet Search Keywords by Sex, Age, and Lifestyle: Infodemiological Study %A Uemura,Kosuke %A Miyagami,Taiju %A Saita,Mizue %A Uchida,Takuro %A Yuasa,Shun %A Kondo,Keita %A Miura,Shun %A Matsushita,Mizuki %A Shirai,Yuka %A Misawa,Richard Baku %A Naito,Toshio %+ Department of General Medicine, Faculty of Medicine, Juntendo University, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan, 81 3 5802 1190, k.uemura.sh@juntendo.ac.jp %K exercise prescriptions %K sex %K age %K lifestyle %K internet search keywords %K infodemiology %K demographic %K physical activity %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Exercise prescription by physicians is beneficial for initiating or intensifying physical activity. However, providing specific exercise prescriptions is challenging; therefore, few physicians prescribe exercise. Objective: This infodemiological study aimed to understand trends in exercise-related internet search keywords based on sex, age, and environmental factors to help doctors prescribe exercise more easily. Methods: Search keyword volume was collected from Yahoo! JAPAN for 2022. Ten exercise-related terms were analyzed to assess exercise interest. Total search activities were analyzed by sex and age. Characteristic scores were based on the Japanese prefecture. By performing hierarchical cluster analysis, regional features were examined, and Kruskal-Wallis tests were used to assess relationships with population and industry data. Results: The top-searched term was “Pilates” (266,000 queries). Male individuals showed higher interest in activities such as “running” (25,400/40,700, 62.4%), “muscle training” (65,800/111,000, 59.3%), and “hiking” (23,400/40,400, 57.9%) than female individuals. Female individuals exhibited higher interest in “Pilates” (199,000/266,000, 74.8%), “yoga” (86,200/117,000, 73.7%), and “tai chi” (45,300/65,900, 68.7%) than male individuals. Based on age, search activity was highest in the 40-49 years age group for both male and female individuals across most terms. For male individuals, 7 of the 10 searched terms’ volume peaked for those in their 40s; “stretch” was most popular among those in their 50s; and “tai chi” and “radio calisthenics” had the highest search volume for those in their 70s. Female individuals in their 40s led the search volume for 9 of the 10 terms, with the exception of “tai chi,” which peaked for those in their 70s. Hierarchical cluster analysis using a characteristic score as a variable classified prefectures into 4 clusters. The characteristics of these clusters were as follows: cluster 1 had the largest population and a thriving tertiary industry, and individuals tended to search for Pilates and yoga. Following cluster 1, cluster 2, with its substantial population, had a thriving secondary industry, with searches for radio calisthenics and exercise bike. Cluster 4 had a small population, a thriving primary industry, and the lowest search volume for any term. Cluster 3 had a similar population to that of cluster 4 but had a larger secondary industry. Conclusions: Male individuals show more interest in individual activities, such as running, whereas female individuals are interested in group activities, such as Pilates. Despite the high search volume among individuals in their 40s, actual exercise habits are low among those in their 30s to 50s. Search volumes for instructor-led exercises are higher in cluster 1 than in other cluster areas, and the total number of searches decreases as the community size decreases. These results suggest that trends in search behavior depending on sex, age, and environment factors are essential when prescribing exercise for effective behavioral change. %M 39527804 %R 10.2196/59395 %U https://formative.jmir.org/2024/1/e59395 %U https://doi.org/10.2196/59395 %U http://www.ncbi.nlm.nih.gov/pubmed/39527804 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48664 %T Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study %A Gulzar,Saleema %A Rahim,Shirin %A Dossa,Khadija %A Saeed,Sana %A Agha,Insiyah %A Khoja,Shariq %A Karmaliani,Rozina %+ School of Nursing and Midwifery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 3332356678, saleema.gulzar@aku.edu %K teleconsultation %K digital health %K school health %K child health %K information technology %K eConsultation %K telehealth %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Pakistan’s remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. Objective: This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. Methods: This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. Results: A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. Conclusions: This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS’s cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue. %M 39531262 %R 10.2196/48664 %U https://formative.jmir.org/2024/1/e48664 %U https://doi.org/10.2196/48664 %U http://www.ncbi.nlm.nih.gov/pubmed/39531262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52788 %T Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals %A Oudshoorn,Cathelijn %A Frielink,Noud %A Riper,Heleen %A Embregts,Petri %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, 5037 DB, Tilburg, Netherlands, 31 0134662969, c.e.m.oudshoorn@tilburguniversity.edu %K acceptance %K health care professionals %K intellectual disabilities %K eHealth %K disability %K psychological therapy %K support %K cross-sectional survey %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals’ acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants’ characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach α=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. %M 39531275 %R 10.2196/52788 %U https://formative.jmir.org/2024/1/e52788 %U https://doi.org/10.2196/52788 %U http://www.ncbi.nlm.nih.gov/pubmed/39531275 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55137 %T Leveraging Implementation Science at the Early-Stage Development of a Novel Telehealth-Delivered Fear of Exercise Program to Understand Intervention Feasibility and Implementation Potential: Feasibility Behavioral Intervention Study %A Duran,Andrea T %A Cumella,Robin M %A Mendieta,Miguel %A Keener-Denoia,Adrianna %A López Veneros,David %A Farris,Samantha G %A Moise,Nathalie %A Kronish,Ian M %+ Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, United States, 1 212 342 4491, atd2127@cumc.columbia.edu %K behavioral intervention development %K implementation science %K acute coronary syndrome %K exercise sensitivity %K interoceptive exposure %K digital health %K mobile phone %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To increase real-world adoption of effective telehealth-delivered behavioral health interventions among midlife and older adults with cardiovascular disease, incorporating implementation science (IS) methods at earlier stages of intervention development may be needed. Objective: This study aims to describe how IS can be incorporated into the design and interpretation of a study assessing the feasibility and implementation potential of a technology-delivered behavioral health intervention. Methods: We assessed the feasibility and implementation potential of a 2-session, remotely delivered, home-based behavioral intervention composed of psychoeducation, interoceptive exposure through low-to-moderate intensity walking, interoceptive counseling, and homework (Reducing Exercise Sensitivity with Exposure Training; RESET) among patients with recent acute coronary syndrome (ACS) and some fear of exercise. To assess intervention feasibility, we measured patient protocol adherence, intervention delivery fidelity, and completion of intervention outcome assessments using direct observations, fidelity checklists, surveys, and device-measured physical activity. To assess implementation potential, we measured implementation outcomes (feasibility, acceptability, and appropriateness) using 4-item measures, each rated from the patient perspective on a 1 to 5 Likert scale (1=completely disagree and 5=completely agree; criteria: ≥4=agree or completely agree), and patient-perceived implementation determinants and design feedback using survey and interview data. Interview data underwent thematic analysis to identify implementation determinant themes, which were then categorized into Consolidated Framework for Implementation Research (CFIR) domains and constructs. Results: Of 31 patients approached during recruitment, 3 (10%) were eligible, enrolled, and completed the study (mean age 46.3, SD 14.0 y; 2/3, 67% male; 1/3, 33% Black; and 1/3, 33% Asian). The intervention was delivered with fidelity for all participants, and all participants completed the entire intervention protocol and outcome assessments. On average, participants agreed that the RESET intervention was feasible and acceptable, while appropriateness ratings did not meet implementation criteria (feasibility: mean 4.2, SD 0.4; acceptability: mean 4.3, SD 0.7; and appropriateness: mean 3.7, SD 0.4). Key patient-perceived implementation determinants were related to constructs in the innovation (design, adaptability, and complexity), inner setting (available resources [physical space, funding, materials, and equipment] and access to knowledge and information), and innovation recipient characteristics (motivation, capability, opportunity, and need) domains of the CFIR, with key barriers related to innovation design. Design feedback indicated that the areas requiring the most revisions were the interoceptive exposure design and the virtual delivery modality, and reasons why included low dose and poor usability. Conclusions: The RESET intervention was feasible but not implementable in a small sample of patients with ACS. Our theory-informed, mixed methods approach aided our understanding of what, how, and why RESET was not perceived as implementable; this information will guide intervention refinement. This study demonstrated how integrating IS methods early in intervention development can guide decisions regarding readiness to advance interventions along the translational research pipeline. %M 39531636 %R 10.2196/55137 %U https://formative.jmir.org/2024/1/e55137 %U https://doi.org/10.2196/55137 %U http://www.ncbi.nlm.nih.gov/pubmed/39531636 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54335 %T Early Identification of Cognitive Impairment in Community Environments Through Modeling Subtle Inconsistencies in Questionnaire Responses: Machine Learning Model Development and Validation %A Gao,Hongxin %A Schneider,Stefan %A Hernandez,Raymond %A Harris,Jenny %A Maupin,Danny %A Junghaenel,Doerte U %A Kapteyn,Arie %A Stone,Arthur %A Zelinski,Elizabeth %A Meijer,Erik %A Lee,Pey-Jiuan %A Orriens,Bart %A Jin,Haomiao %+ School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Guildford, GU2 7YH, United Kingdom, 44 7438534086, h.jin@surrey.ac.uk %K machine learning %K artificial intelligence %K cognitive impairments %K surveys and questionnaires %K community health services %K public health %K early identification %K elder care %K dementia %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The underdiagnosis of cognitive impairment hinders timely intervention of dementia. Health professionals working in the community play a critical role in the early detection of cognitive impairment, yet still face several challenges such as a lack of suitable tools, necessary training, and potential stigmatization. Objective: This study explored a novel application integrating psychometric methods with data science techniques to model subtle inconsistencies in questionnaire response data for early identification of cognitive impairment in community environments. Methods: This study analyzed questionnaire response data from participants aged 50 years and older in the Health and Retirement Study (waves 8-9, n=12,942). Predictors included low-quality response indices generated using the graded response model from four brief questionnaires (optimism, hopelessness, purpose in life, and life satisfaction) assessing aspects of overall well-being, a focus of health professionals in communities. The primary and supplemental predicted outcomes were current cognitive impairment derived from a validated criterion and dementia or mortality in the next ten years. Seven predictive models were trained, and the performance of these models was evaluated and compared. Results: The multilayer perceptron exhibited the best performance in predicting current cognitive impairment. In the selected four questionnaires, the area under curve values for identifying current cognitive impairment ranged from 0.63 to 0.66 and was improved to 0.71 to 0.74 when combining the low-quality response indices with age and gender for prediction. We set the threshold for assessing cognitive impairment risk in the tool based on the ratio of underdiagnosis costs to overdiagnosis costs, and a ratio of 4 was used as the default choice. Furthermore, the tool outperformed the efficiency of age or health-based screening strategies for identifying individuals at high risk for cognitive impairment, particularly in the 50- to 59-year and 60- to 69-year age groups. The tool is available on a portal website for the public to access freely. Conclusions: We developed a novel prediction tool that integrates psychometric methods with data science to facilitate “passive or backend” cognitive impairment assessments in community settings, aiming to promote early cognitive impairment detection. This tool simplifies the cognitive impairment assessment process, making it more adaptable and reducing burdens. Our approach also presents a new perspective for using questionnaire data: leveraging, rather than dismissing, low-quality data. %M 39536306 %R 10.2196/54335 %U https://formative.jmir.org/2024/1/e54335 %U https://doi.org/10.2196/54335 %U http://www.ncbi.nlm.nih.gov/pubmed/39536306 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57390 %T The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design %A Shojaei,Fereshtehossadat %A Shojaei,Fatemehalsadat %A Desai,Archita P %A Long,Emily %A Mehta,Jade %A Fowler,Nicole R %A Holden,Richard J %A Orman,Eric S %A Boustani,Malaz %+ Luddy School of Informatics, Computing, and Engineering, Indiana University Bloomington, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 8128565754, fshojaei@iu.edu %K AgileNudge+ %K agile %K nudge strategy %K nudging interventions %K agile implementation %K human behavior %K software design %K human-computer interaction %K user experience design %K usability testing %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In today’s digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. “AgileNudge+” (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of “AgileNudge+” for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software’s interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science–based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software’s ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool’s usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project’s sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users’ needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. %M 39302134 %R 10.2196/57390 %U https://formative.jmir.org/2024/1/e57390 %U https://doi.org/10.2196/57390 %U http://www.ncbi.nlm.nih.gov/pubmed/39302134 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53768 %T Use of Random Forest to Predict Adherence in an Online Intervention for Depression Using Baseline and Early Usage Data: Model Development and Validation on Retrospective Routine Care Log Data %A Wenger,Franziska %A Allenhof,Caroline %A Schreynemackers,Simon %A Hegerl,Ulrich %A Reich,Hanna %+ Clinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University Frankfurt, Heinrich-Hoffmann-Str. 10, Frankfurt am Main, 60528, Germany, 49 3412238744, franziska.wenger@deutsche-depressionshilfe.de %K depression %K adherence %K machine learning %K digital interventions %K random forest %K iFightDepression %K iFD %K online intervention %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online interventions, such as the iFightDepression (iFD) tool, are increasingly recognized as effective alternatives to traditional face-to-face psychotherapy or pharmacotherapy for treating depression. However, particularly when used outside of study settings, low adherence rates and the resulting diminished benefits of the intervention can limit their effectiveness. Understanding the factors that predict adherence would allow for early, tailored interventions for individuals at risk of nonadherence, thereby enhancing user engagement and optimizing therapeutic outcomes. Objective: This study aims to develop and evaluate a random forest model that predicts adherence to the iFD tool to identify users at risk of noncompletion. The model was based on characteristics collected during baseline and the first week of the intervention in patients with depression. Methods: Log data from 4187 adult patients who registered for the iFD tool between October 1, 2016, and May 5, 2022, and provided informed consent were statistically analyzed. The resulting data set was divided into training (2932/4187, 70%) and test (1255/4187, 30%) sets using a randomly stratified split. The training data set was utilized to train a random forest model aimed at predicting each user’s adherence at baseline, based on the hypothesized predictors: age, self-reported gender, expectations of the intervention, current or previous depression treatments, confirmed diagnosis of depression, baseline 9-item Patient Health Questionnaire (PHQ-9) score, accompanying guide profession, and usage behavior within the first week. After training, the random forest model was evaluated on the test data set to assess its predictive performance. The importance of each variable in predicting adherence was analyzed using mean decrease accuracy, mean decrease Gini, and Shapley Additive Explanations values. Results: Of the 4187 patients evaluated, 1019 (24.34%) were classified as adherent based on our predefined definition. An initial random forest model that relied solely on sociodemographic and clinical predictors collected at baseline did not yield a statistically significant adherence prediction. However, after incorporating each patient’s usage behavior during the first week, we achieved a significant prediction of adherence (P<.001). Within this prediction, the model achieved an accuracy of 0.82 (95% CI 0.79-0.84), an F1-score of 0.53, an area under the curve of 0.83, and a specificity of 0.94 for predicting nonadherent users. The key predictors of adherence included logs, word count on the first workshop’s worksheet, and time spent on the tool, all measured during the first week. Conclusions: Our results highlight that early engagement, particularly usage behavior during the first week of the online intervention, is a far greater predictor of adherence than any sociodemographic or clinical factors. Therefore, analyzing usage behavior within the first week and identifying nonadherers through the algorithm could be beneficial for tailoring interventions aimed at improving user adherence. This could include follow-up calls or face-to-face discussions, optimizing resource utilization in the process. %M 39546342 %R 10.2196/53768 %U https://formative.jmir.org/2024/1/e53768 %U https://doi.org/10.2196/53768 %U http://www.ncbi.nlm.nih.gov/pubmed/39546342 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63298 %T Cultural Adaptation and User Satisfaction of an Internet-Delivered Cognitive Behavioral Program for Depression and Anxiety Among College Students in Two Latin American Countries: Focus Group Study With Potential Users and a Cross-Sectional Questionnaire Study With Actual Users %A Albor,Yesica %A González,Noé %A Benjet,Corina %A Salamanca-Sanabria,Alicia %A Hernández-de la Rosa,Cristiny %A Eslava-Torres,Viridiana %A García-Alfaro,María Carolina %A Melchor-Audirac,Andrés %A Montoya-Montero,Laura Itzel %A Suárez,Karla %+ Center for Research in Global Mental Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, Mexico City, 14370, Mexico, 52 5541605332, cbenjet@gmail.com %K culturally competent care %K mental health %K digital health %K student health services %K Colombia %K Mexico %K SilverCloud %K anxiety %K depression %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To scale up mental health care in low-resource settings, digital interventions must consider cultural fit. Despite the findings that culturally adapted digital interventions have greater effectiveness, there is a lack of empirical evidence of interventions that have been culturally adapted or their adaptation documented. Objective: This study aimed to document the cultural adaptation of the SilverCloud Health Space from Depression and Anxiety program for university students in Colombia and Mexico and evaluate user satisfaction with the adapted program. Methods: A mixed methods process was based on Cultural Sensitivity and Ecological Validity frameworks. In phase 1, the research team added culturally relevant content (eg, expressions, personal stories, photos) for the target population to the intervention. In phase 2, potential users (9 university students) first evaluated the vignettes and photos used throughout the program. We calculated median and modal responses. They then participated in focus groups to evaluate and assess the cultural appropriateness of the materials. Their comments were coded into the 8 dimensions of the Ecological Validity Framework. Phase 3 consisted of choosing the vignettes most highly rated by the potential users and making modifications to the materials based on the student feedback. In the final phase, 765 actual users then engaged with the culturally adapted program and rated their satisfaction with the program. We calculated the percentage of users who agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them attain their goals. Results: The potential users perceived the original vignettes as moderately genuine, or true, which were given median scores between 2.5 and 3 (out of a possible 4) and somewhat identified with the situations presented in the vignettes given median scores between 1.5 and 3. The majority of comments or suggestions for modification concerned language (126/218, 57.5%), followed by concepts (50/218, 22.8%). Much less concerned methods (22/218, 10%), persons (9/218, 4.1%), context (5/218, 2.3%), or content (2/218, 0.9%). There were no comments about metaphors or goals. Intervention materials were modified based on these results. Of the actual users who engaged with the adapted version of the program, 87.7%-96.2% of them agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them to attain their goals. Conclusions: We conclude that the adapted version is satisfactory for this population based on the focus group discussions and the satisfaction scores. Conducting and documenting such cultural adaptations and involving the users in the cultural adaptation process will likely improve the effectiveness of digital mental health interventions in low- and middle-income countries and culturally diverse contexts. %M 39546799 %R 10.2196/63298 %U https://formative.jmir.org/2024/1/e63298 %U https://doi.org/10.2196/63298 %U http://www.ncbi.nlm.nih.gov/pubmed/39546799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59831 %T Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study %A Miller,Michael J %A Eberhart,Lindsay G %A Heliste,Jennifer L %A Tripuraneni,Bhaskara R %+ Mid-Atlantic Permanente Research Institute (MAPRI), 700 2nd St NE, 5th Floor, Washington, DC, 20002, United States, 1 202 317 0618, Michael.J1.Miller@kp.org %K digital mental health applications %K DMHA %K mobile health %K mHealth %K mobile phone %K smartphone %K user experience %K engagement %K implementation %K Kaiser Permanente %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7%) completed the survey and 44 (37%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66%); 73% (32/44) of the respondents were female, 73% (32/44) of the respondents had at least a 4-year college degree, 41% (18/44) of the respondents were Black or African American, and 39% (17/44) of the respondents were White. Moreover, 27% (12/44) of the respondents screened positive for anxiety symptoms, and 23% (10/44) of the respondents screened positive for depression. Overall, 61% (27/44) of the respondents reported DMHA use for ≤6 months since referral, 36% (16/44) reported use within the past 30 days, and 43% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83%). Of the 12 HCPs, 7 (58%) were physicians and 5 (42%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described “typical patients” referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. %M 39546791 %R 10.2196/59831 %U https://formative.jmir.org/2024/1/e59831 %U https://doi.org/10.2196/59831 %U http://www.ncbi.nlm.nih.gov/pubmed/39546791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58608 %T A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration %A Essop,Hafsa %A Kekana,Ramadimetja Mable %A Brosens,Jacques %A Smuts,Hanlie %+ Department of Radiography, University of Pretoria, 30 Bophelo Road, Gezina, Pretoria, 0008, South Africa, 27 0715897939, hafsa.essop@up.ac.za %K mobile app %K design science research %K usefulness %K pregnant radiographers %K fetal dosimetry %K occupational health and safety %K mobile phone %K maternal and child health %K PregiDose %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. Objective: This study aims to describe the users’ perceptions of the app’s usefulness using PregiDose in a natural setting. Methods: The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users’ perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app’s core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53%) engaged with the app, and 4 (24%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Results: Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app’s usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and “pregnancy brain,” were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. Conclusions: PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective. %M 39546780 %R 10.2196/58608 %U https://formative.jmir.org/2024/1/e58608 %U https://doi.org/10.2196/58608 %U http://www.ncbi.nlm.nih.gov/pubmed/39546780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55088 %T An Online Multimodal Food Data Exploration Platform for Specific Population Health: Development Study %A Yang,Lin %A Guo,Zhen %A Xu,Xiaowei %A Kang,Hongyu %A Lai,Jianqiang %A Li,Jiao %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, No. 3, Yabao Rd, Chaoyang District, Beijing, 100020, China, 86 18618461596, li.jiao@imicams.ac.cn %K Chinese food data %K multimodal knowledge graph %K online platform %K population health promotion %K health promotion %K nutrients %K diet %K pregnant women %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nutrient needs vary over the lifespan. Improving knowledge of both population groups and care providers can help with healthier food choices, thereby promoting population health and preventing diseases. Providing evidence-based food knowledge online is credible, low cost, and easily accessible. Objective: This study aimed to develop an online multimodal food data exploration platform for easy access to evidence-based diet- and nutrition-related data. Methods: We developed an online platform named Food Atlas in collaboration with a multidisciplinary expert group from the National Institute for Nutrition and Health and Peking Union Medical College Hospital in China. To demonstrate its feasibility for Chinese food for pregnant women, a user-friendly and high-quality multimodal food knowledge graph was constructed, and various interactions with graph-structured data were developed for easy access, including graph-based interactive visualizations, natural language retrieval, and image-text retrieval. Subsequently, we evaluated Food Atlas from both the system perspective and the user perspective. Results: The constructed multimodal food knowledge graph contained a total of 2011 entities, 10,410 triplets, and 23,497 images. Its schema consisted of 11 entity types and 26 types of semantic relations. Compared with 5 other online dietary platforms (Foodwake, Boohee, Xiachufang, Allrecipes, and Yummly), Food Atlas offers a distinct and comprehensive set of data content and system functions desired by target populations. Meanwhile, a total of 28 participants representing 4 different user groups were recruited to evaluate its usability: preparing for pregnancy (n=8), pregnant (n=12), clinicians (n=5), and dietitians (n=3). The mean System Usability Scale index of our platform was 82.5 (SD 9.94; range 40.0-82.5). This above-average usability score and the use cases indicated that Food Atlas is tailored to the needs of the target users. Furthermore, 96% (27/28) of the participants stated that the platform had high consistency, illustrating the necessity and effectiveness of health professionals participating in online, evidence-based resource development. Conclusions: This study demonstrates the development of an online multimodal food data exploration platform and its ability to meet the rising demand for accessible, credible, and appropriate evidence-based online dietary resources. Further research and broader implementation of such platforms have the potential to popularize knowledge, thereby helping populations at different life stages make healthier food choices. %M 39547662 %R 10.2196/55088 %U https://formative.jmir.org/2024/1/e55088 %U https://doi.org/10.2196/55088 %U http://www.ncbi.nlm.nih.gov/pubmed/39547662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47754 %T Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study %A Fahr,Annina %A Kläy,Andrina %A Coka,Larissa S %A van Hedel,Hubertus J A %+ Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, Affoltern am Albis, 8910, Switzerland, 41 44 762 52 91, hubertus.vanhedel@kispi.uzh.ch %K neurorehabilitation %K single-case design %K interactive computer play %K cerebral palsy %K surface electromyography %K motor control %K mirror movements %K involuntary movements %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements. Objective: This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response–related factors in children with impaired SVMC undergoing inpatient neurorehabilitation. Methods: We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children’s Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment. Results: Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P<.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study. Conclusions: The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention. Trial Registration: German Clinical Trials Register DRKS00025184; https://tinyurl.com/msnkek9b %M 39556826 %R 10.2196/47754 %U https://formative.jmir.org/2024/1/e47754 %U https://doi.org/10.2196/47754 %U http://www.ncbi.nlm.nih.gov/pubmed/39556826 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60865 %T Understanding Patients’ Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study %A Liu,Jianyi %A Giannone,Alyssa %A Wang,Hailing %A Wetherall,Lucy %A Juarascio,Adrienne %+ Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Philadelphia, PA, 19104, United States, 1 2158951895, jl4528@drexel.edu %K bulimia nervosa %K binge eating %K digital intervention %K deterioration prevention %K eating disorder %K bulimia %K digital health %K deterioration %K maintenance %K mHealth %K mobile health app %K interviews %K qualitative %K user-centered design %K psychotherapy %K CBT %K cognitive behavioral therapy %K needs %K preferences %K mobile phone %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs. Objective: This study used a user-centered design approach to explore patients’ interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Methods: A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback. Results: All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended. Conclusions: Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deliver the core features identified in this study that could lead to higher continued skill use and a lower risk of deterioration in the long term. %M 39556809 %R 10.2196/60865 %U https://formative.jmir.org/2024/1/e60865 %U https://doi.org/10.2196/60865 %U http://www.ncbi.nlm.nih.gov/pubmed/39556809 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56999 %T Presenting and Evaluating a Smartwatch-Based Intervention for Smoking Relapse (StopWatch): Feasibility and Acceptability Study %A Stone,Chris %A Essery,Rosie %A Matthews,Joe %A Naughton,Felix %A Munafo,Marcus %A Attwood,Angela %A Skinner,Andy %+ School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 01174555910, chris.stone@bristol.ac.uk %K smoking %K smoking cessation %K passive detection %K just-in-time intervention %K JITAI %K relapse prevention %K relapse %K smartwatch %K wearable technology %K wearable %K mobile health %K mHealth %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the benefits of smoking cessation, maintaining abstinence during a quit attempt is difficult, and most attempts result in relapse. Innovative, evidence-based methods of preventing relapse are needed. We present a smartwatch-based relapse prevention system that uses passive detection of smoking to trigger just-in-time smoking cessation support. Objective: This study aims to evaluate the feasibility of hosting just-in-time smoking cessation support on a smartwatch and the acceptability of the “StopWatch” intervention on this platform. Methods: The person-based approach for intervention development was used to design the StopWatch smoking relapse prevention intervention. Intervention delivery was triggered by an algorithm identifying hand movements characteristic of smoking from the smartwatch’s motion sensors, and the system-generated intervention messages (co-designed by smokers) were delivered on the smartwatch screen. A total of 18 smokers tested the intervention over a 2-week period, and at the end of this period, they provided qualitative feedback on the acceptability of both the intervention and the smartwatch platform. Results: Participants reported that the smartwatch intervention increased their awareness of smoking and motivated them to quit. System-generated intervention messages were generally felt to be relevant and timely. There were some challenges with battery life that had implications for intervention adherence, and the bulkiness of the device and the notification style reduced some participants’ acceptability of the smartwatch platform. Conclusions: Our findings indicate our smoking relapse prevention intervention and the use of a smartwatch as a platform to host a just-in-time behavior change intervention are both feasible and acceptable to most (12/18, 66%) participants as a relapse prevention intervention, but we identify some concerns around the physical limitations of the smartwatch device. In particular, the bulkiness of the device and the battery capacity present risks to adherence to the intervention and the potential for missed detections. We recommend that a longer-term efficacy trial be carried out as the next step. %M 39570656 %R 10.2196/56999 %U https://formative.jmir.org/2024/1/e56999 %U https://doi.org/10.2196/56999 %U http://www.ncbi.nlm.nih.gov/pubmed/39570656 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57109 %T Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial %A van Aubel,Evelyne %A Vaessen,Thomas %A Uyttebroek,Lotte %A Steinhart,Henrietta %A Beijer-Klippel,Annelie %A Batink,Tim %A van Winkel,Ruud %A de Haan,Lieuwe %A van der Gaag,Mark %A van Amelsvoort,Thérèse %A Marcelis,Machteld %A Schirmbeck,Frederike %A Reininghaus,Ulrich %A Myin-Germeys,Inez %+ Center for Contextual Psychiatry, Psychiatry Research Group, Department of Neurosciences, KU Leuven, Herestraat 49, ON5B bus 1029, Leuven, 3000, Belgium, 32 16 37 31 74, lotte.uyttebroek@kuleuven.be %K acceptance and commitment therapy %K ACT %K first episode of psychosis %K FEP %K ultrahigh risk for psychosis %K UHR %K ecological momentary intervention %K EMI %K mobile health %K mHealth %K blended care %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. Objective: This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. Methods: In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. Results: Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=–4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=–0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=–1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. Conclusions: Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Trial Registration: OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803 %M 39570655 %R 10.2196/57109 %U https://formative.jmir.org/2024/1/e57109 %U https://doi.org/10.2196/57109 %U http://www.ncbi.nlm.nih.gov/pubmed/39570655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52883 %T Web-Based Intervention Using Self-Compassionate Writing to Induce Positive Mood in Family Caregivers of Older Adults: Quantitative Study %A Wiita,Farah %A Ho,Aileen K %A Weinstein,Netta %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Berkshire, RG6 6AL, United Kingdom, 44 7951506136, f.l.wiita@pgr.reading.ac.uk %K self-compassion %K caregivers %K mindfulness %K intervention %K writing %K experimental %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregiver burden can impact the mental health of family caregivers, but self-compassion may help reduce this impact. Brief self-compassion interventions have been shown to be useful but have not been tested in family caregivers of older adults. Objective: This study aimed to test the effects of a brief self-compassion intervention and its components (self-kindness, common humanity, and mindfulness) on mental well-being and mood when reflecting on difficult family caregiving experiences. Methods: British caregivers were recruited through a web-based panel. Three experimental studies manipulated the self-compassion intervention. In study 1 (n=206) and study 2 (n=224), participants wrote about a difficult caregiving experience while focusing on 1 self-compassion component (self-kindness, common humanity, or mindfulness). In study 3 (n=222) participants focused on all components. Self-compassion, serenity, guilt, and sadness were measured. Results: In studies 1 and 2, condition effects showed mindfulness unexpectedly lowered mood. Inconsistent and modest benefits to affect were achieved by engagement in self-kindness and common humanity in study 1 (guilt [lowered]: P=.02 and sadness [lowered]: P=.04; serenity [nonsignificantly raised]: P=.20) and also in study 2 (sadness [nonsignificantly lowered]: P=.23 and guilt [nonsignificantly lowered]: P=.26; serenity [raised]: P=.33); significant benefits for self-compassion and mood were found in study 3 (serenity [raised]: P=.01, kindness [raised]: P=.003, and common humanity [raised]: P≤.001; guilt [lowered]: P<.001 and sadness [lowered]: P≤.001). More intensive efforts should be made to promote self-compassion in caregivers of older adults, with caution advised when relying primarily on mindfulness approaches. Conclusions: Self-compassionate writing may be beneficial for family caregivers, but more intensive interventions are needed. Further research is needed to determine the optimal dosage and content for achieving the greatest effects. %M 39571153 %R 10.2196/52883 %U https://formative.jmir.org/2024/1/e52883 %U https://doi.org/10.2196/52883 %U http://www.ncbi.nlm.nih.gov/pubmed/39571153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55639 %T Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study %A Aldridge,Grace %A Wu,Ling %A Seguin,Joshua Paolo %A Robinson,Jennifer %A Battaglia,Elizabeth %A Olivier,Patrick %A Yap,Marie B H %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, 3800, Australia, 61 3 9905 0723, marie.yap@monash.edu %K co-design %K service design %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K health care services %K adverse childhood experience %K ACE %K mental disorder %K innovate %K social services %K community health %K evidence-based %K parenting intervention %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent’s capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite’s design. Results: PaRK-Lite’s hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents’ empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. %M 39576676 %R 10.2196/55639 %U https://formative.jmir.org/2024/1/e55639 %U https://doi.org/10.2196/55639 %U http://www.ncbi.nlm.nih.gov/pubmed/39576676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62742 %T Assessing the Usability and Effectiveness of an AI-Powered Telehealth Platform: Mixed Methods Study on the Perspectives of Patients and Providers %A Jain,Ekta %A Gupta,Srishti %A Yadav,Vandana %A Kachnowski,Stan %+ Healthcare Innovation and Technology Lab, Lasker Hall, 3960 Broadway, Room 501, New York, NY, 10032, United States, 1 (212) 543 0100, vyadav@hitlab.org %K usability study %K telemedicine %K web platform %K patient-provider feedback %K artificial intelligence %K AI triage %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine has revolutionized health care by significantly enhancing accessibility and convenience, yet barriers remain, such as providers’ challenges with technology use. With advancements in telemedicine technologies, understanding the viewpoints of patients and providers is crucial for an effective and acceptable telemedicine service. This study reports the findings on the usability and effectiveness of the HelixVM artificial intelligence powered platform, analyzing key aspetcs like asynchronous health care, access, time efficiency, productivity, data exchange, security, privacy, and quality of care from patient and provider perspectives. Objective: This study aims to assess the usability and effectiveness of the HelixVM marketplace platform. Methods: We recruited 102 patients and 12 providers in a mixed methods study design involving surveys and in-depth structured interviews with a subset of the providers. The survey questionnaires are a modified version of the Telehealth Usability Questionnaire. We analyzed patient data using descriptive statistics and exploratory factor analysis to identify latent demographic patterns. For provider data, we used a deductive thematic analysis approach to identify key themes from the interviews and interpreted overall sentiments of the providers as negative, neutral, or positive. We also calculated percentages of different provider responses from the survey and interviews, where applicable. Results: Overall, 86.3% (88/102) of the patients reported satisfaction with HelixVM, and 89.2% (91/102) indicated that they would use the services again. A total of 91.1% (93/102) of the patients agreed that HelixVM improves access to health care and is an acceptable way to receive health care, and 98% (100/102) agreed it saves time. Chi-square tests demonstrated statistical significance for all survey questions (P<.001). The results from factor analysis show a higher propensity of middle-aged women, who had a fast-track encounter type, who self-reported a medium level of technology savviness, and who are residing in the South region of the United States rating the platform more positively. With regard to the providers, the thematic analysis identified themes of asynchronous medicine in terms of the accessibility and quality of care, time and productivity, integration within the workflow, data exchange, and artificial intelligence triage. Certain challenges regarding incomplete data in patient charts and its impact on provider time were cited. Suggestions for improvements included options to ensure the completeness of patient charts and better screening to ensure that only asynchronous, qualified patients are able to reach the provider. Conclusions: Overall, our study findings indicate a positive experience for patients and providers. The use of fast-track prescription was considered favorable compared to traditional telemedicine. Some concerns on data completeness, gaps, and accuracy exist. Suggestions are provided for improvement. This study adds to the knowledge base of existing literature and provides a detailed analysis of the real-world implementation of a telemedicine market-place platform. %M 39418632 %R 10.2196/62742 %U https://formative.jmir.org/2024/1/e62742 %U https://doi.org/10.2196/62742 %U http://www.ncbi.nlm.nih.gov/pubmed/39418632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60918 %T Evaluating an App-Based Intervention for Preventing Firearm Violence and Substance Use in Young Black Boys and Men: Usability Evaluation Study %A Emezue,Chuka %A Dan-Irabor,Dale %A Froilan,Andrew %A Dunlap,Aaron %A Zamora,Pablo %A Negron,Sarah %A Simmons,Janiya %A Watkins,Jayla %A Julion,Wrenetha A %A Karnik,Niranjan S %+ Department of Women, Children and Family Nursing, Rush University Medical Center, 600 S Paulina St AAC Suite 1064A, Armour Academic Center, Chicago, IL, 60612, United States, 1 312 942 6151, chuka_emezue@rush.edu %K telemedicine %K mobile app %K adolescent %K violence %K substance-related disorder %K African American %K user-computer interface %K software validation %K software development %K mobile phone %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young Black male individuals are 24 times more likely to be impacted by firearm injuries and homicides but encounter significant barriers to care and service disengagement, even in program-rich cities across the United States, leaving them worryingly underserved. Existing community-based interventions focus on secondary and tertiary prevention after firearm violence has occurred and are typically deployed in emergency settings. To address these service and uptake issues, we developed BrotherlyACT—a nurse-led, culturally tailored, multicomponent app—to reduce the risk and effects of firearm injuries and homicides and to improve access to precrisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. Grounded in Acceptance and Commitment Therapy, the app provides life skills coaching, safety planning, artificial intelligence–powered talk therapy, and zip code–based service connections directly to young Black male individuals at risk for violence and substance use. Objective: The primary aim of this study is to evaluate the usability, engagement, and satisfaction of BrotherlyACT among target young Black male users and mobile health (mHealth) experts, using a combination of formative usability testing (UT) and heuristic evaluation (HE). Methods: Using a convergent mixed methods approach, we evaluated the BrotherlyACT app using HE by 8 mHealth specialists and conducted UT with 23 participants, comprising 15 young Black male users (aged 15-24 years), alongside 4 adult internal team testers and 4 high school students who were part of our youth advisory board. UT included the System Usability Scale and thematic analysis of think-aloud interviews and cognitive walkthroughs. HE involved mHealth experts applying the Nielsen severity rating scale (score 0-3, with 3 indicating a major issue). All testing was conducted via REDCap (Research Electronic Data Capture) and Zoom or in person. Results: Qualitative usability issues were categorized into 8 thematic groups, revealing only minor usability concerns. The app achieved an average System Usability Scale score of 79, equivalent to an A-minus grade and placing it in the 85th percentile, indicating near-excellent usability. Similarly, the HE by testers identified minor and cosmetic usability issues, with a median severity score of 1 across various heuristics (on a scale of 0-3), indicating minimal impact on user experience. Overall, minor adjustments were recommended to enhance navigation, customization, and guidance for app users, while the app’s visual and functional design was generally well received. Conclusions: BrotherlyACT was considered highly usable and acceptable. Testers in the UT stage gave the app a positive overall rating and emphasized that several key improvements were made. Findings from our UT prompted revisions to the app prototype. Moving forward, a pilot study with a pretest-posttest design will evaluate the app’s efficacy in community health and emergency care settings. International Registered Report Identifier (IRRID): RR2-10.2196/43842 %M 39589765 %R 10.2196/60918 %U https://formative.jmir.org/2024/1/e60918 %U https://doi.org/10.2196/60918 %U http://www.ncbi.nlm.nih.gov/pubmed/39589765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60222 %T Enhancing Care Coordination in Oncology and Nononcology Thoracic Surgery Care Pathways Through a Digital Health Solution: Mixed Methods Study %A Nabelsi,Véronique %A Plouffe,Véronique %+ Département des sciences administratives, Université du Québec en Outaouais, C.P. 1240, Succ. Hull, Gatineau, QC, J8X 3X7, Canada, 1 8195953900 ext 1915, veronique.nabelsi@uqo.ca %K digital health solution %K care coordination %K optimization %K health care providers %K oncology %K nononcology %K thoracic surgery %K pathways %K continuity of care %K interfacility %K Quebec %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health-system fragmentation in Quebec significantly impacts care coordination, leading to interruptions in patients’ care pathways and adverse effects on their health. Coordinating interfacility service corridors is complex and requires collaboration between multiple health care providers (HCPs) and care settings. Effective care coordination is essential to ensure optimal patient management at transition points. Objective: This study aims to improve oncology and nononcology thoracic surgery care pathways by enhancing care coordination during interfacility transfers through a digital health solution. Methods: A multicenter implementation study was conducted across 2 health regions and 2 health care facilities in Quebec. We conducted 27 semistructured interviews with HCPs and managers to better understand the care pathways. Participatory design workshops were held with future users and key stakeholders at an early stage of the technology’s design to validate the prototype’s functionalities and workflows. A web survey was sent to all end users (N=13) to assess their experience with the platform. Results: All participants (100%) either “agreed” or “strongly agreed” that the platform provided significant benefits. It enhanced interestablishment coordination (4/13, 31% agreed and 9/13, 69% strongly agreed) and continuity of care and services (8/13, 62% agreed and 5/13, 38% strongly agreed), and it contributed to better management and patient intake (10/13, 77% agreed and 3/13, 23% strongly agreed) and process fluidity (3/13, 77% agreed and 3/13, 23% strongly agreed). Surgeons from the McGill University Health Centre confirmed that the platform facilitated and secured information transmission (2/5, 40% agreed and 3/5, 60% strongly agreed) and kept track of oncology patient referrals, follow-up needs, and cases where surgery is unnecessary (2/5, 40% agreed and 3/5, 60% strongly agreed). Nursing staff from the Centre intégré de santé et de services sociaux de l’Outaouais and McGill University Health Centre reported high satisfaction with the platform’s support during preoperative visit, surgery, and discharge processes. All participants perceived the platform as intuitive and easy to use. Additionally, participants valued its efficiency in providing rapid access to patient data, which reduces task time and ensures document security, thereby improving care coordination across facilities. The project’s success has convinced the HCPs and senior management at both health care facilities to pursue long-term use of the Akinox digital health platform. Conclusions: This pilot project represents a significant advancement in thoracic surgery care pathways and the coordination of interfacility health care service corridors. The project provides care pathways that are adaptable to other surgical specialties. It also paves the way for improving care in cancer and other health care networks while highlighting the key role of nurse navigators in patient care management. The project underscores the value of strategic leadership and stakeholders’ collaboration to improve care coordination and operational efficiency by demonstrating technology’s essential role in patient care pathways. %M 39591606 %R 10.2196/60222 %U https://formative.jmir.org/2024/1/e60222 %U https://doi.org/10.2196/60222 %U http://www.ncbi.nlm.nih.gov/pubmed/39591606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64380 %T Public Perception on Artificial Intelligence–Driven Mental Health Interventions: Survey Research %A Varghese,Mahima Anna %A Sharma,Poonam %A Patwardhan,Maitreyee %+ Department of Social Science and Language, Vellore Institute of Technology, Vellore Campus, Tiruvalam Road, Vellore, 632014, India, 91 9702872251, poonam.sharma@vit.ac.in %K public perception %K artificial intelligence %K AI %K AI-driven %K human-driven %K mental health inteventions %K mental health stigma %K trust in AI %K public perception %K digital health %K India %K mobile phone %D 2024 %7 28.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) has become increasingly important in health care, generating both curiosity and concern. With a doctor-patient ratio of 1:834 in India, AI has the potential to alleviate a significant health care burden. Public perception plays a crucial role in shaping attitudes that can facilitate the adoption of new technologies. Similarly, the acceptance of AI-driven mental health interventions is crucial in determining their effectiveness and widespread adoption. Therefore, it is essential to study public perceptions and usage of existing AI-driven mental health interventions by exploring user experiences and opinions on their future applicability, particularly in comparison to traditional, human-based interventions. Objective: This study aims to explore the use, perception, and acceptance of AI-driven mental health interventions in comparison to traditional, human-based interventions. Methods: A total of 466 adult participants from India voluntarily completed a 30-item web-based survey on the use and perception of AI-based mental health interventions between November and December 2023. Results: Of the 466 respondents, only 163 (35%) had ever consulted a mental health professional. Additionally, 305 (65.5%) reported very low knowledge of AI-driven interventions. In terms of trust, 247 (53%) expressed a moderate level of Trust in AI-Driven Mental Health Interventions, while only 24 (5.2%) reported a high level of trust. By contrast, 114 (24.5%) reported high trust and 309 (66.3%) reported moderate Trust in Human-Based Mental Health Interventions; 242 (51.9%) participants reported a high level of stigma associated with using human-based interventions, compared with only 50 (10.7%) who expressed concerns about stigma related to AI-driven interventions. Additionally, 162 (34.8%) expressed a positive outlook toward the future use and social acceptance of AI-based interventions. The majority of respondents indicated that AI could be a useful option for providing general mental health tips and conducting initial assessments. The key benefits of AI highlighted by participants were accessibility, cost-effectiveness, 24/7 availability, and reduced stigma. Major concerns included data privacy, security, the lack of human touch, and the potential for misdiagnosis. Conclusions: There is a general lack of awareness about AI-driven mental health interventions. However, AI shows potential as a viable option for prevention, primary assessment, and ongoing mental health maintenance. Currently, people tend to trust traditional mental health practices more. Stigma remains a significant barrier to accessing traditional mental health services. Currently, the human touch remains an indispensable aspect of human-based mental health care, one that AI cannot replace. However, integrating AI with human mental health professionals is seen as a compelling model. AI is positively perceived in terms of accessibility, availability, and destigmatization. Knowledge and perceived trustworthiness are key factors influencing the acceptance and effectiveness of AI-driven mental health interventions. %M 39607994 %R 10.2196/64380 %U https://formative.jmir.org/2024/1/e64380 %U https://doi.org/10.2196/64380 %U http://www.ncbi.nlm.nih.gov/pubmed/39607994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51470 %T Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study %A Luo,Lingzi %A Li,Gen %A Tang,Weiming %A Wu,Dan %A Hall,Brian %+ New York University Shanghai, Center for Global Health Equity, N812 567 West Yangsi Road, Shanghai, 200124, China, 86 62899837, bhall41@gmail.com %K COVID-19 %K mental health services %K intention %K mobile %K digital %K lockdowns %K depression %K anxiety %K help-seeking %K regression %K applications %K mHealth %K WeChat %K pandemic %K social isolation %K mental health %K intent %K outbreak %K SARS-CoV-2 %K survey %K usage %K service %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population’s intention to use mental health services during this time. Objective: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes–mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results: The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19–related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations. %M 39622023 %R 10.2196/51470 %U https://formative.jmir.org/2024/1/e51470 %U https://doi.org/10.2196/51470 %U http://www.ncbi.nlm.nih.gov/pubmed/39622023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57009 %T The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Betty Irene Moore School of Nursing, University of California, Davis, 2750 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communications technology %K ICT %K digital divide %K technology acceptance model %K mobile phone %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non–US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. %M 39625744 %R 10.2196/57009 %U https://formative.jmir.org/2024/1/e57009 %U https://doi.org/10.2196/57009 %U http://www.ncbi.nlm.nih.gov/pubmed/39625744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60461 %T Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study %A Golsong,Konstanze %A Kaufmann,Luisa %A Baldofski,Sabrina %A Kohls,Elisabeth %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Haus 13, Semmelweisstraße 10, Leipzig, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K mental health %K eHealth %K app %K health care %K app-based support %K psychiatric symptoms %K mobile phone %K COVID-19 %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment–like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment–like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt “definitely” or “rather” encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=–0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. %M 39630503 %R 10.2196/60461 %U https://formative.jmir.org/2024/1/e60461 %U https://doi.org/10.2196/60461 %U http://www.ncbi.nlm.nih.gov/pubmed/39630503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59045 %T Intersection of Performance, Interpretability, and Fairness in Neural Prototype Tree for Chest X-Ray Pathology Detection: Algorithm Development and Validation Study %A Chen,Hongbo %A Alfred,Myrtede %A Brown,Andrew D %A Atinga,Angela %A Cohen,Eldan %+ Department of Mechanical and Industrial Engineering, University of Toronto, 27 King's College Cir, Toronto, ON, Canada, 1 416 978 4184, ecohen@mie.utoronto.ca %K explainable artificial intelligence %K deep learning %K chest x-ray %K thoracic pathology %K fairness %K interpretability %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While deep learning classifiers have shown remarkable results in detecting chest X-ray (CXR) pathologies, their adoption in clinical settings is often hampered by the lack of transparency. To bridge this gap, this study introduces the neural prototype tree (NPT), an interpretable image classifier that combines the diagnostic capability of deep learning models and the interpretability of the decision tree for CXR pathology detection. Objective: This study aimed to investigate the utility of the NPT classifier in 3 dimensions, including performance, interpretability, and fairness, and subsequently examined the complex interaction between these dimensions. We highlight both local and global explanations of the NPT classifier and discuss its potential utility in clinical settings. Methods: This study used CXRs from the publicly available Chest X-ray 14, CheXpert, and MIMIC-CXR datasets. We trained 6 separate classifiers for each CXR pathology in all datasets, 1 baseline residual neural network (ResNet)–152, and 5 NPT classifiers with varying levels of interpretability. Performance, interpretability, and fairness were measured using the area under the receiver operating characteristic curve (ROC AUC), interpretation complexity (IC), and mean true positive rate (TPR) disparity, respectively. Linear regression analyses were performed to investigate the relationship between IC and ROC AUC, as well as between IC and mean TPR disparity. Results: The performance of the NPT classifier improved as the IC level increased, surpassing that of ResNet-152 at IC level 15 for the Chest X-ray 14 dataset and IC level 31 for the CheXpert and MIMIC-CXR datasets. The NPT classifier at IC level 1 exhibited the highest degree of unfairness, as indicated by the mean TPR disparity. The magnitude of unfairness, as measured by the mean TPR disparity, was more pronounced in groups differentiated by age (chest X-ray 14 0.112, SD 0.015; CheXpert 0.097, SD 0.010; MIMIC 0.093, SD 0.017) compared to sex (chest X-ray 14 0.054 SD 0.012; CheXpert 0.062, SD 0.008; MIMIC 0.066, SD 0.013). A significant positive relationship between interpretability (ie, IC level) and performance (ie, ROC AUC) was observed across all CXR pathologies (P<.001). Furthermore, linear regression analysis revealed a significant negative relationship between interpretability and fairness (ie, mean TPR disparity) across age and sex subgroups (P<.001). Conclusions: By illuminating the intricate relationship between performance, interpretability, and fairness of the NPT classifier, this research offers insightful perspectives that could guide future developments in effective, interpretable, and equitable deep learning classifiers for CXR pathology detection. %M 39636692 %R 10.2196/59045 %U https://formative.jmir.org/2024/1/e59045 %U https://doi.org/10.2196/59045 %U http://www.ncbi.nlm.nih.gov/pubmed/39636692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55478 %T Neurological Evidence of Diverse Self-Help Breathing Training With Virtual Reality and Biofeedback Assistance: Extensive Exploration Study of Electroencephalography Markers %A Ng,Hei-Yin Hydra %A Wu,Changwei W %A Hsu,Hao-Che %A Huang,Chih-Mao %A Hsu,Ai-Ling %A Chao,Yi-Ping %A Jung,Tzyy-Ping %A Chuang,Chun-Hsiang %+ Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Rm. 1515, 5/F, Administration Building, National Tsing Hua University, No. 521, Nanda Rd., Hsinchu, 300193, Taiwan, 886 35715131 ext 78608, cch.chuang@gmail.com %K biofeedback %K virtual reality %K breathing training %K EEG %K electroencephalography %K effective connectivity %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advancements in virtual reality (VR) and biofeedback (BF) technologies have opened new avenues for breathing training. Breathing training has been suggested as an effective means for mental disorders, but it is difficult to master the technique at the beginning. VR-BF technologies address the problem of breathing, and visualizing breathing may facilitate the learning of breathing training. This study explores the integration of VR and BF to enhance user engagement in self-help breathing training, which is a multifaceted approach encompassing mindful breathing, guided breathing, and breath counting techniques. Objective: We identified 3 common breathing training techniques in previous studies, namely mindful breathing, guided breathing, and breath counting. Despite the availability of diverse breathing training methods, their varying effectiveness and underlying neurological mechanisms remain insufficiently understood. We investigated using electroencephalography (EEG) indices across multiple breathing training modalities to address this gap. Methods: Our automated VR-based breathing training environment incorporated real-time EEG, heart rate, and breath signal BF. We examined 4 distinct breathing training conditions (resting, mindful breathing, guided breathing, and breath counting) in a cross-sectional experiment involving 51 healthy young adults, who were recruited through online forum advertisements and billboard posters. In an experimental session, participants practiced resting state and each breathing training technique for 6 minutes. We then compared the neurological differences across the 4 conditions in terms of EEG band power and EEG effective connectivity outflow and inflow with repeated measures ANOVA and paired t tests. Results: The analyses included the data of 51 participants. Notably, EEG band power across the theta, alpha, low-beta, high-beta, and gamma bands varied significantly over the entire scalp (t ≥1.96, P values <.05). Outflow analysis identified condition-specific variations in the delta, alpha, and gamma bands (P values <.05), while inflow analysis revealed significant differences across all frequency bands (P values <.05). Connectivity flow analysis highlighted the predominant influence of the right frontal, central, and parietal brain regions in the neurological mechanisms underlying the breathing training techniques. Conclusions: This study provides neurological evidence supporting the effectiveness of self-help breathing training through the combined use of VR and BF technologies. Our findings suggest the involvement of internal-external attention focus and the dorsal attention network in different breathing training conditions. There is a huge potential for the use of breathing training with VR-BF techniques in terms of clinical settings, the new living style since COVID-19, and the commercial value of introducing VR-BF breathing training into consumer-level digital products. Furthermore, we propose avenues for future research with an emphasis on the exploration of applications and the gamification potential in combined VR and BF breathing training. Trial Registration: ClinicalTrials.gov NCT06656741; https://clinicaltrials.gov/study/NCT06656741 %M 39642375 %R 10.2196/55478 %U https://formative.jmir.org/2024/1/e55478 %U https://doi.org/10.2196/55478 %U http://www.ncbi.nlm.nih.gov/pubmed/39642375 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52032 %T Rapid, Tailored Dietary and Health Education Through A Social Media Chatbot Microintervention: Development and Usability Study With Practical Recommendations %A Ali,Shahmir H %A Rahman,Fardin %A Kuwar,Aakanksha %A Khanna,Twesha %A Nayak,Anika %A Sharma,Priyanshi %A Dasraj,Sarika %A Auer,Sian %A Rouf,Rejowana %A Patel,Tanvi %A Dhar,Biswadeep %+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 87918862, sali@nus.edu.sg %K social media %K chatbot %K conversational agent %K intervention %K diet %K health education %K feasibility %K microintervention %K innovation %K dietary education %K social media chatbot %K public health professional %K young adult %K Asian %K curriculum %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an urgent need to innovate methods of health education, which can often be resource- and time-intensive. Microinterventions have shown promise as a platform for rapid, tailored resource dissemination yet have been underexplored as a method of standardized health or dietary education; social media chatbots display unique potential as a modality for accessible, efficient, and affordable educational microinterventions. Objective: This study aims to provide public health professionals with practical recommendations on the use of social media chatbots for health education by (1) documenting the development of a novel social media chatbot intervention aimed at improving dietary attitudes and self-efficacy among South Asian American young adults and (2) describing the applied experiences of implementing the chatbot, along with user experience and engagement data. Methods: In 2023, the “Roti” chatbot was developed on Facebook and Instagram to administer a 4-lesson tailored dietary health curriculum, informed by formative research and the Theory of Planned Behavior, to 18- to 29-year-old South Asian American participants (recruited through social media from across the United States). Each lesson (10-15 minutes) consisted of 40-50 prescripted interactive texts with the chatbot (including multiple-choice and open-response questions). A preintervention survey determined which lesson(s) were suggested to participants based on their unique needs, followed by a postintervention survey informed by the Theory of Planned Behavior to assess changes in attitudes, self-efficacy, and user experiences (User Experience Questionnaire). This study uses a cross-sectional design to examine postintervention user experiences, engagement, challenges encountered, and solutions developed during the chatbot implementation. Results: Data from 168 participants of the intervention (n=92, 54.8% Facebook; n=76, 45.2% Instagram) were analyzed (mean age 24.5, SD 3.1 years; n=129, 76.8% female). Participants completed an average of 2.6 lessons (13.9 minutes per lesson) and answered an average of 75% of questions asked by the chatbot. Most reported a positive chatbot experience (User Experience Questionnaire: 1.34; 81/116, 69.8% positive), with pragmatic quality (ease of use) being higher than hedonic quality (how interesting it felt; 88/116, 75.9% vs 64/116, 55.2% positive evaluation); younger participants reported greater hedonic quality (P=.04). On a scale out of 10 (highest agreement), participants reported that the chatbot was relevant (8.53), that they learned something new (8.24), and that the chatbot was helpful (8.28). Qualitative data revealed an appreciation for the cheerful, interactive messaging of the chatbot and outlined areas of improvement for the length, timing, and scope of text content. Quick replies, checkpoints, online forums, and self-administered troubleshooting were some solutions developed to meet the challenges experienced. Conclusions: The implementation of a standardized, tailored health education curriculum through an interactive social media chatbot displayed strong feasibility. Lessons learned from challenges encountered and user input provide a tangible roadmap for future exploration of such chatbots for accessible, engaging health interventions. %M 39652870 %R 10.2196/52032 %U https://formative.jmir.org/2024/1/e52032 %U https://doi.org/10.2196/52032 %U http://www.ncbi.nlm.nih.gov/pubmed/39652870 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60650 %T Testing 3 Modalities (Voice Assistant, Chatbot, and Mobile App) to Assist Older African American and Black Adults in Seeking Information on Alzheimer Disease and Related Dementias: Wizard of Oz Usability Study %A Bosco,Cristina %A Shojaei,Fereshtehossadat %A Theisz,Alec Andrew %A Osorio Torres,John %A Cureton,Bianca %A Himes,Anna K %A Jessup,Nenette M %A Barnes,Priscilla A %A Lu,Yvonne %A Hendrie,Hugh C %A Hill,Carl V %A Shih,Patrick C %+ Luddy School of Informatics, Computing, and Engineering, Indiana University, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 (812) 856 5754, cribosco@iu.edu %K older African American and Black adults %K Alzheimer disease and related dementias %K health literacy %K Wizard of Oz %K voice assistant %K chatbot %K mobile app %K dementia %K geriatric %K aging %K Alzheimer disease %K artificial intelligence %K AI %K mHealth %K digital tools %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older African American and Black adults are twice as likely to develop Alzheimer disease and related dementias (ADRD) and have the lowest level of ADRD health literacy compared to any other ethnic group in the United States. Low health literacy concerning ADRD negatively impacts African American and Black people in accessing adequate health care. Objective: This study explored how 3 technological modalities—voice assistants, chatbots, and mobile apps—can assist older African American and Black adults in accessing ADRD information to improve ADRD health literacy. By testing each modality independently, the focus could be kept on understanding the unique needs and challenges of this population concerning the use of each modality when accessing ADRD-related information. Methods: Using the Wizard of Oz usability testing method, we assessed the 3 modalities with a sample of 15 older African American and Black adults aged >55 years. The 15 participants were asked to interact with the 3 modalities to search for information on local events happening in their geographical area and search for ADRD-related health information. Results: Our findings revealed that, across the 3 modalities, the content should avoid convoluted and complex language and give the possibility to save, store, and share it to be fully accessible by this population. In addition, content should come from credible sources, including information tailored to the participants’ cultural values, as it has to be culturally relevant for African American and Black communities. Finally, the interaction with the tool must be time efficient, and it should be adapted to the user’s needs to foster a sense of control and representation. Conclusions: We conclude that, when designing ADRD-related interventions for African American and Black older adults, it proves to be crucial to tailor the content provided by the technology to the community’s values and construct an interaction with the technology that is built on African American and Black communities’ needs and demands. %R 10.2196/60650 %U https://formative.jmir.org/2024/1/e60650 %U https://doi.org/10.2196/60650 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50041 %T Tracked Physical Activity Levels Before and After a Change in Incentive Strategy Among UK Adults Using a Rewards App: Retrospective Quasi-Experimental Study %A McCarthy,Hannah %A Potts,Henry W W %A Fisher,Abigail %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, h.potts@ucl.ac.uk %K mHealth %K rewards %K incentives %K physical activity %K smartphone %K apps %K mobile apps %K app-based intervention %K behavior change %K exercise %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Financial incentives delivered via apps appear to be effective in encouraging physical activity. However, the literature on different incentive strategies is limited, and the question remains whether financial incentives offer a cost-effective intervention that could be funded at the population level. Objective: This study aimed to explore patterns of tracked physical activity by users of an incentive-based app before and after a change in incentive strategy. A business decision to alter the incentives in a commercially available app offered a natural experiment to explore GPS-tracked data in a retrospective, quasi-experimental study. The purpose of this exploratory analysis was to inform the design of future controlled trials of incentives delivered via an app to optimize their usability and cost-effectiveness. Methods: Weekly minutes of tracked physical activity were explored among a sample of 1666 participants. A Friedman test was used to determine differences in physical activity before and after the change in incentive strategies. Post hoc Wilcoxon tests were used to assess minutes of physical activity in the 2 weeks before and after the change. A secondary analysis explored longitudinal patterns of physical activity by plotting the mean and median minutes of physical activity from 17 weeks before and 13 weeks after the change in incentive strategy. CIs were calculated using bias-corrected bootstraps. Demographics were also explored in this way. Results: There were significant differences in the weekly minutes of activity before and after the change in incentive strategy (Friedman χ22=42, P<.001). However, a longitudinal view of the data showed a more complex and marked variation in activity over time that undermined the conclusions of the before/after analysis. Conclusions: Short-term before-and-after observational studies of app-tracked physical activity may result in misleading conclusions about the effectiveness of incentive strategies. Longitudinal views of the data show that important fluctuations are occurring over time. Future studies of app-tracked physical activity should explore such variations by using longitudinal analyses and accounting for possible moderating variables to better understand what an effective incentive might be, for whom, and at what cost. %M 39657165 %R 10.2196/50041 %U https://formative.jmir.org/2024/1/e50041 %U https://doi.org/10.2196/50041 %U http://www.ncbi.nlm.nih.gov/pubmed/39657165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64463 %T Improving Self-Efficacy, Quality of Life, and Glycemic Control in Adolescents With Type 1 Diabetes: Randomized Controlled Trial for the Evaluation of the Family-Centered Empowerment Model %A Alzawahreh,Salah %A Ozturk,Candan %+ Ministry of Health, Al-muzdalefah Street, Amman, 11118, Jordan, 962 0772260125, Salahalzwaherh78@yahoo.com %K adolescents %K family-centered empowerment model %K glycemic control %K quality of life %K self-efficacy %K type 1 diabetes mellitus %K T1DM %K family-centered %K teenager %K glycemic %K experimental evaluation %K empowerment %K Jordan %K glycosylated hemoglobin %K HbA1c %K experimental study %K family %K care education %K self-care %K educational program %K mobile phone %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor glycemic management in adolescents with type 1 diabetes mellitus (T1DM) increases complications. Enhanced control is associated with other factors, such as cultural, socioeconomic, and health care system disparities specific to the Middle East, which can greatly influence individuals’ ability to get and use health care services as well as their reaction to treatment approaches. Objective: This study aims to evaluate the impact of the family-centered empowerment model on Jordanian adolescents with T1DM, focusing on their glycosylated hemoglobin levels, self-efficacy, and quality of life (QOL). Methods: A randomized controlled trial involved 68 adolescents with T1DM visiting Jordanian Royal Medical Services’ clinics. Two sets of participant groups were created: control (n=34) and intervention (n=34). Participants were randomly assigned to either the intervention group, receiving the family-centered empowerment model intervention, or the control group, receiving standard care. Data were collected through face-to-face interviews and medical records. Results: From April to October 2023, a total of 68 adolescents with T1DM participated in the study at the Jordanian Royal Medical Services. QOL had significant improvement among 13 (38%) of the 34 participants in the intervention group, and the program significantly improved moderate self-efficacy levels in 12 (35%) patients (P<.001). In addition, the average glycosylated hemoglobin levels dropped from 11.25% to 10.23% (P<.001). Additionally, improvements were seen in stress management, communication, and treatment adherence, with a substantial decrease in treatment obstacles. The intervention was successful in improving both clinical and psychosocial outcomes, as evidenced by the fact that the control group showed no noticeable improvements in these parameters. Conclusions: The study suggests that patients with T1DM should receive continuous care education sessions, including self-care training, to improve their health. Nurses should also incorporate this training into treatment plans and educational programs for adolescents to enhance their QOL. Trial Registration: ClinicalTrials.gov NCT06694467; https://clinicaltrials.gov/study/NCT06694467 %M 39658013 %R 10.2196/64463 %U https://formative.jmir.org/2024/1/e64463 %U https://doi.org/10.2196/64463 %U http://www.ncbi.nlm.nih.gov/pubmed/39658013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59513 %T Usability Testing of a Digitized Interventional Prehabilitation Tool for Health Care Professionals and Patients Before Major Surgeries: Formative and Summative Evaluation %A Schnitzbauer,Andreas A %A Detemble,Charlotte %A Faqar-Uz-Zaman,Sara Fatima %A Dreilich,Julia %A Mohr,Lisa %A Sliwinski,Svenja %A Zmuc,Dora %A Siller,Mark %A Fleckenstein,Johannes %+ Department of General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany, 49 696301, andreas.schnitzbauer@icloud.com %K usability testing %K prehabilitation %K MARS %K Mobile Application Rating Scale %K trustworthiness %K surgical research %K usability %K prerehabilitation tool %K tool %K medical device %K surgery %K device %K application %K design %K engineering %K development %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of a medical device requires strict adherence to regulatory processes. Prehabilitation in this context is a new area in surgery that trains, coaches, and advises patients in mental well-being, nutrition, and physical activity. As staff is permanently drained from clinical care, remote and digital solutions with real-time assessments of data, including patient-related outcome reporting, may simplify preparation before major surgeries. Objective: This study aimed to evaluate the usability engineering process for the Prehab App, a newly developed medical device, in order to identify and adapt any design and usability flaws found. Methods: We hypothesized that formative and summative usability testing would achieve 80% interrater and intrarater reliability and consistency and that the safety-relevant scenarios would uncover undetected risks of the medical device (stand-alone software class IIa). In total, 8 experts and 8 laypersons (patients and potential patients) were asked to evaluate paper-based mockups, followed by an evaluation of the minimal viable product (MVP) of the Prehab App at least more than 8 weeks later after instruction and training. The experts had to face 5 and the laypersons 6 usability scenarios. Their evaluations were measured with the Mobile App Rating Scale (MARS) and trustworthiness checklists (range 0-64, with higher scores indicating trustworthiness), and the usability scenarios were evaluated with the After Scenario Questionnaire (ASQ) and a judgment by an observer. The time taken for the scenarios was also recorded. Results: MARS achieved constant scores of more than 4 out of 5 points for both experts and laypersons. The mean trustworthiness score was 51.3 (SD 2.7) for the experts and 50.8 (SD 2.1) for the laypersons (P=.68) in task I. The interrater correlation, shown by the Fleiss-Kappa value, was 0.87 (range 0.85-0.89) for all raters (N=16), 0.86 (range 0.82-0.91) for the experts (n=8, 50%), and 0.88 (range 0.84-0.93) for the laypersons (n=8, 50%), reflecting almost perfect agreement between the raters. This indicated the high quality of the usability. The usability scenarios were performed with ease, except for the onboarding part, when the wearable was required to be connected; this took a considerable amount of time and was recognized as a challenge to good usability. Conclusions: The formative and summative evaluation of the Prehab App design resulted in good-to-acceptable results of the design and usability of the critical and safety-relevant areas of the medical device and stand-alone software. Usability testing improves medical devices early in the design and development process, reduces errors, and mitigates risks, and in this study, it delivered a profound ethical and medical justification for a randomized controlled trial (RCT) of the Prehab App in a remote setting as a next step in the development process. Trial Registration: German Registry for Clinical Trials (DRKS00026985); https://drks.de/search/en/trial/DRKS00026985 %M 39661439 %R 10.2196/59513 %U https://formative.jmir.org/2024/1/e59513 %U https://doi.org/10.2196/59513 %U http://www.ncbi.nlm.nih.gov/pubmed/39661439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60760 %T Prevalence and Independent Predictors of Anxiety and Depression Among Elementary and High School Educators: Cross-Sectional Study %A Agyapong,Belinda %A Brett-MacLean,Pamela %A Orimalade,Adedamola %A Dias,Raquel da Luz %A Wei,Yifeng %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, 4-142A Katz Group Centre for Research, 11315- 87 Ave NW, Edmonton, AB, T6G 2H5, Canada, 1 7804928560, bagyapon@ualberta.ca %K generalized anxiety disorder %K major depressive disorder %K resilience %K stress %K Wellness4Teachers %K teachers %K prevalence %K predictors %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, anxiety and depression are primary contributors to work disability and impact the mental and physical well-being of educators. Objective: This study aims to determine the prevalence and independent predictors of likely generalized anxiety disorder (GAD) and likely major depressive disorder (MDD) among teachers in the Canadian provinces of Newfoundland and Labrador, Alberta, and Nova Scotia. Methods: The study used a cross-sectional design. Educators from the 3 Canadian provinces participated by completing a web-based survey after enrolling in the Wellness4Teachers program, a free, self-subscription, daily, supportive SMS text messaging initiative. The program was launched at the beginning of the 2022-2023 academic year, and all teachers in the 3 provinces were eligible to enroll. Likely GAD and likely MDD among subscribers were assessed using the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-9, respectively. Data analysis was conducted using SPSS (version 28.0). Results: Of the 1912 Wellness4Teachers subscribers, 763 (39.9%) completed the survey. The prevalence of likely MDD was 55.7% (425/763) and that of likely GAD was 46% (349/759). After controlling for all other variables in the regression model, participants who reported high stress were 7.24 times more likely to experience MDD (odds ratio [OR] 7.24, 95% CI 4.22-12.42) and 7.40 times more likely to experience GAD (OR 7.40, 95% CI 4.63-11.80) than those with mild to moderate stress. Participants with emotional exhaustion were 4.92 times more likely to experience MDD (OR 4.92, 95% CI 3.01-8.05) and 4.34 times more likely to experience GAD (OR 4.34, 95% CI 2.47-7.62) than those without. Moreover, respondents with a lack of professional accomplishment were 2.13 times as likely to have MDD symptoms (OR 2.13, 95% CI 1.41-3.23) and 1.52 times more likely to experience GAD symptoms (OR 1.524, 95% CI 1.013-2.293) than those without. Similarly, respondents with low resilience were 1.82 times more likely to have likely MDD than those with normal to high resilience (OR 1.82, 95% CI 1.24-2.66). In addition, respondents with low resilience were 3.01 times more likely to experience likely GAD than those with normal to high resilience (OR 3.01, 95% CI 2.03-7.62). Participants with >20 years of teaching experience were 0.28 times less likely to experience GAD symptoms than those with ≤5 years of teaching experience (OR 0.28, 95% CI 0.12-0.64). Sociodemographic and work-related variables did not independently predict likely GAD and likely MDD. Conclusions: This study underscores the need for governments and policy makers in the education sector to implement comprehensive mental health support programs. Addressing the unique stressors faced by educators, reducing emotional exhaustion, and enhancing resilience are crucial steps toward mitigating anxiety and depression, promoting educators’ well-being, and improving the quality of educational delivery. International Registered Report Identifier (IRRID): RR2-10.2196/37934. %M 39528340 %R 10.2196/60760 %U https://formative.jmir.org/2024/1/e60760 %U https://doi.org/10.2196/60760 %U http://www.ncbi.nlm.nih.gov/pubmed/39528340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58623 %T Integrating GPT-Based AI into Virtual Patients to Facilitate Communication Training Among Medical First Responders: Usability Study of Mixed Reality Simulation %A Gutiérrez Maquilón,Rodrigo %A Uhl,Jakob %A Schrom-Feiertag,Helmut %A Tscheligi,Manfred %+ Center for Technology Experience, AIT - Austrian Institute of Technology, Giefinggasse 4, Vienna, 1210, Austria, 43 66478588121, rodrigo.gutierrez@ait.ac.at %K medical first responders %K verbal communication skills %K training %K virtual patient %K generative artificial intelligence %K GPT %K large language models %K prompt engineering %K mixed reality %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Training in social-verbal interactions is crucial for medical first responders (MFRs) to assess a patient’s condition and perform urgent treatment during emergency medical service administration. Integrating conversational agents (CAs) in virtual patients (VPs), that is, digital simulations, is a cost-effective alternative to resource-intensive human role-playing. There is moderate evidence that CAs improve communication skills more effectively when used with instructional interventions. However, more recent GPT-based artificial intelligence (AI) produces richer, more diverse, and more natural responses than previous CAs and has control of prosodic voice qualities like pitch and duration. These functionalities have the potential to better match the interaction expectations of MFRs regarding habitability. Objective: We aimed to study how the integration of GPT-based AI in a mixed reality (MR)–VP could support communication training of MFRs. Methods: We developed an MR simulation of a traffic accident with a VP. ChatGPT (OpenAI) was integrated into the VP and prompted with verified characteristics of accident victims. MFRs (N=24) were instructed on how to interact with the MR scenario. After assessing and treating the VP, the MFRs were administered the Mean Opinion Scale-Expanded, version 2, and the Subjective Assessment of Speech System Interfaces questionnaires to study their perception of the voice quality and the usability of the voice interactions, respectively. Open-ended questions were asked after completing the questionnaires. The observed and logged interactions with the VP, descriptive statistics of the questionnaires, and the output of the open-ended questions are reported. Results: The usability assessment of the VP resulted in moderate positive ratings, especially in habitability (median 4.25, IQR 4-4.81) and likeability (median 4.50, IQR 3.97-5.91). Interactions were negatively affected by the approximately 3-second latency of the responses. MFRs acknowledged the naturalness of determining the physiological states of the VP through verbal communication, for example, with questions such as “Where does it hurt?” However, the question-answer dynamic in the verbal exchange with the VP and the lack of the VP’s ability to start the verbal exchange were noticed. Noteworthy insights highlighted the potential of domain-knowledge prompt engineering to steer the actions of MFRs for effective training. Conclusions: Generative AI in VPs facilitates MFRs’ training but continues to rely on instructions for effective verbal interactions. Therefore, the capabilities of the GPT-VP and a training protocol need to be communicated to trainees. Future interactions should implement triggers based on keyword recognition, the VP pointing to the hurting area, conversational turn-taking techniques, and add the ability for the VP to start a verbal exchange. Furthermore, a local AI server, chunk processing, and lowering the audio resolution of the VP’s voice could ameliorate the delay in response and allay privacy concerns. Prompting could be used in future studies to create a virtual MFR capable of assisting trainees. %M 39661979 %R 10.2196/58623 %U https://formative.jmir.org/2024/1/e58623 %U https://doi.org/10.2196/58623 %U http://www.ncbi.nlm.nih.gov/pubmed/39661979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65469 %T Exploring Self-Reported Symptoms for Developing and Evaluating Digital Symptom Checkers for Polycystic Ovarian Syndrome, Endometriosis, and Uterine Fibroids: Exploratory Survey Study %A Wickham,Aidan P %A Hewings-Martin,Yella %A Goddard,Frederick GB %A Rodgers,Allison K %A Cunningham,Adam C %A Prentice,Carley %A Wilks,Octavia %A Kaplan,Yusuf C %A Marhol,Andrei %A Meczner,András %A Stsefanovich,Heorhi %A Klepchukova,Anna %A Zhaunova,Liudmila %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 44 60396823, a_wickham@flo.health %K polycystic ovary syndrome %K PCOS %K self-assessment %K self-reported %K endometriosis %K uterine fibroids %K symptoms %K digital symptom checker %K women's health %K gynecological conditions %K reproductive health %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Reproductive health conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids pose a significant burden to people who menstruate, health care systems, and economies. Despite clinical guidelines for each condition, prolonged delays in diagnosis are commonplace, resulting in an increase to health care costs and risk of health complications. Symptom checker apps have the potential to significantly reduce time to diagnosis by providing users with health information and tools to better understand their symptoms. Objective: This study aims to study the prevalence and predictive importance of self-reported symptoms of PCOS, endometriosis, and uterine fibroids, and to explore the efficacy of 3 symptom checkers (developed by Flo Health UK Limited) that use self-reported symptoms when screening for each condition. Methods: Flo’s symptom checkers were transcribed into separate web-based surveys for PCOS, endometriosis, and uterine fibroids, asking respondents their diagnostic history for each condition. Participants were aged 18 years or older, female, and living in the United States. Participants either had a confirmed diagnosis (condition-positive) and reported symptoms retrospectively as experienced at the time of diagnosis, or they had not been examined for the condition (condition-negative) and reported their current symptoms as experienced at the time of surveying. Symptom prevalence was calculated for each condition based on the surveys. Least absolute shrinkage and selection operator regression was used to identify key symptoms for predicting each condition. Participants’ symptoms were processed by Flo’s 3 single-condition symptom checkers, and accuracy was assessed by comparing the symptom checker output with the participant’s condition designation. Results: A total of 1317 participants were included with 418, 476, and 423 in the PCOS, endometriosis, and uterine fibroids groups, respectively. The most prevalent symptoms for PCOS were fatigue (92%), feeling anxious (87%), BMI over 25 (84%); for endometriosis: very regular lower abdominal pain (89%), fatigue (85%), and referred lower back pain (80%); for uterine fibroids: fatigue (76%), bloating (69%), and changing sanitary protection often (68%). Symptoms of anovulation and amenorrhea (long periods, irregular cycles, and absent periods), and hyperandrogenism (excess hair on chin and abdomen, scalp hair loss, and BMI over 25) were identified as the most predictive symptoms for PCOS, while symptoms related to abdominal pain and the effect pain has on life, bleeding, and fertility complications were among the most predictive symptoms for both endometriosis and uterine fibroids. Symptom checker accuracy was 78%, 73%, and 75% for PCOS, endometriosis, and uterine fibroids, respectively. Conclusions: This exploratory study characterizes self-reported symptomatology and identifies the key predictive symptoms for 3 reproductive conditions. The Flo symptom checkers were evaluated using real, self-reported symptoms and demonstrated high levels of accuracy. %M 39666967 %R 10.2196/65469 %U https://formative.jmir.org/2024/1/e65469 %U https://doi.org/10.2196/65469 %U http://www.ncbi.nlm.nih.gov/pubmed/39666967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52834 %T Exploring Older Adults’ Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study %A Choukou,Mohamed-Amine %A Banihani,Jasem %A Azizkhani,Sarah %+ Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R111, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada, 1 204 333 4778, amine.choukou@umanitoba.ca %K agetech %K attitude %K opinion %K perception %K perspective %K home based %K community based %K research %K strategic planning %K gerontechnology %K geriatric %K older adults %K aging %K co-construction %K workshop %K inductive analysis %K development %K aging-in-place %K independent %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. Objective: The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. Methods: A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Results: Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. Conclusions: This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption. %M 39671577 %R 10.2196/52834 %U https://formative.jmir.org/2024/1/e52834 %U https://doi.org/10.2196/52834 %U http://www.ncbi.nlm.nih.gov/pubmed/39671577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64437 %T Mitochondrial Fitness Science Communication for Aging Adults: Prospective Formative Pilot Study %A Maxwell,Cathy A %A Grubbs,Brandon %A Dietrich,Mary S %A Boon,Jeffrey T %A Dunavan,John %A Knickerbocker,Kelly J %A Patel,Maulik R %+ College of Nursing, University of Utah, 10 South, 2000 Eaast, Salt Lake City, UT, 84112, United States, 1 7065738853, cathy.maxwell@nurs.utah.edu %K older adults %K physical activity %K exercise %K science communication %K gerontology %K usability %K behavior change %K mitochondria %K fitness %K health intervention %K digital health %K evaluation %K feasibility study %K community dwelling %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A key driver that leads to age-associated decline and chronic disease is mitochondrial dysfunction. Our previous work revealed strong community interest in the concept of mitochondrial fitness, which led to the development of a video-based science communication intervention to prompt behavior change in adults aged 50 years and older. Objective: This study aimed to conduct formative and summative evaluations of MitoFit, an instructional, biologically based communication intervention aimed at improving physical activity in older adults aged 50 years and older. Methods: In the phase-1 formative evaluation, community-dwelling older adults (N=101) rated the acceptability, appropriateness, and helpfulness of our MitoFit video series, titled “How to Slow Down Aging Through Mitochondrial Fitness.” In the phase-2 summative evaluation, a subgroup of phase-1 participants (n=19) participated in a 1-month MitoFit intervention prototype to evaluate the intervention and data collection feasibility. Results: In phase 1, participants (mean age 67.8, SD 8.9 y; 75/100, 75% female) rated the MitoFit videos as acceptable (≥4 out of 5 on a Likert-scale survey; from 97/101, 96% to 100/101, 99%), appropriate (101/101, 100%), and helpful (from 95/101, 94% to 100/101, 99%) to support adaptation and continued work on our novel approach. Previous knowledge of mitochondria ranged from 52% (50/97; What are mitochondria?) to 80% (78/97; What are the primary functions of mitochondria?). In phase 2, participants (mean age 71.4, SD 7.9 y; 13/19, 72% female) scored better than the national average (50) on the Patient-Reported Outcomes Measurement Information System-19 for physical function (57), social activities (55.5), depression (41), fatigue (48.6), and sleep disturbance (49.6) but worse for anxiety (55.3) and pain interference (52.4). Additionally, 95% (18/19) of participants demonstrated MitoFit competencies within 2 attempts (obtaining pulse: 19/19, 100%; calculating maximum and zone 2 heart rate: 18/19, 95%; and demonstration of exercises: 19/19, 100%). At 1 month after instruction, 68% (13/19) had completed a self-initiated daily walking/exercise plan and submitted a daily activity log. A walking pulse was documented by 85% (11/13) of participants. The time needed to walk 1 mile ranged from 17.4 to 27.1 minutes. The number of miles walked in 1 month was documented by 62% (8/13) of participants and ranged from 10 miles to 31 miles. The number of days of strength training ranged from 2 to 31 days/month. Intervention feasibility scores ranged from 89% (17/19; seems easy to follow) to 95% (18/19; seems implementable, possible, and doable). Overall, 79% (15/19) stated an intention to continue the MitoFit intervention. Furthermore, 4 weeks after delivery of the prototype intervention, the percentage of participants doing aerobic activity for regular moderate activity increased from 35% (6/17) to 59% (10/17; P=.03). Conclusions: MitoFit was enthusiastically embraced and is a cost-effective, scalable, and potentially efficacious intervention to advance with community-dwelling older adults. %M 39671578 %R 10.2196/64437 %U https://formative.jmir.org/2024/1/e64437 %U https://doi.org/10.2196/64437 %U http://www.ncbi.nlm.nih.gov/pubmed/39671578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63041 %T Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study %A Grewal,Karl S %A Gowda-Sookochoff,Rory %A Peacock,Shelley %A Cammer,Allison %A McWilliams,Lachlan A %A Spiteri,Raymond J %A Haase,Kristen R %A Harrison,Mary %A Holtslander,Lorraine %A MacRae,Rhoda %A Michael,Joanne %A Green,Shoshana %A O'Connell,Megan E %+ Department of Psychology and Health Studies, College of Arts and Science, University of Saskatchewan, 9 Campus Drive, Sasktoon, SK, S7N 5A5, Canada, 1 3069662496, karl.grewal@usask.ca %K care partner %K caregiving %K dementia %K technology %K content analysis %K mobile phone %K technology adoption %K assistive technology %K support %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Examining ways to support persons with dementia and their caregivers to help minimize the disease’s impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes). Objective: Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner’s everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia. Methods: We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis. Results: Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic. Conclusions: The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners’ relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners’ reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology. %M 39671589 %R 10.2196/63041 %U https://formative.jmir.org/2024/1/e63041 %U https://doi.org/10.2196/63041 %U http://www.ncbi.nlm.nih.gov/pubmed/39671589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65626 %T Appropriately Matching Transport Care Units to Patients in Interhospital Transport Care: Implementation Study %A Hasavari,Shirin %A Esmaeilzadeh,Pouyan %+ Department of Information Science & Systems, Graves School of Business & Management, Morgan State University, 21251, 4100 Hillen Rd, Baltimore, MD, 21218, United States, 1 3015090562, shirin.hasavari@morgan.edu %K interfacility transport care %K electronic health records %K data sharing %K blockchain %K hyperledger fabric %K privacy %K implementation %K EMS %K emergency medical services %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In interfacility transport care, a critical challenge exists in accurately matching ambulance response levels to patients’ needs, often hindered by limited access to essential patient data at the time of transport requests. Existing systems cannot integrate patient data from sending hospitals’ electronic health records (EHRs) into the transfer request process, primarily due to privacy concerns, interoperability challenges, and the sensitive nature of EHR data. We introduce a distributed digital health platform, Interfacility Transport Care (ITC)–InfoChain, designed to solve this problem without compromising EHR security or data privacy. Objective: This study aimed to detail the implementation of ITC-InfoChain, a secure, blockchain-based platform designed to enhance real-time data sharing without compromising data privacy or EHR security. Methods: The ITC-InfoChain platform prototype was implemented on Amazon Web Services cloud infrastructure, using Hyperledger Fabric as a permissioned blockchain. Key elements included participant registration, identity management, and patient data collection isolated from the sending hospital’s EHR system. The client program submits encrypted patient data to a distributed ledger, accessible to the receiving facility’s critical care unit at the time of transport request and emergency medical services (EMS) teams during transport through the PatienTrack web app. Performance was evaluated through key performance indicators such as data transaction times and scalability across transaction loads. Results: The ITC-InfoChain demonstrated strong performance and scalability. Data transaction times averaged 3.1 seconds for smaller volumes (1-20 transactions) and 6.4 seconds for 100 transactions. Optimized configurations improved processing times to 1.8-1.9 seconds for 400 transactions. These results confirm the platform’s capacity to handle high transaction volumes, supporting timely, real-time data access for decision-making during transport requests and patient transfers. Conclusions: The ITC-InfoChain platform addresses the challenge of matching appropriate transport units to patient needs by ensuring data privacy, integrity, and real-time data sharing, enhancing the coordination of patient care. The platform’s success suggests potential for regional pilots and broader adoption in secure health care systems. Stakeholder resistance due to blockchain unfamiliarity and data privacy concerns remains. Funding has been sought to support a pilot program to address these challenges through targeted education and engagement. %M 39540868 %R 10.2196/65626 %U https://formative.jmir.org/2024/1/e65626 %U https://doi.org/10.2196/65626 %U http://www.ncbi.nlm.nih.gov/pubmed/39540868 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64343 %T “Crying in the Wilderness”—The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis %A Pearce,Emily Eidenier %A Majid,Alina %A Brown,Toniya %A Shepherd,Rowan Forbes %A Rising,Camella %A Wilsnack,Catherine %A Thompson,Ashley S %A Gilkey,Melissa B %A Ribisl,Kurt M %A Lazard,Allison J %A Han,Paul KJ %A Werner-Lin,Allison %A Hutson,Sadie P %A Savage,Sharon A %+ Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, 6E578, Rockville, MD, 20850, United States, 1 919 699 2547, emily.pearce@nih.gov %K social media %K dyskeratosis congenita %K telomere biology disorder %K health communication %K qualitative %K thematic analysis %K web-based information %K web-based support %K telomere %K biology disorder %K social support %K emotional support %K genetic %K internet-based %K information-seeking %K descriptive study %K semistructured interview %K adult %K illness experience %K psychosocial %K digital health %K health intervention %K health informatics %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based information and social support are commonly used in rare disease communities where geographic dispersion and limited provider expertise complicate in-person support. We examined web-based resource use among caregivers of individuals with telomere biology disorders (TBDs), which are rare genetic conditions with long diagnostic odysseys and uncertain prognoses including multiorgan system cancer risk. Objective: This study explored internet-based information-seeking and social support practices and perspectives of patients with TBDs and their caregivers. Methods: Our qualitative descriptive study used semistructured interviews of patients with TBDs and caregivers. Data were transcribed verbatim and thematically analyzed by an interdisciplinary team. Results: A total of 32 adults completed interviews. Participant ages ranged from 27 to 74 years. The majority (n=28, 88%) were female, occupied multiple TBD roles (eg, patient and parent), and had undergone genetic testing. Most engaged in web-based information-seeking (n=29, 91%) and TBD-specific social media (n=26, 81%). Participants found web-based resources useful for information-seeking but reported privacy concerns and frustration with forming supportive relationships. Most participants described ambivalence toward web-based resource use, citing tensions between hunger for information versus distrust, empowerment versus overwhelm, disclosure versus privacy, and accessibility versus connection. Fluctuations in web-based support use arose from perceived harms, information saturation, or decreased relevance over the course of TBD illness experience. Conclusions: Individuals with TBDs and their caregivers reported frequent use of web-based informational and emotional support. However, ambivalence about the benefits and liabilities of web-based resources and persistent medical uncertainty may impact the adoption of and adherence to web-based support among patients with TBD and caregivers. Our findings suggest web-based psychosocial support should target long-term and multifaceted informational and emotional needs, be user-initiated, be offered alongside in-person formats, provide expert-informed information, and be attentive to personal privacy and evolving support needs of the TBD community. This study suggests web-based resources will be most effective in the TBD context when they achieve the following features: (1) offer a variety of ways to engage (eg, active and passive), (2) provide privacy protections in moderated “safe spaces” designed for personal disclosure, (3) offer separate venues for informational versus emotional support, (4) combine web-based relationship formation with opportunities for in-person gathering, (5) provide information that is reliable, easy to access, and informed by medical professionals, (6) remain mindful of user distress, and (7) are responsive to variations in levels and types of engagement. Additionally, advocacy organizations may wish to avoid traditional social media platforms when designing safe spaces for web-based emotional support, instead pivoting to internet-based tools that minimize privacy threats and limit the perpetual public availability of shared information. %M 39680438 %R 10.2196/64343 %U https://formative.jmir.org/2024/1/e64343 %U https://doi.org/10.2196/64343 %U http://www.ncbi.nlm.nih.gov/pubmed/39680438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63068 %T The Impact and Wider Implications of Remote Consultations for General Practice in Norway: Qualitative Study Among Norwegian Contract General Practitioners %A Norberg,Børge Lønnebakke %A Austad,Bjarne %A Kristiansen,Eli %A Zanaboni,Paolo %A Getz,Linn Okkenhaug %+ General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway, 47 73598859, borge.norberg@ntnu.no %K remote consultations %K e-health %K digital medicine %K telemedicine %K impact %K downsides %K disadvantages %K pitfalls %K safety %K general practice %K family medicine %K practice organization %K ecology of healthcare %K remote consultation %K monitoring %K teleconsultation %K social determinants of health %D 2024 %7 17.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The digital shift toward remote consultations in general practice needs ongoing monitoring to understand its impact on general practice organizations and the wider health care system. Objective: This study aimed to explore how remote consultations impact on contracted general practitioner (GP) practices and how GPs perceive the implications of this uptake for the overall health care system. Methods: In total, 5 focus groups were conducted with a total of 18 GPs from all 4 health regions of Norway in 2022. The material was subjected to Braun and Clarke’s thematic analysis. Results: The analysis yielded six themes: (1) the design of novel effective clinical pathways: remote consultations empower GPs to tailor new effective clinical trajectories, blending modalities to address diverse needs across clinical episodes—from initial triage, through investigations to case closure; (2) increased workday flexibility: remote consultations introduce variability into daily work, allowing GPs to adjust patient contact intensity, and leading to a less stressful work-home balance; (3) erosion of organizational boundaries: easy remote access to GPs appears to reduce patients’ tolerance for minor illness and self-care, hindering effective gatekeeping and shifting GPs’ focus from proactive to more reactive work, increasing work-related stress; (4) degradation of clinical shrewdness: confronted with an increasing amount of unsorted and trivial remote inquiries, GPs observe challenges in detecting and prioritizing serious cases; (5) dilemmas related to responsibility, ethics, and legislation: remote consultations highlight a tension for contract GPs between legal responsibilities and ethical obligations, with implications for patients with limited health literacy; this may entail suboptimal evaluation or delayed treatment—potentially contributing to increased health care inequity; and (6) retaining clinical core values in a changing world. Overall, GPs affirm that remote consultations have come to stay and describe efforts to effectively manage the advantages and disadvantages inherent in such interactions to safeguard clinical effectiveness and organizational sustainability of primary health care. Conclusions: The widespread adoption of remote consultations in the Norwegian contract GP scheme fundamentally reshapes the dynamics of GP work and the overall health care system. Awareness and proactive management of these changes are essential for maintaining sustainable, high-quality primary health care. %M 39688890 %R 10.2196/63068 %U https://formative.jmir.org/2024/1/e63068 %U https://doi.org/10.2196/63068 %U http://www.ncbi.nlm.nih.gov/pubmed/39688890 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57580 %T Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study %A Ahmed,Nisar %A Hall,Alex %A Poku,Brenda %A McDermott,Jane %A Astbury,Jayne %A Todd,Chris %+ National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK, United Kingdom, 44 161306600, nisar.ahmed-2@manchester.ac.uk %K digital health and primary care services %K digital exclusion %K digital divide %K health inequalities %K older adults %K South Asian %K Black African %K Caribbean %K COVID-19 pandemic %K qualitative focus group study %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales—people of South Asian, Black African, and Caribbean backgrounds—in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. %M 39693146 %R 10.2196/57580 %U https://formative.jmir.org/2024/1/e57580 %U https://doi.org/10.2196/57580 %U http://www.ncbi.nlm.nih.gov/pubmed/39693146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55450 %T Service Attributes and Acceptability of Digital and Nondigital Depression Management Methods Among Individuals With Depressive Symptoms: Survey Study %A Auyeung,Larry %A Mak,Winnie W S %A Tsang,Ella Zoe %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China (Hong Kong), 852 31906792, larryauyeung@link.cuhk.edu.hk %K eHealth %K acceptability %K user preference %K diffusion of innovation %K mental health services %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Academic research on digital mental health tends to focus on its efficacy and effectiveness, with much less attention paid to user preferences and experiences in real-world settings. Objective: This study aims to analyze service characteristics that service users value and compare the extent to which various digital and nondigital mental health treatments and management methods fulfill users’ expectations. Methods: A total of 114 people with at least moderate levels of depressive symptoms (as measured by Patient Health Questionnaire–9 score ≥10) completed a web-based questionnaire measuring their awareness and adoption of digital mental health services and their valuation of 15 psychological service attributes, including effectiveness, credibility, waiting time, and more. They were also assessed on their expectations toward seven common mental health treatments and management methods, including (1) face-to-face psychological intervention, (2) medication, (3) guided internet-based psychological intervention, (4) face-to-face counseling service, (5) self-guided mental health apps for depression, (6) self-help bibliotherapy, and (7) psychological intervention via videoconferencing. Results: A Friedman test with a Dunn posttest showed the average importance rank of “effectiveness” was significantly higher than all other measured attributes. “Privacy,” “credibility,” and “cost” were ranked as equally important. Participants rated face-to-face psychological intervention the most effective management method, while other digital management methods were perceived as less effective. Medication was perceived as the least appealing method, while other methods were deemed equally appealing. Face-to-face psychological intervention, medication, and counseling were considered less satisfactory due to their higher costs and longer waiting times when compared to digital services. Repeated measures ANOVA showed some forms of management method were more likely to be adopted, including guided internet-based psychological intervention, psychological intervention via videoconferencing, face-to-face psychological intervention, and face-to-face counseling services provided by a counselor as compared to self-guided mobile apps, self-help bibliotherapy, and medication. Conclusions: The study highlights the importance of considering multiple service attributes beyond effectiveness in depression management methods, despite effectiveness being regarded as the most crucial factor using the rank method. Compared to nondigital services, digital services were identified as having specific strengths as perceived by users. Future dissemination and promotion efforts may focus on debunking myths of guided internet-based psychological intervention as a less effective option and promoting the particular service strengths of digital services. %M 39699956 %R 10.2196/55450 %U https://formative.jmir.org/2024/1/e55450 %U https://doi.org/10.2196/55450 %U http://www.ncbi.nlm.nih.gov/pubmed/39699956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e42774 %T Identification of Gender Differences in Acute Myocardial Infarction Presentation and Management at Aga Khan University Hospital-Pakistan: Natural Language Processing Application in a Dataset of Patients With Cardiovascular Disease %A Ngaruiya,Christine %A Samad,Zainab %A Tajuddin,Salma %A Nasim,Zarmeen %A Leff,Rebecca %A Farhad,Awais %A Pires,Kyle %A Khan,Muhammad Alamgir %A Hartz,Lauren %A Safdar,Basmah %+ Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, United States, 1 2037852353, christine.ngaruiya@yale.edu %K natural language processing %K gender-based differences %K acute coronary syndrome %K global health %K Pakistan %K gender %K data %K dataset %K clinical %K research %K management %K patient %K medication %K women %K tool %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Ischemic heart disease is a leading cause of death globally with a disproportionate burden in low- and middle-income countries (LMICs). Natural language processing (NLP) allows for data enrichment in large datasets to facilitate key clinical research. We used NLP to assess gender differences in symptoms and management of patients hospitalized with acute myocardial infarction (AMI) at Aga Khan University Hospital-Pakistan. Objective: The primary objective of this study was to use NLP to assess gender differences in the symptoms and management of patients hospitalized with AMI at a tertiary care hospital in Pakistan. Methods: We developed an NLP-based methodology to extract AMI symptoms and medications from 5358 discharge summaries spanning the years 1988 to 2018. This dataset included patients admitted and discharged between January 1, 1988, and December 31, 2018, who were older than 18 years with a primary discharge diagnosis of AMI (using ICD-9 [International Classification of Diseases, Ninth Revision], diagnostic codes). The methodology used a fuzzy keyword-matching algorithm to extract AMI symptoms from the discharge summaries automatically. It first preprocesses the free text within the discharge summaries to extract passages indicating the presenting symptoms. Then, it applies fuzzy matching techniques to identify relevant keywords or phrases indicative of AMI symptoms, incorporating negation handling to minimize false positives. After manually reviewing the quality of extracted symptoms in a subset of discharge summaries through preliminary experiments, a similarity threshold of 80% was determined. Results: Among 1769 women and 3589 men with AMI, women had higher odds of presenting with shortness of breath (odds ratio [OR] 1.46, 95% CI 1.26-1.70) and lower odds of presenting with chest pain (OR 0.65, 95% CI 0.55-0.75), even after adjustment for diabetes and age. Presentation with abdominal pain, nausea, or vomiting was much less frequent but consistently more common in women (P<.001). “Ghabrahat,” a culturally distinct term for a feeling of impending doom was used by 5.09% of women and 3.69% of men as presenting symptom for AMI (P=.06). First-line medication prescription (statin and β-blockers) was lower in women: women had nearly 30% lower odds (OR 0.71, 95% CI 0.57-0.90) of being prescribed statins, and they had 40% lower odds (OR 0.67, 95% CI 0.57-0.78) of being prescribed β-blockers. Conclusions: Gender-based differences in clinical presentation and medication management were demonstrated in patients with AMI at a tertiary care hospital in Pakistan. The use of NLP for the identification of culturally nuanced clinical characteristics and management is feasible in LMICs and could be used as a tool to understand gender disparities and address key clinical priorities in LMICs. %M 39705071 %R 10.2196/42774 %U https://formative.jmir.org/2024/1/e42774 %U https://doi.org/10.2196/42774 %U http://www.ncbi.nlm.nih.gov/pubmed/39705071 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63866 %T Building a Human Digital Twin (HDTwin) Using Large Language Models for Cognitive Diagnosis: Algorithm Development and Validation %A Sprint,Gina %A Schmitter-Edgecombe,Maureen %A Cook,Diane %+ School of Electrical Engineering and Computer Science, Washington State University, Box 642752, Pullman, WA, 99164-2752, United States, 1 509 335 4985, djcook@wsu.edu %K human digital twin %K cognitive health %K cognitive diagnosis %K large language models %K artificial intelligence %K machine learning %K digital behavior marker %K interview marker %K health information %K chatbot %K digital twin %K smartwatch %D 2024 %7 23.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Human digital twins have the potential to change the practice of personalizing cognitive health diagnosis because these systems can integrate multiple sources of health information and influence into a unified model. Cognitive health is multifaceted, yet researchers and clinical professionals struggle to align diverse sources of information into a single model. Objective: This study aims to introduce a method called HDTwin, for unifying heterogeneous data using large language models. HDTwin is designed to predict cognitive diagnoses and offer explanations for its inferences. Methods: HDTwin integrates cognitive health data from multiple sources, including demographic, behavioral, ecological momentary assessment, n-back test, speech, and baseline experimenter testing session markers. Data are converted into text prompts for a large language model. The system then combines these inputs with relevant external knowledge from scientific literature to construct a predictive model. The model’s performance is validated using data from 3 studies involving 124 participants, comparing its diagnostic accuracy with baseline machine learning classifiers. Results: HDTwin achieves a peak accuracy of 0.81 based on the automated selection of markers, significantly outperforming baseline classifiers. On average, HDTwin yielded accuracy=0.77, precision=0.88, recall=0.63, and Matthews correlation coefficient=0.57. In comparison, the baseline classifiers yielded average accuracy=0.65, precision=0.86, recall=0.35, and Matthews correlation coefficient=0.36. The experiments also reveal that HDTwin yields superior predictive accuracy when information sources are fused compared to single sources. HDTwin’s chatbot interface provides interactive dialogues, aiding in diagnosis interpretation and allowing further exploration of patient data. Conclusions: HDTwin integrates diverse cognitive health data, enhancing the accuracy and explainability of cognitive diagnoses. This approach outperforms traditional models and provides an interface for navigating patient information. The approach shows promise for improving early detection and intervention strategies in cognitive health. %M 39715540 %R 10.2196/63866 %U https://formative.jmir.org/2024/1/e63866 %U https://doi.org/10.2196/63866 %U http://www.ncbi.nlm.nih.gov/pubmed/39715540 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60024 %T Impact of Artificial Intelligence–Generated Content Labels On Perceived Accuracy, Message Credibility, and Sharing Intentions for Misinformation: Web-Based, Randomized, Controlled Experiment %A Li,Fan %A Yang,Ya %+ School of Journalism and Communication, Beijing Normal University, NO.19, Xinjiekouwai Street, Haidian District, Beijing, 100875, China, 86 18810305219, yangya@bnu.edu.cn %K generative AI %K artificial intelligence %K ChatGPT %K AIGC label %K misinformation %K perceived accuracy %K message credibility %K sharing intention %K social media %K health information %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The proliferation of generative artificial intelligence (AI), such as ChatGPT, has added complexity and richness to the virtual environment by increasing the presence of AI-generated content (AIGC). Although social media platforms such as TikTok have begun labeling AIGC to facilitate the ability for users to distinguish it from human-generated content, little research has been performed to examine the effect of these AIGC labels. Objective: This study investigated the impact of AIGC labels on perceived accuracy, message credibility, and sharing intention for misinformation through a web-based experimental design, aiming to refine the strategic application of AIGC labels. Methods: The study conducted a 2×2×2 mixed experimental design, using the AIGC labels (presence vs absence) as the between-subjects factor and information type (accurate vs inaccurate) and content category (for-profit vs not-for-profit) as within-subjects factors. Participants, recruited via the Credamo platform, were randomly assigned to either an experimental group (with labels) or a control group (without labels). Each participant evaluated 4 sets of content, providing feedback on perceived accuracy, message credibility, and sharing intention for misinformation. Statistical analyses were performed using SPSS version 29 and included repeated-measures ANOVA and simple effects analysis, with significance set at P<.05. Results: As of April 2024, this study recruited a total of 957 participants, and after screening, 400 participants each were allocated to the experimental and control groups. The main effects of AIGC labels were not significant for perceived accuracy, message credibility, or sharing intention. However, the main effects of information type were significant for all 3 dependent variables (P<.001), as were the effects of content category (P<.001). There were significant differences in interaction effects among the 3 variables. For perceived accuracy, the interaction between information type and content category was significant (P=.005). For message credibility, the interaction between information type and content category was significant (P<.001). Regarding sharing intention, both the interaction between information type and content category (P<.001) and the interaction between information type and AIGC labels (P=.008) were significant. Conclusions: This study found that AIGC labels minimally affect perceived accuracy, message credibility, or sharing intention but help distinguish AIGC from human-generated content. The labels do not negatively impact users’ perceptions of platform content, indicating their potential for fact-checking and governance. However, AIGC labeling applications should vary by information type; they can slightly enhance sharing intention and perceived accuracy for misinformation. This highlights the need for more nuanced strategies for AIGC labels, necessitating further research. %R 10.2196/60024 %U https://formative.jmir.org/2024/1/e60024 %U https://doi.org/10.2196/60024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64081 %T Effects of Large Language Model–Based Offerings on the Well-Being of Students: Qualitative Study %A Selim,Rania %A Basu,Arunima %A Anto,Ailin %A Foscht,Thomas %A Eisingerich,Andreas Benedikt %+ Faculty of Medicine, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, rania.selim18@imperial.ac.uk %K large language models %K ChatGPT %K functional support %K escapism %K fantasy fulfillment %K angst %K despair %K anxiety %K deskilling %K pessimism about the future %D 2024 %7 27.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, the adoption of large language model (LLM) applications, such as ChatGPT, has seen a significant surge, particularly among students. These artificial intelligence–driven tools offer unprecedented access to information and conversational assistance, which is reshaping the way students engage with academic content and manage the learning process. Despite the growing prevalence of LLMs and reliance on these technologies, there remains a notable gap in qualitative in-depth research examining the emotional and psychological effects of LLMs on users’ mental well-being. Objective: In order to address these emerging and critical issues, this study explores the role of LLM-based offerings, such as ChatGPT, in students’ lives, namely, how postgraduate students use such offerings and how they make students feel, and examines the impact on students’ well-being. Methods: To address the aims of this study, we employed an exploratory approach, using in-depth, semistructured, qualitative, face-to-face interviews with 23 users (13 female and 10 male users; mean age 23 years, SD 1.55 years) of ChatGPT-4o, who were also university students at the time (inclusion criteria). Interviewees were invited to reflect upon how they use ChatGPT, how it makes them feel, and how it may influence their lives. Results: The current findings from the exploratory qualitative interviews showed that users appreciate the functional support (8/23, 35%), escapism (8/23, 35%), and fantasy fulfillment (7/23, 30%) they receive from LLM-based offerings, such as ChatGPT, but at the same time, such usage is seen as a “double-edged sword,” with respondents indicating anxiety (8/23, 35%), dependence (11/23, 48%), concerns about deskilling (12/23, 52%), and angst or pessimism about the future (11/23, 48%). Conclusions: This study employed exploratory in-depth interviews to examine how the usage of LLM-based offerings, such as ChatGPT, makes users feel and assess the effects of using LLM-based offerings on mental well-being. The findings of this study show that students used ChatGPT to make their lives easier and felt a sense of cognitive escapism and even fantasy fulfillment, but this came at the cost of feeling anxious and pessimistic about the future. %M 39729617 %R 10.2196/64081 %U https://formative.jmir.org/2024/1/e64081 %U https://doi.org/10.2196/64081 %U http://www.ncbi.nlm.nih.gov/pubmed/39729617 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53613 %T Using Active and Passive Smartphone Data to Enhance Adolescents’ Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study %A Leijse,Merel M L %A van Dam,Levi %A Jambroes,Tijs %A Timmerman,Amber %A Popma,Arne %+ Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 020 8901000, m.m.l.leijse@amsterdamumc.nl %K emotion regulation %K emotion awareness %K smartphone data %K forensic outpatient youth care %K treatment motivation %K treatment alliance %K emotion %K behavioral %K interview %K mHealth %K app %K forensic %K usability %K feasibility %K delinquent %K pediatrics %K youth %K adolescent %K teenager %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K emoji %K behavioral data %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents’ limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee’s clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings. %M 39753211 %R 10.2196/53613 %U https://formative.jmir.org/2024/1/e53613 %U https://doi.org/10.2196/53613 %U http://www.ncbi.nlm.nih.gov/pubmed/39753211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57204 %T Allied Health Professionals’ Perceptions of Artificial Intelligence in the Clinical Setting: Cross-Sectional Survey %A Hoffman,Jane %A Hattingh,Laetitia %A Shinners,Lucy %A Angus,Rebecca L %A Richards,Brent %A Hughes,Ian %A Wenke,Rachel %+ Pharmacy Department, Gold Coast Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, 4215, Australia, 61 756870620, jane.hoffman@health.qld.gov.au %K allied health %K artificial intelligence %K hospital %K digital health %K impact %K AI %K mHealth %K cross sectional %K survey %K health professional %K medical professional %K perception %K clinical setting %K opportunity %K challenge %K healthcare %K delivery %K Australia %K clinician %K confirmatory factor analysis %K linear regression %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) has the potential to address growing logistical and economic pressures on the health care system by reducing risk, increasing productivity, and improving patient safety; however, implementing digital health technologies can be disruptive. Workforce perception is a powerful indicator of technology use and acceptance, however, there is little research available on the perceptions of allied health professionals (AHPs) toward AI in health care. Objective: This study aimed to explore AHP perceptions of AI and the opportunities and challenges for its use in health care delivery. Methods: A cross-sectional survey was conducted at a health service in, Queensland, Australia, using the Shinners Artificial Intelligence Perception tool. Results: A total of 231 (22.1%) participants from 11 AHPs responded to the survey. Participants were mostly younger than 40 years (157/231, 67.9%), female (189/231, 81.8%), working in a clinical role (196/231, 84.8%) with a median of 10 years’ experience in their profession. Most participants had not used AI (185/231, 80.1%), had little to no knowledge about AI (201/231, 87%), and reported workforce knowledge and skill as the greatest challenges to incorporating AI in health care (178/231, 77.1%). Age (P=.01), profession (P=.009), and AI knowledge (P=.02) were strong predictors of the perceived professional impact of AI. AHPs generally felt unprepared for the implementation of AI in health care, with concerns about a lack of workforce knowledge on AI and losing valued tasks to AI. Prior use of AI (P=.02) and years of experience as a health care professional (P=.02) were significant predictors of perceived preparedness for AI. Most participants had not received education on AI (190/231, 82.3%) and desired training (170/231, 73.6%) and believed AI would improve health care. Ideas and opportunities suggested for the use of AI within the allied health setting were predominantly nonclinical, administrative, and to support patient assessment tasks, with a view to improving efficiencies and increasing clinical time for direct patient care. Conclusions: Education and experience with AI are needed in health care to support its implementation across allied health, the second largest workforce in health. Industry and academic partnerships with clinicians should not be limited to AHPs with high AI literacy as clinicians across all knowledge levels can identify many opportunities for AI in health care. %M 39753215 %R 10.2196/57204 %U https://formative.jmir.org/2024/1/e57204 %U https://doi.org/10.2196/57204 %U http://www.ncbi.nlm.nih.gov/pubmed/39753215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54438 %T Translation Effectiveness of Offset Heart Rate Biofeedback as a Mindless Intervention for Alcohol Craving Among Risky Drinkers: Controlled Experiment %A Zhao,Yiran %A Arora,Jatin %A Tao,Yujie %A Miller,Dave B %A Adams,Alexander T %A Choudhury,Tanzeem %+ Department of Information Science, Cornell University, 2 West Loop Rd, New York, NY, 10044, United States, 1 240 888 3213, yz2647@cornell.edu %K wearable device %K alcohol craving %K risky drinking %K digital intervention %K entrainment %K offset heart rate biofeedback %K mindless intervention %D 2024 %7 31.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital and wearable intervention systems promise to improve how people manage their behavioral health conditions by making interventions available when the user can best benefit from them. However, existing interventions are obtrusive because they require attention and motivation to engage in, limiting the effectiveness of such systems in demanding contexts, such as when the user experiences alcohol craving. Mindless interventions, developed by the human-computer interaction community, offer an opportunity to intervene unobtrusively. Offset heart rate biofeedback is an iconic type of mindless intervention powered by entrainment and can mitigate the physiological and psychological response to stressors. Objective: This work aimed to characterize the translational effectiveness of offset heart rate biofeedback on cue-elicit alcohol craving among risky drinkers. Methods: We conducted an out-of-lab, between-group, controlled experiment with 26 participants who performed harmful or hazardous drinking. The control group served as negative control and received no intervention, while the experimental group received offset heart rate biofeedback during alcohol exposure and recovery. We elicited alcohol cravings through a series of alcohol cues, including performing mental imagery, viewing alcohol images, and sniffing alcohol. We measured the physiological response to alcohol (ie, heart rate variability), self-reported craving, and self-reported anxiety. We constructed linear mixed-effects models to understand the effect of intervention during alcohol exposure and alcohol recovery after exposure. Following the linear mixed effect model, we conducted pair-wise comparisons for measures between the control and experimental groups. Results: We found that offset heart rate biofeedback significantly reduced the increase in heart rate variability (P=.01 and P=.052) and self-reported craving (P=.04 and P=.02) in response to alcohol cues. Participants’ anxiety was not affected by either the alcohol cues or the offset heart rate biofeedback. Conclusions: Offset heart rate biofeedback has the potential to immediately and unobtrusively mitigate cue-elicit alcohol craving among risky drinkers. The results of this study opened new opportunities for digital and wearable interventions to mitigate alcohol craving, either as wellness apps for risky drinkers or as digital prescriptions and integration with sensing systems for people with alcohol dependency. %M 39740221 %R 10.2196/54438 %U https://formative.jmir.org/2024/1/e54438 %U https://doi.org/10.2196/54438 %U http://www.ncbi.nlm.nih.gov/pubmed/39740221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57884 %T Visualizing Empathy in Patient-Practitioner Interactions Using Eye-Tracking Technology: Proof-of-Concept Study %A Park,Yuyi %A ­Kim,Hyungsin %A Kim,Hakkyun %K clinical empathy %K eye tracking %K medical communication %K nonverbal behavior %K doctor-patient encounters %D 2024 %7 11.12.2024 %9 %J JMIR Form Res %G English %X Background: Communication between medical practitioners and patients in health care settings is essential for positive patient health outcomes. Nonetheless, researchers have paid scant attention to the significance of clinical empathy in these interactions as a practical skill. Objective: This study aims to understand clinical empathy during practitioner-patient encounters by examining practitioners’ and patients’ verbal and nonverbal behaviors. Using eye-tracking techniques, we focused on the relationship between traditionally assessed clinical empathy and practitioners’ actual gaze behavior. Methods: We used mixed methods to understand clinical encounters by comparing 3 quantitative measures: eye-tracking data, scores from the Korean version of the Jefferson Scale of Empathy–Health Professional, and Consultation and Relational Empathy survey scores. We also conducted qualitative interviews with patients regarding their encounters. Results: One practitioner and 6 patients were involved in the experiment. Perceived empathy on the part of the practitioner was notably higher when the practitioner focused on a patient’s mouth area during the consultation, as indicated by gaze patterns that focused on a patient’s face. Furthermore, an analysis of areas of interest revealed different patterns in interactions with new as opposed to returning patients. Postconsultation interviews suggested that task-oriented and socially oriented empathy are critical in aligning with patients’ expectations of empathetic communication. Conclusions: This proof-of-concept study advocates a multidimensional approach to clinical empathy, revealing that a combination of verbal and nonverbal behaviors significantly reinforces perceived empathy from health care workers. This evolved paradigm of empathy underscores the profound consequences for medical education and the quality of health care delivery. %R 10.2196/57884 %U https://formative.jmir.org/2024/1/e57884 %U https://doi.org/10.2196/57884 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50827 %T Medical Students’ Perceptions on Identifying and Addressing Emotional Responses in Emergency Medicine: Pilot Investigation %A Agarwal,Anish Kumar %A Gonzales,Rachel %A Munden,Cory %A Albright,DaCarla %A Tsao,Suzana %+ Department of Emergency Medicine, University of Pennsylvania, 423 Guardian Drive, 410 Blockley Hall, Philadelphia, PA, 19104, United States, 1 215 573 6784, anish.agarwal@pennmedicine.upenn.edu %K well-being %K burnout %K medical education %K coping %K student %K students %K university %K college %K acute care %K trauma %K traumatic %K emotion %K emotional %K stress %K distress %K psychological %K cross-sectional %K survey %K surveys %K critical %K critically %K perception %K perspectives %K prepared %K preparedness %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Training in acute care, such as emergency medicine (EM), where exposure to critically ill and injured patients is high, impacts the well-being of trainees and contributes to burnout. Investigating how, and if, trainees prepare for these situations is necessary to ensure they are supported. Objective: This study aimed to evaluate medical students’ perspectives and emotional preparedness for handling acute care and trauma. Methods: We conducted a pilot investigation using a remote digital survey of medical students during their EM clerkship at a large, urban academic institution. The primary outcome of interest was student-reported preparedness and comfort in handling trauma and critical care patient encounters. Secondary outcomes included awareness of well-being resources and comfort in accessing digital well-being resources. Results: A total of 57 medical students completed the voluntary digital survey, and half of the students (n=28, 49%) reported having witnessed the care of a critically ill or a penetrating trauma patient (eg, a victim of gun violence). A majority (n=40, 70%) had thought about how these events may impact them, and over half felt unprepared to identify the emotional impact these cases may have on them (n=31, 54%) or address the emotional or mental health impact (n=36, 63%). Less than a quarter (n=14, 25%) were aware of digital mental health resources, and 58% (n=33) did not feel fully comfortable connecting with resources if needed. Students who had previously witnessed critical care were significantly more likely to report feeling well prepared in identifying the emotional impact and addressing this impact. Conclusions: In this cross-sectional survey, students did not feel fully prepared to identify or address the emotional impact of working in EM. Additionally, they lacked awareness of or comfort with accessing digital institutional resources meant to support their well-being, such as a large web-based platform. These findings can help inform and guide interventions by educational and academic leaders. The aim would be to create and promote environments that empower students with tools to identify their own emotions and connect to well-being resources. %M 38198202 %R 10.2196/50827 %U https://formative.jmir.org/2024/1/e50827 %U https://doi.org/10.2196/50827 %U http://www.ncbi.nlm.nih.gov/pubmed/38198202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53353 %T Factors Associated With Perception of Stigma Among Parents of Children With Cleft Lip and Palate: Cross-Sectional Study %A Zhang,Yanan %A Zhang,Xinwen %A Jiang,Jinzhuo %A Xie,Wanhua %A Xiang,Daoman %+ Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, 9 Jinsui Road, Guangzhou, 510623, China, 1 13725370379, xiewanhua1@126.com %K stigma %K social anxiety %K depression %K parents of children with cleft lip and palate %K cleft lip %K cleft palate %K cross-sectional study %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Parents of children with cleft lip with or without cleft palate (CL/P) often face stigmatization, which has a significant impact on their quality of life and mental health. However, to date, there is a lack of comprehensive, multicenter empirical research on parents of children with CL/P in China, particularly those with large-scale samples. Objective: This study aimed to identify major factors that contribute to the perception of stigma experienced by parents of children with CL/P. Methods: A cross-sectional survey was conducted. A total of 104 parents of children diagnosed with CL/P in 2 hospitals were selected by convenience sampling. Demographics and disease information, the Chinese Perception of Stigma Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Social Anxiety Scale were used in this study. Descriptive statistics, t tests, and one-way ANOVA were used to compare the differences between participants’ demographic information and perception of stigma. Multivariable linear regression was performed to assess associations between demographic factors, social anxiety, depression, and perception of stigma. Results: The mean scores for the dimensions of perception of stigma, depression, and social anxiety were 22.97 (SD 9.21), 38.34 (SD 8.25), and 22.86 (SD 6.69), respectively. Depression and social anxiety were positively associated with discrimination, while surgery status was a negatively associated variable. Parents with a college education or higher had significantly lower levels of perceived stigma compared to parents with a junior high school education (all P values <.05). These 4 factors explained 40.4% of the total model variance (F8=9.726; P<.001; R2=0.450; adjusted R2=0.404). Conclusions: Our findings highlight a concerning trend of diminished quality of life among parents of children with CL/P. Factors such as parents’ education level, surgery status, depression, and social anxiety are shown to influence the level of stigma experienced. Implementing comprehensive nursing care and providing presurgical support are effective strategies for alleviating parents’ social anxiety, reducing perceived stigma, and preventing depression. %M 38437002 %R 10.2196/53353 %U https://formative.jmir.org/2024/1/e53353 %U https://doi.org/10.2196/53353 %U http://www.ncbi.nlm.nih.gov/pubmed/38437002 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51669 %T Health Behavior Change Intervention Preferences Expressed by American Indian Cancer Survivors From a Southwest Tribal Community: Semistructured Interview Study %A Erdrich,Jennifer %A Cordova-Marks,Felina M %A Carson,William O %A Bea,Jennifer W %A Montfort,William R %A Thomson,Cynthia A %+ Department of Surgery, College of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724-5018, United States, 1 520 626 2635, jerdrich@surgery.arizona.edu %K Native American cancer disparities %K diet %K physical activity %K prehabilitation %K native %K exercise %K fitness %K interviews %K thematic analysis %K lifestyle %K Apache %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While many factors, including social determinants of health, affect cancer mortality, one modifiable risk factor that may contribute to cancer disparities is obesity. The prevalence of obesity in the American Indian/Alaska Native population is 48.1% per the Centers for Disease Control and Prevention. The overall cancer mortality for the American Indian/Alaska Native population is 18% higher than the White population as reported by the American Cancer Society. Interventions tailored to American Indian/Alaska Native communities that promote healthy lifestyle behaviors after cancer diagnosis and prior to cancer surgery (prehab) might improve cancer outcomes for this population. Objective: The aim of the study is to characterize the lifestyle behaviors of San Carlos Apache cancer survivors and identify preferences for the adaption of a prehab intervention. Methods: Semistructured interviews and validated questionnaires were completed with San Carlos Apache cancer survivors (N=4), exploring their viewpoints on healthy lifestyle and cancer risk and preferences for program development. A thematic content analysis was conducted. Results: Participants had an average BMI of 31 kg/m2 and walked 53 minutes daily. The majority of participants reported a high willingness to change eating habits (n=3, 75%). All 4 reported willingness to participate in a diet and exercise program. Important themes and subthemes were identified: (1) cancer is perceived as a serious health condition in the community (N=4, 100%); (2) environmental exposures are perceived as cancer-causing threats (n=3, 75%); (3) healthy diet, exercise, and avoiding harmful substances are perceived as mitigating cancer risk (n=3, 75%); (4) barriers to healthy habits include distance to affordable groceries (n=3, 75%) and lack of transportation (n=2, 50%); (5) there is high interest in a prehab program geared toward patients with cancer (N=4, 100%); and (6) standard monitoring practiced in published prehab programs showed early acceptability with participants (N=4, 100%). Conclusions: Collaboration with tribal partners provided important insight that can help inform the adaptation of a culturally appropriate prehab program for San Carlos Apache patients diagnosed with cancer. %M 38536214 %R 10.2196/51669 %U https://formative.jmir.org/2024/1/e51669 %U https://doi.org/10.2196/51669 %U http://www.ncbi.nlm.nih.gov/pubmed/38536214 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51848 %T Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study %A Yoon,Sungwon %A Tan,Chao Min %A Phang,Jie Kie %A Liu,Venice Xi %A Tan,Wee Boon %A Kwan,Yu Heng %A Low,Lian Leng %+ Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore, 65 65167666, sungwon.yoon@duke-nus.edu.sg %K decision-making %K diabetes %K health coach %K health coaching %K healthcare professional %K hypertension %K patient %K patient-centered care %K person-centered care %K qualitative research %K self-management %K shared decision-making %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient’s stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach’s personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. %M 38573763 %R 10.2196/51848 %U https://formative.jmir.org/2024/1/e51848 %U https://doi.org/10.2196/51848 %U http://www.ncbi.nlm.nih.gov/pubmed/38573763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51542 %T The Effect of a Combined Intermittent Fasting Healthy Plate Intervention on Anthropometric Outcomes and Body Composition Among Adults With Overweight and Obesity: Nonrandomized Controlled Trial %A Abdullah,Shazana Rifham %A Wan Mohd Zin,Ruziana Mona %A Azizul,Nur Hayati %A Sulaiman,Nur Suffia %A Khalid,Norhayati Mustafa %A Mohd Salim Mullahi Jahn,Roshan Jahn %A Khalil,Muhamad Khairul Nazrin %A Abu Seman,Norhashimah %A Zainal Abidin,Nur Azlin %A Ali,Azizan %A Tan,You Zhuan %A Omar,Azahadi %A Seman,Zamtira %A Yahya,Abqariyah %A Md Noh,Mohd Fairulnizal %+ Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Persiaran Setia Murni, Setia Alam, Shah Alam, 40170, Malaysia, 60 333627487, shazana.a@moh.gov.my %K intermittent fasting %K dry fasting %K healthy plate %K obesity %K overweight %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown. Objective: This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition. Methods: This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline. Results: Most participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). After 3 months, there were significant reductions in weight (difference −1.68; P<.001), BMI (difference −0.62; P<.001), body fat percentage (difference −0.921; P<.001), body fat mass (difference −1.28; P<.001), and visceral fat area (difference −4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference −1.428; P=.003), BMI (difference −0.522; P=.005), body fat percentage (difference −1.591; P<.001), body fat mass (difference −1.501; P<.001), visceral fat area (difference −7.130; P<.001), waist circumference (difference −2.304; P=.001), and hip circumference (difference −1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference −3.206; P<.001, HP difference −2.675; P=.004) and hip (IFHP difference −2.443; P<.001; HP difference −2.896; P<.001) circumferences were significantly reduced in both groups (P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference −2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05). Conclusions: A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity. International Registered Report Identifier (IRRID): RR2-10.2196/33801. %M 38598283 %R 10.2196/51542 %U https://formative.jmir.org/2024/1/e51542 %U https://doi.org/10.2196/51542 %U http://www.ncbi.nlm.nih.gov/pubmed/38598283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45700 %T Effect of the COVID-19 Pandemic on Gambling Behavior in Mainland Chinese Gamblers in Macau: Cross-Sectional Survey Study %A Zhou,Jinquan %A Ho,Hong-Wai %A Chan,ChiBiu %+ Macao Polytechnic University, R de Luís Gonzaga Gomes, Macao, China, 853 88593326, jqzhou@mpu.edu.mo %K Chinese gamblers %K gambling behavior %K online gambling %K COVID-19 %K Macau %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study examined the effects of the COVID-19 pandemic on the gambling behavior of individuals who were already actively engaged in such pursuits. We aimed to uncover the intricate consequences of the pandemic on this specific demographic, emphasizing the importance of understanding the complex connection between public health concerns such as the COVID-19 pandemic and gambling behavior from a public health perspective. In addition to identifying immediate impacts, this study holds significance in assessing potential long-term public health implications for the broader gambling industry. Objective: This study investigated how the COVID-19 pandemic has affected the gambling behavior of Mainland Chinese tourists in Macau from a public health perspective. We aimed to understand the changing patterns of gambling habits within this specific demographic by comparing their behavior before and during the pandemic, with a particular emphasis on the evolving dynamics of gambling and their public health consequences. This study provides a detailed exploration of the impact and implications of global health emergencies on this particular demographic’s gambling behaviors and preferences. Methods: This study used a robust cross-sectional analysis involving a sample of 334 Mainland Chinese gamblers with prior experiences in casinos in Macau. The sample deliberately encompassed individuals involved in gambling before and during the COVID-19 pandemic. Data were collected through carefully designed questionnaires to gather information on gambling habits, preferences, and observed behavioral changes in the sample. Results: This study unveiled a notable shift in Mainland Chinese gamblers’ behavior during the COVID-19 pandemic. A considerable number of participants opted for web-based platforms over traditional land-based casinos, resulting in reduced budgets, less time spent on gambling, and decreased participation in social gambling. Remarkably, there was a notable surge in online gambling, indicating a noteworthy adaptability of gamblers to changing circumstances. These findings emphasize the dynamic nature of gambling habits during global public health emergencies, revealing the resilient and evolving preferences of Mainland Chinese gamblers in response to the challenges posed by the pandemic. Conclusions: This study highlights the negative impact of the COVID-19 pandemic on casino gambling, notably evident in a significant decline in Mainland Chinese tourists visiting Macau for gambling. There is a noticeable shift from traditional gambling to web-based alternatives, with individuals seeking options within the pandemic constraints. Furthermore, the findings point out an increase in gambling among the younger generation and behavioral changes in individuals with mood disorders. The findings of this study emphasize the critical need for proactive measures to address evolving gambling preferences and associated risks during public health crises; furthermore, these findings underscore the importance of adaptive strategies within the gambling industry, as well as the necessity for effective public health interventions and regulatory frameworks to respond to unprecedented challenges with efficacy and precision. %M 38648630 %R 10.2196/45700 %U https://formative.jmir.org/2024/1/e45700 %U https://doi.org/10.2196/45700 %U http://www.ncbi.nlm.nih.gov/pubmed/38648630 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49815 %T Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study %A Hasan,Md Zahid %A Rabbani,Md Golam %A Akter,Orin %A Mehdi,Gazi Golam %A Ahmed,Mohammad Wahid %A Ahmed,Sayem %A Chowdhury,Mahbub Elahi %+ Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 01673163613, md.zahid@icddrb.org %K Shasthyo Surokhsha Karmasuchi %K health care services %K health care utilization %K satisfaction %K below poverty line %K Bangladesh %K patient satisfaction %K physician behavior %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients’ experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients’ socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results: We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians’ behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses’ behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility. %M 38656783 %R 10.2196/49815 %U https://formative.jmir.org/2024/1/e49815 %U https://doi.org/10.2196/49815 %U http://www.ncbi.nlm.nih.gov/pubmed/38656783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55064 %T Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations %A Arsenault-Lapierre,Genevieve %A Lemay-Compagnat,Alexandra %A Guillette,Maxime %A Couturier,Yves %A Massamba,Victoria %A Dufour,Isabelle %A Maubert,Eric %A Fournier,Christine %A Denis,Julie %A Morin,Caroline %A Vedel,Isabelle %+ Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, 5800 Boulevard Cavendish suite 600, Côte Saint-Luc, QC, H4W 2T5, Canada, 1 514 484 7878 ext 61553, genevieve.arsenault-lapierre@mail.mcgill.ca %K dashboard %K learning health system %K health policy %K dementia care %K health care regionalization %K dementia %K Alzheimer disease %K qualitative %K collaborative %K focus group %K primary care %K implementation %K attitude %K opinion %K perception %K perspective %K service %K health care management %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization’s jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled “university/peripheral”; organizations for which only part of the territory is in rural areas, labeled “mixed”; and organizations in remote or isolated areas, labeled “remote/isolated”) and according to different types of participants (managers, leading clinicians, and other participants). Results: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards. %M 38717803 %R 10.2196/55064 %U https://formative.jmir.org/2024/1/e55064 %U https://doi.org/10.2196/55064 %U http://www.ncbi.nlm.nih.gov/pubmed/38717803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53898 %T Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study %A Zhou,Yaxu %A Zhou,Ying %A Xu,Di %A Min,Jie %A Du,Yu %A Duan,Qi %A Bao,Wen %A Sun,Yingying %A Xi,Huiqin %A Wang,Chunming %A Bischof,Evelyne %+ Smart Hospital Development Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, No160 Pujian Road, Shanghai, 200127, China, 86 2168383408, wangchunming@renji.com %K patients %K international medical service %K demand %K satisfaction %K strategy %K health care optimization %K smart hospital %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving health care in cities with a diverse, international population is crucial for ensuring health equity, particularly for foreigners facing challenges due to cultural and language barriers. This situation is especially relevant in China, a major destination for expatriates and travelers, where optimizing health care services and incorporating international standards in the public sector are vital. Achieving this involves understanding the operational details, cultural and linguistic nuances, and advancing medical digitalization. A strategic approach focusing on cultural competence and awareness of health care systems is essential for effectively navigating health care for foreigners and expatriates in China. Objective: The aim of this study was to perform an in-depth analysis of the subjective and objective experiences of local and international patients in public hospitals in China to provide a basis for enhancing the medical experience of all patients. Methods: A structured questionnaire was provided to patients at an international outpatient service of a top-tier university hospital in China. Qualitative analysis of the survey responses was performed to methodically categorize and analyze medical treatment, focusing on patient demand and satisfaction across four main category elements (“high demand, high satisfaction”; “high demand, low satisfaction”; “low demand, high satisfaction”; and “low demand, low satisfaction”), enabling a detailed cross-sectional analysis to identify areas for improvement. Results: Elements falling under “high demand, high satisfaction” for both Chinese and international patients were primarily in the realms of medical quality and treatment processes. In contrast, elements identified as “high demand, low satisfaction” were significantly different between the two patient groups. Conclusions: The findings highlight the importance of systematic, objective research in advancing the quality of international health care services within China’s leading academic medical centers. Key to this improvement is rigorous quality control involving both patients and providers. This study highlights the necessity of certifying such centers and emphasizes the role of digital platforms in disseminating information about medical services. This strategy is expected to cater to diverse patient needs, enhancing the overall patient experience. Furthermore, by developing comprehensive diagnosis and treatment services and highlighting the superior quality and costs associated with international health care, these efforts aim to foster a sense of belonging among international patients and increase the attractiveness of China’s medical services for this demographic. %M 38739428 %R 10.2196/53898 %U https://formative.jmir.org/2024/1/e53898 %U https://doi.org/10.2196/53898 %U http://www.ncbi.nlm.nih.gov/pubmed/38739428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51728 %T Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study %A Cailhol,Johann %A Bihan,Hélène %A Bourovali-Zade,Chloé %A Boloko,Annie %A Duclos,Catherine %+ Laboratoire Educations et Promotion de la Santé, University Sorbonne Paris Nord, 74 rue marcel cachin, Bobigny, 93007, France, 33 148955426, johann.cailhol@aphp.fr %K social prescription %K discharge coordination %K language barriers %K readmission rates %K ethnic matching %K trust %K personalized care %K discharge %K social determinant %K social need %K tool %K quality of care %K readmission %K quality improvement %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates. Objective: This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates. Methods: We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining. Results: A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference. Conclusions: First, our study revealed the breadth of patient’s unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator’s work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination. %M 38739912 %R 10.2196/51728 %U https://formative.jmir.org/2024/1/e51728 %U https://doi.org/10.2196/51728 %U http://www.ncbi.nlm.nih.gov/pubmed/38739912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54074 %T Demographic Profile, Health, and Associated Factors of Family Caregivers and Functionality of Hospitalized Older Adults: Cross-Sectional, Exploratory, and Descriptive Study %A Gomes,Mateus Cunha %A Castro,Robert %A Silva Serra,Willian %A Sagica de Vasconcelos,Jhak %A Parente,Andressa %A Botelho,Eliã Pinheiro %A Ferreira,Glenda %A Sousa,Fabianne %+ Nursing School, Federal University of Para, Rua Augusto Correa n 1, Belem, 66075-110, Brazil, 55 91 981219404, fabiannesousa@hotmail.com %K family caregiver %K older adult %K hospitalization %K functionality %K caregiver %K health %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers. Objective: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context. Methods: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5% was adopted. Results: Among the 49 family caregivers, the majority were women (n=40, 81.6%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1%) and had completed an average level of education (n=26, 53.1%). Additionally, 25 (51%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9%), specifically in the age group between 60 and 69 years (21/49, 67.8%). Conclusions: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult’s hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource. %M 38905627 %R 10.2196/54074 %U https://formative.jmir.org/2024/1/e54074 %U https://doi.org/10.2196/54074 %U http://www.ncbi.nlm.nih.gov/pubmed/38905627 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56716 %T Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study %A Belanger,Christopher %A Peixoto,Cayden %A Francoeur,Sara %A Bjerre,Lise M %+ Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada, 1 613 746 4621, lbjerre@uottawa.ca %K primary care %K language-concordant care %K web-based maps %K maps %K physicians %K experience %K language %K access %K accessibility %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. %M 38980717 %R 10.2196/56716 %U https://formative.jmir.org/2024/1/e56716 %U https://doi.org/10.2196/56716 %U http://www.ncbi.nlm.nih.gov/pubmed/38980717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48434 %T The Impact of COVID-19 Health Measures on Adults With Multiple Chemical Sensitivity: Cross-Sectional Study %A Bray,Riina %A Wang,Yifan %A Argiropoulos,Nikolas %A Robins,Stephanie %A Molot,John %A Pigeon,Marie-Andrée %A Gaudet,Michel %A Auger,Pierre %A Bélanger,Emilie %A Peris,Rohini %+ Association pour la santé environnementale du Québec - Environmental Health Association of Québec, 1065 Montée Saint-Elmire, Saint Sauveur, QC, J0R 1R1, Canada, 1 5147955701, rohiniperis@aseq-ehaq.ca %K COVID-19 %K multiple chemical sensitivity %K Canada %K accessibility %K social isolation %K physical environment %K health care %K air pollution %K pollution %K air quality %K isolation %K social network %K social interaction %K lived experience %K sensitivity %K environment %K environmental %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition. Objective: This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic. Methods: An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network. Results: In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before (“prepandemic period”) and after (“postpandemic period”) March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=–3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=–2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=–2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001). Conclusions: During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures. %M 39018551 %R 10.2196/48434 %U https://formative.jmir.org/2024/1/e48434 %U https://doi.org/10.2196/48434 %U http://www.ncbi.nlm.nih.gov/pubmed/39018551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55797 %T Japanese Perception of Organ Donation and Implications for New Medical Technologies: Quantitative and Qualitative Social Media Analyses %A Vargas Meza,Xanat %A Oikawa,Masanori %+ Institute for the Advanced Study of Human Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Japan Faculty of Medicine Bldg.B, Kyoto, 606-8501, Japan, 81 0757539882, vargasmeza.xanat.8z@kyoto-u.ac.jp %K Japan %K organ donation %K social media %K multidimensional analysis %K Twitter/X %K YouTube %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Rapid Autopsy Program (RAP) is a valuable procedure for studying human biology and diseases such as cancer. However, implementing the RAP in Japan necessitates a thorough understanding of concepts such as good death and the integration of sociocultural aspects. By revising perceptions of organ donation on social media, we bring attention to the challenges associated with implementing new medical research procedures such as the RAP. Objective: This study aims to examine YouTube and Twitter/X to identify stakeholders, evaluate the quality of organ donation communication, and analyze sociocultural aspects associated with organ donation. Based on our findings, we propose recommendations for the implementation of new medical research procedures. Methods: Using the term “臓器提供” (organ donation), we collected data from YouTube and Twitter/X, categorizing them into 5 dimensions: time, individuality, place, activity, and relationships. We utilized a scale to evaluate the quality of organ donation information and categorized YouTube videos into 3 groups to analyze their differences using statistical methods. Additionally, we conducted a text-based analysis to explore narratives associated with organ donation. Results: Most YouTube videos were uploaded in 2021 (189/638, 29.6%) and 2022 (165/638, 25.9%), while tweets about organ donation peaked between 2019 and 2022. Citizens (184/770, 23.9%), media (170/770, 22.0%), and unknown actors (121/770, 15.7%) were the primary uploaders of videos on organ donation. In a sample of average retweeted and liked tweets, citizens accounted for the majority of identified users (64/91, 70%, and 65/95, 68%, respectively). Regarding Japanese regions, there were numerous information videos about organ donation in Hokkaido (F2.46,147.74=–5.28, P=.005) and Kyushu and Okinawa (F2.46,147.74=–5.28, P=.005). On Twitter/X, Japan and China were the most frequently mentioned countries in relation to organ donation discussions. Information videos often focused on themes such as borrowed life and calls to register as donors, whereas videos categorized as no information and misinformation frequently included accusations of organ trafficking, often propagated by Chinese-American media. Tweets primarily centered around statements of donation intention and discussions about family consent. The majority of video hyperlinks directed users to YouTube and Twitter/X platforms, while Twitter/X hyperlinks predominantly led to news reports from Japanese media outlets. Conclusions: There is significant potential to implement new medical research procedures such as the RAP in Japan. Recommendations include conceptualizing research data as borrowed data, implementing horizontally diversified management of donation programs, and addressing issues related to science misinformation and popular culture trends. %M 39028549 %R 10.2196/55797 %U https://formative.jmir.org/2024/1/e55797 %U https://doi.org/10.2196/55797 %U http://www.ncbi.nlm.nih.gov/pubmed/39028549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52533 %T Preuniversity Students' Perceptions and Attitudes About an Anatomy and Physiology Outreach Program: Survey Study and Inductive Thematic Analysis %A Vallabhajosyula,Ranganath %A Perumal,Vivek %A Chandrasekaran,Ramya %A Mogali,Sreenivasulu Reddy %+ Department of Anatomy, Lee Kong Chian School of Medicine, Nanyang Technological University, 11, Mandalay Road, Singapore, 308232, Singapore, 65 94455527, sreenivasulu.reddy@ntu.edu.sg %K anatomy %K physiology %K educational outreach %K preuniversity outreach %K team-based learning %K anatomy workshop %K medical education %K health profession education %K health professions %K health care careers %K student %K students %K outreach activity %K physiological %K school %K university %K Singapore %K thematic analysis %K learning %K education %K motivation %K health care %K health profession %K medical school %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Science and health outreach activities are aimed at motivating and sparking interest among prospective students to pursue careers in these fields; however, research studies supporting this hypothesis are limited. Objective: The aim of our study was to organize an integrated Anatomy and Physiology outreach to examine preuniversity students’ learning experiences (learning tools, activities, and facilitators) and motivation to pursue a career in health care and to gather evidence on their attitudes and perceptions of such activities. Methods: A 2-day course on cardiorespiratory and gastrointestinal anatomical systems was presented at the Lee Kong Chian School of Medicine in Singapore using its key pedagogies, that is, multimodal practical and team-based learning. Ninety preuniversity students from 21 preuniversity institutions in Singapore participated in this 2-day course, and their experiences were evaluated using a 4-point Likert scale and open-ended survey questions. Free-text comments were analyzed using inductive thematic analysis. Results: The survey using the 4-point Likert scale was completed by 81 (92%) of the 88 participants. Most students felt that the course materials were adequate (mean 3.57, SD 0.57) and met the learning objectives (mean 3.73, SD 0.52). The students felt that the instructors were clear (mean 3.73, SD 0.52) and effective (mean 3.70, SD 0.53). They liked the organization of the outreach session (mean 3.64, SD 0.48) and were highly motivated to study medicine or allied/biomedical sciences (mean 3.69, SD 0.54). Practical and team-based learning were regarded as exceedingly satisfactory (mean 3.63, SD 0.53 and mean 3.58, SD 0.54, respectively). All the respondents said that they would recommend this course to peers. Thematic analysis revealed that the participants gained a new perspective of the human body structure and function, they liked the unique learning settings, they were motivated to pursue a career in health care, they were satisfied with the sessions, and interactions with the facilitators increased their understanding of the human anatomy and physiology. Conclusions: Structured health outreach activities provide students with unique opportunities to experience a preclinical learning environment in a medical school, deepen their understanding of human body structure and function, and increase their motivation and interest in science. Further, outreach programs may lay the foundations for potential students aiming to pursue health profession education. %M 39133908 %R 10.2196/52533 %U https://formative.jmir.org/2024/1/e52533 %U https://doi.org/10.2196/52533 %U http://www.ncbi.nlm.nih.gov/pubmed/39133908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55339 %T Behavioral Intervention for Adults With Autism on Distribution of Attention in Triadic Conversations: A/B-Tested Pre-Post Study %A Tepencelik,Onur Necip %A Wei,Wenchuan %A Luo,Mirabel %A Cosman,Pamela %A Dey,Sujit %+ Electrical and Computer Engineering, University of California San Diego, UC San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 (858) 534 2230, otepence@ucsd.edu %K autism spectrum condition %K social attention %K social orienting %K behavioral intervention %K attention distribution %K triadic conversation %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cross-neurotype differences in social communication patterns contribute to high unemployment rates among adults with autism. Adults with autism can be unsuccessful in job searches or terminated from employment due to mismatches between their social attention behaviors and society’s expectations on workplace communication. Objective: We propose a behavioral intervention concerning distribution of attention in triadic (three-way) conversations. Specifically, the objective is to determine whether providing personalized feedback to each individual with autism based on an analysis of their attention distribution behavior during an initial conversation session would cause them to modify their orientation behavior in a subsequent conversation session. Methods: Our system uses an unobtrusive head orientation estimation model to track the focus of attention of each individual. Head orientation sequences from a conversation session are analyzed based on five statistical domains (eg, maximum exclusion duration and average contact duration) representing different types of attention distribution behavior. An intervention is provided to a participant if they exceeded the nonautistic average for that behavior by at least 2 SDs. The intervention uses data analysis and video modeling along with a constructive discussion about the targeted behaviors. Twenty-four individuals with autism with no intellectual disabilities participated in the study. The participants were divided into test and control groups of 12 participants each. Results: Based on their attention distribution behavior in the initial conversation session, 11 of the 12 participants in the test group received an intervention in at least one domain. Of the 11 participants who received the intervention, 10 showed improvement in at least one domain on which they received feedback. Independent t tests for larger test groups (df>15) confirmed that the group improvements are statistically significant compared with the corresponding controls (P<.05). Crawford-Howell t tests confirmed that 78% of the interventions resulted in significant improvements when compared individually against corresponding controls (P<.05). Additional t tests comparing the first conversation sessions of the test and control groups and comparing the first and second conversation sessions of the control group resulted in nonsignificant differences, pointing to the intervention being the main effect behind the behavioral changes displayed by the test group, as opposed to confounding effects or group differences. Conclusions: Our proposed behavioral intervention offers a useful framework for practicing social attention behavior in multiparty conversations that are common in social and professional settings. %M 39133914 %R 10.2196/55339 %U https://formative.jmir.org/2024/1/e55339 %U https://doi.org/10.2196/55339 %U http://www.ncbi.nlm.nih.gov/pubmed/39133914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58330 %T Current Status of Outcomes Reported by Patients With Stroke and an Analysis of Influencing Factors: Cross-Sectional Questionnaire Study %A Sun,Jia %A Ma,Liang %A Miao,Xiao %A Sun,Hui %A Zhu,SuSu %A Zhang,Ran %A Fan,LeLe %A Hu,TingTing %+ Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No.6 Zhenhua East Road, Haizhou District, Lianyungang, 222061, China, 86 18961322211, 18961322211@189.cn %K stroke %K patient-reported outcomes %K blood lipids %K influence factor %K correlation analysis %K nursing care %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stroke is the leading cause of acquired disability and the second leading cause of death worldwide. Its rate of incidence, disability, mortality, and recurrence is high, and the patients experience various symptoms of discomfort, which not only affect their rehabilitation function but also reduce their ability to perform daily activities and their quality of life. Nowadays, with the improvement of China’s medical standards, patients are increasingly attentive to their quality of life and health status. However, diagnostic techniques and effective treatments for patients with stroke are still limited but urgently required. Objective: This study aimed to evaluate the quality of life during hospitalization using a stroke patient-reported outcomes (PROs) scale and additionally to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. Methods: This is a registry-based, retrospective observational cross-sectional study on patients with stroke. A convenient sampling method was used to select various indicators of patients. The Stroke-PRO scale was then used to assess patients’ conditions across physical, psychological, social, and therapeutic domains. Multiple linear regression analysis was applied to identify factors influencing stroke PROs, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. Results: The mean Stroke-PRO score in this study was 4.09 (SD 0.29) points. By multiple linear regression analysis, residence, occupation, physical exercise, Barthel index, Braden scale, National Institutes of Health Stroke Scale scores at admission, and stroke type were the risk factors for reported outcomes of patients with stroke (P<.05). Correlation analysis showed that serum triglyceride, total cholesterol, and low-density lipoprotein were negatively correlated with Stroke-PRO scores in patients with stroke (P<.05), while high-density lipoprotein was positively correlated with patients with stroke (P<.05). The 95% CI was –0.31 to –0.03 for triglyceride, 0.17-0.44 for high-density lipoprotein, –0.29 to –0.01 for cholesterol, –0.30 to –0.02 for low-density lipoprotein, and –0.12 to 0.16 for blood glucose. Conclusions: Patients with stroke have a low level of health, and their reported outcomes need to be improved. Accordingly, nursing staff should pay attention to the quality of life and blood lipid indexes of patients with stroke, actively assess their actual health status, and take early intervention measures to promote their recovery. %M 39186763 %R 10.2196/58330 %U https://formative.jmir.org/2024/1/e58330 %U https://doi.org/10.2196/58330 %U http://www.ncbi.nlm.nih.gov/pubmed/39186763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58727 %T Application and Evaluation of a Multimodal Training on the Second Victim Phenomenon at the European Researchers’ Network Working on Second Victims Training School: Mixed Methods Study %A Guerra-Paiva,Sofia %A Mira,José Joaquín %A Strametz,Reinhard %A Fernandes,Joana %A Klemm,Victoria %A Madarasova Geckova,Andrea %A Knezevic,Bojana %A Potura,Eva %A Buttigieg,Sandra %A Carrillo,Irene %A Sousa,Paulo %+ NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Avenida Padre Cruz, Lisbon, 1600-560, Portugal, 351 961908960, sg.paiva@ensp.unl.pt %K patient safety %K second victim %K training %K education %K healthcare %D 2024 %7 30.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs’ well-being and ultimately improve the quality of care and patient safety. Objective: This study aims to describe and evaluate a multimodal training organized by the European Researchers’ Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs. Methods: We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities. Results: Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants’ satisfaction increased, particularly when adjusting the allocated time for the case studies’ discussion (P<.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team. Conclusions: This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts. %R 10.2196/58727 %U https://formative.jmir.org/2024/1/e58727 %U https://doi.org/10.2196/58727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56402 %T Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training %A Darnell,Doyanne %A Pierson,Andria %A Tanana,Michael J %A Dorsey,Shannon %A Boudreaux,Edwin D %A Areán,Patricia A %A Comtois,Katherine Anne %+ Department of Psychiatry & Behavioral Sciences, University of Washington, 325 9th Ave, Box 359911, Seattle, WA, 98104, United States, 1 12067449108, darnelld@uw.edu %K suicide prevention %K hospital %K training %K e-learning %K artificial intelligence %K AI %K task-shifting %K quality assessment %K fidelity %K acceptability %K feasibility %K eLearning %K suicide %K quality %K innovative %K nurse %K education training %K safety planning %K pilot study %K virtual patient %K web-based %K role-play %K microcounseling skills %K United States %D 2024 %7 6.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance. Objective: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively. Methods: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses’ performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor. Results: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94%) and White (n=13, 72%). Of the 17 nurses who started the training, 82% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (≥14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7). Conclusions: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills. International Registered Report Identifier (IRRID): RR2-10.2196/33695 %M 39239987 %R 10.2196/56402 %U https://formative.jmir.org/2024/1/e56402 %U https://doi.org/10.2196/56402 %U http://www.ncbi.nlm.nih.gov/pubmed/39239987 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57384 %T Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis %A Aggarwal,Sumit %A Simmy,Simmy %A Mahajan,Nupur %A Nigam,Kuldeep %+ Indian Council of Medical Research, V Ramalingaswami Bhawan, PO Box No. 4911, Ansari Nagar, New Delhi, 110029, India, 91 8329944688, drsumiticmr@gmail.com %K challenges %K thematic analysis %K infrastructure %K communication %K supply distribution %K resilience %K adaptability %K vaccination awareness %K innovative solutions %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region’s intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers’ challenges and alternative strategies in Manipur and Nagaland. Objective: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. Methods: This study is part of the i-DRONE (Indian Council of Medical Research’s Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Results: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Conclusions: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland. %M 39255009 %R 10.2196/57384 %U https://formative.jmir.org/2024/1/e57384 %U https://doi.org/10.2196/57384 %U http://www.ncbi.nlm.nih.gov/pubmed/39255009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50028 %T Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention %A Thomson,Maria D %A Shahab,Guleer H %A Cooper-McGill,Chelsey A %A Sheppard,Vanessa B %A Hill,Sherrick S %A Preston,Michael %A Keen II,Larry %+ Department of Social and Behavioral Sciences, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, United States, 1 8044844910, mthomson2@vcu.edu %K colorectal cancer %K cancer screening %K mHealth %K screening %K Black men %K early detection %K health disparities %K design thinking %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25% (24/98) of them did not see a doctor and 16.3% (16/98) of them did not have a regular doctor. Regarding CRC, 27% (26/98) and 38% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge–based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 %M 39388688 %R 10.2196/50028 %U https://formative.jmir.org/2024/1/e50028 %U https://doi.org/10.2196/50028 %U http://www.ncbi.nlm.nih.gov/pubmed/39388688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58658 %T An Evidence-Based Nurse-Led Intervention to Reduce Diabetes Distress Among Adults With Type 1 Diabetes and Diabetes Distress (REDUCE): Development of a Complex Intervention Using Qualitative Methods Informed by the Medical Research Council Framework %A Stenov,Vibeke %A Cleal,Bryan %A Willaing,Ingrid %A Christensen,Jette Normann %A Jensen,Christian Gaden %A Mouritsen,Julie Drotner %A Due-Christensen,Mette %+ Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen-Copenhagen University Hospital, Borgmester Ib Juels Vej 83, Herlev, 2730, Denmark, 45 24488359, vibeke.stenov@regionh.dk %K diabetes mellitus %K mental health %K diabetes distress %K qualitative research %K co-design study %K complex intervention %K Medical Research Council framework %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. Objective: This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress. Methods: The overall framework of this study was informed by the initial phase of the Medical Research Council’s complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach. Results: The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. Conclusions: This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms. %M 39239797 %R 10.2196/58658 %U https://formative.jmir.org/2024/1/e58658 %U https://doi.org/10.2196/58658 %U http://www.ncbi.nlm.nih.gov/pubmed/39239797 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60370 %T Interest in the Use of Herbal Supplements to Close the Treatment Gap for Hazardous Alcohol Use Among Men Who Have Sex With Men: Secondary Analysis of a Cross-Sectional Study %A Hernandez,Christopher %A Rowe,Christopher %A Ikeda,Janet %A Arenander,Justine %A Santos,Glenn-Milo %+ David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States, 1 (310) 825 6373, chrishernandezb@berkeley.edu %K alcohol use disorder %K herbal supplements %K HIV %K herbal %K supplement %K alcohol %K alcoholic %K alcohol use %K alcohol consumption %K cross-sectional study %K California %K USA: binge drinking %K alcohol dependence %K men %K social %K clinical %K logistic regression %K drinking %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hazardous alcohol consumption is highly prevalent for men who have sex with men (MSM). The 4 treatments currently approved by the Food and Drug Administration for alcohol use are reaching an alarmingly low percentage of people who would benefit from a reduction in their alcohol use. There is increasing interest in alternative methods of treatment, such as herbal supplements, to address hazardous drinking. However, research on the acceptability of alternative pharmacotherapies among MSM remains limited. Objective: We examined the prevalence and correlates of expressing interest in using herbal supplements for alcohol treatment among MSM with hazardous alcohol consumption. Methods: We conducted a secondary data analysis from a cross-sectional study of MSM who use alcohol, conducted from March 2015 to July 2017 in San Francisco, California, to assess the overall prevalence of interest in using herbal supplements to help reduce alcohol consumption. Associations between expressing interest in herbal supplements and demographic, social, and clinical characteristics were examined using bivariate and multivariable logistic regression models. Results: One-third (66/200, 33%) of the participants expressed interest in an herbal supplement for reducing alcohol consumption. In the multivariable analyses, weekly binge drinking (adjusted odds ratio [aOR] 2.85, 95% CI 1.17-6.93), interest in abstaining from alcohol use (aOR 5.04, 95% CI 1.46-17.40), higher severity of alcohol dependence score (aOR 1.22, 95% CI 1.04-1.41), and interest in naltrexone (aOR 3.22, 95% CI 2.12-4.91) were independently associated with higher odds of being interested in using an herbal supplement to reduce alcohol consumption, adjusting for age, race or ethnicity, and education. Conclusions: We found that MSM who have hazardous drinking habits, more severe alcohol dependence, and interest in pharmacotherapy were more likely to express interest in using an herbal supplement for reducing alcohol consumption. To our knowledge, this is the first study that has evaluated correlates of interest in herbal supplements for alcohol use among MSM. As researchers implement novel alcohol treatment studies, they should focus on recruitment efforts among MSM with a motivation to reduce their alcohol use patterns. %M 39471379 %R 10.2196/60370 %U https://formative.jmir.org/2024/1/e60370 %U https://doi.org/10.2196/60370 %U http://www.ncbi.nlm.nih.gov/pubmed/39471379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49761 %T #TraumaTok—TikTok Videos Relating to Trauma: Content Analysis %A Woolard,Alix %A Paciente,Rigel %A Munro,Emily %A Wickens,Nicole %A Wells,Gabriella %A Ta,Daniel %A Mandzufas,Joelie %A Lombardi,Karen %+ The Kids Research Institute Australia, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 63191823, alix.woolard@thekids.org.au %K trauma %K traumatic events %K traumatic stress %K TikTok %K public health %K social media %K content analysis %D 2024 %7 7.11.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Experiencing a traumatic event can significantly impact mental and emotional well-being. Social media platforms offer spaces for sharing stories, seeking support, and accessing psychoeducation. TikTok (ByteDance), a rapidly growing social media platform, is increasingly used for advice, validation, and information, although the content of this requires further study. Research is particularly needed to better understand TikTok content relating to trauma and the potential implications for young viewers, considering the distressing nature of the subject and the possibility of users experiencing vicarious trauma through exposure to these videos. Objective: This study aims to explore the content of trauma-related videos on TikTok, focusing on hashtags related to trauma. Specifically, this study analyzes how TikTok videos present information, advice, stories, and support relating to trauma. Methods: A quantitative cross-sectional descriptive content analysis was performed on TikTok in December 2022. A total of 5 hashtags related to trauma were selected: #trauma, #traumatized, #traumatok, #traumatic, and #traumabond, with the top 50 videos from each hashtag analyzed (total N=250 videos). A standardized codebook was developed inductively to analyze the content of the videos, while an existing generic codebook was used to collect the video features (eg, age of people in the video) and metadata (likes, comments, and shares) for each video. Results: A total of 2 major content themes were identified, which were instructional videos (54/250, 21.6%) and videos disclosing personal stories (168/250, 67.3%). The videos garnered significant engagement, with a total of 296.6 million likes, 2.3 million comments, and 4.6 million shares, indicating that users find this content engaging and useful. Alarmingly, only 3.7% (9/250) of videos included a trigger warning, despite many featuring highly distressing stories that young people and those with trauma may be exposed to. Conclusions: The study highlights the potential risks of vicarious trauma due to trauma dumping without trigger warnings on TikTok, and the need for further research to assess the accuracy of advice and information in these videos. However, it also underscores the platform’s potential to foster social connections, provide validation, and reduce stigma around mental health issues. Public health professionals should leverage social media to disseminate accurate mental health information, while promoting user education and content moderation to mitigate potential harms. People often use social media, such as TikTok to share advice, stories, and support around mental health, including their experiences with trauma. Out of 250 videos, most were either giving advice (54/250, 21.6%) or sharing personal experiences (168/250, 67.3%). The study found many videos lacked warnings about upsetting content, which could potentially harm young viewers or people suffering from trauma. While TikTok can help people feel connected and reduce the stigma around mental health, it is important to seek support from professionals when needed. %M 39509697 %R 10.2196/49761 %U https://formative.jmir.org/2024/1/e49761 %U https://doi.org/10.2196/49761 %U http://www.ncbi.nlm.nih.gov/pubmed/39509697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57244 %T Role of HIV Serostatus Communication on Frequent HIV Testing and Self-Testing Among Men Who Have Sex With Men Who Seek Sexual Partners on the Internet in Zhejiang, China: Cross-Sectional Study %A Chen,Wanjun %A Chen,Lin %A Ni,Zhikan %A He,Lin %A Pan,Xiaohong %+ Department of AIDS and STD Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang, 310051, China, 86 057187115190, xhpan@cdc.zj.cn %K human immunodeficiency virus %K HIV %K men who have sex with men %K HIV serostatus communication %K HIV testing %K HIV self-testing %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are increasingly using the internet to meet casual sexual partners. Those who do are at higher risk of sexually transmitted diseases. However, little is known about the rates and associations of frequent HIV testing and self-testing among such MSM. Objective: We aimed to examine HIV serostatus communication and perceptions regarding the HIV infection risk of internet-based partners, along with their associations with frequent HIV testing and self-testing. Methods: A cross-sectional study was conducted between May 2018 and April 2019 in Zhejiang Province, China. The study participants were assigned male at birth, were aged 18 years or older, had had casual sex with another male found through the internet in the last 6 months, and were HIV-negative. Information was obtained on HIV-testing behavior, along with demographic characteristics, HIV-related knowledge, internet-based behaviors, sexual behaviors with male partners, HIV serostatus communication, and perceptions regarding the HIV infection risk of internet-based partners. Uni- and multivariate logistic regression models were used to measure the associations of HIV testing and self-testing. Results: The study recruited 281 individuals who had sought casual sexual partners through the internet during the previous 6 months. Of the participants, 61.9% (174/281) reported frequent HIV testing (twice or more frequently) and 50.9% (119/234; 47 with missing values) reported frequent HIV self-testing. MSM who always or usually communicated about the HIV serostatus of internet-based partners in the previous 6 months had 3.12 (95% CI 1.76-5.52) and 2.45 (95% CI 1.42-4.22) times higher odds of being frequently tested or self-tested for HIV, respectively, compared with those who communicated about this issue minimally or not at all. Conclusions: There remains a need to improve the frequency of HIV testing and self-testing among internet-based MSM. HIV serostatus communication should be improved within the context of social networking applications to promote frequent HIV testing among internet-based MSM, especially for those who communicated about this issue minimally or not at all. %M 39541583 %R 10.2196/57244 %U https://formative.jmir.org/2024/1/e57244 %U https://doi.org/10.2196/57244 %U http://www.ncbi.nlm.nih.gov/pubmed/39541583 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56091 %T Associations Between Successful Home Discharge and Posthospitalization Care Planning: Cross-Sectional Ecological Study %A Takashi,Naoki %A Fujisawa,Misaki %A Ohtera,Shosuke %+ Department of Health Economics, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430, Morioka-Cho, Aichi, 474-8511, Japan, 81 562 46 2311, takashi@ncgg.go.jp %K health services research %K health policy %K quality of care %K access to care %K outcome assessment %K public health %K health service %K accessible %K accessibility %K care coordination %K health outcome %K surveillance %K regional disparities %K nonstandardized care %K nonstandardization %K hospital discharge %K hospital care %K analysis %K Japan %K older adults %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear. Objective: This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors. Methods: This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups. Results: The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km2 of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102). Conclusions: The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms. %R 10.2196/56091 %U https://formative.jmir.org/2024/1/e56091 %U https://doi.org/10.2196/56091 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65957 %T Medical Marijuana Documentation Practices in Patient Electronic Health Records: Retrospective Observational Study Using Smart Data Elements and a Review of Medical Records %A Beiler,Donielle %A Chopra,Aanya %A Gregor,Christina M %A Tusing,Lorraine D %A Pradhan,Apoorva M %A Romagnoli,Katrina M %A Kraus,Chadd K %A Piper,Brian J %A Wright,Eric A %A Troiani,Vanessa %K cannabis %K learning health system %K Epic %K prescription drug monitoring program %K medical marijuana %K electronic health records %K physician %K cannabis use %K drug use %K data sharing %K patient care %K legalization %K dosage %K chart review protocol %K human data extraction %K data collection %D 2024 %7 23.12.2024 %9 %J JMIR Form Res %G English %X Background: Medical marijuana (MMJ) is available in Pennsylvania, and participation in the state-regulated program requires patient registration and receiving certification by an approved physician. Currently, no integration of MMJ certification data with health records exists in Pennsylvania that would allow clinicians to rapidly identify patients using MMJ, as exists with other scheduled drugs. This absence of a formal data sharing structure necessitates tools aiding in consistent documentation practices to enable comprehensive patient care. Customized smart data elements (SDEs) were made available to clinicians at an integrated health system, Geisinger, following MMJ legalization in Pennsylvania. Objective: The purpose of this project was to examine and contextualize the use of MMJ SDEs in the Geisinger population. We accomplished this goal by developing a systematic protocol for review of medical records and creating a tool that resulted in consistent human data extraction. Methods: We developed a protocol for reviewing medical records for extracting MMJ-related information. The protocol was developed between August and December of 2022 and focused on a patient group that received one of several MMJ SDEs between January 25, 2019, and May 26, 2022. Characteristics were first identified on a pilot sample (n=5), which were then iteratively reviewed to optimize for consistency. Following the pilot, 2 reviewers were assigned 200 randomly selected patients’ medical records, with a third reviewer examining a subsample (n=30) to determine reliability. We then summarized the clinician- and patient-level features from 156 medical records with a table-format SDE that best captured MMJ information. Results: We found the review protocol for medical records was feasible for those with minimal medical background to complete, with high interrater reliability (κ=0.966; P<.001; odds ratio 0.97, 95% CI 0.954-0.978). MMJ certification was largely documented by nurses and medical assistants (n=138, 88.5%) and typically within primary care settings (n=107, 68.6%). The SDE has 6 preset field prompts with heterogeneous documentation completion rates, including certifying conditions (n=146, 93.6%), product (n=145, 92.9%), authorized dispensary (n=137, 87.8%), active ingredient (n=130, 83.3%), certifying provider (n=96, 61.5%), and dosage (n=48, 30.8%). We found preset fields were overall well-recorded (mean 76.6%, SD 23.7% across all fields). Primary diagnostic codes recorded at documentation encounters varied, with the most frequent being routine examinations and testing (n=34, 21.8%), musculoskeletal or nervous conditions, and signs and symptoms not classified elsewhere (n=21, 13.5%). Conclusions: This method of reviewing medical records yields high-quality data extraction that can serve as a model for other health record inquiries. Our evaluation showed relatively high completeness of SDE fields, primarily by clinical staff responsible for rooming patients, with an overview of conditions under which MMJ is documented. Improving the adoption and fidelity of SDE data collection may present a valuable data source for future research on patient MMJ use, treatment efficacy, and outcomes. %R 10.2196/65957 %U https://formative.jmir.org/2024/1/e65957 %U https://doi.org/10.2196/65957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57592 %T Evaluating Bard Gemini Pro and GPT-4 Vision Against Student Performance in Medical Visual Question Answering: Comparative Case Study %A Roos,Jonas %A Martin,Ron %A Kaczmarczyk,Robert %K medical education %K visual question answering %K image analysis %K large language model %K LLM %K student %K performance %K comparative %K case study %K artificial intelligence %K AI %K ChatGPT %K effectiveness %K diagnostic %K training %K accuracy %K utility %K image-based %K question %K image %K AMBOSS %K English %K German %K question and answer %K Python %K AI in health care %K health care %D 2024 %7 17.12.2024 %9 %J JMIR Form Res %G English %X Background: The rapid development of large language models (LLMs) such as OpenAI’s ChatGPT has significantly impacted medical research and education. These models have shown potential in fields ranging from radiological imaging interpretation to medical licensing examination assistance. Recently, LLMs have been enhanced with image recognition capabilities. Objective: This study aims to critically examine the effectiveness of these LLMs in medical diagnostics and training by assessing their accuracy and utility in answering image-based questions from medical licensing examinations. Methods: This study analyzed 1070 image-based multiple-choice questions from the AMBOSS learning platform, divided into 605 in English and 465 in German. Customized prompts in both languages directed the models to interpret medical images and provide the most likely diagnosis. Student performance data were obtained from AMBOSS, including metrics such as the “student passed mean” and “majority vote.” Statistical analysis was conducted using Python (Python Software Foundation), with key libraries for data manipulation and visualization. Results: GPT-4 1106 Vision Preview (OpenAI) outperformed Bard Gemini Pro (Google), correctly answering 56.9% (609/1070) of questions compared to Bard’s 44.6% (477/1070), a statistically significant difference (χ2₁=32.1, P<.001). However, GPT-4 1106 left 16.1% (172/1070) of questions unanswered, significantly higher than Bard’s 4.1% (44/1070; χ2₁=83.1, P<.001). When considering only answered questions, GPT-4 1106’s accuracy increased to 67.8% (609/898), surpassing both Bard (477/1026, 46.5%; χ2₁=87.7, P<.001) and the student passed mean of 63% (674/1070, SE 1.48%; χ2₁=4.8, P=.03). Language-specific analysis revealed both models performed better in German than English, with GPT-4 1106 showing greater accuracy in German (282/465, 60.65% vs 327/605, 54.1%; χ2₁=4.4, P=.04) and Bard Gemini Pro exhibiting a similar trend (255/465, 54.8% vs 222/605, 36.7%; χ2₁=34.3, P<.001). The student majority vote achieved an overall accuracy of 94.5% (1011/1070), significantly outperforming both artificial intelligence models (GPT-4 1106: χ2₁=408.5, P<.001; Bard Gemini Pro: χ2₁=626.6, P<.001). Conclusions: Our study shows that GPT-4 1106 Vision Preview and Bard Gemini Pro have potential in medical visual question-answering tasks and to serve as a support for students. However, their performance varies depending on the language used, with a preference for German. They also have limitations in responding to non-English content. The accuracy rates, particularly when compared to student responses, highlight the potential of these models in medical education, yet the need for further optimization and understanding of their limitations in diverse linguistic contexts remains critical. %R 10.2196/57592 %U https://formative.jmir.org/2024/1/e57592 %U https://doi.org/10.2196/57592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62995 %T Supplemental Intervention for Alcohol Use Disorder Treatment Patients With a Co-Occurring Anxiety Disorder: Technical Development and Functional Testing of an Autonomous Digital Program %A Rinehart,Linda Marie %A Anker,Justin %A Unruh,Amanda %A Degeneffe,Nikki %A Thuras,Paul %A Norden,Amie %A Hartnett,Lilly %A Kushner,Matt %K alcohol use disorder %K anxiety disorder %K comorbidity %K digital intervention %K psychological treatments %K addiction %K community-based practice %K therapy %K stress %K depression %K therapist-delivered therapies %D 2024 %7 31.12.2024 %9 %J JMIR Form Res %G English %X Background: Anxiety disorders are common in alcohol use disorder (AUD) treatment patients. Such co-occurring conditions (“comorbidity”) have negative prognostic implications for AUD treatment outcomes, yet they commonly go unaddressed in standard AUD care. Over a decade ago, we developed and validated a cognitive behavioral therapy intervention to supplement standard AUD care that, when delivered by trained therapists, improves outcomes in comorbid patients. However, this validated intervention, like many others in addiction care, has not been taken up in community-based AUD treatment programs. This phenomenon—empirically validated treatments that fail to be widely adopted in community care—has been termed the “research-to-practice gap.” Researchers have suggested that the availability of fully autonomous digital equivalents of validated therapist-delivered therapies could reduce some barriers underlying the research-to-practice gap, especially by eliminating the need for costly and intensive therapist training and supervision. Objective: With this in mind, we obtained a Program Development Grant (R34) to conduct formative work in the development of a fully autonomous digital version of our previously validated therapist-delivered intervention for AUD treatment patients with a comorbid anxiety disorder. Methods: In the first phase of the project, we developed the digital intervention. This process included: (1) identifying appropriate collaborators and vendors; (2) consultation with an e-learning expert to develop a storyboard and accompanying graphics and narrative; (3) video production and editing; and (4) interactive programming. The second phase of the project was functional testing of the newly developed digital intervention conducted in 52 residential AUD treatment patients with a comorbid anxiety disorder. Patients underwent the 3 one-hour segments of the newly developed intervention and completed user surveys, knowledge quizzes, and behavioral competence tests. Results: While the development of the digital intervention was successful, the timeline was approximately double that projected (1 vs 2 years) due to false starts and inefficiencies that we describe, including lessons learned. Functional testing of the newly developed digital intervention showed that, on average, patients rated the user experience in the upper (favorable) 20% of the response scales. Knowledge quizzes and behavioral demonstrations showed that over 80% of participants gained functional mastery of the key skills and information taught in the program. Conclusions: Functional testing results in this study justify a randomized controlled trial of the digital intervention’s efficacy, which is currently ongoing. In sharing the details of our challenges and solutions in developing the digital intervention, we hope to inform others developing digital tools. The extent to which the availability of empirically validated, fully autonomous digital interventions achieves their potential to reduce the research-to-practice gap remains an open but important empirical question. The present work stands as a necessary first step toward that end. %R 10.2196/62995 %U https://formative.jmir.org/2024/1/e62995 %U https://doi.org/10.2196/62995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56682 %T Quantifying Similarities Between MediaPipe and a Known Standard to Address Issues in Tracking 2D Upper Limb Trajectories: Proof of Concept Study %A Wagh,Vaidehi %A Scott,Matthew W %A Kraeutner,Sarah N %K markerless pose estimation %K procrustes analysis %K artificial intelligence %K motion %K movement tracking %K touchscreen %K markerless tracking %K upper limb %K motor %D 2024 %7 17.12.2024 %9 %J JMIR Form Res %G English %X Background: Markerless motion tracking methods have promise for use in a range of domains, including clinical settings where traditional marker-based systems for human pose estimation are not feasible. Artificial intelligence (AI)–based systems can offer a markerless, lightweight approach to motion capture. However, the accuracy of such systems, such as MediaPipe, for tracking fine upper limb movements involving the hand has not been explored. Objective: The aim of this study is to evaluate the 2D accuracy of MediaPipe against a known standard. Methods: Participants (N=10) performed a touchscreen-based shape-tracing task requiring them to trace the trajectory of a moving cursor using their index finger. Cursor trajectories created a reoccurring or random shape at 5 different speeds (500-2500 ms, in increments of 500 ms). Movement trajectories on each trial were simultaneously captured by the touchscreen and a separate video camera. Movement coordinates for each trial were extracted from the touchscreen and compared to those predicted by MediaPipe. Specifically, following resampling, normalization, and Procrustes transformations, root-mean-squared error (RMSE; primary outcome measure) was calculated between predicted coordinates and those generated by the touchscreen computer. Results: Although there was some size distortion in the frame-by-frame estimates predicted by MediaPipe, shapes were similar between the 2 methods and transformations improved the general overlap and similarity of the shapes. The resultant mean RMSE between predicted coordinates and those generated by the touchscreen was 0.28 (SD 0.06) normalized px. Equivalence testing revealed that accuracy differed between MediaPipe and the touchscreen, but that the true difference was between 0 and 0.30 normalized px (t114=−3.02; P=.002). Additional analyses revealed no differences in resultant RMSE between methods when comparing across lower frame rates (30 and 60 frames per second [FPS]), although there was greater RMSE for 120 FPS than for 60 FPS (t35.43=−2.51; P=.03). Conclusions: Overall, we quantified similarities between one AI-based approach to motion capture and a known standard for tracking fine upper limb movements, informing applications of such systems in domains such as clinical and research settings. Future work should address accuracy in 3 dimensions to further validate the use of AI-based systems, including MediaPipe, in such domains. %R 10.2196/56682 %U https://formative.jmir.org/2024/1/e56682 %U https://doi.org/10.2196/56682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56788 %T Data Verification and Respondent Validity for a Web-Based Sexual Health Survey: Tutorial %A Parker,Jayelin N %A Rager,Theresa L %A Burns,Jade %A Mmeje,Okeoma %K sexually transmitted infections %K adolescent and young adults %K sexual health %K recruitment %K survey design %K social media %K data verification %K web-based surveys %K data integrity %K social media advertisements %K online advertisements %K STI %K STD %K sexual health survey %K sexually transmitted disease %D 2024 %7 9.12.2024 %9 %J JMIR Form Res %G English %X Background: As technology continues to shape the landscape of health research, the utilization of web-based surveys for collecting sexual health information among adolescents and young adults has become increasingly prevalent. However, this shift toward digital platforms brings forth a new set of challenges, particularly the infiltration of automated bots that can compromise data integrity and the reliability of survey results. Objective: We aimed to outline the data verification process used in our study design, which employed survey programming and data cleaning protocols. Methods: A 26-item survey was developed and programmed with several data integrity functions, including reCAPTCHA scores, RelevantID fraud and duplicate scores, verification of IP addresses, and honeypot questions. Participants aged 15‐24 years were recruited via social media advertisements over 7 weeks and received a US $15 incentive after survey completion. Data verification occurred through a 2-part cleaning process, which removed responses that were incomplete, flagged as spam by Qualtrics, or from duplicate IP addresses, or those that did not meet the inclusion criteria. Final comparisons of reported age with date of birth and reported state with state inclusion criteria were performed. Participants who completed the study survey were linked to a second survey to receive their incentive. Responses without first and last names and full addresses were removed, as were those with duplicate IP addresses or the exact same longitude and latitude coordinates. Finally, IP addresses used to complete both surveys were compared, and consistent responses were eligible for an incentive. Results: Over 7 weeks, online advertisements for a web-based survey reached 1.4 million social media users. Of the 20,585 survey responses received, 4589 (22.3%) were verified. Incentives were sent to 462 participants; of these, 14 responses were duplicates and 3 contained discrepancies, resulting in a final sample of 445 responses. Conclusions: Confidential web-based surveys are an appealing method for reaching populations—particularly adolescents and young adults, who may be reluctant to disclose sensitive information to family, friends, or clinical providers. Web-based surveys are a useful tool for researchers targeting hard-to-reach populations due to the difficulty in obtaining a representative sample. However, researchers face the ongoing threat of bots and fraudulent participants in a technology-driven world, necessitating the adoption of evolving bot detection software and tailored protocols for data collection in unique contexts. %R 10.2196/56788 %U https://formative.jmir.org/2024/1/e56788 %U https://doi.org/10.2196/56788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58423 %T A Pathological Diagnosis Method for Fever of Unknown Origin Based on Multipath Hierarchical Classification: Model Design and Validation %A Du,Jianchao %A Ding,Junyao %A Wu,Yuan %A Chen,Tianyan %A Lian,Jianqi %A Shi,Lei %A Zhou,Yun %K fever of unknown origin %K FUO %K intelligent diagnosis %K machine learning %K hierarchical classification %K feature selection %K model design %K validation %K diagnostic %K prediction model %D 2024 %7 9.12.2024 %9 %J JMIR Form Res %G English %X Background: Fever of unknown origin (FUO) is a significant challenge for the medical community due to its association with a wide range of diseases, the complexity of diagnosis, and the likelihood of misdiagnosis. Machine learning can extract valuable information from the extensive data of patient indicators, aiding doctors in diagnosing the underlying cause of FUO. Objective: The study aims to design a multipath hierarchical classification algorithm to diagnose FUO due to the hierarchical structure of the etiology of FUO. In addition, to improve the diagnostic performance of the model, a mechanism for feature selection is added to the model. Methods: The case data of patients with FUO admitted to the First Affiliated Hospital of Xi’an Jiaotong University between 2011 and 2020 in China were used as the dataset for model training and validation. The hierarchical structure tree was then characterized according to etiology. The structure included 3 layers, with the top layer representing the FUO, the middle layer dividing the FUO into 5 categories of etiology (bacterial infection, viral infection, other infection, autoimmune diseases, and other noninfection), and the last layer further refining them to 16 etiologies. Finally, ablation experiments were set to determine the optimal structure of the proposed method, and comparison experiments were to verify the diagnostic performance. Results: According to ablation experiments, the model achieved the best performance with an accuracy of 76.08% when the number of middle paths was 3%, and 25% of the features were selected. According to comparison experiments, the proposed model outperformed the comparison methods, both from the perspective of feature selection methods and hierarchical classification methods. Specifically, brucellosis had an accuracy of 100%, and liver abscess, viral infection, and lymphoma all had an accuracy of more than 80%. Conclusions: In this study, a novel multipath feature selection and hierarchical classification model was designed for the diagnosis of FUO and was adequately evaluated quantitatively. Despite some limitations, this model enriches the exploration of FUO in machine learning and assists physicians in their work. %R 10.2196/58423 %U https://formative.jmir.org/2024/1/e58423 %U https://doi.org/10.2196/58423 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55856 %T Screening for Depression and Anxiety Using a Nonverbal Working Memory Task in a Sample of Older Brazilians: Observational Study of Preliminary Artificial Intelligence Model Transferability %A Georgescu,Alexandra Livia %A Cummins,Nicholas %A Molimpakis,Emilia %A Giacomazzi,Eduardo %A Rodrigues Marczyk,Joana %A Goria,Stefano %K depression %K anxiety %K Brazil %K machine learning %K n-back %K working memory %K artificial intelligence %K gerontology %K older adults %K mental health %K AI %K transferability %K detection %K screening %K questionnaire %K longitudinal study %D 2024 %7 12.12.2024 %9 %J JMIR Form Res %G English %X Background: Anxiety and depression represent prevalent yet frequently undetected mental health concerns within the older population. The challenge of identifying these conditions presents an opportunity for artificial intelligence (AI)–driven, remotely available, tools capable of screening and monitoring mental health. A critical criterion for such tools is their cultural adaptability to ensure effectiveness across diverse populations. Objective: This study aims to illustrate the preliminary transferability of two established AI models designed to detect high depression and anxiety symptom scores. The models were initially trained on data from a nonverbal working memory game (1- and 2-back tasks) in a dataset by thymia, a company that develops AI solutions for mental health and well-being assessments, encompassing over 6000 participants from the United Kingdom, United States, Mexico, Spain, and Indonesia. We seek to validate the models’ performance by applying it to a new dataset comprising older Brazilian adults, thereby exploring its transferability and generalizability across different demographics and cultures. Methods: A total of 69 Brazilian participants aged 51-92 years old were recruited with the help of Laços Saúde, a company specializing in nurse-led, holistic home care. Participants received a link to the thymia dashboard every Monday and Thursday for 6 months. The dashboard had a set of activities assigned to them that would take 10-15 minutes to complete, which included a 5-minute game with two levels of the n-back tasks. Two Random Forest models trained on thymia data to classify depression and anxiety based on thresholds defined by scores of the Patient Health Questionnaire (8 items) (PHQ-8) ≥10 and those of the Generalized Anxiety Disorder Assessment (7 items) (GAD-7) ≥10, respectively, were subsequently tested on the Laços Saúde patient cohort. Results: The depression classification model exhibited robust performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.78, a specificity of 0.69, and a sensitivity of 0.72. The anxiety classification model showed an initial AUC of 0.63, with a specificity of 0.58 and a sensitivity of 0.64. This performance surpassed a benchmark model using only age and gender, which had AUCs of 0.47 for PHQ-8 and 0.53 for GAD-7. After recomputing the AUC scores on a cross-sectional subset of the data (the first n-back game session), we found AUCs of 0.79 for PHQ-8 and 0.76 for GAD-7. Conclusions: This study successfully demonstrates the preliminary transferability of two AI models trained on a nonverbal working memory task, one for depression and the other for anxiety classification, to a novel sample of older Brazilian adults. Future research could seek to replicate these findings in larger samples and other cultural contexts. Trial Registration: ISRCTN Registry ISRCTN90727704; https://www.isrctn.com/ISRCTN90727704 %R 10.2196/55856 %U https://formative.jmir.org/2024/1/e55856 %U https://doi.org/10.2196/55856 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65477 %T Therapy Mode Preference Scale: Preliminary Validation Methodological Design %A Cerrito,Brianna %A Xiao,Jamie %A Fialk,Amanda %A Buono,Frank D %K virtual teletherapy %K young adult mental health treatment %K in-person therapy %K virtual mental health care %K telehealth %K mental health treatment %K virtual care %K therapeutic %K virtual therapy %K in-person treatment %K exploratory factor analysis %K hierarchical linear regression %K standardized tool %K herapeutic impact %D 2024 %7 29.11.2024 %9 %J JMIR Form Res %G English %X Background: The use of tele–mental health care increased rapidly in 2020 as a critical response to the COVID-19 pandemic, serving as an effective contact-free alternative to treatment. Today, tele–mental health care remains a viable option for individuals with geographic and physical barriers to treatment. However, there are several potential therapeutic disadvantages to tele–mental health care (ie, missing nonverbal signals, handling crises, confidentiality, weakened social connection in group therapy) that should be evaluated. While published literature has explored client satisfaction within teletherapy and the effect of using technology for tele–mental health care demands, there is a need for published surveys that evaluate the therapeutic experience in teletherapy and in-person mediums of care. Objective: The authors of this study sought to develop and validate a survey that could evaluate the comparative impact of teletherapy and in-person care from a therapeutic perspective across key factors (ie, therapeutic alliance, engagement, rapport, and confidentiality). Methods: Participants were clients who experienced both tele–mental health care and in-person therapy at an intensive outpatient mental health treatment program for young adults from April 2020 through June 2022. Generated items on the survey were formulated based on input from experts in the field and existing validated scales. All individuals completed the survey on the internet, following informed consent (n=89). An exploratory factor analysis was conducted to understand factor structure, and Cronbach α was used to determine internal consistency. Incremental validity was demonstrated through a hierarchical linear regression. Results: The exploratory factor analysis revealed a 14-item, 3-factor structure. All 14 items correlated at a minimum of 0.30 with at least one other item. Kaiser-Meyer-Olkin measure of sampling adequacy was 0.75 and Bartlett’s test of sphericity was significant (χ291=528.41, P<.001). In total, 3 factors accounted for 61% of the variance, and the preliminary Cronbach α (α=0.71) indicates a satisfactory level of internal consistency. The Zoom Exhaustion and Fatigue Scale (ZEF) and Client Satisfaction Questionnaire (CSQ; −0.29) were significantly correlated, as well as the ZEF and Therapy Mode Preference Scale (TMPS; −0.31), and CSQ and TMPS (0.50; P<.001). Hierarchical linear regression revealed that the CSQ significantly accounted for additional variance in the TMPS (P<.001). With the ZEF entered into the model, no further variance was accounted for (P=.06). Conclusions: Continual research is warranted to expand the current findings by validating this standardized tool for assessing the therapeutic impact of teletherapy versus in-person care in a generalizable population. %R 10.2196/65477 %U https://formative.jmir.org/2024/1/e65477 %U https://doi.org/10.2196/65477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49328 %T Web-Based Platform for Systematic Reviews and Meta-Analyses of Traditional Chinese Medicine: Platform Development Study %A Zhou,Weiqiang %A Liu,Dongliang %A Yi,Zhaoxu %A Lei,Yang %A Zhang,Zhenming %A Deng,Yu %A Tan,Ying %K evidence-based medicine %K information science %K medical librarian %K web development %K web design %K meta-analysis %K traditional Chinese medicine %K systematic review %K review methodology %K Chinese medicine %K traditional medicine %D 2024 %7 22.11.2024 %9 %J JMIR Form Res %G English %X Background: There are many problems associated with systematic reviews of traditional Chinese medicine (TCM), such as considering “integrated traditional Chinese and Western medicine” or treatment methods as intervention measures without considering the differences in drug use, disregarding dosage and courses of treatment, disregarding interindividual differences in control groups, etc. Classifying a large number of heterogeneous intervention measures into the same measure is easy but results in inaccurate results. In April 2023, Cochrane launched RevMan Web to digitalize systematic reviews and meta-analyses. We believe that this web-based working model helps solve the abovementioned problems. Objective: This study aims to (1) develop a web-based platform that is more suitable for systematic review and meta-analysis of TCM and (2) explore the characteristics and future development directions of this work through the testing of digital workflow. Methods: We developed TCMeta (Traditional Chinese Medicine Meta-analysis)—a platform focused on systematic reviews of TCM types. All systematic review–related work can be completed on the web, including creating topics, writing protocols, arranging personnel, obtaining literature, screening literature, inputting and analyzing data, and designing illustrations. The platform was developed using the latest internet technology and can be continuously modified and updated based on user feedback. When screening the literature on the platform, in addition to the traditional manual screening mode, the platform also creatively provides a query mode where users input keywords and click on Search to find literature with the same characteristics; this better reflects the objectivity of the screening with higher efficiency. Productivity can be improved by analyzing data and generating graphs digitally. Results: We used some test data in TCMeta to simulate data processing in a systematic review. In the literature screening stage, researchers could rapidly screen 19 sources of literature from among multiple sources with the manual screening mode. This traditional method could result in bias due to differences in the researchers’ cognitive levels. The query mode is much more complex and involves inputting of data regarding drug compatibility, dosage, syndrome type, etc; different query methods can yield very different results, thus increasing the stringency of screening. We integrated data analysis tools on the platform and used third-party software to generate graphs. Conclusions: TCMeta has shown great potential in improving the quality of systematic reviews of TCM types in simulation tests. Several indicators show that this web-based mode of working is superior to the traditional way. Future research is required to focus on validating and refining the performance of TCMeta, emphasizing the ability to handle complex data. The system has good scalability and adaptability, and it has the potential to have a positive impact on the field of evidence-based medicine. %R 10.2196/49328 %U https://formative.jmir.org/2024/1/e49328 %U https://doi.org/10.2196/49328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48487 %T Machine Learning for Early Prediction of Major Adverse Cardiovascular Events After First Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: Retrospective Cohort Study %A Zhang,Pin %A Wu,Lei %A Zou,Ting-Ting %A Zou,ZiXuan %A Tu,JiaXin %A Gong,Ren %A Kuang,Jie %+ Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461 BaYi Road, Nanchang, 330006, China, 86 0791 8636228, kuangjie@ncu.edu.cn %K acute myocardial infarction %K percutaneous coronary intervention %K machine learning %K early prediction %K cardiovascular event %D 2024 %7 3.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of major adverse cardiovascular events (MACEs) remains high in patients with acute myocardial infarction (AMI) who undergo percutaneous coronary intervention (PCI), and early prediction models to guide their clinical management are lacking. Objective: This study aimed to develop machine learning–based early prediction models for MACEs in patients with newly diagnosed AMI who underwent PCI. Methods: A total of 1531 patients with AMI who underwent PCI from January 2018 to December 2019 were enrolled in this consecutive cohort. The data comprised demographic characteristics, clinical investigations, laboratory tests, and disease-related events. Four machine learning models—artificial neural network (ANN), k-nearest neighbors, support vector machine, and random forest—were developed and compared with the logistic regression model. Our primary outcome was the model performance that predicted the MACEs, which was determined by accuracy, area under the receiver operating characteristic curve, and F1-score. Results: In total, 1362 patients were successfully followed up. With a median follow-up of 25.9 months, the incidence of MACEs was 18.5% (252/1362). The area under the receiver operating characteristic curve of the ANN, random forest, k-nearest neighbors, support vector machine, and logistic regression models were 80.49%, 72.67%, 79.80%, 77.20%, and 71.77%, respectively. The top 5 predictors in the ANN model were left ventricular ejection fraction, the number of implanted stents, age, diabetes, and the number of vessels with coronary artery disease. Conclusions: The ANN model showed good MACE prediction after PCI for patients with AMI. The use of machine learning–based prediction models may improve patient management and outcomes in clinical practice. %M 38170581 %R 10.2196/48487 %U https://formative.jmir.org/2024/1/e48487 %U https://doi.org/10.2196/48487 %U http://www.ncbi.nlm.nih.gov/pubmed/38170581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45998 %T Differences in Psychological Inflexibility Among Men With Erectile Dysfunction Younger and Older Than 40 Years: Web-Based Cross-Sectional Study %A Saito,Junichi %A Kumano,Hiroaki %A Ghazizadeh,Mohammad %A Shimokawa,Chigusa %A Tanemura,Hideki %+ Comprehensive Research Organization, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, 359-1192, Japan, 81 429498113, tekuteke@aoni.waseda.jp %K erectile dysfunction %K acceptance and commitment therapy %K psychological inflexibility %K depression %K anxiety %K men %K cross-sectional study %K psychological %K utility %K psychosocial %K men %K therapy %K impotence %K erection %D 2024 %7 3.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological inflexibility is a core concept of acceptance and commitment therapy (ACT), which is a comprehensive, transdiagnostic interpretation of mental health symptoms. Erectile dysfunction (ED) is a condition that affects male sexual performance, involving the inability to achieve and maintain a penile erection sufficient for satisfactory sexual activity. Psychosocial factors primarily influence ED in men younger than 40 years, whereas biological factors are more likely to be the underlying cause in older men. Objective: This web-based cross-sectional study examined differences in depression, anxiety, and psychological inflexibility among men with ED younger and older than 40 years in a Japanese population. Methods: We used a web-based survey to gather data from various community samples. ED was assessed by the International Index of Erectile Function‐5 (IIEF-5) questionnaire, while depression, anxiety, and psychological inflexibility were evaluated by the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), and Valuing Questionnaire–Obstacle Subscale (VQ-OB) questionnaires. The chi‐square test estimated the scores of PHQ-9 and GAD-7 among men with ED, comparing those younger than 40 years and those older than 40 years. Additionally, a two-way ANOVA was conducted with ED severity and age group as independent variables, assessing psychological inflexibility. Results: Valid responses from 643 individuals (mean age 36.19, SD 7.54 years) were obtained. Of these, 422 were younger than 40 years (mean age 31.76, SD 5.00 years), and 221 were older than 40 years (mean age 44.67, SD 2.88 years). There was a statistical difference in the prevalence of depression as judged by PHQ≥10 between men with ED younger and older than 40 years (P<.001). On the other hand, there was no difference in the prevalence of anxiety as judged by GAD≥10 (P=.12). The two-way ANOVA revealed that the interactions for CFQ (P=.04) and VQ-OB (P=.01) were significant. The simple main effect was that men with ED younger than 40 years had significantly higher CFQ (P=.01; d=0.62) and VQ-OB (P<.001; d=0.87) scores compared to those older than 40 years in moderate ED and severe ED. Additionally, it was found that men younger than 40 years with moderate to severe ED had significantly higher CFQ (P=.01; d=0.42) and VQ-OB (P=.02; d=0.38) scores compared to men younger than 40 years without ED. On the other hand, no interaction was found for AAQ-II (P=.16) scores. Conclusions: To the best of our knowledge, this web-based cross-sectional study is the first to examine the relationship between psychological inflexibility and ED. We conclude that men with moderate and severe ED younger than 40 years have higher psychological inflexibility and might be eligible for ACT. %M 38170587 %R 10.2196/45998 %U https://formative.jmir.org/2024/1/e45998 %U https://doi.org/10.2196/45998 %U http://www.ncbi.nlm.nih.gov/pubmed/38170587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46364 %T Determining Distinct Suicide Attempts From Recurrent Electronic Health Record Codes: Classification Study %A Bentley,Kate H %A Madsen,Emily M %A Song,Eugene %A Zhou,Yu %A Castro,Victor %A Lee,Hyunjoon %A Lee,Younga H %A Smoller,Jordan W %+ Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, 2nd Floor, Boston, MA, 02114, United States, 1 6177247741, kbentley@mgh.harvard.edu %K suicide %K suicide attempt %K self-injury %K electronic health record %K EHR %K prediction %K predictive model %K predict %K model %K suicidal %K informatics %K automated rule %K psychiatry %K machine learning %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior suicide attempts are a relatively strong risk factor for future suicide attempts. There is growing interest in using longitudinal electronic health record (EHR) data to derive statistical risk prediction models for future suicide attempts and other suicidal behavior outcomes. However, model performance may be inflated by a largely unrecognized form of “data leakage” during model training: diagnostic codes for suicide attempt outcomes may refer to prior attempts that are also included in the model as predictors. Objective: We aimed to develop an automated rule for determining when documented suicide attempt diagnostic codes identify distinct suicide attempt events. Methods: From a large health care system’s EHR, we randomly sampled suicide attempt codes for 300 patients with at least one pair of suicide attempt codes documented at least one but no more than 90 days apart. Supervised chart reviewers assigned the clinical settings (ie, emergency department [ED] versus non-ED), methods of suicide attempt, and intercode interval (number of days). The probability (or positive predictive value) that the second suicide attempt code in a given pair of codes referred to a distinct suicide attempt event from its preceding suicide attempt code was calculated by clinical setting, method, and intercode interval. Results: Of 1015 code pairs reviewed, 835 (82.3%) were nonindependent (ie, the 2 codes referred to the same suicide attempt event). When the second code in a pair was documented in a clinical setting other than the ED, it represented a distinct suicide attempt 3.3% of the time. The more time elapsed between codes, the more likely the second code in a pair referred to a distinct suicide attempt event from its preceding code. Code pairs in which the second suicide attempt code was assigned in an ED at least 5 days after its preceding suicide attempt code had a positive predictive value of 0.90. Conclusions: EHR-based suicide risk prediction models that include International Classification of Diseases codes for prior suicide attempts as a predictor may be highly susceptible to bias due to data leakage in model training. We derived a simple rule to distinguish codes that reflect new, independent suicide attempts: suicide attempt codes documented in an ED setting at least 5 days after a preceding suicide attempt code can be confidently treated as new events in EHR-based suicide risk prediction models. This rule has the potential to minimize upward bias in model performance when prior suicide attempts are included as predictors in EHR-based suicide risk prediction models. %M 38190236 %R 10.2196/46364 %U https://formative.jmir.org/2024/1/e46364 %U https://doi.org/10.2196/46364 %U http://www.ncbi.nlm.nih.gov/pubmed/38190236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51693 %T Synergizing the Behavior Change Wheel and a Cocreative Approach to Design a Physical Activity Intervention for Adolescents and Young Adults With Intellectual Disabilities: Development Study %A Maenhout,Laura %A Latomme,Julie %A Cardon,Greet %A Crombez,Geert %A Van Hove,Geert %A Compernolle,Sofie %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 92646312, laura.maenhout@ugent.be %K Behavior Change Wheel %K cocreation %K intervention %K physical activity %K adolescents %K young adults %K intellectual disabilities %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need for physical activity promotion interventions in adolescents and young adults with intellectual disabilities. Current interventions have shown limited effectiveness, which may be attributed to the absence of theory and a population-specific development. Combining a planning model (including theory) and cocreation with the target audience during intervention development could potentially address this gap. Objective: This study aimed to report the systematic development of the Move it, Move ID! intervention by describing how the 8 different steps of the Behavior Change Wheel (BCW) were applied and present the results that emerged from those steps. In doing so, the (theoretical) content of the intervention is described in detail. Methods: A total of 23 adolescents and young adults (aged 14-22 years) with mild to moderate intellectual disabilities were designated as cocreators of the intervention. Across 2 groups, 6 similar cocreation sessions were organized in each. The content and sequence of the sessions were structured to align with the 8 steps of the BCW. All sessions were recorded and transcribed verbatim. Both a deductive (ie, steps of the BCW) and inductive (ie, resonating the voice of the participants) analysis approach were applied specifically focusing on identifying and describing the findings within each of the BCW steps. Results: After behavioral analysis (steps 1-4), 10 intervention goals were chosen and linked to Capability, Opportunity, and Motivation–Behavior components (theory within the BCW) that needed to be addressed. Psychological capability, social opportunity, and reflective motivation were emphasized as the first targets to focus on. A key finding was the urge for real-life social connectedness and social integration, which makes the social component as part of physical activity a central theme to focus on within intervention development. Judgments on the most suitable intervention functions (step 5) and behavior change techniques (step 7) were explained. When discussing the mode of delivery of the intervention (step 8), it was underscored that solely relying on a mobile health app would not fulfill participants’ social needs. Hence, the chosen intervention adopts a dyadic approach in which young individuals with intellectual disabilities are matched with peers without intellectual disabilities to engage in physical activities together, with a mobile app playing a supportive role in this partnership. Conclusions: The transparent description of the development process highlights why certain intervention components and behavior change techniques were chosen and how they are intertwined by means of the selected intervention design. This paper provides a detailed blueprint for practitioners wanting to integrate the BCW and its associated behavior change techniques, in combination with actively involving the target group, into their intervention development for people with intellectual disabilities. %M 38206648 %R 10.2196/51693 %U https://formative.jmir.org/2024/1/e51693 %U https://doi.org/10.2196/51693 %U http://www.ncbi.nlm.nih.gov/pubmed/38206648 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47091 %T Assessing and Improving Data Integrity in Web-Based Surveys: Comparison of Fraud Detection Systems in a COVID-19 Study %A Bonett,Stephen %A Lin,Willey %A Sexton Topper,Patrina %A Wolfe,James %A Golinkoff,Jesse %A Deshpande,Aayushi %A Villarruel,Antonia %A Bauermeister,José %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 2155734299, stepdo@nursing.upenn.edu %K web-based survey %K data quality %K fraud %K survey methodology %K COVID-19 %K survey %K fraud detection %K Philadelphia %K data privacy %K data protection %K privacy %K security %K data %K information security %K data validation %K cross-sectional %K web-based %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based surveys increase access to study participation and improve opportunities to reach diverse populations. However, web-based surveys are vulnerable to data quality threats, including fraudulent entries from automated bots and duplicative submissions. Widely used proprietary tools to identify fraud offer little transparency about the methods used, effectiveness, or representativeness of resulting data sets. Robust, reproducible, and context-specific methods of accurately detecting fraudulent responses are needed to ensure integrity and maximize the value of web-based survey research. Objective: This study aims to describe a multilayered fraud detection system implemented in a large web-based survey about COVID-19 attitudes, beliefs, and behaviors; examine the agreement between this fraud detection system and a proprietary fraud detection system; and compare the resulting study samples from each of the 2 fraud detection methods. Methods: The PhillyCEAL Common Survey is a cross-sectional web-based survey that remotely enrolled residents ages 13 years and older to assess how the COVID-19 pandemic impacted individuals, neighborhoods, and communities in Philadelphia, Pennsylvania. Two fraud detection methods are described and compared: (1) a multilayer fraud detection strategy developed by the research team that combined automated validation of response data and real-time verification of study entries by study personnel and (2) the proprietary fraud detection system used by the Qualtrics (Qualtrics) survey platform. Descriptive statistics were computed for the full sample and for responses classified as valid by 2 different fraud detection methods, and classification tables were created to assess agreement between the methods. The impact of fraud detection methods on the distribution of vaccine confidence by racial or ethnic group was assessed. Results: Of 7950 completed surveys, our multilayer fraud detection system identified 3228 (40.60%) cases as valid, while the Qualtrics fraud detection system identified 4389 (55.21%) cases as valid. The 2 methods showed only “fair” or “minimal” agreement in their classifications (κ=0.25; 95% CI 0.23-0.27). The choice of fraud detection method impacted the distribution of vaccine confidence by racial or ethnic group. Conclusions: The selection of a fraud detection method can affect the study’s sample composition. The findings of this study, while not conclusive, suggest that a multilayered approach to fraud detection that includes conservative use of automated fraud detection and integration of human review of entries tailored to the study’s specific context and its participants may be warranted for future survey research. %M 38214962 %R 10.2196/47091 %U https://formative.jmir.org/2024/1/e47091 %U https://doi.org/10.2196/47091 %U http://www.ncbi.nlm.nih.gov/pubmed/38214962 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44653 %T Virtual and Interprofessional Objective Structured Clinical Examination in Dentistry and Dental Technology: Development and User Evaluations %A Pang,MengWei %A Dong,YanLing %A Zhao,XiaoHan %A Wan,JiaWu %A Jiang,Li %A Song,JinLin %A Ji,Ping %A Jiang,Lin %+ Stomatological Hospital of Chongqing Medical University, 426# Songshibei Road, Yubei District, Chongqing, 401147, China, 86 15922650133, jianglin@hospital.cqmu.edu.cn %K dentist %K dental technician %K objective structured clinical examination %K OSCE %K interprofessional education %K interprofessional collaborative practice %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Interprofessional education (IPE) facilitates interprofessional collaborative practice (IPCP) to encourage teamwork among dental care professionals and is increasingly becoming a part of training programs for dental and dental technology students. However, the focus of previous IPE and IPCP studies has largely been on subjective student and instructor perceptions without including objective assessments of collaborative practice as an outcome measure. Objective: The purposes of this study were to develop the framework for a novel virtual and interprofessional objective structured clinical examination (viOSCE) applicable to dental and dental technology students, to assess the effectiveness of the framework as a tool for measuring the outcomes of IPE, and to promote IPCP among dental and dental technology students. Methods: The framework of the proposed novel viOSCE was developed using the modified Delphi method and then piloted. The lead researcher and a group of experts determined the content and scoring system. Subjective data were collected using the Readiness for Interprofessional Learning Scale and a self-made scale, and objective data were collected using examiner ratings. Data were analyzed using nonparametric tests. Results: We successfully developed a viOSCE framework applicable to dental and dental technology students. Of 50 students, 32 (64%) participated in the pilot study and completed the questionnaires. On the basis of the Readiness for Interprofessional Learning Scale, the subjective evaluation indicated that teamwork skills were improved, and the only statistically significant difference in participant motivation between the 2 professional groups was in the mutual evaluation scale (P=.004). For the viOSCE evaluation scale, the difference between the professional groups in removable prosthodontics was statistically significant, and a trend for negative correlation between subjective and objective scores was noted, but it was not statistically significant. Conclusions: The results confirm that viOSCE can be used as an objective evaluation tool to assess the outcomes of IPE and IPCP. This study also revealed an interesting relationship between mutual evaluation and IPCP results, further demonstrating that the IPE and IPCP results urgently need to be supplemented with objective evaluation tools. Therefore, the implementation of viOSCE as part of a large and more complete objective structured clinical examination to test the ability of students to meet undergraduate graduation requirements will be the focus of our future studies. %M 38231556 %R 10.2196/44653 %U https://formative.jmir.org/2024/1/e44653 %U https://doi.org/10.2196/44653 %U http://www.ncbi.nlm.nih.gov/pubmed/38231556 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49031 %T Use of Machine Learning Tools in Evidence Synthesis of Tobacco Use Among Sexual and Gender Diverse Populations: Algorithm Development and Validation %A Ma,Shaoying %A Jiang,Shuning %A Yang,Olivia %A Zhang,Xuanzhi %A Fu,Yu %A Zhang,Yusen %A Kaareen,Aadeeba %A Ling,Meng %A Chen,Jian %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Road, 1st Floor, Suite 110, Columbus, OH, 43214, United States, 1 6148976063, shaoying.ma@osumc.edu %K machine learning %K natural language processing %K tobacco control %K sexual and gender diverse populations %K lesbian %K gay %K bisexual %K transgender %K queer %K LGBTQ+ %K evidence synthesis %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: From 2016 to 2021, the volume of peer-reviewed publications related to tobacco has experienced a significant increase. This presents a considerable challenge in efficiently summarizing, synthesizing, and disseminating research findings, especially when it comes to addressing specific target populations, such as the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, Two Spirit, and other persons who identify as part of this community) populations. Objective: In order to expedite evidence synthesis and research gap discoveries, this pilot study has the following three aims: (1) to compile a specialized semantic database for tobacco policy research to extract information from journal article abstracts, (2) to develop natural language processing (NLP) algorithms that comprehend the literature on nicotine and tobacco product use among sexual and gender diverse populations, and (3) to compare the discoveries of the NLP algorithms with an ongoing systematic review of tobacco policy research among LGBTQ+ populations. Methods: We built a tobacco research domain–specific semantic database using data from 2993 paper abstracts from 4 leading tobacco-specific journals, with enrichment from other publicly available sources. We then trained an NLP model to extract named entities after learning patterns and relationships between words and their context in text, which further enriched the semantic database. Using this iterative process, we extracted and assessed studies relevant to LGBTQ+ tobacco control issues, further comparing our findings with an ongoing systematic review that also focuses on evidence synthesis for this demographic group. Results: In total, 33 studies were identified as relevant to sexual and gender diverse individuals’ nicotine and tobacco product use. Consistent with the ongoing systematic review, the NLP results showed that there is a scarcity of studies assessing policy impact on this demographic using causal inference methods. In addition, the literature is dominated by US data. We found that the product drawing the most attention in the body of existing research is cigarettes or cigarette smoking and that the number of studies of various age groups is almost evenly distributed between youth or young adults and adults, consistent with the research needs identified by the US health agencies. Conclusions: Our pilot study serves as a compelling demonstration of the capabilities of NLP tools in expediting the processes of evidence synthesis and the identification of research gaps. While future research is needed to statistically test the NLP tool’s performance, there is potential for NLP tools to fundamentally transform the approach to evidence synthesis. %M 38265858 %R 10.2196/49031 %U https://formative.jmir.org/2024/1/e49031 %U https://doi.org/10.2196/49031 %U http://www.ncbi.nlm.nih.gov/pubmed/38265858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50942 %T Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study %A Cranston,Kaela D %A Grieve,Natalie J %A Dineen,Tineke E %A Jung,Mary E %+ Faculty of Health and Social Development, University of British Columbia, 1238 Discovery Road, Kelowna, BC, V1V 1V7, Canada, 1 2508079670, mary.jung@ubc.ca %K program evaluation %K prediabetic state %K e-learning education %K e-learning %K platform %K usability %K diabetes %K prevention %K knowledge translation %K end user %K type 2 diabetes %K framework %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: e-Learning has rapidly become a popular alternative to in-person learning due to its flexibility, convenience, and wide reach. Using a systematic and partnered process to transfer in-person training to an e-learning platform helps to ensure the training will be effective and acceptable to learners. Objective: This study aimed to develop an e-learning platform for Small Steps for Big Changes (SSBC) type 2 diabetes prevention program coaches to improve the viability of coach training. Methods: An integrated knowledge translation approach was used in the first 3 stages of the technology-enhanced learning (TEL) evaluation framework to address the study objective. This included three steps: (1) conducting a needs analysis based on focus groups with previously trained SSBC coaches, meetings with the SSBC research team, and a review of research results on the effectiveness of the previous in-person version of the training; (2) documenting processes and decisions in the design and development of the e-learning training platform; and (3) performing usability testing. Previously trained SSBC coaches and the SSBC research team were included in all stages of this study. Results: Step 1 identified components from the in-person training that should be maintained in the e-learning training (ie, a focus on motivational interviewing), additional components to be added to the e-learning training (ie, how to deliver culturally safe and inclusive care), and mode of delivery (videos and opportunities to synchronously practice skills). Step 2 documented the processes and decisions made in the design and development of the e-learning training, including the resources (ie, time and finances) used, the content of the training modules, and how coaches would flow through the training process. The design and development process consisted of creating a blueprint of the training. The training included 7 e-learning modules, the learning modalities of which included narrated demonstration videos and user-engaging activities, a mock session with feedback from the research team, and a final knowledge test. Step 3, usability testing, demonstrated high levels of learnability, efficiency, memorability, and satisfaction, with minor bugs documented and resolved. Conclusions: Using an integrated knowledge translation approach to the technology-enhanced learning evaluation framework was successful in developing an e-learning training platform for SSBC coaches. Incorporating end users in this process can increase the chances that the e-learning training platform is usable, engaging, and acceptable. Future research will include examining the satisfaction of coaches using the SSBC coach e-learning training platform, assessing coach learning outcomes (ie, knowledge and behavior), and estimating the cost and viability of implementing this training. %M 38277214 %R 10.2196/50942 %U https://formative.jmir.org/2024/1/e50942 %U https://doi.org/10.2196/50942 %U http://www.ncbi.nlm.nih.gov/pubmed/38277214 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49347 %T Evaluation of Eligibility Criteria Relevance for the Purpose of IT-Supported Trial Recruitment: Descriptive Quantitative Analysis %A Blasini,Romina %A Strantz,Cosima %A Gulden,Christian %A Helfer,Sven %A Lidke,Jakub %A Prokosch,Hans-Ulrich %A Sohrabi,Keywan %A Schneider,Henning %+ Institute of Medical Informatics, Justus Liebig University, Rudolf-Buchheim-Strasse 6, Giessen, 35392, Germany, 49 06419941386, romina.blasini@informatik.med.uni-giessen.de %K CTRSS %K clinical trial recruitment support system %K PRS %K patient recruitment system %K clinical trials %K classifications %K data groups %K data elements %K data classification %K criteria %K relevance %K automated clinical trials %K participants %K clinical trial %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical trials (CTs) are crucial for medical research; however, they frequently fall short of the requisite number of participants who meet all eligibility criteria (EC). A clinical trial recruitment support system (CTRSS) is developed to help identify potential participants by performing a search on a specific data pool. The accuracy of the search results is directly related to the quality of the data used for comparison. Data accessibility can present challenges, making it crucial to identify the necessary data for a CTRSS to query. Prior research has examined the data elements frequently used in CT EC but has not evaluated which criteria are actually used to search for participants. Although all EC must be met to enroll a person in a CT, not all criteria have the same importance when searching for potential participants in an existing data pool, such as an electronic health record, because some of the criteria are only relevant at the time of enrollment. Objective: In this study, we investigated which groups of data elements are relevant in practice for finding suitable participants and whether there are typical elements that are not relevant and can therefore be omitted. Methods: We asked trial experts and CTRSS developers to first categorize the EC of their CTs according to data element groups and then to classify them into 1 of 3 categories: necessary, complementary, and irrelevant. In addition, the experts assessed whether a criterion was documented (on paper or digitally) or whether it was information known only to the treating physicians or patients. Results: We reviewed 82 CTs with 1132 unique EC. Of these 1132 EC, 350 (30.9%) were considered necessary, 224 (19.8%) complementary, and 341 (30.1%) total irrelevant. To identify the most relevant data elements, we introduced the data element relevance index (DERI). This describes the percentage of studies in which the corresponding data element occurs and is also classified as necessary or supplementary. We found that the query of “diagnosis” was relevant for finding participants in 79 (96.3%) of the CTs. This group was followed by “date of birth/age” with a DERI of 85.4% (n=70) and “procedure” with a DERI of 35.4% (n=29). Conclusions: The distribution of data element groups in CTs has been heterogeneously described in previous works. Therefore, we recommend identifying the percentage of CTs in which data element groups can be found as a more reliable way to determine the relevance of EC. Only necessary and complementary criteria should be included in this DERI. %M 38294862 %R 10.2196/49347 %U https://formative.jmir.org/2024/1/e49347 %U https://doi.org/10.2196/49347 %U http://www.ncbi.nlm.nih.gov/pubmed/38294862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47850 %T User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study %A van der Heijden,Zoë %A de Gooijer,Femke %A Camps,Guido %A Lucassen,Desiree %A Feskens,Edith %A Lasschuijt,Marlou %A Brouwer-Brolsma,Elske %+ Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, Wageningen, 6700 AA, Netherlands, 31 7480 100, zoe.vanderheijden@wur.nl %K diet %K children %K dietary assessment %K recall %K technological innovation %K mobile health %K mHealth %K mobile phone %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. Objective: This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Methods: Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57% boys and n=6, 43% girls). Results: Most children were able to complete FoodBear’s (11/14, 79%), myBear’s (10/14, 71%), and FoodCam’s (9/14, 64%) usability tasks, but all children required assistance (14/14, 100%) and most of the children encountered usability problems (13/14, 93%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Conclusions: Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children’s autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children’s dietary assessment and the provision of personalized dietary support. %M 38300689 %R 10.2196/47850 %U https://formative.jmir.org/2024/1/e47850 %U https://doi.org/10.2196/47850 %U http://www.ncbi.nlm.nih.gov/pubmed/38300689 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52096 %T The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults %A Dryden,Eileen M %A Anwar,Chitra %A Conti,Jennifer %A Boudreau,Jacqueline H %A Kennedy,Meaghan A %A Hung,William W %A Nearing,Kathryn A %A Pimentel,Camilla B %A Moo,Lauren %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 506 2369, eileen.dryden@va.gov %K qualitative interviews %K visual recall aid %K older adults %K health services research %K web-based methods %K visual tool %K recall %K qualitative interview %K experience %K perspective %K motivation %K patient %K recall capacity %K medical information %K visual appointment %K geriatric %K older people %K telemedicine %K videoconference %K e-consultation %K e-medicine %K internet medicine %K REVISIT %K Remembering Healthcare Encounters Visually and Interactively %K mobile phone %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient’s recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. Objective: We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. Methods: The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors’ experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. Results: REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants. REVISIT appeared to support older patients’ and caregivers’ recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. Conclusions: REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences. %M 38300691 %R 10.2196/52096 %U https://formative.jmir.org/2024/1/e52096 %U https://doi.org/10.2196/52096 %U http://www.ncbi.nlm.nih.gov/pubmed/38300691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48538 %T Testing Behavioral Messages to Increase Recruitment to Health Research When Embedded Within Social Media Campaigns on Twitter: Web-Based Experimental Study %A Stoffel,Sandro T %A Law,Jing Hui %A Kerrison,Robert %A Brewer,Hannah R %A Flanagan,James M %A Hirst,Yasemin %+ Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2076792000, s.stoffel@ucl.ac.uk %K advertise %K advertisement %K advertisements %K advertising %K behavior change %K behavioral %K behaviour change %K behavioural %K campaign %K campaigns %K experimental design %K message %K messages %K messaging %K recruit %K recruiting %K recruitment %K social media %K social norms %K Twitter %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media is rapidly becoming the primary source to disseminate invitations to the public to consider taking part in research studies. There is, however, little information on how the contents of the advertisement can be communicated to facilitate engagement and subsequently promote intentions to participate in research. Objective: This paper describes an experimental study that tested different behavioral messages for recruiting study participants for a real-life observational case-control study. Methods: We included 1060 women in a web-based experiment and randomized them to 1 of 3 experimental conditions: standard advertisement (n=360), patient endorsement advertisement (n=345), and social norms advertisement (n=355). After seeing 1 of the 3 advertisements, participants were asked to state (1) their intention to take part in the advertised case-control study, (2) the ease of understanding the message and study aims, and (3) their willingness to be redirected to the website of the case-control study after completing the survey. Individuals were further asked to suggest ways to improve the messages. Intentions were compared between groups using ordinal logistic regression, reported in percentages, adjusted odds ratio (aOR), and 95% CIs. Results: Those who were in the patient endorsement and social norms–based advertisement groups had significantly lower intentions to take part in the advertised study compared with those in the standard advertisement group (aOR 0.73, 95% CI 0.55-0.97; P=.03 and aOR 0.69, 95% CI 0.52-0.92; P=.009, respectively). The patient endorsement advertisement was perceived to be more difficult to understand (aOR 0.65, 95% CI 0.48-0.87; P=.004) and to communicate the study aims less clearly (aOR 0.72, 95% CI 0.55-0.95; P=.01). While the patient endorsement advertisement had no impact on intention to visit the main study website, the social norms advertisement decreased willingness compared with the standard advertisement group (157/355, 44.2% vs 191/360, 53.1%; aOR 0.74, 95% CI 0.54-0.99; P=.02). The majority of participants (395/609, 64.8%) stated that the messages did not require changes, but some preferred clearer (75/609, 12.3%) and shorter (59/609, 9.7%) messages. Conclusions: The results of this study indicate that adding normative behavioral messages to simulated tweets decreased participant intention to take part in our web-based case-control study, as this made the tweet harder to understand. This suggests that simple messages should be used for participant recruitment through Twitter (subsequently rebranded X). %M 38315543 %R 10.2196/48538 %U https://formative.jmir.org/2024/1/e48538 %U https://doi.org/10.2196/48538 %U http://www.ncbi.nlm.nih.gov/pubmed/38315543 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53302 %T Clinical Informatics Team Members’ Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study %A Recsky,Chantelle %A Rush,Kathy L %A MacPhee,Maura %A Stowe,Megan %A Blackburn,Lorraine %A Muniak,Allison %A Currie,Leanne M %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 604 822 7417, chantelle.recsky@ubc.ca %K informatics %K community health services %K knowledge translation %K qualitative research %K patient safety %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). Objective: This study aimed to explore clinical informaticians’ experiences of incorporating safety practices into their work. Methods: We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. Results: A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. Conclusions: As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work. %M 38315544 %R 10.2196/53302 %U https://formative.jmir.org/2024/1/e53302 %U https://doi.org/10.2196/53302 %U http://www.ncbi.nlm.nih.gov/pubmed/38315544 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48668 %T Attitudes, Barriers, and Motivators Toward Daily Walking and a Mobile App to Increase Walking Among Women: Web-Based Anonymous Survey %A Jones,Catherine %A Chandarana,Shikha %A Vyas,Amita %A Napolitano,Melissa %+ Milken Institute School of Public Health, The George Washington University, 950 New Hampsire Avenue, Washington, DC, 20052, United States, 1 301 283 8703, catherinegjones@gwu.edu %K mHealth %K mobile health %K mobile app %K walking %K physical activity %K step counts %K women’s health %K age %K wearable activity tracker %K chronic disease %K mental health %K mobile phone %K COVID-19 %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There are disparities in the prevalence of physical activity (PA) with women engaging in less PA than men, a gap which widens during midlife. Walking is a generally accepted form of PA among women and should be encouraged. Motivations, barriers, and attitudes to engaging in walking change with age, but the influencing factors are not well understood nor are the features of mobile apps that facilitate daily walking. Objective: This study explores the relationship between age and women’s self-reported motivations, barriers, attitudes, and beliefs toward daily walking. It further assesses attitudes toward features of a mobile app designed to sync with a wearable step tracker to increase and maintain levels of daily walking among women. Methods: A web-based anonymous survey was completed by 400 women, aged 21-75 years. The 31-item survey captured women’s perceived barriers and motivators toward daily walking and attitudes toward mobile apps to support and maintain daily walking. For analysis, responses to the survey were grouped into 2 categories of women: ages 21-49 years and ages 50-75 years. Bivariate analyses were conducted through SPSS (IBM Corp) for each of the survey questions using chi-square for dichotomous variables and 1-tailed t tests for scales and continuous variables to identify significant differences between the groups. One-tailed t tests were run for scaled variables to identify significant differences between the 10-year age increments. Results: Significant barriers to daily walking were observed in the 21-49–year group for personal and work responsibilities, motivational and psychosocial factors, and physical and environmental factors. Motivators to walk daily in the 21- 49–year group were significantly higher to reduce stress and anxiety, and motivators to walk daily in the 50-75–year group were significantly higher to help manage or lose weight and to reduce the risk of chronic illness. Women’s walking preferences, beliefs around their walking behaviors, and their perceived importance of the features of a future mobile app for walking designed specifically for women showed significant variation according to age. When asked about the importance of features for a mobile app, women aged 21-49 years indicated a significantly higher number of positive responses for the following features: digital community support, rewards or point system, and seeing a daily or weekly or monthly progress chart. Conclusions: Our findings indicate that barriers, motivators, and beliefs around daily walking and the importance of preferred features of a mobile app vary according to women’s ages. Messaging and app features should be tailored to different age groups of women. These study results can be viewed as a foundation for future research and development of mobile health interventions to effectively increase daily walking among women of all ages. %M 38319695 %R 10.2196/48668 %U https://formative.jmir.org/2024/1/e48668 %U https://doi.org/10.2196/48668 %U http://www.ncbi.nlm.nih.gov/pubmed/38319695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51862 %T Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series %A Bjelkarøy,Maria Torheim %A Simonsen,Tone Breines %A Siddiqui,Tahreem Ghazal %A Halset,Sigrid %A Cheng,Socheat %A Grambaite,Ramune %A Benth,Jūratė Šaltytė %A Gerwing,Jennifer %A Kristoffersen,Espen Saxhaug %A Lundqvist,Christofer %+ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Sykehusveien 25, Lørenskog, 1478, Norway, 47 67960000, matobj@ahus.no %K prescription medication misuse %K older adults %K brief intervention %K z-drugs %K benzodiazepine-related drugs %K BZD-related drugs %K z-hypnotic %K intervention %K feasibility %K case series %K insomnia %K sleep %K substance overuse %K older adult %K treatment %K reduction %K benzodiazepine %K hypnotics %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. Objective: Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. Methods: This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. Results: Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient’s own general practitioner was supported by the participants. Conclusions: We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. Trial Registration: ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn %M 38329779 %R 10.2196/51862 %U https://formative.jmir.org/2024/1/e51862 %U https://doi.org/10.2196/51862 %U http://www.ncbi.nlm.nih.gov/pubmed/38329779 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53216 %T Investigating the Impact of Prompt Engineering on the Performance of Large Language Models for Standardizing Obstetric Diagnosis Text: Comparative Study %A Wang,Lei %A Bi,Wenshuai %A Zhao,Suling %A Ma,Yinyao %A Lv,Longting %A Meng,Chenwei %A Fu,Jingru %A Lv,Hanlin %+ BGI Research, Building 11, Beishan Industrial Zone, Yantian District, Shenzhen, 518083, China, 86 18707190886, lvhanlin@genomics.cn %K obstetric data %K similarity embedding %K term standardization %K large language models %K LLMs %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The accumulation of vast electronic medical records (EMRs) through medical informatization creates significant research value, particularly in obstetrics. Diagnostic standardization across different health care institutions and regions is vital for medical data analysis. Large language models (LLMs) have been extensively used for various medical tasks. Prompt engineering is key to use LLMs effectively. Objective: This study aims to evaluate and compare the performance of LLMs with various prompt engineering techniques on the task of standardizing obstetric diagnostic terminology using real-world obstetric data. Methods: The paper describes a 4-step approach used for mapping diagnoses in electronic medical records to the International Classification of Diseases, 10th revision, observation domain. First, similarity measures were used for mapping the diagnoses. Second, candidate mapping terms were collected based on similarity scores above a threshold, to be used as the training data set. For generating optimal mapping terms, we used two LLMs (ChatGLM2 and Qwen-14B-Chat [QWEN]) for zero-shot learning in step 3. Finally, a performance comparison was conducted by using 3 pretrained bidirectional encoder representations from transformers (BERTs), including BERT, whole word masking BERT, and momentum contrastive learning with BERT (MC-BERT), for unsupervised optimal mapping term generation in the fourth step. Results: LLMs and BERT demonstrated comparable performance at their respective optimal levels. LLMs showed clear advantages in terms of performance and efficiency in unsupervised settings. Interestingly, the performance of the LLMs varied significantly across different prompt engineering setups. For instance, when applying the self-consistency approach in QWEN, the F1-score improved by 5%, with precision increasing by 7.9%, outperforming the zero-shot method. Likewise, ChatGLM2 delivered similar rates of accurately generated responses. During the analysis, the BERT series served as a comparative model with comparable results. Among the 3 models, MC-BERT demonstrated the highest level of performance. However, the differences among the versions of BERT in this study were relatively insignificant. Conclusions: After applying LLMs to standardize diagnoses and designing 4 different prompts, we compared the results to those generated by the BERT model. Our findings indicate that QWEN prompts largely outperformed the other prompts, with precision comparable to that of the BERT model. These results demonstrate the potential of unsupervised approaches in improving the efficiency of aligning diagnostic terms in daily research and uncovering hidden information values in patient data. %M 38329787 %R 10.2196/53216 %U https://formative.jmir.org/2024/1/e53216 %U https://doi.org/10.2196/53216 %U http://www.ncbi.nlm.nih.gov/pubmed/38329787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50465 %T Efficacy of Digital Outreach Strategies for Collecting Smoking Data: Pragmatic Randomized Trial %A Kearney,Lauren E %A Jansen,Emily %A Kathuria,Hasmeena %A Steiling,Katrina %A Jones,Kayla C %A Walkey,Allan %A Cordella,Nicholas %+ The Pulmonary Center, Boston University, 72 East Concord Street, Boston, MA, 02118, United States, 1 9788070286, lekearn@bu.edu %K electronic health records %K EHR %K informatics %K learning health system %K lung cancer screening %K smoking history %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco smoking is an important risk factor for disease, but inaccurate smoking history data in the electronic medical record (EMR) limits the reach of lung cancer screening (LCS) and tobacco cessation interventions. Patient-generated health data is a novel approach to documenting smoking history; however, the comparative effectiveness of different approaches is unclear. Objective: We designed a quality improvement intervention to evaluate the effectiveness of portal questionnaires compared to SMS text message–based surveys, to compare message frames, and to evaluate the completeness of patient-generated smoking histories. Methods: We randomly assigned patients aged between 50 and 80 years with a history of tobacco use who identified English as a preferred language and have never undergone LCS to receive an EMR portal questionnaire or a text survey. The portal questionnaire used a “helpfulness” message, while the text survey tested frame types informed by behavior economics (“gain,” “loss,” and “helpfulness”) and nudge messaging. The primary outcome was the response rate for each modality and framing type. Completeness and consistency with documented structured smoking data were also evaluated. Results: Participants were more likely to respond to the text survey (191/1000, 19.1%) compared to the portal questionnaire (35/504, 6.9%). Across all text survey rounds, patients were less responsive to the “helpfulness” frame compared with the “gain” frame (odds ratio [OR] 0.29, 95% CI 0.09-0.91; P<.05) and “loss” frame (OR 0.32, 95% CI 11.8-99.4; P<.05). Compared to the structured data in the EMR, the patient-generated data were significantly more likely to be complete enough to determine LCS eligibility both compared to the portal questionnaire (OR 34.2, 95% CI 3.8-11.1; P<.05) and to the text survey (OR 6.8, 95% CI 3.8-11.1; P<.05). Conclusions: We found that an approach using patient-generated data is a feasible way to engage patients and collect complete smoking histories. Patients are likely to respond to a text survey using “gain” or “loss” framing to report detailed smoking histories. Optimizing an SMS text message approach to collect medical information has implications for preventative and follow-up clinical care beyond smoking histories, LCS, and smoking cessation therapy. %M 38335012 %R 10.2196/50465 %U https://formative.jmir.org/2024/1/e50465 %U https://doi.org/10.2196/50465 %U http://www.ncbi.nlm.nih.gov/pubmed/38335012 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50839 %T mHealth App Usability Questionnaire for Stand-Alone mHealth Apps Used by Health Care Providers: Canadian French Translation, Cross-Cultural Adaptation, and Validation (Part 1) %A Gagnon,Julie %A Probst,Sebastian %A Chartrand,Julie %A Lalonde,Michelle %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8L1, Canada, 1 613 562 5700, jgagn156@uottawa.ca %K cross-cultural adaptation %K French language %K mHealth App Usability Questionnaire %K MAUQ %K mobile health %K mHealth %K mobile app %K questionnaire translation %K usability %K validation %K health care providers %K French translation %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An increasing number of health care professionals are using mobile apps. The mHealth App Usability Questionnaire (MAUQ) was designed to evaluate the usability of mobile health apps by patients and providers. However, this questionnaire is not available in French. Objective: This study aims to translate (from English to Canadian French), cross-culturally adapt, and initiate the validation of the original version of MAUQ for stand-alone mobile health apps used by French-speaking health care providers. Methods: A cross-cultural research study using a well-established method was conducted to translate MAUQ to Canadian French by certified translators and subsequently review it with a translation committee. It was then back translated to English. The back translations were compared with the original by the members of the committee to reach consensus regarding the prefinal version. A pilot test of the prefinal version was conducted with a sample of 49 potential users and 10 experts for content validation. Results: The statements are considered clear, with interrater agreement of 99.14% among potential users and 90% among experts. Of 21 statements, 5 (24%) did not exceed the 80% interrater agreement of the experts regarding clarity. Following the revisions, interrater agreement exceeded 80%. The content validity index of the items varied from 0.90 to 1, and the overall content validity index was 0.981. Individual Fleiss multirater κ of each item was between 0.89 and 1, showing excellent agreement and increasing confidence in the questionnaire’s content validity. Conclusions: This process of translation and cultural adaptation produced a new version of MAUQ that was validated for later use among the Canadian French–speaking population. An upcoming separate study will investigate the psychometric properties of the adapted questionnaire. %M 38349710 %R 10.2196/50839 %U https://formative.jmir.org/2024/1/e50839 %U https://doi.org/10.2196/50839 %U http://www.ncbi.nlm.nih.gov/pubmed/38349710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53316 %T Predictive Criterion Validity of the Parsley Symptom Index Against the Patient-Reported Outcomes Measurement Information System-10 in a Chronic Disease Cohort: Retrospective Cohort Study %A Williams,Hants %A Steinberg,Sarah %A Leon,Kendall %A Vingum,Ryan %A Hu,Mengyao %A Berzin,Robin %A Hagg,Heather %A Hanaway,Patrick %+ Applied Health Informatics, School of Health Professions, Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11794, United States, 1 631 444 2252, hantsawilliams@gmail.com %K chronic disease %K eHealth %K ePROM %K mHealth %K Parsley Symptom Index %K patient-reported outcome measure %K PROM %K PSI %K telehealth %K telemedicine %K validation %K web-based %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 60% of US adults live with chronic disease, imposing a significant burden on patients and the health care system. With the rise of telehealth, patient-reported outcomes measures (PROMs) have emerged as pivotal tools for managing chronic disease. While numerous PROMs exist, few have been designed explicitly for telehealth settings. The Parsley Symptom Index (PSI) is an electronic patient-reported outcome measure (ePROM) developed specifically for telehealth environments. Objective: Our aim is to determine whether the PSI predicts changes in the established Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10) Global Health, a 10-question short form. Methods: We conducted a retrospective cohort study using data from 367 unique patients, amassing 1170 observations between August 30, 2017, and January 30, 2023. Patients completed the PSI and the PROMIS-10 multiple times throughout the study period. Using univariate regression models, we assess the predictive criterion validity of the PSI against PROMIS-10 scores. Results: This study revealed significant relationships between the PSI and PROMIS-10 physical and mental health scores through comprehensive univariate analyses, thus establishing support for the criterion validity of the PSI. These analyses highlighted the PSI’s potential as an insightful tool for understanding and predicting both mental and physical health dimensions. Conclusions: Our findings emphasize the importance of the PSI in capturing the nuanced interactions between symptomatology and health outcomes. These insights reinforce the value of the PSI in clinical contexts and support its potential as a versatile tool in both research and practice. %M 38363587 %R 10.2196/53316 %U https://formative.jmir.org/2024/1/e53316 %U https://doi.org/10.2196/53316 %U http://www.ncbi.nlm.nih.gov/pubmed/38363587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51248 %T Daily Activity Lifelogs of People With Heart Failure: Observational Study %A Tegegne,Teketo Kassaw %A Tran,Ly-Duyen %A Nourse,Rebecca %A Gurrin,Cathal %A Maddison,Ralph %+ Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 0406722673, teketo.tegegne@deakin.edu.au %K heart failure %K self-management %K lifelogs %K daily activity %K wearable camera %K E-Myscéal %K activities of daily living %K ADL %K intervention %K self-report method %K wearable %K chronic condition %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, heart failure (HF) affects more than 64 million people, and attempts to reduce its social and economic burden are a public health priority. Interventions to support people with HF to self-manage have been shown to reduce hospitalizations, improve quality of life, and reduce mortality rates. Understanding how people self-manage is imperative to improve future interventions; however, most approaches to date, have used self-report methods to achieve this. Wearable cameras provide a unique tool to understand the lived experiences of people with HF and the daily activities they undertake, which could lead to more effective interventions. However, their potential for understanding chronic conditions such as HF is unclear. Objective: This study aimed to determine the potential utility of wearable cameras to better understand the activities of daily living in people living with HF. Methods: The “Seeing is Believing (SIB)” study involved 30 patients with HF who wore wearable cameras for a maximum of 30 days. We used the E-Myscéal web-based lifelog retrieval system to process and analyze the wearable camera image data set. Search terms for 7 daily activities (physical activity, gardening, shopping, screen time, drinking, eating, and medication intake) were developed and used for image retrieval. Sensitivity analysis was conducted to compare the number of images retrieved using different search terms. Temporal patterns in daily activities were examined, and differences before and after hospitalization were assessed. Results: E-Myscéal exhibited sensitivity to specific search terms, leading to significant variations in the number of images retrieved for each activity. The highest number of images returned were related to eating and drinking, with fewer images for physical activity, screen time, and taking medication. The majority of captured activities occurred before midday. Notably, temporal differences in daily activity patterns were observed for participants hospitalized during this study. The number of medication images increased after hospital discharge, while screen time images decreased. Conclusions: Wearable cameras offer valuable insights into daily activities and self-management in people living with HF. E-Myscéal efficiently retrieves relevant images, but search term sensitivity underscores the need for careful selection. %M 38381484 %R 10.2196/51248 %U https://formative.jmir.org/2024/1/e51248 %U https://doi.org/10.2196/51248 %U http://www.ncbi.nlm.nih.gov/pubmed/38381484 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48954 %T Designing and Validating a Novel Method for Assessing Delay Discounting Associated With Health Behaviors: Ecological Momentary Assessment Study %A Luken,Amanda %A Rabinowitz,Jill A %A Wells,Jonathan L %A Sosnowski,David W %A Strickland,Justin C %A Thrul,Johannes %A Kirk,Gregory D %A Maher,Brion S %+ Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 212055, United States, 1 4432878287, brion@jhu.edu %K delay discounting %K measurement %K Monetary Choice Questionnaire %K ecological momentary assessment %K substance use %K substance abuse %K questionnaire %K validity %K validation %K measurement %K monetary %K reward %K rewards %K survey %K mobile phone %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delay discounting quantifies an individual’s preference for smaller, short-term rewards over larger, long-term rewards and represents a transdiagnostic factor associated with numerous adverse health outcomes. Rather than a fixed trait, delay discounting may vary over time and place, influenced by individual and contextual factors. Continuous, real-time measurement could inform adaptive interventions for various health conditions. Objective: The goals of this paper are 2-fold. First, we present and validate a novel, short, ecological momentary assessment (EMA)–based delay discounting scale we developed. Second, we assess this tool’s ability to reproduce known associations between delay discounting and health behaviors (ie, substance use and craving) using a convenience-based sample. Methods: Participants (N=97) were adults (age range 18-71 years), recruited on social media. In phase 1, data were collected on participant sociodemographic characteristics, and delay discounting was evaluated via the traditional Monetary Choice Questionnaire (MCQ) and our novel method (ie, 7-item time-selection and 7-item monetary-selection scales). During phase 2 (approximately 6 months later), participants completed the MCQ, our novel delay discounting measures, and health outcomes questions. The correlations between our method and the traditional MCQ within and across phases were examined. For scale reduction, a random number of items were iteratively selected, and the correlation between the full and random scales was assessed. We then examined the association between our time- and monetary-selection scales assessed during phase 2 and the percentage of assessments that participants endorsed using or craving alcohol, tobacco, or cannabis. Results: In total, 6 of the 7 individual time-selection items were highly correlated with the full scale (r>0.89). Both time-selection (r=0.71; P<.001) and monetary-selection (r=0.66; P<.001) delay discounting rates had high test-retest reliability across phases 1 and 2. Phase 1 MCQ delay discounting function highly correlated with phase 1 (r=0.76; P<.001) and phase 2 (r=0.45; P<.001) time-selection delay discounting scales. One or more randomly chosen time-selection items were highly correlated with the full scale (r>0.94). Greater delay discounting measured via the time-selection measure (adjusted mean difference=5.89, 95% CI 1.99-9.79), but not the monetary-selection scale (adjusted mean difference=–0.62, 95% CI –3.57 to 2.32), was associated with more past-hour tobacco use endorsement in follow-up surveys. Conclusions: This study evaluated a novel EMA-based scale’s ability to validly and reliably assess delay discounting. By measuring delay discounting with fewer items and in situ via EMA in natural environments, researchers may be better able to identify individuals at risk for poor health outcomes. %M 38412027 %R 10.2196/48954 %U https://formative.jmir.org/2024/1/e48954 %U https://doi.org/10.2196/48954 %U http://www.ncbi.nlm.nih.gov/pubmed/38412027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49905 %T The Influence of Human Connections and Collaboration on Research Grant Success at Various Career Stages: Regression Analysis %A Hashiguchi,Akiko %A Asashima,Makoto %A Takahashi,Satoru %+ Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan, 81 298537276, hashiguchi.akiko.ge@u.tsukuba.ac.jp %K biomedical researchers %K grant success %K human connection %K peer researchers %K synergistic collaborations %K research development %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Documenting the grant acquisition characteristics of a highly selective group of researchers could provide insights into the research and faculty development of talented individuals, and the insights gained to foster such researchers will help university management strengthen their research capacity. Objective: This study examines the role of human connections in the success of biomedical researchers in Japanese universities. Methods: This study used grant data from the Grants-in-Aid for Scientific Research (GIA) program, the largest competitive research funding program in Japan, to collect information on projects and their implementation systems obtained throughout the participants’ careers. Grant success was measured by the number and amounts of the awards obtained while participants occupied the role of principal investigator. Human connections were quantified by the number of projects in which the participants took part as members and were classified by their relationship with the project leader. Data were matched with information on career history, publication performance, and experience of the participants with government-funded programs apart from GIA and were analyzed using univariate and multivariate regression analyses. Results: Early-career interpersonal relationships, as measured using the h-index value of the researchers who provided the participants with their initial experience as project members, had a positive effect on grant success. The experience of contributing to prestigious research programs led by top researchers dramatically increased the cumulative amount of GIA awards received by the participants over time. Univariate logistic regression analyses revealed that more interactions with upper-level researchers resulted in fewer acquisitions of large programs (odds ratio [OR] 0.67, 95% CI 0.50-0.89). Collaboration with peers increased the success rate of ≥2 research grants in large programs in situations in which both the participant and project leader were professors (OR 1.16, 95% CI 1.06-1.26). Tracking the process of research development, we found that collaboration during the periods of 10 to 14 years and 15 to 19 years after completing a doctorate degree determined the size of the project that the participant would obtain—interactions with peer researchers and subordinates during the 10- to 14-year postdegree period had positive effects on ≥2 large-program acquisitions (OR 1.51, 95% CI 1.09-2.09 and OR 1.31, 95% CI 1.10-1.57, respectively), whereas interactions with subordinates during the 15- to 19-year postdegree period also had positive effects (OR 1.25, 95% CI 1.06-1.47). Furthermore, relationships that remained narrowly focused resulted in limited grant success for small programs. Conclusions: Human networking is important for improving an individual’s ability to obtain external funding. The results emphasize the importance of having a high-h-indexed collaborator to obtain quality information early in one’s career; working with diverse, nonsupervisory personnel at the midcareer stage; and engaging in synergistic collaborations upon establishing a research area in which one can take more initiatives. %M 38416548 %R 10.2196/49905 %U https://formative.jmir.org/2024/1/e49905 %U https://doi.org/10.2196/49905 %U http://www.ncbi.nlm.nih.gov/pubmed/38416548 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48894 %T Identifying Unmet Needs in Major Depressive Disorder Using a Computer-Assisted Alternative to Conventional Thematic Analysis: Qualitative Interview Study With Psychiatrists %A Worthington,Michelle A %A Christie,Richard H %A Masino,Aaron J %A Kark,Sarah M %+ AiCure, 214 Sullivan Street 6C, New York, NY, 10012, United States, 1 (800) 570 0448, sarah.kark@aicure.com %K consumer health informatics %K interview %K major depressive disorder %K medical informatics applications %K needs assessment %K psychiatry and psychology %D 2024 %7 1.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of digital health tools that are clinically relevant requires a deep understanding of the unmet needs of stakeholders, such as clinicians and patients. One way to reveal unforeseen stakeholder needs is through qualitative research, including stakeholder interviews. However, conventional qualitative data analytical approaches are time-consuming and resource-intensive, rendering them untenable in many industry settings where digital tools are conceived of and developed. Thus, a more time-efficient process for identifying clinically relevant target needs for digital tool development is needed. Objective: The objective of this study was to address the need for an accessible, simple, and time-efficient alternative to conventional thematic analysis of qualitative research data through text analysis of semistructured interview transcripts. In addition, we sought to identify important themes across expert psychiatrist advisor interview transcripts to efficiently reveal areas for the development of digital tools that target unmet clinical needs. Methods: We conducted 10 (1-hour-long) semistructured interviews with US-based psychiatrists treating major depressive disorder. The interviews were conducted using an interview guide that comprised open-ended questions predesigned to (1) understand the clinicians’ experience of the care management process and (2) understand the clinicians’ perceptions of the patients’ experience of the care management process. We then implemented a hybrid analytical approach that combines computer-assisted text analyses with deductive analyses as an alternative to conventional qualitative thematic analysis to identify word combination frequencies, content categories, and broad themes characterizing unmet needs in the care management process. Results: Using this hybrid computer-assisted analytical approach, we were able to identify several key areas that are of interest to clinicians in the context of major depressive disorder and would be appropriate targets for digital tool development. Conclusions: A hybrid approach to qualitative research combining computer-assisted techniques with deductive techniques provides a time-efficient approach to identifying unmet needs, targets, and relevant themes to inform digital tool development. This can increase the likelihood that useful and practical tools are built and implemented to ultimately improve health outcomes for patients. %M 38427407 %R 10.2196/48894 %U https://formative.jmir.org/2024/1/e48894 %U https://doi.org/10.2196/48894 %U http://www.ncbi.nlm.nih.gov/pubmed/38427407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48823 %T Risk Identification in Perinatal Health Care Settings via Technology-Based Recruitment Methods: Comparative Study %A Beatty,Jessica R %A Zelenak,Logan %A Gillon,Spencer %A McGoron,Lucy %A Goyert,Gregory %A Ondersma,Steven J %+ Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Room 368, Flint, MI, 48502, United States, 1 313 444 9797, onders12@msu.edu %K participant recruitment %K engagement %K health care screening %K mobile phone %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital screening and intervention tools have shown promise in the identification and reduction of substance use in health care settings. However, research in this area is impeded by challenges in integrating recruitment efforts into ongoing clinical workflows or staffing multiple study clinics with full-time research assistants, as well as by the underreporting of substance use. Objective: The aim of the study is to evaluate pragmatic methods for facilitating study recruitment in health care settings by examining recruitment rates and participant characteristics using in-person–based versus flyer approaches. Methods: This study compared recruitment rates at a Women’s Health clinic in the Midwest under 2 different recruitment strategies: in person versus via a flyer with a QR code. We also examined the disclosure of substance use and risk screener positivity for the 2 strategies. We also obtained information about the current use of technology and willingness to use it for study participation. Results: A greater percentage of patients recruited in person participated than those recruited via flyers (57/63, 91% vs 64/377, 17%). However, the final number recruited in each group was roughly equal (n=57 vs n=64). Additionally, participants recruited via flyers were more likely to screen positive for alcohol use risk on the Tolerance, Annoyed, Cut Down, Eye-Opener alcohol screen than those recruited at the clinic (24/64, 38% vs 11/57, 19%; χ21=4.9; P=.03). Participants recruited via flyers were also more likely to screen positive for drug use risk on the Wayne Indirect Drug Use Screener than those recruited at the clinic (20/64, 31% vs 9/57, 16%; χ21=4.0; P=.05). Furthermore, of the 121 pregnant women, 117 (96.7%) reported owning a smartphone, 111 (91.7%) had an SMS text message plan on their phone, and 94 (77.7%) reported being willing to receive SMS text messages or participate in a study if sent a link to their phone. Conclusions: The distribution of flyers with a QR code by medical staff appears to be an efficient and cost-effective method of recruitment that also facilitates disclosure while reducing the impact on clinic workflows. This method of recruitment can be useful for data collection at multiple locations and lead to larger samples across and between health systems. Participant recruitment via technology in perinatal health care appears to facilitate disclosure, particularly when participants can learn about the research and complete screening using their own device at a place and time convenient for them. Pregnant women in an urban Midwestern hospital had access to and were comfortable using technology. %M 38437004 %R 10.2196/48823 %U https://formative.jmir.org/2024/1/e48823 %U https://doi.org/10.2196/48823 %U http://www.ncbi.nlm.nih.gov/pubmed/38437004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49411 %T Machine Learning–Based Approach for Identifying Research Gaps: COVID-19 as a Case Study %A Abd-alrazaq,Alaa %A Nashwan,Abdulqadir J %A Shah,Zubair %A Abujaber,Ahmad %A Alhuwail,Dari %A Schneider,Jens %A AlSaad,Rawan %A Ali,Hazrat %A Alomoush,Waleed %A Ahmed,Arfan %A Aziz,Sarah %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, A031, Weill Cornell Medicine-Qatar, Education City, Al Luqta St, Doha, 23435, Qatar, 974 55708599, aaa4027@qatar-med.cornell.edu %K research gaps %K research gap %K research topic %K research topics %K scientific literature %K literature review %K machine learning %K COVID-19 %K BERTopic %K topic clustering %K text analysis %K BERT %K NLP %K natural language processing %K review methods %K review methodology %K SARS-CoV-2 %K coronavirus %K COVID %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research gaps refer to unanswered questions in the existing body of knowledge, either due to a lack of studies or inconclusive results. Research gaps are essential starting points and motivation in scientific research. Traditional methods for identifying research gaps, such as literature reviews and expert opinions, can be time consuming, labor intensive, and prone to bias. They may also fall short when dealing with rapidly evolving or time-sensitive subjects. Thus, innovative scalable approaches are needed to identify research gaps, systematically assess the literature, and prioritize areas for further study in the topic of interest. Objective: In this paper, we propose a machine learning–based approach for identifying research gaps through the analysis of scientific literature. We used the COVID-19 pandemic as a case study. Methods: We conducted an analysis to identify research gaps in COVID-19 literature using the COVID-19 Open Research (CORD-19) data set, which comprises 1,121,433 papers related to the COVID-19 pandemic. Our approach is based on the BERTopic topic modeling technique, which leverages transformers and class-based term frequency-inverse document frequency to create dense clusters allowing for easily interpretable topics. Our BERTopic-based approach involves 3 stages: embedding documents, clustering documents (dimension reduction and clustering), and representing topics (generating candidates and maximizing candidate relevance). Results: After applying the study selection criteria, we included 33,206 abstracts in the analysis of this study. The final list of research gaps identified 21 different areas, which were grouped into 6 principal topics. These topics were: “virus of COVID-19,” “risk factors of COVID-19,” “prevention of COVID-19,” “treatment of COVID-19,” “health care delivery during COVID-19,” “and impact of COVID-19.” The most prominent topic, observed in over half of the analyzed studies, was “the impact of COVID-19.” Conclusions: The proposed machine learning–based approach has the potential to identify research gaps in scientific literature. This study is not intended to replace individual literature research within a selected topic. Instead, it can serve as a guide to formulate precise literature search queries in specific areas associated with research questions that previous publications have earmarked for future exploration. Future research should leverage an up-to-date list of studies that are retrieved from the most common databases in the target area. When feasible, full texts or, at minimum, discussion sections should be analyzed rather than limiting their analysis to abstracts. Furthermore, future studies could evaluate more efficient modeling algorithms, especially those combining topic modeling with statistical uncertainty quantification, such as conformal prediction. %M 38441952 %R 10.2196/49411 %U https://formative.jmir.org/2024/1/e49411 %U https://doi.org/10.2196/49411 %U http://www.ncbi.nlm.nih.gov/pubmed/38441952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e40868 %T Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation %A Burch,Vanessa %A McGuire,Jessica %A Buch,Eric %A Sathekge,Mike %A M'bouaffou,Francis %A Senkubuge,Flavia %A Fagan,Johannes %+ The Colleges of Medicine of South Africa, 17 Milner Rd, Cape Town, 7700, South Africa, 27 216899533, vanessa.burch@cmsa.co.za %K web-based certification examinations %K web-based structured oral examinations %K medical education %K specialist and subspecialist examinations %K structured oral examinations %K Colleges of Medicine of South Africa %D 2024 %7 6.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. Objective: This formative evaluation explored candidates’ acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates’ overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. Methods: This mixed methods, single-arm evaluation anonymously gathered candidates’ perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. Results: Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4%) withdrew, 2812 (90.6%) wrote, and 2799 (99.9%) passed, and 1525 (54.2%) were invited to a further web-based SOE. Examination participation was 96.2% (n=1467). During the first web-based examination cycle (2020), 542 (87.1%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69%) and adequately testing their clinical reasoning and insight (396/542, 73.1%). Few would have preferred real patient encounters (173/542, 31.9%) or in-person oral examinations (152/542, 28%). Most found Zoom acceptable (434/542, 80%) and fair (396/542, 73.1%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80%) and time (428/542, 79%) savings for candidates. Many (336/542, 62%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39%) and 2021 (850/1067, 79.66%). These were significantly higher (2020: N=8635; χ21=667; P<.001; 2021: N=7988; χ21=178; P<.001) than the previous in-person certification examination pass rate of 58.23% (4030/6921; 2017-2019). Conclusions: Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method. %M 38064633 %R 10.2196/40868 %U https://formative.jmir.org/2024/1/e40868 %U https://doi.org/10.2196/40868 %U http://www.ncbi.nlm.nih.gov/pubmed/38064633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54732 %T Development of a Social Risk Score in the Electronic Health Record to Identify Social Needs Among Underserved Populations: Retrospective Study %A Hatef,Elham %A Chang,Hsien-Yen %A Richards,Thomas M %A Kitchen,Christopher %A Budaraju,Janya %A Foroughmand,Iman %A Lasser,Elyse C %A Weiner,Jonathan P %+ Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, 624 N Broadway, Room 502, Baltimore, MD, 21205, United States, 1 4109788006, ehatef1@jhu.edu %K AI %K algorithms %K artificial intelligence %K community health %K deep learning %K EHR %K electronic health record %K machine learning %K ML %K population demographics %K population health %K practical models %K predictive analytics %K predictive modeling %K predictive modelling %K predictive models %K predictive system %K public health %K public surveillance %K SDOH %K social determinants of health %K social needs %K social risks %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with unmet social needs and social determinants of health (SDOH) challenges continue to face a disproportionate risk of increased prevalence of disease, health care use, higher health care costs, and worse outcomes. Some existing predictive models have used the available data on social needs and SDOH challenges to predict health-related social needs or the need for various social service referrals. Despite these one-off efforts, the work to date suggests that many technical and organizational challenges must be surmounted before SDOH-integrated solutions can be implemented on an ongoing, wide-scale basis within most US-based health care organizations. Objective: We aimed to retrieve available information in the electronic health record (EHR) relevant to the identification of persons with social needs and to develop a social risk score for use within clinical practice to better identify patients at risk of having future social needs. Methods: We conducted a retrospective study using EHR data (2016-2021) and data from the US Census American Community Survey. We developed a prospective model using current year-1 risk factors to predict future year-2 outcomes within four 2-year cohorts. Predictors of interest included demographics, previous health care use, comorbidity, previously identified social needs, and neighborhood characteristics as reflected by the area deprivation index. The outcome variable was a binary indicator reflecting the likelihood of the presence of a patient with social needs. We applied a generalized estimating equation approach, adjusting for patient-level risk factors, the possible effect of geographically clustered data, and the effect of multiple visits for each patient. Results: The study population of 1,852,228 patients included middle-aged (mean age range 53.76-55.95 years), White (range 324,279/510,770, 63.49% to 290,688/488,666, 64.79%), and female (range 314,741/510,770, 61.62% to 278,488/448,666, 62.07%) patients from neighborhoods with high socioeconomic status (mean area deprivation index percentile range 28.76-30.31). Between 8.28% (37,137/448,666) and 11.55% (52,037/450,426) of patients across the study cohorts had at least 1 social need documented in their EHR, with safety issues and economic challenges (ie, financial resource strain, employment, and food insecurity) being the most common documented social needs (87,152/1,852,228, 4.71% and 58,242/1,852,228, 3.14% of overall patients, respectively). The model had an area under the curve of 0.702 (95% CI 0.699-0.705) in predicting prospective social needs in the overall study population. Previous social needs (odds ratio 3.285, 95% CI 3.237-3.335) and emergency department visits (odds ratio 1.659, 95% CI 1.634-1.684) were the strongest predictors of future social needs. Conclusions: Our model provides an opportunity to make use of available EHR data to help identify patients with high social needs. Our proposed social risk score could help identify the subset of patients who would most benefit from further social needs screening and data collection to avoid potentially more burdensome primary data collection on all patients in a target population of interest. %M 38470477 %R 10.2196/54732 %U https://formative.jmir.org/2024/1/e54732 %U https://doi.org/10.2196/54732 %U http://www.ncbi.nlm.nih.gov/pubmed/38470477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53742 %T Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study %A Abdulai,Abdul-Fatawu %A Naghdali,Hasti %A Noga,Heather %A Yong,Paul J %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 604 822 7214, fatawu.abdulai@ubc.ca %K stigma %K digital health %K sexual pain %K destigmatizing %K end user patients %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients. Objective: The purpose of this study was to understand patients’ perspectives on how sexual pain–related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions. Methods: Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis. Results: The findings revealed 4 overarching themes that represented participants’ perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain. Conclusions: This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions. %M 38488844 %R 10.2196/53742 %U https://formative.jmir.org/2024/1/e53742 %U https://doi.org/10.2196/53742 %U http://www.ncbi.nlm.nih.gov/pubmed/38488844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49822 %T Investigating the Roles and Responsibilities of Institutional Signing Officials After Data Sharing Policy Reform for Federally Funded Research in the United States: National Survey %A Baek,Jinyoung %A Lawson,Jonathan %A Rahimzadeh,Vasiliki %+ Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Suite 310DF, Houston, TX, 77030, United States, 1 (713) 798 3500, vasiliki.rahimzadeh@bcm.edu %K biomedical research %K survey %K surveys %K data sharing %K data management %K secondary use %K National Institutes of Health %K signing official %K information sharing %K exchange %K access %K data science %K accessibility %K policy %K policies %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: New federal policies along with rapid growth in data generation, storage, and analysis tools are together driving scientific data sharing in the United States. At the same, triangulating human research data from diverse sources can also create situations where data are used for future research in ways that individuals and communities may consider objectionable. Institutional gatekeepers, namely, signing officials (SOs), are therefore at the helm of compliant management and sharing of human data for research. Of those with data governance responsibilities, SOs most often serve as signatories for investigators who deposit, access, and share research data between institutions. Although SOs play important leadership roles in compliant data sharing, we know surprisingly little about their scope of work, roles, and oversight responsibilities. Objective: The purpose of this study was to describe existing institutional policies and practices of US SOs who manage human genomic data access, as well as how these may change in the wake of new Data Management and Sharing requirements for National Institutes of Health–funded research in the United States. Methods: We administered an anonymous survey to institutional SOs recruited from biomedical research institutions across the United States. Survey items probed where data generated from extramurally funded research are deposited, how researchers outside the institution access these data, and what happens to these data after extramural funding ends. Results: In total, 56 institutional SOs participated in the survey. We found that SOs frequently approve duplicate data deposits and impose stricter access controls when data use limitations are unclear or unspecified. In addition, 21% (n=12) of SOs knew where data from federally funded projects are deposited after project funding sunsets. As a consequence, most investigators deposit their scientific data into “a National Institutes of Health–funded repository” to meet the Data Management and Sharing requirements but also within the “institution’s own repository” or a third-party repository. Conclusions: Our findings inform 5 policy recommendations and best practices for US SOs to improve coordination and develop comprehensive and consistent data governance policies that balance the need for scientific progress with effective human data protections. %M 38506894 %R 10.2196/49822 %U https://formative.jmir.org/2024/1/e49822 %U https://doi.org/10.2196/49822 %U http://www.ncbi.nlm.nih.gov/pubmed/38506894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52462 %T Automated Category and Trend Analysis of Scientific Articles on Ophthalmology Using Large Language Models: Development and Usability Study %A Raja,Hina %A Munawar,Asim %A Mylonas,Nikolaos %A Delsoz,Mohammad %A Madadi,Yeganeh %A Elahi,Muhammad %A Hassan,Amr %A Abu Serhan,Hashem %A Inam,Onur %A Hernandez,Luis %A Chen,Hao %A Tran,Sang %A Munir,Wuqaas %A Abd-Alrazaq,Alaa %A Yousefi,Siamak %+ Department of Ophthalmology, University of Tennessee Health Science Center, 930 Madison Avenue, Ste. 468, Memphis, TN, 38111, United States, 1 9016595035, hinaraja65@gmail.com %K Bidirectional and Auto-Regressive Transformers %K BART %K bidirectional encoder representations from transformers %K BERT %K ophthalmology %K text classification %K large language model %K LLM %K trend analysis %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In this paper, we present an automated method for article classification, leveraging the power of large language models (LLMs). Objective: The aim of this study is to evaluate the applicability of various LLMs based on textual content of scientific ophthalmology papers. Methods: We developed a model based on natural language processing techniques, including advanced LLMs, to process and analyze the textual content of scientific papers. Specifically, we used zero-shot learning LLMs and compared Bidirectional and Auto-Regressive Transformers (BART) and its variants with Bidirectional Encoder Representations from Transformers (BERT) and its variants, such as distilBERT, SciBERT, PubmedBERT, and BioBERT. To evaluate the LLMs, we compiled a data set (retinal diseases [RenD] ) of 1000 ocular disease–related articles, which were expertly annotated by a panel of 6 specialists into 19 distinct categories. In addition to the classification of articles, we also performed analysis on different classified groups to find the patterns and trends in the field. Results: The classification results demonstrate the effectiveness of LLMs in categorizing a large number of ophthalmology papers without human intervention. The model achieved a mean accuracy of 0.86 and a mean F1-score of 0.85 based on the RenD data set. Conclusions: The proposed framework achieves notable improvements in both accuracy and efficiency. Its application in the domain of ophthalmology showcases its potential for knowledge organization and retrieval. We performed a trend analysis that enables researchers and clinicians to easily categorize and retrieve relevant papers, saving time and effort in literature review and information gathering as well as identification of emerging scientific trends within different disciplines. Moreover, the extendibility of the model to other scientific fields broadens its impact in facilitating research and trend analysis across diverse disciplines. %M 38517457 %R 10.2196/52462 %U https://formative.jmir.org/2024/1/e52462 %U https://doi.org/10.2196/52462 %U http://www.ncbi.nlm.nih.gov/pubmed/38517457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48783 %T Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey %A Choi,Soyoung %+ Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 272 Freer Hall, 906 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 2173332573, soyoung@illinois.edu %K college students %K personal health data %K self-tracking %K eHealth literacy %K well-being %K tracking %K students %K disability %K cross-sectional survey %K pediatric care %K adult care %K smartphone health app %K application %K literacy %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors. Objective: As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students. Methods: The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants. Results: More than 80% (563/702, 80.2%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=–5.97, P<.001) and perceived efficacy (t411=–4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status (β=3.81, P<.001), self-tracking health practices (β=2.22, P=.03), and eHealth literacy (β=24.29, P<.001). Conclusions: Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students. %M 38598285 %R 10.2196/48783 %U https://formative.jmir.org/2024/1/e48783 %U https://doi.org/10.2196/48783 %U http://www.ncbi.nlm.nih.gov/pubmed/38598285 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55795 %T Examining and Comparing the Validity and Reproducibility of Scales to Determine the Variety of Vegetables Consumed: Validation Study %A Ominami,Kaya %A Kushida,Osamu %+ Department of Nutrition and Life Sciences, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan, 81 542645832, kushida@u-shizuoka-ken.ac.jp %K vegetable %K variety %K scale %K validity %K reproducibility %K dietary records %K nutrition %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies have reported that vegetable variety reduces the risk for noncommunicable diseases independent of the amount consumed. Objective: This study aimed to examine and compare the validity and reproducibility of several scales to determine vegetable variety. Methods: In total, 23 nutrition students in Japan reported their vegetable intake over the past month using a self-administered questionnaire between July and August 2021. Specifically, four scales were used: (1) a single question regarding the number of vegetables consumed (scale A); (2) a scale containing 9 vegetable subgroups included in the brief-type self-administered diet history questionnaire (scale B); (3) a scale containing 19 vegetable items included in a self-administered diet history questionnaire (scale C); and (4) a scale containing 20 vegetable items from the Ranking of Vegetable Consumers in Japan, which was analyzed based on a report on the National Health and Nutrition Survey in Japan (scale D). Scale validity was assessed by correlation with the number of vegetables consumed, which was collected from dietary records for 7 consecutive days. Reproducibility was assessed by test-retest reliability. Results: Regarding the validity of the 4 scales, significant correlations were found between scales C (ρ=0.51) and D (ρ=0.44) with vegetable variety based on dietary records, but scales A (ρ=0.28) and B (ρ=0.22) were not significantly correlated. Reproducibility showed a significant correlation in scale B (ρ=0.45) and strong correlations in scales C (ρ=0.73) and D (ρ=0.75). Conclusions: The scales for vegetable items have acceptable validity and reproducibility compared to the scales that used a single question or vegetable subgroup and, therefore, may determine the variety of vegetables consumed. %M 38603775 %R 10.2196/55795 %U https://formative.jmir.org/2024/1/e55795 %U https://doi.org/10.2196/55795 %U http://www.ncbi.nlm.nih.gov/pubmed/38603775 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55285 %T Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study %A Beverly,Elizabeth A %A Koopman-Gonzalez,Sarah %A Wright,Jackson %A Dungan,Kathleen %A Pallerla,Harini %A Gubitosi-Klug,Rose %A Baughman,Kristin %A Konstan,Michael W %A Bolen,Shari D %+ Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, 1 Ohio University, 122 Medical Education Center, Athens, OH, 45701, United States, 1 7405934616, beverle1@ohio.edu %K health collaborative %K cardiovascular disease %K type 2 diabetes %K needs assessment %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio’s Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Objective: Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. Methods: A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non–grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). Results: In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non–grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non–grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non–grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non–grant-funded members’ choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non–grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non–grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. Conclusions: Cardi-OH grant- and non–grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers. %M 38607661 %R 10.2196/55285 %U https://formative.jmir.org/2024/1/e55285 %U https://doi.org/10.2196/55285 %U http://www.ncbi.nlm.nih.gov/pubmed/38607661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50475 %T Integrating Explainable Machine Learning in Clinical Decision Support Systems: Study Involving a Modified Design Thinking Approach %A Shulha,Michael %A Hovdebo,Jordan %A D’Souza,Vinita %A Thibault,Francis %A Harmouche,Rola %+ Lady Davis Institute for Medical Research, Jewish General Hospital, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Ouest-de-l'Île-de-Montréal, Pavilion B-274, 3755 Chem. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada, 1 514 340 8222, michael.shulha.ccomtl@ssss.gouv.qc.ca %K explainable machine learning %K XML %K design thinking approach %K NASSS framework %K clinical decision support %K clinician engagement %K clinician-facing interface %K clinician trust in machine learning %K COVID-19 %K chest x-ray %K severity prediction %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Though there has been considerable effort to implement machine learning (ML) methods for health care, clinical implementation has lagged. Incorporating explainable machine learning (XML) methods through the development of a decision support tool using a design thinking approach is expected to lead to greater uptake of such tools. Objective: This work aimed to explore how constant engagement of clinician end users can address the lack of adoption of ML tools in clinical contexts due to their lack of transparency and address challenges related to presenting explainability in a decision support interface. Methods: We used a design thinking approach augmented with additional theoretical frameworks to provide more robust approaches to different phases of design. In particular, in the problem definition phase, we incorporated the nonadoption, abandonment, scale-up, spread, and sustainability of technology in health care (NASSS) framework to assess these aspects in a health care network. This process helped focus on the development of a prognostic tool that predicted the likelihood of admission to an intensive care ward based on disease severity in chest x-ray images. In the ideate, prototype, and test phases, we incorporated a metric framework to assess physician trust in artificial intelligence (AI) tools. This allowed us to compare physicians’ assessments of the domain representation, action ability, and consistency of the tool. Results: Physicians found the design of the prototype elegant, and domain appropriate representation of data was displayed in the tool. They appreciated the simplified explainability overlay, which only displayed the most predictive patches that cumulatively explained 90% of the final admission risk score. Finally, in terms of consistency, physicians unanimously appreciated the capacity to compare multiple x-ray images in the same view. They also appreciated the ability to toggle the explainability overlay so that both options made it easier for them to assess how consistently the tool was identifying elements of the x-ray image they felt would contribute to overall disease severity. Conclusions: The adopted approach is situated in an evolving space concerned with incorporating XML or AI technologies into health care software. We addressed the alignment of AI as it relates to clinician trust, describing an approach to wire framing and prototyping, which incorporates the use of a theoretical framework for trust in the design process itself. Moreover, we proposed that alignment of AI is dependent upon integration of end users throughout the larger design process. Our work shows the importance and value of engaging end users prior to tool development. We believe that the described approach is a unique and valuable contribution that outlines a direction for ML experts, user experience designers, and clinician end users on how to collaborate in the creation of trustworthy and usable XML-based clinical decision support tools. %M 38625728 %R 10.2196/50475 %U https://formative.jmir.org/2024/1/e50475 %U https://doi.org/10.2196/50475 %U http://www.ncbi.nlm.nih.gov/pubmed/38625728 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48767 %T Recruitment Strategies in the Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization Study (meSH): Multicenter Survey Study %A Nwosu,Chinonyelum %A Khan,Hamda %A Masese,Rita %A Nocek,Judith M %A Gollan,Siera %A Varughese,Taniya %A Bourne,Sarah %A Clesca,Cindy %A Jacobs,Sara R %A Baumann,Ana %A Klesges,Lisa M %A Shah,Nirmish %A Hankins,Jane S %A Smeltzer,Matthew P %+ The University of Memphis, 222 Robison Hall, Memphis, TN, 38152, United States, 1 901 678 3702, msmltzer@memphis.edu %K sickle cell %K recruitment %K eHealth %K multicenter %K utilization %K strategy %K hydroxyurea %K mobile health %K mhealth %K intervention %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hydroxyurea is an evidence-based disease-modifying therapy for sickle cell disease (SCD) but is underutilized. The Integration of Mobile Health into Sickle Cell Disease Care to Increase Hydroxyurea Utilization (meSH) multicenter study leveraged mHealth to deliver targeted interventions to patients and providers. SCD studies often underenroll; and recruitment strategies in the SCD population are not widely studied. Unanticipated events can negatively impact enrollment, making it important to study strategies that ensure adequate study accrual. Objective: The goal of this study was to evaluate enrollment barriers and the impact of modified recruitment strategies among patients and providers in the meSH study in response to a global emergency. Methods: Recruitment was anticipated to last 2 months for providers and 6 months for patients. The recruitment strategies used with patients and providers, new recruitment strategies, and recruitment rates were captured and compared. To document recruitment adaptations and their reasons, study staff responsible for recruitment completed an open-ended 9-item questionnaire eliciting challenges to recruitment and strategies used. Themes were extrapolated using thematic content analysis. Results: Total enrollment across the 7 sites included 89 providers and 293 patients. The study acceptance rate was 85.5% (382/447) for both patients and providers. The reasons patients declined participation were most frequently a lack of time and interest in research, while providers mostly declined because of self-perceived high levels of SCD expertise, believing they did not need the intervention. Initially, recruitment involved an in-person invitation to participate during clinic visits (patients), staff meetings (providers), or within the office (providers). We identified several important recruitment challenges, including (1) lack of interest in research, (2) lack of human resources, (3) unavailable physical space for recruitment activities, and (4) lack of documentation to verify eligibility. Adaptive strategies were crucial to alleviate enrollment disruptions due to the COVID-19 pandemic. These included remote approaching and consenting (eg, telehealth, email, and telephone) for patients and providers. Additionally, for patients, recruitment was enriched by simplification of enrollment procedures (eg, directly approaching patients without a referral from the provider) and a multitouch method (ie, warm introductions with flyers, texts, and patient portal messages). We found that patient recruitment rates were similar between in-person and adapted (virtual with multitouch) approaches (167/200, 83.5% and 126/143, 88.1%, respectively; P=.23). However, for providers, recruitment was significantly higher for in-person vs remote recruitment (48/50, 96% and 41/54, 76%, respectively, P<.001). Conclusions: We found that timely adaptation in recruitment strategies secured high recruitment rates using an assortment of enriched remote recruitment strategies. Flexibility in approach and reducing the burden of enrollment procedures for participants aided enrollment. It is important to continue identifying effective recruitment strategies in studies involving patients with SCD and their providers and the impact and navigation of recruitment challenges. Trial Registration: ClinicalTrials.Gov NCT03380351; https://clinicaltrials.gov/study/NCT03380351 International Registered Report Identifier (IRRID): RR2-10.2196/16319 %M 38625729 %R 10.2196/48767 %U https://formative.jmir.org/2024/1/e48767 %U https://doi.org/10.2196/48767 %U http://www.ncbi.nlm.nih.gov/pubmed/38625729 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50832 %T Development of a Management App for Postviral Fibromyalgia-Like Symptoms: Patient Preference-Guided Approach %A Blanchard,Marc %A Koller,Cinja Nadana %A Azevedo,Pedro Ming %A Prétat,Tiffany %A Hügle,Thomas %+ Department of Rheumatology, Lausanne University Hospital (CHUV), University of Lausanne, Pierre-Decker 4, Lausanne, 1011, Switzerland, 41 794266883, marc_blanchard@bluewin.ch %K digital health %K patient preference %K user experience %K patient-centricity %K platform %K development %K fibromyalgia %K self-management %K quality of life %K patient outcome %K musculoskeletal %K usability testing %K digital health solution %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent fibromyalgia-like symptoms have been increasingly reported following viral infections, including SARS-CoV-2. About 30% of patients with post–COVID-19 syndrome fulfill the fibromyalgia criteria. This complex condition presents significant challenges in terms of self-management. Digital health interventions offer a viable means to assist patients in managing their health conditions. However, the challenge of ensuring their widespread adoption and adherence persists. This study responds to this need by developing a patient-centered digital health management app, incorporating patient preferences to enhance usability and effectiveness, ultimately aiming to improve patient outcomes and quality of life. Objective: This research aims to develop a digital health self-management app specifically for patients experiencing postviral fibromyalgia-like symptoms. By prioritizing patient preferences and engagement through the app’s design and functionality, the study intends to facilitate better self-management practices and improve adherence. Methods: Using an exploratory study design, the research used patient preference surveys and usability testing as primary tools to inform the development process of the digital health solution. We gathered and analyzed patients’ expectations regarding design features, content, and usability to steer the iterative app development. Results: The study uncovered crucial insights from patient surveys and usability testing, which influenced the app’s design and functionality. Key findings included a preference for a symptom list over an automated chatbot, a desire to report on a moderate range of symptoms and activities, and the importance of an intuitive onboarding process. While usability testing identified some challenges in the onboarding process, it also confirmed the importance of aligning the app with patient needs to enhance engagement and satisfaction. Conclusions: Incorporating patient feedback has been a significant factor in the development of the digital health app. Challenges encountered with user onboarding during usability testing have highlighted the importance of this process for user adoption. The study acknowledges the role of patient input in developing digital health technologies and suggests further research to improve onboarding procedures, aiming to enhance patient engagement and their ability to manage digital health resources effectively. International Registered Report Identifier (IRRID): RR2-10.2196/32193 %M 38639986 %R 10.2196/50832 %U https://formative.jmir.org/2024/1/e50832 %U https://doi.org/10.2196/50832 %U http://www.ncbi.nlm.nih.gov/pubmed/38639986 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53241 %T Creating High-Quality Synthetic Health Data: Framework for Model Development and Validation %A Karimian Sichani,Elnaz %A Smith,Aaron %A El Emam,Khaled %A Mosquera,Lucy %+ Department of Mathematics and Statistics, University of Ottawa, 150 Louis-Pasteur Pvt, Ottawa, ON, K1N 6N5, Canada, 1 6137690585, ekari037@uottawa.ca %K synthetic data %K tensor decomposition %K data sharing %K data utility %K data privacy %K electronic health record %K longitudinal %K model development %K model validation %K generative models %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health records are a valuable source of patient information that must be properly deidentified before being shared with researchers. This process requires expertise and time. In addition, synthetic data have considerably reduced the restrictions on the use and sharing of real data, allowing researchers to access it more rapidly with far fewer privacy constraints. Therefore, there has been a growing interest in establishing a method to generate synthetic data that protects patients’ privacy while properly reflecting the data. Objective: This study aims to develop and validate a model that generates valuable synthetic longitudinal health data while protecting the privacy of the patients whose data are collected. Methods: We investigated the best model for generating synthetic health data, with a focus on longitudinal observations. We developed a generative model that relies on the generalized canonical polyadic (GCP) tensor decomposition. This model also involves sampling from a latent factor matrix of GCP decomposition, which contains patient factors, using sequential decision trees, copula, and Hamiltonian Monte Carlo methods. We applied the proposed model to samples from the MIMIC-III (version 1.4) data set. Numerous analyses and experiments were conducted with different data structures and scenarios. We assessed the similarity between our synthetic data and the real data by conducting utility assessments. These assessments evaluate the structure and general patterns present in the data, such as dependency structure, descriptive statistics, and marginal distributions. Regarding privacy disclosure, our model preserves privacy by preventing the direct sharing of patient information and eliminating the one-to-one link between the observed and model tensor records. This was achieved by simulating and modeling a latent factor matrix of GCP decomposition associated with patients. Results: The findings show that our model is a promising method for generating synthetic longitudinal health data that is similar enough to real data. It can preserve the utility and privacy of the original data while also handling various data structures and scenarios. In certain experiments, all simulation methods used in the model produced the same high level of performance. Our model is also capable of addressing the challenge of sampling patients from electronic health records. This means that we can simulate a variety of patients in the synthetic data set, which may differ in number from the patients in the original data. Conclusions: We have presented a generative model for producing synthetic longitudinal health data. The model is formulated by applying the GCP tensor decomposition. We have provided 3 approaches for the synthesis and simulation of a latent factor matrix following the process of factorization. In brief, we have reduced the challenge of synthesizing massive longitudinal health data to synthesizing a nonlongitudinal and significantly smaller data set. %M 38648097 %R 10.2196/53241 %U https://formative.jmir.org/2024/1/e53241 %U https://doi.org/10.2196/53241 %U http://www.ncbi.nlm.nih.gov/pubmed/38648097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49512 %T Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment %A Tate,Allan D %A Fertig,Angela R %A de Brito,Junia N %A Ellis,Émilie M %A Carr,Christopher Patrick %A Trofholz,Amanda %A Berge,Jerica M %+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 202 Miller Hall, 101 Buck Rd, Health Sciences Campus, Athens, GA, 30602, United States, 1 706 542 6317, allan.tate@uga.edu %K adherence %K burden %K data quality %K ecological momentary assessment %K mental health %K mHealth %K mobile health %K participant adherence %K public health %K stress %K study design %K survey burden %K survey %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. Objective: This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. Methods: The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question “Overall, how difficult was it for you to fill out the surveys today?” on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. Results: The burden was low at 1.2 (SD 1.14) indicating “a little” burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English–speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (β=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. Conclusions: The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives. %M 38656787 %R 10.2196/49512 %U https://formative.jmir.org/2024/1/e49512 %U https://doi.org/10.2196/49512 %U http://www.ncbi.nlm.nih.gov/pubmed/38656787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52189 %T Assessing Electronic Health Literacy in Individuals With the Post–COVID-19 Condition Using the German Revised eHealth Literacy Scale: Validation Study %A Marsall,Matthias %A Dinse,Hannah %A Schröder,Julia %A Skoda,Eva-Maria %A Teufel,Martin %A Bäuerle,Alexander %+ Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany, 49 228 287 ext 11595, matthias.marsall@ukbonn.de %K eHealth literacy %K eHEALS %K factor analysis %K measurement invariance %K psychometric properties %K infodemic %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is a widely used instrument for measuring eHealth literacy (eHL). However, little is known so far about whether the instrument is valid for the assessment of eHL in persons who are affected by the post–COVID-19 condition. This is particularly important as people with the post–COVID-19 condition are frequently affected by false information from the internet. Objective: The objective of our study was to evaluate the validity and reliability of the German Revised eHealth Literacy Scale (GR-eHEALS) in individuals with the post–COVID-19 condition. Methods: A cross-sectional study was conducted from January to May 2022. The self-assessment survey consisted of the GR-eHEALS, health status– and internet use–related variables, sociodemographic data, and (post)–COVID-19–related medical data. Confirmatory factor analysis (CFA), correlational analyses, and tests of measurement invariance were deployed. Results: In total, 330 participants were included in the statistical analyses. CFA revealed that the 2-factor model reached an excellent model fit (comparative fit index=1.00, Tucker–Lewis index=0.99, root mean square error of approximation=0.036, standardized root mean square residual=0.038). Convergent validity was confirmed by significant positive correlations between eHL and knowledge of internet-based health promotion programs, experience in using these programs, and the duration of private internet use. In addition, a significantly negative relationship of eHL with internet anxiety supported convergent validity. Further, significant relationships of eHL with mental health status and internal health locus of control confirmed the criterion validity of the instrument. However, relationships of eHL with physical health status and quality of life could not be confirmed. The 2-factor model was fully measurement invariant regarding gender. Regarding age and educational level, partial measurement invariance was confirmed. The subscales as well as the overall GR-eHEALS reached good-to-excellent reliability (Cronbach α≥.86). Conclusions: The GR-eHEALS is a reliable and largely valid instrument for assessing eHL in individuals with the post–COVID-19 condition. Measurement invariance regarding gender was fully confirmed and allows the interpretation of group differences. Regarding age and educational level, group differences should be interpreted with caution. Given the high likelihood that individuals with the post–COVID-19 condition will be confronted with misinformation on the Internet, eHL is a core competency that is highly relevant in this context, in both research and clinical practice. Therefore, future research should also explore alternative instruments to capture eHL to overcome shortcomings in the validity of the GR-eHEALS. %M 38662429 %R 10.2196/52189 %U https://formative.jmir.org/2024/1/e52189 %U https://doi.org/10.2196/52189 %U http://www.ncbi.nlm.nih.gov/pubmed/38662429 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54373 %T Proactive Identification of Patients with Diabetes at Risk of Uncontrolled Outcomes during a Diabetes Management Program: Conceptualization and Development Study Using Machine Learning %A Khalilnejad,Arash %A Sun,Ruo-Ting %A Kompala,Tejaswi %A Painter,Stefanie %A James,Roberta %A Wang,Yajuan %+ Teladoc Health, 2 Manhattanville Road, Purchase, NY, 10577, United States, 1 3045469968, spainter@teladochealth.com %K diabetes %K diabetic %K DM %K diabetes mellitus %K type 2 diabetes %K type 1 diabetes %K self-monitoring %K predictive model %K predictive models %K predictive analytics %K predictive system %K practical model %K practical models %K ML %K machine learning %K AI %K artificial intelligence %K algorithm %K algorithms %K behavior %K behaviour %K telehealth %K tele-health %K chronic condition %K chronic conditions %K chronic disease %K chronic diseases %K chronic illness %K chronic illnesses %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growth in the capabilities of telehealth have made it possible to identify individuals with a higher risk of uncontrolled diabetes and provide them with targeted support and resources to help them manage their condition. Thus, predictive modeling has emerged as a valuable tool for the advancement of diabetes management. Objective: This study aimed to conceptualize and develop a novel machine learning (ML) approach to proactively identify participants enrolled in a remote diabetes monitoring program (RDMP) who were at risk of uncontrolled diabetes at 12 months in the program. Methods: Registry data from the Livongo for Diabetes RDMP were used to design separate dynamic predictive ML models to predict participant outcomes at each monthly checkpoint of the participants’ program journey (month-n models) from the first day of onboarding (month-0 model) up to the 11th month (month-11 model). A participant’s program journey began upon onboarding into the RDMP and monitoring their own blood glucose (BG) levels through the RDMP-provided BG meter. Each participant passed through 12 predicative models through their first year enrolled in the RDMP. Four categories of participant attributes (ie, survey data, BG data, medication fills, and health signals) were used for feature construction. The models were trained using the light gradient boosting machine and underwent hyperparameter tuning. The performance of the models was evaluated using standard metrics, including precision, recall, specificity, the area under the curve, the F1-score, and accuracy. Results: The ML models exhibited strong performance, accurately identifying observable at-risk participants, with recall ranging from 70% to 94% and precision from 40% to 88% across the 12-month program journey. Unobservable at-risk participants also showed promising performance, with recall ranging from 61% to 82% and precision from 42% to 61%. Overall, model performance improved as participants progressed through their program journey, demonstrating the importance of engagement data in predicting long-term clinical outcomes. Conclusions: This study explored the Livongo for Diabetes RDMP participants’ temporal and static attributes, identification of diabetes management patterns and characteristics, and their relationship to predict diabetes management outcomes. Proactive targeting ML models accurately identified participants at risk of uncontrolled diabetes with a high level of precision that was generalizable through future years within the RDMP. The ability to identify participants who are at risk at various time points throughout the program journey allows for personalized interventions to improve outcomes. This approach offers significant advancements in the feasibility of large-scale implementation in remote monitoring programs and can help prevent uncontrolled glycemic levels and diabetes-related complications. Future research should include the impact of significant changes that can affect a participant’s diabetes management. %M 38669074 %R 10.2196/54373 %U https://formative.jmir.org/2024/1/e54373 %U https://doi.org/10.2196/54373 %U http://www.ncbi.nlm.nih.gov/pubmed/38669074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46945 %T Expanding Youth-Friendly HIV Self-Testing Services During the COVID-19 Pandemic: Qualitative Analysis of a Crowdsourcing Open Call in Nigeria %A Anikamadu,Onyekachukwu %A Ezechi,Oliver %A Engelhart,Alexis %A Nwaozuru,Ucheoma %A Obiezu-Umeh,Chisom %A Ogunjemite,Ponmile %A Bale,Babatunde Ismail %A Nwachukwu,Daniel %A Gbaja-biamila,Titilola %A Oladele,David %A Musa,Adesola Z %A Mason,Stacey %A Ojo,Temitope %A Tucker,Joseph %A Iwelunmor,Juliet %+ Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO, 63130, United States, 1 314 935 6600, a.onyekachukwu@wustl.edu %K crowdsourcing %K World AIDS Day %K HIV %K self-testing %K young people %K COVID-19 pandemic restrictions %K Nigeria %K HIV self-testing %K health promotion %K crowdsourcing open call %K young adult %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST. Objective: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions. Methods: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: “How will you promote HIV self-testing among young people during COVID-19 pandemic?” Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest). Results: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services. Conclusions: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic. Trial Registration: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784 %M 38687582 %R 10.2196/46945 %U https://formative.jmir.org/2024/1/e46945 %U https://doi.org/10.2196/46945 %U http://www.ncbi.nlm.nih.gov/pubmed/38687582 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50035 %T Real-World Gait Detection Using a Wrist-Worn Inertial Sensor: Validation Study %A Kluge,Felix %A Brand,Yonatan E %A Micó-Amigo,M Encarna %A Bertuletti,Stefano %A D'Ascanio,Ilaria %A Gazit,Eran %A Bonci,Tecla %A Kirk,Cameron %A Küderle,Arne %A Palmerini,Luca %A Paraschiv-Ionescu,Anisoara %A Salis,Francesca %A Soltani,Abolfazl %A Ullrich,Martin %A Alcock,Lisa %A Aminian,Kamiar %A Becker,Clemens %A Brown,Philip %A Buekers,Joren %A Carsin,Anne-Elie %A Caruso,Marco %A Caulfield,Brian %A Cereatti,Andrea %A Chiari,Lorenzo %A Echevarria,Carlos %A Eskofier,Bjoern %A Evers,Jordi %A Garcia-Aymerich,Judith %A Hache,Tilo %A Hansen,Clint %A Hausdorff,Jeffrey M %A Hiden,Hugo %A Hume,Emily %A Keogh,Alison %A Koch,Sarah %A Maetzler,Walter %A Megaritis,Dimitrios %A Niessen,Martijn %A Perlman,Or %A Schwickert,Lars %A Scott,Kirsty %A Sharrack,Basil %A Singleton,David %A Vereijken,Beatrix %A Vogiatzis,Ioannis %A Yarnall,Alison %A Rochester,Lynn %A Mazzà,Claudia %A Del Din,Silvia %A Mueller,Arne %+ Novartis Biomedical Research, Novartis Pharma AG, Fabrikstrasse 2, Basel, 4056, Switzerland, 41 795544701, felix.kluge@novartis.com %K digital mobility outcomes %K validation %K wearable sensor %K walking %K digital health %K inertial measurement unit %K accelerometer %K Mobilise-D %D 2024 %7 1.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Wrist-worn inertial sensors are used in digital health for evaluating mobility in real-world environments. Preceding the estimation of spatiotemporal gait parameters within long-term recordings, gait detection is an important step to identify regions of interest where gait occurs, which requires robust algorithms due to the complexity of arm movements. While algorithms exist for other sensor positions, a comparative validation of algorithms applied to the wrist position on real-world data sets across different disease populations is missing. Furthermore, gait detection performance differences between the wrist and lower back position have not yet been explored but could yield valuable information regarding sensor position choice in clinical studies. Objective: The aim of this study was to validate gait sequence (GS) detection algorithms developed for the wrist position against reference data acquired in a real-world context. In addition, this study aimed to compare the performance of algorithms applied to the wrist position to those applied to lower back–worn inertial sensors. Methods: Participants with Parkinson disease, multiple sclerosis, proximal femoral fracture (hip fracture recovery), chronic obstructive pulmonary disease, and congestive heart failure and healthy older adults (N=83) were monitored for 2.5 hours in the real-world using inertial sensors on the wrist, lower back, and feet including pressure insoles and infrared distance sensors as reference. In total, 10 algorithms for wrist-based gait detection were validated against a multisensor reference system and compared to gait detection performance using lower back–worn inertial sensors. Results: The best-performing GS detection algorithm for the wrist showed a mean (per disease group) sensitivity ranging between 0.55 (SD 0.29) and 0.81 (SD 0.09) and a mean (per disease group) specificity ranging between 0.95 (SD 0.06) and 0.98 (SD 0.02). The mean relative absolute error of estimated walking time ranged between 8.9% (SD 7.1%) and 32.7% (SD 19.2%) per disease group for this algorithm as compared to the reference system. Gait detection performance from the best algorithm applied to the wrist inertial sensors was lower than for the best algorithms applied to the lower back, which yielded mean sensitivity between 0.71 (SD 0.12) and 0.91 (SD 0.04), mean specificity between 0.96 (SD 0.03) and 0.99 (SD 0.01), and a mean relative absolute error of estimated walking time between 6.3% (SD 5.4%) and 23.5% (SD 13%). Performance was lower in disease groups with major gait impairments (eg, patients recovering from hip fracture) and for patients using bilateral walking aids. Conclusions: Algorithms applied to the wrist position can detect GSs with high performance in real-world environments. Those periods of interest in real-world recordings can facilitate gait parameter extraction and allow the quantification of gait duration distribution in everyday life. Our findings allow taking informed decisions on alternative positions for gait recording in clinical studies and public health. Trial Registration: ISRCTN Registry 12246987; https://www.isrctn.com/ISRCTN12246987 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-050785 %M 38691395 %R 10.2196/50035 %U https://formative.jmir.org/2024/1/e50035 %U https://doi.org/10.2196/50035 %U http://www.ncbi.nlm.nih.gov/pubmed/38691395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46420 %T Regulatory Issues in Electronic Health Records for Adolescent HIV Research: Strategies and Lessons Learned %A Green,Sara Shaw %A Lee,Sung-Jae %A Chahin,Samantha %A Pooler-Burgess,Meardith %A Green-Jones,Monique %A Gurung,Sitaji %A Outlaw,Angulique Y %A Naar,Sylvie %+ Center for Translational Behavioral Science, Department of Behavioral Sciences and Social Medicine, Florida State University, 2010 Levy Ave, Building B, Suite B0266, Tallahassee, FL, 32310, United States, 1 8506442334, sara.green@med.fsu.edu %K electronic health record %K HIV %K pragmatic trial %K regulatory %K EHR %K pre-exposure prophylaxis %K retention %K attrition %K dropout %K legal %K regulation %K adherence %K ethic %K review board %K implementation %K data use %K privacy %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health records (EHRs) are a cost-effective approach to provide the necessary foundations for clinical trial research. The ability to use EHRs in real-world clinical settings allows for pragmatic approaches to intervention studies with the emerging adult HIV population within these settings; however, the regulatory components related to the use of EHR data in multisite clinical trials poses unique challenges that researchers may find themselves unprepared to address, which may result in delays in study implementation and adversely impact study timelines, and risk noncompliance with established guidance. Objective: As part of the larger Adolescent Trials Network (ATN) for HIV/AIDS Interventions Protocol 162b (ATN 162b) study that evaluated clinical-level outcomes of an intervention including HIV treatment and pre-exposure prophylaxis services to improve retention within the emerging adult HIV population, the objective of this study is to highlight the regulatory process and challenges in the implementation of a multisite pragmatic trial using EHRs to assist future researchers conducting similar studies in navigating the often time-consuming regulatory process and ensure compliance with adherence to study timelines and compliance with institutional and sponsor guidelines. Methods: Eight sites were engaged in research activities, with 4 sites selected from participant recruitment venues as part of the ATN, who participated in the intervention and data extraction activities, and an additional 4 sites were engaged in data management and analysis. The ATN 162b protocol team worked with site personnel to establish the necessary regulatory infrastructure to collect EHR data to evaluate retention in care and viral suppression, as well as para-data on the intervention component to assess the feasibility and acceptability of the mobile health intervention. Methods to develop this infrastructure included site-specific training activities and the development of both institutional reliance and data use agreements. Results: Due to variations in site-specific activities, and the associated regulatory implications, the study team used a phased approach with the data extraction sites as phase 1 and intervention sites as phase 2. This phased approach was intended to address the unique regulatory needs of all participating sites to ensure that all sites were properly onboarded and all regulatory components were in place. Across all sites, the regulatory process spanned 6 months for the 4 data extraction and intervention sites, and up to 10 months for the data management and analysis sites. Conclusions: The process for engaging in multisite clinical trial studies using EHR data is a multistep, collaborative effort that requires proper advanced planning from the proposal stage to adequately implement the necessary training and infrastructure. Planning, training, and understanding the various regulatory aspects, including the necessity of data use agreements, reliance agreements, external institutional review board review, and engagement with clinical sites, are foremost considerations to ensure successful implementation and adherence to pragmatic trial timelines and outcomes. %M 38696775 %R 10.2196/46420 %U https://formative.jmir.org/2024/1/e46420 %U https://doi.org/10.2196/46420 %U http://www.ncbi.nlm.nih.gov/pubmed/38696775 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51346 %T ChatGPT as a Tool for Medical Education and Clinical Decision-Making on the Wards: Case Study %A Skryd,Anthony %A Lawrence,Katharine %+ Department of Medicine, NYU Langone Health, 550 1st Avenue, New York City, NY, 10016, United States, 1 646 929 7800, anthony.skryd@nyulangone.org %K ChatGPT %K medical education %K large language models %K LLMs %K clinical decision-making %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Large language models (LLMs) are computational artificial intelligence systems with advanced natural language processing capabilities that have recently been popularized among health care students and educators due to their ability to provide real-time access to a vast amount of medical knowledge. The adoption of LLM technology into medical education and training has varied, and little empirical evidence exists to support its use in clinical teaching environments. Objective: The aim of the study is to identify and qualitatively evaluate potential use cases and limitations of LLM technology for real-time ward-based educational contexts. Methods: A brief, single-site exploratory evaluation of the publicly available ChatGPT-3.5 (OpenAI) was conducted by implementing the tool into the daily attending rounds of a general internal medicine inpatient service at a large urban academic medical center. ChatGPT was integrated into rounds via both structured and organic use, using the web-based “chatbot” style interface to interact with the LLM through conversational free-text and discrete queries. A qualitative approach using phenomenological inquiry was used to identify key insights related to the use of ChatGPT through analysis of ChatGPT conversation logs and associated shorthand notes from the clinical sessions. Results: Identified use cases for ChatGPT integration included addressing medical knowledge gaps through discrete medical knowledge inquiries, building differential diagnoses and engaging dual-process thinking, challenging medical axioms, using cognitive aids to support acute care decision-making, and improving complex care management by facilitating conversations with subspecialties. Potential additional uses included engaging in difficult conversations with patients, exploring ethical challenges and general medical ethics teaching, personal continuing medical education resources, developing ward-based teaching tools, supporting and automating clinical documentation, and supporting productivity and task management. LLM biases, misinformation, ethics, and health equity were identified as areas of concern and potential limitations to clinical and training use. A code of conduct on ethical and appropriate use was also developed to guide team usage on the wards. Conclusions: Overall, ChatGPT offers a novel tool to enhance ward-based learning through rapid information querying, second-order content exploration, and engaged team discussion regarding generated responses. More research is needed to fully understand contexts for educational use, particularly regarding the risks and limitations of the tool in clinical settings and its impacts on trainee development. %M 38717811 %R 10.2196/51346 %U https://formative.jmir.org/2024/1/e51346 %U https://doi.org/10.2196/51346 %U http://www.ncbi.nlm.nih.gov/pubmed/38717811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53623 %T The Real-World Usability, Feasibility, and Performance Distributions of Deploying a Digital Toolbox of Computerized Assessments to Remotely Evaluate Brain Health: Development and Usability Study %A Attarha,Mouna %A Mahncke,Henry %A Merzenich,Michael %+ Posit Science, 160 Pine St Suite 200, San Francisco, CA, 94111, United States, 1 415 394 3100, Mouna.attarha@positscience.com %K web-based cognitive assessment %K remote data collection %K neurocognition %K cognitive profiles %K normative assessment data %K brain health %K cognitive status %K assessment accessibility %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An ongoing global challenge is managing brain health and understanding how performance changes across the lifespan. Objective: We developed and deployed a set of self-administrable, computerized assessments designed to measure key indexes of brain health across the visual and auditory sensory modalities. In this pilot study, we evaluated the usability, feasibility, and performance distributions of the assessments in a home-based, real-world setting without supervision. Methods: Potential participants were untrained users who self-registered on an existing brain training app called BrainHQ. Participants were contacted via a recruitment email and registered remotely to complete a demographics questionnaire and 29 unique assessments on their personal devices. We examined participant engagement, descriptive and psychometric properties of the assessments, associations between performance and self-reported demographic variables, cognitive profiles, and factor loadings. Results: Of the 365,782 potential participants contacted via a recruitment email, 414 (0.11%) registered, of whom 367 (88.6%) completed at least one assessment and 104 (25.1%) completed all 29 assessments. Registered participants were, on average, aged 63.6 (SD 14.8; range 13-107) years, mostly female (265/414, 64%), educated (329/414, 79.5% with a degree), and White (349/414, 84.3% White and 48/414, 11.6% people of color). A total of 72% (21/29) of the assessments showed no ceiling or floor effects or had easily modifiable score bounds to eliminate these effects. When correlating performance with self-reported demographic variables, 72% (21/29) of the assessments were sensitive to age, 72% (21/29) of the assessments were insensitive to gender, 93% (27/29) of the assessments were insensitive to race and ethnicity, and 93% (27/29) of the assessments were insensitive to education-based differences. Assessments were brief, with a mean duration of 3 (SD 1.0) minutes per task. The pattern of performance across the assessments revealed distinctive cognitive profiles and loaded onto 4 independent factors. Conclusions: The assessments were both usable and feasible and warrant a full normative study. A digital toolbox of scalable and self-administrable assessments that can evaluate brain health at a glance (and longitudinally) may lead to novel future applications across clinical trials, diagnostics, and performance optimization. %M 38739916 %R 10.2196/53623 %U https://formative.jmir.org/2024/1/e53623 %U https://doi.org/10.2196/53623 %U http://www.ncbi.nlm.nih.gov/pubmed/38739916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56889 %T Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study %A Yanez Touzet,Alvaro %A Houhou,Tatiana %A Rahic,Zerina %A Kolias,Angelos %A Yordanov,Stefan %A Anderson,David B %A Laufer,Ilya %A Li,Maggie %A Grahovac,Gordan %A Kotter,Mark RN %A Davies,Benjamin M %A , %+ Department of Clinical Neurosciences, University of Cambridge, Level 3, A Block, Box 165, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 01223746454, bd375@cam.ac.uk %K reproducibility of results %K patient outcome assessment %K smartphone %K neurology %K psychometrics %K spinal cord compression %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective: The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. Methods: A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ≥0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ≤1 point and MCID ≤2 points. Results: In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ≤2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ≥0.7) in both MCID ≤1 and MCID ≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. Conclusions: The criteria from COSMIN provide “very good” quality evidence of the reliability of the MoveMed tests in an adult population living with DCM. %M 38787602 %R 10.2196/56889 %U https://formative.jmir.org/2024/1/e56889 %U https://doi.org/10.2196/56889 %U http://www.ncbi.nlm.nih.gov/pubmed/38787602 %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 e56218 %T Lessons Learned From a Sequential Mixed-Mode Survey Design to Recruit and Collect Data From Case-Control Study Participants: Formative Evaluation %A Tran,Amanda D %A White,Alice E %A Torok,Michelle R %A Jervis,Rachel H %A Albanese,Bernadette A %A Scallan Walter,Elaine J %+ Department of Epidemiology, Colorado School of Public Health, University of Colorado, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, United States, 1 303 724 5162, elaine.scallanwalter@cuanschutz.edu %K case-control studies %K mixed-mode design %K epidemiologic study methods %K web-based survey %K telephone interview %K public health %K outbreak preparedness %K COVID-19 %K survey %K recruitment %K epidemiology %K methods %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sequential mixed-mode surveys using both web-based surveys and telephone interviews are increasingly being used in observational studies and have been shown to have many benefits; however, the application of this survey design has not been evaluated in the context of epidemiological case-control studies. Objective: In this paper, we discuss the challenges, benefits, and limitations of using a sequential mixed-mode survey design for a case-control study assessing risk factors during the COVID-19 pandemic. Methods: Colorado adults testing positive for SARS-CoV-2 were randomly selected and matched to those with a negative SARS-CoV-2 test result from March to April 2021. Participants were first contacted by SMS text message to complete a self-administered web-based survey asking about community exposures and behaviors. Those who did not respond were contacted for a telephone interview. We evaluated the representativeness of survey participants to sample populations and compared sociodemographic characteristics, participant responses, and time and resource requirements by survey mode using descriptive statistics and logistic regression models. Results: Of enrolled case and control participants, most were interviewed by telephone (308/537, 57.4% and 342/648, 52.8%, respectively), with overall enrollment more than doubling after interviewers called nonresponders. Participants identifying as female or White non-Hispanic, residing in urban areas, and not working outside the home were more likely to complete the web-based survey. Telephone participants were more likely than web-based participants to be aged 18-39 years or 60 years and older and reside in areas with lower levels of education, more linguistic isolation, lower income, and more people of color. While there were statistically significant sociodemographic differences noted between web-based and telephone case and control participants and their respective sample pools, participants were more similar to sample pools when web-based and telephone responses were combined. Web-based participants were less likely to report close contact with an individual with COVID-19 (odds ratio [OR] 0.70, 95% CI 0.53-0.94) but more likely to report community exposures, including visiting a grocery store or retail shop (OR 1.55, 95% CI 1.13-2.12), restaurant or cafe or coffee shop (OR 1.52, 95% CI 1.20-1.92), attending a gathering (OR 1.69, 95% CI 1.34-2.15), or sport or sporting event (OR 1.05, 95% CI 1.05-1.88). The web-based survey required an average of 0.03 (SD 0) person-hours per enrolled participant and US $920 in resources, whereas the telephone interview required an average of 5.11 person-hours per enrolled participant and US $70,000 in interviewer wages. Conclusions: While we still encountered control recruitment challenges noted in other observational studies, the sequential mixed-mode design was an efficient method for recruiting a more representative group of participants for a case-control study with limited impact on data quality and should be considered during public health emergencies when timely and accurate exposure information is needed to inform control measures. %M 38801768 %R 10.2196/56218 %U https://formative.jmir.org/2024/1/e56218 %U https://doi.org/10.2196/56218 %U http://www.ncbi.nlm.nih.gov/pubmed/38801768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56561 %T MyPEEPS Mobile App for HIV Prevention Among Transmasculine Youth: Adaptation Through Community-Based Feedback and Usability Evaluation %A Adedoja,Dorcas %A Kuhns,Lisa M %A Radix,Asa %A Garofalo,Robert %A Brin,Maeve %A Schnall,Rebecca %+ Columbia University School of Nursing, 560 W. 168th Street, New York City, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K HIV %K mobile app %K transgender men %K transmasculine %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community–informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term—at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity. Objective: The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth. Methods: The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation. Results: MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20). Conclusions: Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth. %M 38814701 %R 10.2196/56561 %U https://formative.jmir.org/2024/1/e56561 %U https://doi.org/10.2196/56561 %U http://www.ncbi.nlm.nih.gov/pubmed/38814701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49907 %T Controlling Inputter Variability in Vignette Studies Assessing Web-Based Symptom Checkers: Evaluation of Current Practice and Recommendations for Isolated Accuracy Metrics %A Meczner,András %A Cohen,Nathan %A Qureshi,Aleem %A Reza,Maria %A Sutaria,Shailen %A Blount,Emily %A Bagyura,Zsolt %A Malak,Tamer %+ Healthily, 167-169 Great Portland Street, London, W1W 5PF, United Kingdom, meczner@gmail.com %K symptom checker %K accuracy %K vignette studies %K variability %K methods %K triage %K evaluation %K vignette %K performance %K metrics %K mobile phone %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid growth of web-based symptom checkers (SCs) is not matched by advances in quality assurance. Currently, there are no widely accepted criteria assessing SCs’ performance. Vignette studies are widely used to evaluate SCs, measuring the accuracy of outcome. Accuracy behaves as a composite metric as it is affected by a number of individual SC- and tester-dependent factors. In contrast to clinical studies, vignette studies have a small number of testers. Hence, measuring accuracy alone in vignette studies may not provide a reliable assessment of performance due to tester variability. Objective: This study aims to investigate the impact of tester variability on the accuracy of outcome of SCs, using clinical vignettes. It further aims to investigate the feasibility of measuring isolated aspects of performance. Methods: Healthily’s SC was assessed using 114 vignettes by 3 groups of 3 testers who processed vignettes with different instructions: free interpretation of vignettes (free testers), specified chief complaints (partially free testers), and specified chief complaints with strict instruction for answering additional symptoms (restricted testers). κ statistics were calculated to assess agreement of top outcome condition and recommended triage. Crude and adjusted accuracy was measured against a gold standard. Adjusted accuracy was calculated using only results of consultations identical to the vignette, following a review and selection process. A feasibility study for assessing symptom comprehension of SCs was performed using different variations of 51 chief complaints across 3 SCs. Results: Intertester agreement of most likely condition and triage was, respectively, 0.49 and 0.51 for the free tester group, 0.66 and 0.66 for the partially free group, and 0.72 and 0.71 for the restricted group. For the restricted group, accuracy ranged from 43.9% to 57% for individual testers, averaging 50.6% (SD 5.35%). Adjusted accuracy was 56.1%. Assessing symptom comprehension was feasible for all 3 SCs. Comprehension scores ranged from 52.9% and 68%. Conclusions: We demonstrated that by improving standardization of the vignette testing process, there is a significant improvement in the agreement of outcome between testers. However, significant variability remained due to uncontrollable tester-dependent factors, reflected by varying outcome accuracy. Tester-dependent factors, combined with a small number of testers, limit the reliability and generalizability of outcome accuracy when used as a composite measure in vignette studies. Measuring and reporting different aspects of SC performance in isolation provides a more reliable assessment of SC performance. We developed an adjusted accuracy measure using a review and selection process to assess data algorithm quality. In addition, we demonstrated that symptom comprehension with different input methods can be feasibly compared. Future studies reporting accuracy need to apply vignette testing standardization and isolated metrics. %M 38820578 %R 10.2196/49907 %U https://formative.jmir.org/2024/1/e49907 %U https://doi.org/10.2196/49907 %U http://www.ncbi.nlm.nih.gov/pubmed/38820578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53642 %T Development of a Subjective Visual Vertical Test System Using a Smartphone With Virtual Reality Goggles for Screening of Otolithic Dysfunction: Observational Study %A Umibe,Akiko %A Fushiki,Hiroaki %A Tsunoda,Reiko %A Kuroda,Tatsuaki %A Kuroda,Kazuhiro %A Tanaka,Yasuhiro %+ Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama, 343-8555, Japan, 81 489651111, aumibe@dokkyomed.ac.jp %K vestibular function tests %K telemedicine %K smartphone %K virtual reality %K otolith dysfunction screening tool %K vestibular evoked myogenic potential %K iPhone %K mobile phone %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The subjective visual vertical (SVV) test can evaluate otolith function and spatial awareness and is performed in dedicated vertigo centers using specialized equipment; however, it is not otherwise widely used because of the specific equipment and space requirements. An SVV test smartphone app was developed to easily perform assessments in outpatient facilities. Objective: This study aimed to verify whether the SVV test smartphone app with commercially available virtual reality goggles can be used in a clinical setting. Methods: The reference range was calculated for 15 healthy participants. We included 14 adult patients with unilateral vestibular neuritis, sudden sensorineural hearing loss with vertigo, and Meniere disease and investigated the correlation between the SVV test results and vestibular evoked myogenic potential (VEMP) results. Results: The SVV reference range of healthy participants for the sitting front-facing position was small, ranging from –2.6º to 2.3º. Among the 14 patients, 6 (43%) exceeded the reference range for healthy participants. The SVV of patients with vestibular neuritis and sudden sensorineural hearing loss tended to deviate to the affected side. A total of 9 (64%) had abnormal cervical VEMP (cVEMP) values and 6 (43%) had abnormal ocular VEMP (oVEMP) values. No significant difference was found between the presence or absence of abnormal SVV values and the presence or absence of abnormal cVEMP and oVEMP values; however, the odds ratios (ORs) suggested a higher likelihood of abnormal SVV values among those with abnormal cVEMP and oVEMP responses (OR 2.40, 95% CI 0.18-32.88; P>.99; and OR 2, 95% CI 0.90-4.45; P=.46, respectively). Conclusions: The SVV app can be used anywhere and in a short period while reducing directional bias by using virtual reality goggles, thus making it highly versatile and useful as a practical otolith dysfunction screening tool. %M 38833295 %R 10.2196/53642 %U https://formative.jmir.org/2024/1/e53642 %U https://doi.org/10.2196/53642 %U http://www.ncbi.nlm.nih.gov/pubmed/38833295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51530 %T Evaluating the Problem of Fraudulent Participants in Health Care Research: Multimethod Pilot Study %A Kumarasamy,Vithusa %A Goodfellow,Nicole %A Ferron,Era Mae %A Wright,Amy L %+ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, 1 416 978 0695, amyl.wright@utoronto.ca %K fraudulent participants %K threats to data integrity %K online recruitment %K multimethod study %K health care research %K bots %K social media %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The shift toward online recruitment methods, accelerated by the COVID-19 pandemic, has brought to the forefront the growing concern of encountering fraudulent participants in health care research. The increasing prevalence of this issue poses a serious threat to the reliability and integrity of research data and subsequent findings. Objective: This study aims to explore the experiences of health care researchers (HCRs) who have encountered fraudulent participants while using online recruitment methods and platforms. The primary objective was to gain insights into how researchers detect and mitigate fraudulent behavior in their work and provide prevention recommendations. Methods: A multimethod sequential design was used for this pilot study, comprising a quantitative arm involving a web-based survey followed by a qualitative arm featuring semistructured interviews. The qualitative description approach framed the qualitative arm of the study. Sample sizes for the quantitative and qualitative arms were based on pragmatic considerations that in part stemmed from encountering fraudulent participants in a concurrent study. Content analysis was used to analyze open-ended survey questions and interview data. Results: A total of 37 HCRs participated, with 35% (13/37) of them engaging in qualitative interviews. Online platforms such as Facebook, email, Twitter (subsequently rebranded X), and newsletters were the most used methods for recruitment. A total of 84% (31/37) of participants indicated that fraudulent participation occurred in studies that mentioned incentives in their recruitment communications, with 71% (26/37) of HCRs offering physical or electronic gift cards as incentives. Researchers identified several indicators of suspicious behavior, including email surges, discrepancies in contact or personal information, geographical inconsistencies, and suspicious responses to survey questions. HCRs emphasized the need for a comprehensive screening protocol that extends beyond eligibility checks and is seamlessly integrated into the study protocol, grant applications, and research ethics board submissions. Conclusions: This study sheds light on the intricate and pervasive problem of fraudulent participation in health care research using online recruitment methods. The findings underscore the importance of vigilance and proactivity among HCRs in identifying, preventing, and addressing fraudulent behavior. To effectively tackle this challenge, researchers are encouraged to develop a comprehensive prevention strategy and establish a community of practice, facilitating real-time access to solutions and support and the promotion of ethical research practices. This collaborative approach will enable researchers to effectively address the issue of fraudulent participation, ensuring the conduct of high-quality and ethically sound research in the digital age. %M 38833292 %R 10.2196/51530 %U https://formative.jmir.org/2024/1/e51530 %U https://doi.org/10.2196/51530 %U http://www.ncbi.nlm.nih.gov/pubmed/38833292 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49562 %T Identifying X (Formerly Twitter) Posts Relevant to Dementia and COVID-19: Machine Learning Approach %A Azizi,Mehrnoosh %A Jamali,Ali Akbar %A Spiteri,Raymond J %+ Department of Computer Science, University of Saskatchewan, S425 Thorvaldson Building, 110 Science Place, Saskatoon, SK, S7N5C9, Canada, 1 306 966 2909, spiteri@cs.usask.ca %K machine learning %K dementia %K Alzheimer disease %K COVID-19 %K X (Twitter) %K natural language processing %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the pandemic, patients with dementia were identified as a vulnerable population. X (formerly Twitter) became an important source of information for people seeking updates on COVID-19, and, therefore, identifying posts (formerly tweets) relevant to dementia can be an important support for patients with dementia and their caregivers. However, mining and coding relevant posts can be daunting due to the sheer volume and high percentage of irrelevant posts. Objective: The objective of this study was to automate the identification of posts relevant to dementia and COVID-19 using natural language processing and machine learning (ML) algorithms. Methods: We used a combination of natural language processing and ML algorithms with manually annotated posts to identify posts relevant to dementia and COVID-19. We used 3 data sets containing more than 100,000 posts and assessed the capability of various algorithms in correctly identifying relevant posts. Results: Our results showed that (pretrained) transfer learning algorithms outperformed traditional ML algorithms in identifying posts relevant to dementia and COVID-19. Among the algorithms tested, the transfer learning algorithm A Lite Bidirectional Encoder Representations from Transformers (ALBERT) achieved an accuracy of 82.92% and an area under the curve of 83.53%. ALBERT substantially outperformed the other algorithms tested, further emphasizing the superior performance of transfer learning algorithms in the classification of posts. Conclusions: Transfer learning algorithms such as ALBERT are highly effective in identifying topic-specific posts, even when trained with limited or adjacent data, highlighting their superiority over other ML algorithms and applicability to other studies involving analysis of social media posts. Such an automated approach reduces the workload of manual coding of posts and facilitates their analysis for researchers and policy makers to support patients with dementia and their caregivers and other vulnerable populations. %M 38833288 %R 10.2196/49562 %U https://formative.jmir.org/2024/1/e49562 %U https://doi.org/10.2196/49562 %U http://www.ncbi.nlm.nih.gov/pubmed/38833288 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56003 %T Smartphone-Based Survey and Message Compliance in Adults Initially Unready to Quit Smoking: Secondary Analysis of a Randomized Controlled Trial %A Ulm,Clayton %A Chen,Sixia %A Fleshman,Brianna %A Benson,Lizbeth %A Kendzor,Darla E %A Frank-Pearce,Summer %A Neil,Jordan M %A Vidrine,Damon %A De La Torre,Irene %A Businelle,Michael S %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001, michael-businelle@ouhsc.edu %K just-in-time adaptive intervention %K tailored messaging %K smoking cessation %K mobile health %K survey compliance %K phase-based model %K smoking %K smoker %K survey %K smokers %K messaging %K smartphone %K efficacy %K pilot randomized controlled trial %K adult smokers %K linear regression %K age %K intervention engagement %K engagement %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Efficacy of smartphone-based interventions depends on intervention content quality and level of exposure to that content. Smartphone-based survey completion rates tend to decline over time; however, few studies have identified variables that predict this decline over longer-term interventions (eg, 26 weeks). Objective: This study aims to identify predictors of survey completion and message viewing over time within a 26-week smoking cessation trial. Methods: This study examined data from a 3-group pilot randomized controlled trial of adults who smoke (N=152) and were not ready to quit smoking within the next 30 days. For 182 days, two intervention groups received smartphone-based morning and evening messages based on current readiness to quit smoking. The control group received 2 daily messages unrelated to smoking. All participants were prompted to complete 26 weekly smartphone-based surveys that assessed smoking behavior, quit attempts, and readiness to quit. Compliance was operationalized as percentages of weekly surveys completed and daily messages viewed. Linear regression and mixed-effects models were used to identify predictors (eg, intervention group, age, and sex) of weekly survey completion and daily message viewing and decline in compliance over time. Results: The sample (mean age 50, SD 12.5, range 19-75 years; mean years of education 13.3, SD 1.6, range 10-20 years) was 67.8% (n=103) female, 74.3% (n=113) White, 77% (n=117) urban, and 52.6% (n=80) unemployed, and 61.2% (n=93) had mental health diagnoses. On average, participants completed 18.3 (71.8%) out of 25.5 prompted weekly surveys and viewed 207.3 (60.6%) out of 345.1 presented messages (31,503/52,460 total). Age was positively associated with overall weekly survey completion (P=.003) and daily message viewing (P=.02). Mixed-effects models indicated a decline in survey completion from 77% (114/148) in the first week of the intervention to 56% (84/150) in the last week of the intervention (P<.001), which was significantly moderated by age, sex, ethnicity, municipality (ie, rural/urban), and employment status. Similarly, message viewing declined from 72.3% (1533/2120) in the first week of the intervention to 44.6% (868/1946) in the last week of the intervention (P<.001). This decline in message viewing was significantly moderated by age, sex, municipality, employment status, and education. Conclusions: This study demonstrated the feasibility of a 26-week smartphone-based smoking cessation intervention. Study results identified subgroups that displayed accelerated rates in the decline of survey completion and message viewing. Future research should identify ways to maintain high levels of interaction with mobile health interventions that span long intervention periods, especially among subgroups that have demonstrated declining rates of intervention engagement over time. Trial Registration: ClinicalTrials.gov NCT03405129; https://clinicaltrials.gov/ct2/show/NCT03405129 %M 38848557 %R 10.2196/56003 %U https://formative.jmir.org/2024/1/e56003 %U https://doi.org/10.2196/56003 %U http://www.ncbi.nlm.nih.gov/pubmed/38848557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53159 %T Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study %A Stang,Garrett S %A Tanner,Nichole T %A Hatch,Ashley %A Godbolt,Jakarri %A Toll,Benjamin A %A Rojewski,Alana M %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, Box G-S121-3, Providence, RI, 02912, United States, 1 4018633375, garrett_stang@brown.edu %K lung cancer screening %K LCS %K electronic health records %K EHR %K Health Belief Model %K HBM %K self-refer %K tobacco treatment %K cancer screening %K development %K self-referral tool %K electronic health record %K decision-making %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. Objective: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Methods: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. Results: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Conclusions: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment. %M 38865702 %R 10.2196/53159 %U https://formative.jmir.org/2024/1/e53159 %U https://doi.org/10.2196/53159 %U http://www.ncbi.nlm.nih.gov/pubmed/38865702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52801 %T Feasibility of a 2-Part Substance Use Screener Self-Administered by Patients on Paper: Observational Study %A Kramer,Joanna %A Wilens,Timothy E %A Rao,Vinod %A Villa,Richard %A Yule,Amy M %+ Department of Psychiatry, Boston Medical Center, Crosstown Building 408, 801 Massachusetts Avenue, Boston, MA, 02118, United States, 1 6174141936, amy.yule@bmc.org %K patient reported outcome measures %K patient reported outcomes %K substance use screening %K paper and pencil screening %K screening %K tobacco %K prescription medication %K medication %K substance use %K care %K mental health %K symptoms %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Measurement-based care in behavioral health uses patient-reported outcome measures (PROMs) to screen for mental health symptoms and substance use and to assess symptom change over time. While PROMs are increasingly being integrated into electronic health record systems and administered electronically, paper-based PROMs continue to be used. It is unclear if it is feasible to administer a PROM on paper when the PROM was initially developed for electronic administration. Objective: This study aimed to examine the feasibility of patient self-administration of a 2-part substance use screener—the Tobacco, Alcohol, Prescription medications, and other Substances (TAPS)—on paper. This screener was originally developed for electronic administration. It begins with a limited number of questions and branches to either skip or reflex to additional questions based on an individual’s responses. In this study, the TAPS was adapted for paper use due to barriers to electronic administration within an urgent care behavioral health clinic at an urban health safety net hospital. Methods: From August 2021 to March 2022, research staff collected deidentified paper TAPS responses and tracked TAPS completion rates and adherence to questionnaire instructions. A retrospective chart review was subsequently conducted to obtain demographic information for the patients who presented to the clinic between August 2021 and March 2022. Since the initial information collected from TAPS responses was deidentified, demographic information was not linked to the individual TAPS screeners that were tracked by research staff. Results: A total of 507 new patients were seen in the clinic with a mean age of 38.7 (SD 16.6) years. In all, 258 (50.9%) patients were male. They were predominantly Black (n=212, 41.8%), White (n=152, 30%), and non-Hispanic or non-Latino (n=403, 79.5%). Most of the patients were publicly insured (n=411, 81.1%). Among these 507 patients, 313 (61.7%) completed the TAPS screener. Of these 313 patients, 76 (24.3%) adhered to the instructions and 237 (75.7%) did not follow the instructions correctly. Of the 237 respondents who did not follow the instructions correctly, 166 (70%) answered more questions and 71 (30%) answered fewer questions than required in TAPS part 2. Among the 237 patients who did not adhere to questionnaire instructions, 44 (18.6%) responded in a way that contradicted their response in part 1 of the screener and ultimately affected their overall TAPS score. Conclusions: It was challenging for patients to adhere to questionnaire instructions when completing a substance use screener on paper that was originally developed for electronic use. When selecting PROMs for measurement-based care, it is important to consider the structure of the questionnaire and how the PROM will be administered to determine if additional support for PROM self-administration needs to be implemented. %M 38916950 %R 10.2196/52801 %U https://formative.jmir.org/2024/1/e52801 %U https://doi.org/10.2196/52801 %U http://www.ncbi.nlm.nih.gov/pubmed/38916950 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56241 %T Clinical Simulation in the Regulation of Software as a Medical Device: An eDelphi Study %A O'Driscoll,Fiona %A O'Brien,Niki %A Guo,Chaohui %A Prime,Matthew %A Darzi,Ara %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, Room 1035, Queen Elizabeth Queen Mother Wing, St Mary's Campus, South Wharf Road, London, W2 1NY, United Kingdom, 44 020 7594 1419, saira.ghafur13@imperial.ac.uk %K digital health technology %K software as a medical device %K clinical simulation %K Delphi study %K eDelphi study %K artificial intelligence %K digital health %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and effective. Software as a medical device (SaMD) is a commonly used DHT by clinicians to provide care to patients. Traditional research methods for evaluating health care products, such as randomized clinical trials, may not be suitable for DHTs, such as SaMD. However, evidence to show their safety and efficacy is needed by regulators before they can be used in practice. Clinical simulation can be used by researchers to test SaMD in an agile and low-cost way; yet, there is limited research on criteria to assess the robustness of simulations and, subsequently, their relevance for a regulatory decision. Objective: The objective of this study was to gain consensus on the criteria that should be used to assess clinical simulation from a regulatory perspective when it is used to generate evidence for SaMD. Methods: An eDelphi study approach was chosen to develop a set of criteria to assess clinical simulation when used to evaluate SaMD. Participants were recruited through purposive and snowball sampling based on their experience and knowledge in relevant sectors. They were guided through an initial scoping questionnaire with key themes identified from the literature to obtain a comprehensive list of criteria. Participants voted upon these criteria in 2 Delphi rounds, with criteria being excluded if consensus was not met. Participants were invited to add qualitative comments during rounds and qualitative analysis was performed on the comments gathered during the first round. Consensus was predefined by 2 criteria: if <10% of the panelists deemed the criteria as “not important” or “not important at all” and >60% “important” or “very important.” Results: In total, 33 international experts in the digital health field, including academics, regulators, policy makers, and industry representatives, completed both Delphi rounds, and 43 criteria gained consensus from the participants. The research team grouped these criteria into 7 domains—background and context, overall study design, study population, delivery of the simulation, fidelity, software and artificial intelligence, and study analysis. These 7 domains were formulated into the simulation for regulation of SaMD framework. There were key areas of concern identified by participants regarding the framework criteria, such as the importance of how simulation fidelity is achieved and reported and the avoidance of bias throughout all stages. Conclusions: This study proposes the simulation for regulation of SaMD framework, developed through an eDelphi consensus process, to evaluate clinical simulation when used to assess SaMD. Future research should prioritize the development of safe and effective SaMD, while implementing and refining the framework criteria to adapt to new challenges. %M 38917454 %R 10.2196/56241 %U https://formative.jmir.org/2024/1/e56241 %U https://doi.org/10.2196/56241 %U http://www.ncbi.nlm.nih.gov/pubmed/38917454 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58549 %T A Digital Sexual Health Education Web Application for Resource-Poor Regions in Kenya: Implementation-Oriented Case Study Using the Intercultural Research Model %A Soehnchen,Clarissa %A Burmann,Anja %A Henningsen,Maike %A Meister,Sven %+ Health Informatics, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany, 49 2302 9260, clarissa.soehnchen@uni-wh.de %K sexual health education %K Intercultural Research Model %K semistructured interview %K SUS analysis %K user-centered design %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Developing a digital educational application focused on sexual health education necessitates a framework that integrates cultural considerations effectively. Drawing from previous research, we identified the problem and essential requirements to incorporate cultural insights into the development of a solution. Objective: This study aims to explore the Solution Room of the self-established Intercultural Research Model, with a focus on creating a reusable framework for developing and implementing a widely accessible digital educational tool for sexual health. The study centers on advancing from a low-fidelity prototype (She!Masomo) to a high-fidelity prototype (We!Masomo), while evaluating its system usability through differentiation. This research contributes to the pursuit of Sustainable Development Goals 3, 4, and 5. Methods: The research methodology is anchored in the Solution Room of the self-expanded Intercultural Research Model, which integrates cultural considerations. It uses a multimethod, user-centered design thinking approach, focusing on extensive human involvement for the open web-based application. This includes gathering self-assessed textual user feedback, conducting a System Usability Scale (SUS) analysis, and conducting 4 face-to-face semistructured expert interviews, following COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Results: Based on the identified limitations of the low-fidelity prototype, She!Masomo (SUS score 67), which were highlighted through textual user feedback (63/77) and prototype feature comparisons, iterative development and improvement were implemented. This process led to the creation of an enhanced high-fidelity prototype (We!Masomo). The improved effectiveness of the enhanced prototype was evaluated using the qualitative SUS analysis (82/90), resulting in a favorable score of 77.3, compared with the previous SUS score of 67 for the low-fidelity prototype. Highlighting the importance of accessible digital educational tools, this study conducted 4 expert interviews (4/4) and reported e-survey results following the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guideline. The digital educational platform, We!Masomo, is specifically designed to promote universal and inclusive free access to information. Therefore, the developed high-fidelity prototype was implemented in Kenya. Conclusions: The primary outcome of this research provides a comprehensive exploration of utilizing a case study methodology to advance the development of digital educational web tools, particularly focusing on cultural sensitivity and sensitive educational subjects. It offers critical insights for effectively introducing such tools in regions with limited resources. Nonetheless, it is crucial to emphasize that the findings underscore the importance of integrating culture-specific components during the design phase. This highlights the necessity of conducting a thorough requirement engineering analysis and developing a low-fidelity prototype, followed by an SUS analysis. These measures are particularly critical when disseminating sensitive information, such as sexual health, through digital platforms. International Registered Report Identifier (IRRID): RR2-10.1186/s12905-023-02839-6 %M 38959047 %R 10.2196/58549 %U https://formative.jmir.org/2024/1/e58549 %U https://doi.org/10.2196/58549 %U http://www.ncbi.nlm.nih.gov/pubmed/38959047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50240 %T The Impact of Incentives on Data Collection for Online Surveys: Social Media Recruitment Study %A Sobolewski,Jessica %A Rothschild,Allie %A Freeman,Andrew %+ RTI International, 3040 E Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 203 770 3115, jsobolewski@rti.org %K social media %K online survey recruitment %K incentive %K experiment %K online surveys %K Facebook %K Instagram %K data collection %K users %K cost %K social media recruitment %K survey %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of targeted advertisements on social media platforms (eg, Facebook and Instagram) has become increasingly popular for recruiting participants for online survey research. Many of these surveys offer monetary incentives for survey completion in the form of gift cards; however, little is known about whether the incentive amount impacts the cost, speed, and quality of data collection. Objective: This experiment addresses this gap in the literature by examining how different incentives in paid advertising campaigns on Instagram for completing a 10-minute online survey influence the response rate, recruitment advertising cost, data quality, and length of data collection. Methods: This experiment tested three incentive conditions using three Instagram campaigns that were each allocated a US $1400 budget to spend over a maximum of 4 days; ads targeted users aged 15-24 years in three nonadjacent designated market areas of similar size to avoid overlapping audiences. Four ad creatives were designed for each campaign; all ads featured the same images and text, but the incentive amount varied: no incentive, US $5 gift card, and US $15 gift card. All ads had a clickable link that directed users to an eligibility screener and a 10-minute online survey, if eligible. Each campaign ran for either the full allotted time (4 days) or until there were 150 total survey completes, prior to data quality checks for fraud. Results: The US $15 incentive condition resulted in the quickest and cheapest data collection, requiring 17 hours and ad spending of US $338.64 to achieve 142 survey completes. The US $5 condition took more than twice as long (39 hours) and cost US $864.33 in ad spending to achieve 148 survey completes. The no-incentive condition ran for 60 hours, spending nearly the full budget (US $1398.23), and achieved only 24 survey completes. The US $15 and US $5 incentive conditions had similar levels of fraudulent respondents, whereas the no-incentive condition had no fraudulent respondents. The completion rate for the US $15 and US $5 incentive conditions were 93.4% (155/166) and 89.8% (149/166), respectively, while the completion rate for the no-incentive condition was 43.6% (24/55). Conclusions: Overall, we found that a higher incentive resulted in quicker data collection, less money spent on ads, and higher response rates, despite some fraudulent cases that had to be dropped from the sample. However, when considering the total incentive amounts in addition to the ad spending, a US $5 incentive appeared to be the most cost-effective data collection option. Other costs associated with running a campaign for a longer period should also be considered. A longer experiment is warranted to determine whether fraud varies over time across conditions. %M 38963924 %R 10.2196/50240 %U https://formative.jmir.org/2024/1/e50240 %U https://doi.org/10.2196/50240 %U http://www.ncbi.nlm.nih.gov/pubmed/38963924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57118 %T Development of Promising Interventions to Improve Human Papillomavirus Vaccination in a School-Based Program in Quebec, Canada: Results From a Formative Evaluation Using a Mixed Methods Design %A Dionne,Maude %A Sauvageau,Chantal %A Etienne,Doriane %A Kiely,Marilou %A Witteman,Holly %A Dubé,Eve %+ Faculty of Social Sciences, Université Laval, 1030 avenue des Sciences-Humaines, Québec City, QC, G1V 0A6, Canada, 1 1 418 650 2131 ext 404062, Eve.Dube@ant.ulaval.ca %K immunization %K human papillomavirus %K HPV %K HPV vaccine %K school-based immunization program %K intervention %K strategies %K vaccination %K vaccine %K Quebec %K school-based %K vaccine coverage %K decision aid %K student %K students %K nurse %K nurses %K parent %K parents %K focus group %K descriptive analyses %K user-centered %K effectiveness %K data collection %K vaccine safety %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques. Objective: Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students’ parents in Quebec, Canada. Methods: In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions’ relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses’ knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool’s relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019). Results: The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired. Conclusions: We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents’ knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale. %M 38976317 %R 10.2196/57118 %U https://formative.jmir.org/2024/1/e57118 %U https://doi.org/10.2196/57118 %U http://www.ncbi.nlm.nih.gov/pubmed/38976317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55496 %T Accessible Ecosystem for Clinical Research (Federated Learning for Everyone): Development and Usability Study %A Pirmani,Ashkan %A Oldenhof,Martijn %A Peeters,Liesbet M %A De Brouwer,Edward %A Moreau,Yves %+ ESAT-STADIUS, KU Leuven, Kasteelpark Arenberg 10, Leuven, 3001, Belgium, 32 16 32 86 45, Yves.Moreau@esat.kuleuven.be %K federated learning %K multistakeholder collaboration %K real-world data %K integrity %K reliability %K clinical research %K implementation %K inclusivity %K inclusive %K accessible %K ecosystem %K design effectiveness %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The integrity and reliability of clinical research outcomes rely heavily on access to vast amounts of data. However, the fragmented distribution of these data across multiple institutions, along with ethical and regulatory barriers, presents significant challenges to accessing relevant data. While federated learning offers a promising solution to leverage insights from fragmented data sets, its adoption faces hurdles due to implementation complexities, scalability issues, and inclusivity challenges. Objective: This paper introduces Federated Learning for Everyone (FL4E), an accessible framework facilitating multistakeholder collaboration in clinical research. It focuses on simplifying federated learning through an innovative ecosystem-based approach. Methods: The “degree of federation” is a fundamental concept of FL4E, allowing for flexible integration of federated and centralized learning models. This feature provides a customizable solution by enabling users to choose the level of data decentralization based on specific health care settings or project needs, making federated learning more adaptable and efficient. By using an ecosystem-based collaborative learning strategy, FL4E encourages a comprehensive platform for managing real-world data, enhancing collaboration and knowledge sharing among its stakeholders. Results: Evaluating FL4E’s effectiveness using real-world health care data sets has highlighted its ecosystem-oriented and inclusive design. By applying hybrid models to 2 distinct analytical tasks—classification and survival analysis—within real-world settings, we have effectively measured the “degree of federation” across various contexts. These evaluations show that FL4E’s hybrid models not only match the performance of fully federated models but also avoid the substantial overhead usually linked with these models. Achieving this balance greatly enhances collaborative initiatives and broadens the scope of analytical possibilities within the ecosystem. Conclusions: FL4E represents a significant step forward in collaborative clinical research by merging the benefits of centralized and federated learning. Its modular ecosystem-based design and the “degree of federation” feature make it an inclusive, customizable framework suitable for a wide array of clinical research scenarios, promising to revolutionize the field through improved collaboration and data use. Detailed implementation and analyses are available on the associated GitHub repository. %M 39018557 %R 10.2196/55496 %U https://formative.jmir.org/2024/1/e55496 %U https://doi.org/10.2196/55496 %U http://www.ncbi.nlm.nih.gov/pubmed/39018557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57804 %T Measurement of Daily Actions Associated With Mental Health Using the Things You Do Questionnaire–15-Item: Questionnaire Development and Validation Study %A Bisby,Madelyne A %A Jones,Michael P %A Staples,Lauren %A Dear,Blake %A Titov,Nickolai %+ MindSpot Clinic, MQ Health, Macquarie University, 16 University Avenue, Macquarie Park, 2109, Australia, 61 298508724, madelyne.bisby@mq.edu.au %K daily actions %K depression %K anxiety %K psychometric %K mental health %K questionnaire %K activities %K goals %K plans %K healthy habits %K habits %K psychometric %K treatment-seeking %K treatment %K confirmatory factor analysis %K survey %K adult %K adult %K assessment %K digital psychology service %K digital %K psychology %K depression symptoms %K anxiety symptoms %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A large number of modifiable and measurable daily actions are thought to impact mental health. The “Things You Do” refers to 5 types of daily actions that have been associated with mental health: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Previous studies have reported the psychometric properties of the Things You Do Questionnaire (TYDQ)–21-item (TYDQ21). The 21-item version, however, has an uneven distribution of items across the 5 aforementioned factors and may be lengthy to administer on a regular basis. Objective: This study aimed to develop and evaluate a brief version of the TYDQ. To accomplish this, we identified the top 10 and 15 items on the TYDQ21 and then evaluated the performance of the 10-item and 15-item versions of the TYDQ in community and treatment-seeking samples. Methods: Using confirmatory factor analysis, the top 2 or 3 items were used to develop the 10-item and 15-item versions, respectively. Model fit, reliability, and validity were examined for both versions in 2 samples: a survey of community adults (n=6070) and adults who completed an assessment at a digital psychology service (n=14,878). Treatment responsivity was examined in a subgroup of participants (n=448). Results: Parallel analysis supported the 5-factor structure of the TYDQ. The brief (10-item and 15-item) versions were associated with better model fit than the 21-item version, as revealed by its comparative fit index, root-mean-square error of approximation, and Tucker-Lewis index. Configural, metric, and scalar invariance were supported. The 15-item version explained more variance in the 21-item scores than the 10-item version. Internal consistency was appropriate (eg, the 15-item version had a Cronbach α of >0.90 in both samples) and there were no marked differences between how the brief versions correlated with validated measures of depression or anxiety symptoms. The measure was responsive to treatment. Conclusions: The 15-item version is appropriate for use as a brief measure of daily actions associated with mental health while balancing brevity and clinical utility. Further research is encouraged to replicate our psychometric evaluation in other settings (eg, face-to-face services). Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000407796; https://tinyurl.com/2s67a6ps %M 39038286 %R 10.2196/57804 %U https://formative.jmir.org/2024/1/e57804 %U https://doi.org/10.2196/57804 %U http://www.ncbi.nlm.nih.gov/pubmed/39038286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47578 %T Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study %A Galvin,Karyn %A Tomlin,Dani %A Timmer,Barbra H B %A McNeice,Zoe %A Mount,Nicole %A Gray,Kathleen %A Short,Camille E %+ Department of Audiology and Speech Pathology, University of Melbourne, 550 Swanston St, Carlton, 3053, Australia, 61 61390355323, kgalvin@unimelb.edu.au %K adults %K hearing loss %K listening difficulties %K digital health %K app %K self-management %K mobile health %K smartphone %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. %M 39042452 %R 10.2196/47578 %U https://formative.jmir.org/2024/1/e47578 %U https://doi.org/10.2196/47578 %U http://www.ncbi.nlm.nih.gov/pubmed/39042452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54322 %T Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals %A Ladune,Raphaelle %A Hayotte,Meggy %A Vuillemin,Anne %A d'Arripe-Longueville,Fabienne %+ Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, 261 Bd du Mercantour, Nice, 06200, France, 33 618383410, r.ladune@sfr.fr %K cystic fibrosis %K decisional balance %K digital app %K acceptability %K physical activity %K mobile phone %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals. Objective: This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF. Methods: This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app’s creation. The app’s acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses. Results: In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO_BALAD, designed for people with CF aged ≥18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities. Conclusions: This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study. %M 39078689 %R 10.2196/54322 %U https://formative.jmir.org/2024/1/e54322 %U https://doi.org/10.2196/54322 %U http://www.ncbi.nlm.nih.gov/pubmed/39078689 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52165 %T Burden and Inattentive Responding in a 12-Month Intensive Longitudinal Study: Interview Study Among Young Adults %A Wang,Shirlene D %A Hatzinger,Lori %A Morales,Jeremy %A Hewus,Micaela %A Intille,Stephen %A Dunton,Genevieve F %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1875 N Soto St, Los Angeles, CA, 90032, United States, 1 3125327663, shirlenw@usc.edu %K data quality %K burden %K exit interview %K careless responding %K ecological momentary assessment %K intensive longitudinal data collection %K mobile phone %D 2024 %7 2.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Intensive longitudinal data (ILD) collection methods have gained popularity in social and behavioral research as a tool to better understand behavior and experiences over time with reduced recall bias. Engaging participants in these studies over multiple months and ensuring high data quality are crucial but challenging due to the potential burden of repeated measurements. It is suspected that participants may engage in inattentive responding (IR) behavior to combat burden, but the processes underlying this behavior are unclear as previous studies have focused on the barriers to compliance rather than the barriers to providing high-quality data. Objective: This study aims to broaden researchers’ knowledge about IR during ILD studies using qualitative analysis and uncover the underlying IR processes to aid future hypothesis generation. Methods: We explored the process of IR by conducting semistructured qualitative exit interviews with 31 young adult participants (aged 18-29 years) who completed a 12-month ILD health behavior study with daily evening smartphone-based ecological momentary assessment (EMA) surveys and 4-day waves of hourly EMA surveys. The interviews assessed participants’ motivations, the impact of time-varying contexts, changes in motivation and response patterns over time, and perceptions of attention check questions (ACQs) to understand participants’ response patterns and potential factors leading to IR. Results: Thematic analysis revealed 5 overarching themes on factors that influence participant engagement: (1) friends and family also had to tolerate the frequent surveys, (2) participants tried to respond to surveys quickly, (3) the repetitive nature of surveys led to neutral responses, (4) ACQs within the surveys helped to combat overly consistent response patterns, and (5) different motivations for answering the surveys may have led to different levels of data quality. Conclusions: This study aimed to examine participants’ perceptions of the quality of data provided in an ILD study to contribute to the field’s understanding of engagement. These findings provide insights into the complex process of IR and participant engagement in ILD studies with EMA. The study identified 5 factors influencing IR that could guide future research to improve EMA survey design. The identified themes offer practical implications for researchers and study designers, including the importance of considering social context, the consideration of dynamic motivations, and the potential benefit of including ACQs as a technique to reduce IR and leveraging the intrinsic motivators of participants. By incorporating these insights, researchers might maximize the scientific value of their multimonth ILD studies through better data collection protocols. International Registered Report Identifier (IRRID): RR2-10.2196/36666 %M 39093606 %R 10.2196/52165 %U https://formative.jmir.org/2024/1/e52165 %U https://doi.org/10.2196/52165 %U http://www.ncbi.nlm.nih.gov/pubmed/39093606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58928 %T Development of a Video Consultation Patient-Satisfaction Questionnaire (vCare-PSQ): A Cross-Sectional Explorative Study %A Larrabee Sonderlund,Anders %A Quirina Bang Van Sas,Tessa %A Wehberg,Sonja %A Huibers,Linda %A Nielsen,Jesper Bo %A Søndergaard,Jens %A Assing Hvidt,Elisabeth %+ Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 65503994, asonderlund@health.sdu.dk %K video consultation %K patient satisfaction %K patient-physician relationship %K telehealth %K general practice %K pilot-testing %K COVID-19 %K SARS-CoV-2 %K pandemic %K primary care %K healthcare %K health professional %K health professionals %K Danish %K adult %K adults %K IT-literacy %K methodological %K vCare-PSQ %K COSMIN %D 2024 %7 2.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the COVID-19 pandemic, the use of video consultation (VC) in primary care has expanded considerably in many countries. VC and other telehealth formats are often touted as a solution to improved health care access, with numerous studies showing high satisfaction with this care format among health professionals and patients. However, operationalization and measurement of patient satisfaction with VC varies across studies and often lacks consideration of dynamic contextual factors (eg, convenience, ease-of-use, or privacy) and doctor-patient relational variables that may influence patient satisfaction. Objective: We aim to develop a comprehensive and evidence-based questionnaire for assessing patient satisfaction with VC in general practice. Methods: The vCare Patient-Satisfaction Questionnaire (the vCare-PSQ) was developed according to the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) guidelines. To achieve our overall objective, we pursued three aims: (1) a validation analysis of an existing patient-satisfaction scale (the PS-14), (2) an assessment of extrinsic contextual factors that may impact patient satisfaction, and (3) an assessment of pertinent intrinsic and relational satisfaction correlates (eg, health anxiety, information technology literacy, trust in the general practitioner, or convenience). For validation purposes, the questionnaire was filled out by a convenience sample of 188 Danish adults who had attended at least 1 VC. Results: Our validation analysis of the PS-14 in a Danish population produced reliable results, indicating that the PS-14 is an appropriate measure of patient satisfaction with VC in Danish patient populations. Regressing situational and doctor-patient relational factors onto patient satisfaction further suggested that patient satisfaction is contingent on several factors not measured by the PS-14. These include information technology literacy and patient trust in the general practitioner, as well as several contextual pros and cons. Conclusions: Supplementing the PS-14 with dynamic measures of situational and doctor-patient relational factors may provide a more comprehensive understanding of patient satisfaction with VC. The vCare-PSQ may thus contribute to an enhanced methodological approach to assessing patient satisfaction with VC. We hope that the vCare-PSQ format may be useful for future research and implementation efforts regarding VC in a general practice setting. %M 39094110 %R 10.2196/58928 %U https://formative.jmir.org/2024/1/e58928 %U https://doi.org/10.2196/58928 %U http://www.ncbi.nlm.nih.gov/pubmed/39094110 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53977 %T Continuous Monitoring of Heart Rate Variability in Free-Living Conditions Using Wearable Sensors: Exploratory Observational Study %A Gaur,Pooja %A Temple,Dorota S %A Hegarty-Craver,Meghan %A Boyce,Matthew D %A Holt,Jonathan R %A Wenger,Michael F %A Preble,Edward A %A Eckhoff,Randall P %A McCombs,Michelle S %A Davis-Wilson,Hope C %A Walls,Howard J %A Dausch,David E %+ Research Triangle Institute, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 9192481458, pgaur@rti.org %K heart rate variability %K physiological monitoring %K wearable sensors %K smartwatch %K PPG %K photoplethysmography %K monitoring %K physiological %K heart rate %K wearable %K wearables %K sensor %K sensors %K observation study %K wearable devices %K devices %K remote monitoring %K community %K data platform %K data collection %K health risk %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable physiological monitoring devices are promising tools for remote monitoring and early detection of potential health changes of interest. The widespread adoption of such an approach across communities and over long periods of time will require an automated data platform for collecting, processing, and analyzing relevant health information. Objective: In this study, we explore prospective monitoring of individual health through an automated data collection, metrics extraction, and health anomaly analysis pipeline in free-living conditions over a continuous monitoring period of several months with a focus on viral respiratory infections, such as influenza or COVID-19. Methods: A total of 59 participants provided smartwatch data and health symptom and illness reports daily over an 8-month window. Physiological and activity data from photoplethysmography sensors, including high-resolution interbeat interval (IBI) and step counts, were uploaded directly from Garmin Fenix 6 smartwatches and processed automatically in the cloud using a stand-alone, open-source analytical engine. Health risk scores were computed based on a deviation in heart rate and heart rate variability metrics from each individual’s activity-matched baseline values, and scores exceeding a predefined threshold were checked for corresponding symptoms or illness reports. Conversely, reports of viral respiratory illnesses in health survey responses were also checked for corresponding changes in health risk scores to qualitatively assess the risk score as an indicator of acute respiratory health anomalies. Results: The median average percentage of sensor data provided per day indicating smartwatch wear compliance was 70%, and survey responses indicating health reporting compliance was 46%. A total of 29 elevated health risk scores were detected, of which 12 (41%) had concurrent survey data and indicated a health symptom or illness. A total of 21 influenza or COVID-19 illnesses were reported by study participants; 9 (43%) of these reports had concurrent smartwatch data, of which 6 (67%) had an increase in health risk score. Conclusions: We demonstrate a protocol for data collection, extraction of heart rate and heart rate variability metrics, and prospective analysis that is compatible with near real-time health assessment using wearable sensors for continuous monitoring. The modular platform for data collection and analysis allows for a choice of different wearable sensors and algorithms. Here, we demonstrate its implementation in the collection of high-fidelity IBI data from Garmin Fenix 6 smartwatches worn by individuals in free-living conditions, and the prospective, near real-time analysis of the data, culminating in the calculation of health risk scores. To our knowledge, this study demonstrates for the first time the feasibility of measuring high-resolution heart IBI and step count using smartwatches in near real time for respiratory illness detection over a long-term monitoring period in free-living conditions. %M 39110968 %R 10.2196/53977 %U https://formative.jmir.org/2024/1/e53977 %U https://doi.org/10.2196/53977 %U http://www.ncbi.nlm.nih.gov/pubmed/39110968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56921 %T Examining the Light Heart Mobile Device App for Assessing Human Pulse Interval and Heart Rate Variability: Validation Study %A Klassen,Stephen A %A Jabbar,Jesica %A Osborne,Jenna %A Iannarelli,Nathaniel J %A Kirby,Emerson S %A O'Leary,Deborah D %A Locke,Sean %+ Faculty of Applied Health Sciences, Brock University, 1812 Sir Issac Brock Way, St. Catharines, ON, L2S 3A1, Canada, 1 9056885550, slocke@brocku.ca %K pulse interval %K mobile app %K validation %K mHealth %K mHealth app %K app mobile device %K mobile device app %K pulse %K heart %K heart rate %K validation study %K biomarker %K psychological %K physiological %K pulse rate %K young adults %K youth %K linear correlation %K heart rate variability %K examining %K examine %K validity %K psychological health %K physiological health %K interval data %K mobile phone %D 2024 %7 20.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pulse interval is a biomarker of psychological and physiological health. Pulse interval can now be assessed using mobile phone apps, which expands researchers’ ability to assess pulse interval in the real world. Prior to implementation, measurement accuracy should be established. Objective: This investigation evaluated the validity of the Light Heart mobile app to measure pulse interval and pulse rate variability in healthy young adults. Methods: Validity was assessed by comparing the pulse interval and SD of normal pulse intervals obtained by Light Heart to the gold standard, electrocardiogram (ECG), in 14 young healthy individuals (mean age 24, SD 5 years; n=9, 64% female) in a seated posture. Results: Mean pulse interval (Light Heart: 859, SD 113 ms; ECG: 857, SD 112 ms) demonstrated a strong positive linear correlation (r=0.99; P<.001) and strong agreement (intraclass correlation coefficient=1.00, 95% CI 0.99-1.00) between techniques. The Bland-Altman plot demonstrated good agreement for the mean pulse interval measured with Light Heart and ECG with evidence of fixed bias (–1.56, SD 1.86; 95% CI –5.2 to 2.1 ms), suggesting that Light Heart overestimates pulse interval by a small margin. When Bland-Altman plots were constructed for each participant’s beat-by-beat pulse interval data, all participants demonstrated strong agreement between Light Heart and ECG with no evidence of fixed bias between measures. Heart rate variability, assessed by SD of normal pulse intervals, demonstrated strong agreement between techniques (Light Heart: mean 73, SD 23 ms; ECG: mean 73, SD 22 ms; r=0.99; P<.001; intraclass correlation coefficient=0.99, 95% CI 0.97-1.00). Conclusions: This study provides evidence to suggest that the Light Heart mobile app provides valid measures of pulse interval and heart rate variability in healthy young adults. %M 39163099 %R 10.2196/56921 %U https://formative.jmir.org/2024/1/e56921 %U https://doi.org/10.2196/56921 %U http://www.ncbi.nlm.nih.gov/pubmed/39163099 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38189 %T Recruitment in Appalachian, Rural and Older Adult Populations in an Artificial Intelligence World: Study Using Human-Mediated Follow-Up %A Milliken,Tabitha %A Beiler,Donielle %A Hoffman,Samantha %A Olenginski,Ashlee %A Troiani,Vanessa %+ Research Institute, Geisinger, 100 N. Academy Ave, Danville, PA, 17821, United States, 1 215 681 1733, vtroiani@geisinger.edu %K telecommunication %K enrollment rate %K Northern Appalachia %K web-based %K aging %K recruitment %K rural %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Participant recruitment in rural and hard-to-reach (HTR) populations can present unique challenges. These challenges are further exacerbated by the need for low-cost recruiting, which often leads to use of web-based recruitment methods (eg, email, social media). Despite these challenges, recruitment strategy statistics that support effective enrollment strategies for underserved and HTR populations are underreported. This study highlights how a recruitment strategy that uses email in combination with follow-up, mostly phone calls and email reminders, produced a higher-than-expected enrollment rate that includes a diversity of participants from rural, Appalachian populations in older age brackets and reports recruitment and demographic statistics within a subset of HTR populations. Objective: This study aims to provide evidence that a recruitment strategy that uses a combination of email, telephonic, and follow-up recruitment strategies increases recruitment rates in various HTR populations, specifically in rural, older, and Appalachian populations. Methods: We evaluated the overall enrollment rate of 1 recruitment arm of a larger study that aims to understand the relationship between genetics and substance use disorders. We evaluated the enrolled population’s characteristics to determine recruitment success of a combined email and follow-up recruitment strategy, and the enrollment rate of HTR populations. These characteristics included (1) enrollment rate before versus after follow-up; (2) zip code and county of enrollee to determine rural or urban and Appalachian status; (3) age to verify recruitment in all eligible age brackets; and (4) sex distribution among age brackets and rural or urban status. Results: The email and follow-up arm of the study had a 17.4% enrollment rate. Of the enrolled participants, 76.3% (4602/6030) lived in rural counties and 23.7% (1428/6030) lived in urban counties in Pennsylvania. In addition, of patients enrolled, 98.7% (5956/6030) were from Appalachian counties and 1.3% (76/6030) were from non-Appalachian counties. Patients from rural Appalachia made up 76.2% (4603/6030) of the total rural population. Enrolled patients represented all eligible age brackets from ages 20 to 75 years, with the 60-70 years age bracket having the most enrollees. Females made up 72.5% (4371/6030) of the enrolled population and males made up 27.5% (1659/6030) of the population. Conclusions: Results indicate that a web-based recruitment method with participant follow-up, such as a phone call and email follow-up, increases enrollment numbers more than web-based methods alone for rural, Appalachian, and older populations. Adding a humanizing component, such as a live person phone call, may be a key element needed to establish trust and encourage patients from underserved and rural areas to enroll in studies via web-based recruitment methods. Supporting statistics on this recruitment strategy should help researchers identify whether this strategy may be useful in future studies and HTR populations. %M 39173153 %R 10.2196/38189 %U https://formative.jmir.org/2024/1/e38189 %U https://doi.org/10.2196/38189 %U http://www.ncbi.nlm.nih.gov/pubmed/39173153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59952 %T Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study %A Hawkins,Alexander T %A Fa,Andrea %A Younan,Samuel A %A Ivatury,Srinivas Joga %A Bonnet,Kemberlee %A Schlundt,David %A Gordon,Elisa J %A Cavanaugh,Kerri L %+ Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, United States, 1 615 343 4612, alex.hawkins@vumc.org %K design sprint %K diverticulitis %K decision aid %K shared decision-making %K colectomy %K diverticulitis %K decision-making %K diverticular diseases %K gastrointestinal diagnosis %K American %K America %K tools %K tool %K effectiveness %K surgeon %K patients %K patient %K communication %K synopsis %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that “the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized.” However, tools to individualize this decision are lacking. Objective: This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. Methods: We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. Results: Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. Conclusions: Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions. %M 39226090 %R 10.2196/59952 %U https://formative.jmir.org/2024/1/e59952 %U https://doi.org/10.2196/59952 %U http://www.ncbi.nlm.nih.gov/pubmed/39226090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54638 %T Constructing a Hospital Department Development–Level Assessment Model: Machine Learning and Expert Consultation Approach in Complex Hospital Data Environments %A Liu,Jingkun %A Tai,Jiaojiao %A Han,Junying %A Zhang,Meng %A Li,Yang %A Yang,Hongjuan %A Yan,Ziqiang %+ Big Data Analysis Center, Honghui Hospital, Xi'an Jiaotong University, No. 555, Youyi Road, Beilin District, Xi'an, 710054, China, 86 15389268019, heluxue68@hotmail.com %K machine algorithms %K hospital management %K model construction %K support vector machine %K clustering %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Every hospital manager aims to build harmonious, mutually beneficial, and steady-state departments. Therefore, it is important to explore a hospital department development assessment model based on objective hospital data. Objective: This study aims to use a novel machine learning algorithm to identify key evaluation indexes for hospital departments, offering insights for strategic planning and resource allocation in hospital management. Methods: Data related to the development of a hospital department over the past 3 years were extracted from various hospital information systems. The resulting data set was mined using neural machine algorithms to assess the possible role of hospital departments in the development of a hospital. A questionnaire was used to consult senior experts familiar with the hospital to assess the actual work in each hospital department and the impact of each department’s development on overall hospital discipline. We used the results from this questionnaire to verify the accuracy of the departmental risk scores calculated by the machine learning algorithm. Results: Deep machine learning was performed and modeled on the hospital system training data set. The model successfully leveraged the hospital’s training data set to learn, predict, and evaluate the working and development of hospital departments. A comparison of the questionnaire results with the risk ranking set from the departments machine learning algorithm using the cosine similarity algorithm and Pearson correlation analysis showed a good match. This indicates that the department development assessment model and risk score based on the objective data of hospital systems are relatively accurate and objective. Conclusions: This study demonstrated that our machine learning algorithm provides an accurate and objective assessment model for hospital department development. The strong alignment of the model's risk assessments with expert opinions, validated through statistical analysis, highlights its reliability and potential to guide strategic hospital management decisions. %M 39230941 %R 10.2196/54638 %U https://formative.jmir.org/2024/1/e54638 %U https://doi.org/10.2196/54638 %U http://www.ncbi.nlm.nih.gov/pubmed/39230941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56784 %T Assessing and Enhancing Movement Quality Using Wearables and Consumer Technologies: Thematic Analysis of Expert Perspectives %A Swain,T Alexander %A McNarry,Melitta A %A Mackintosh,Kelly A %+ Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, A110 Engineering East, Bay Campus, Fabian Way, Swansea, SA1 8EN, United Kingdom, 44 1792295075, k.mackintosh@swansea.ac.uk %K physical activity %K exercise %K wellness %K qualitative %K sensors %K motor skill %K motor learning %K movement skills %K skill development %K movement assessment %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Improvements in movement quality (ie, how well an individual moves) facilitate increases in movement quantity, subsequently improving general health and quality of life. Wearable technology offers a convenient, affordable means of measuring and assessing movement quality for the general population, while technology more broadly can provide constructive feedback through various modalities. Considering the perspectives of professionals involved in the development and implementation of technology helps translate user needs into effective strategies for the optimal application of consumer technologies to enhance movement quality. Objective: This study aimed to obtain the opinions of wearable technology experts regarding the use of wearable devices to measure movement quality and provide feedback. A secondary objective was to determine potential strategies for integrating preferred assessment and feedback characteristics into a technology-based movement quality intervention for the general, recreationally active population. Methods: Semistructured interviews were conducted with 12 participants (age: mean 42, SD 9 years; 5 males) between August and September 2022 using a predetermined interview schedule. Participants were categorized based on their professional roles: commercial (n=4) and research and development (R&D; n=8). All participants had experience in the development or application of wearable technology for sports, exercise, and wellness. The verbatim interview transcripts were analyzed using reflexive thematic analysis in QSR NVivo (release 1.7), resulting in the identification of overarching themes and subthemes. Results: Three main themes were generated as follows: (1) “Grab and Go,” (2) “Adjust and Adapt,” and (3) “Visualize and Feedback.” Participants emphasized the importance of convenience to enhance user engagement when using wearables to collect movement data. However, it was suggested that users would tolerate minor inconveniences if the benefits were perceived as valuable. Simple, easily interpretable feedback was recommended to accommodate diverse audiences and aid understanding of their movement quality, while avoiding excessive detail was advised to prevent overload, which could deter users. Adaptability was endorsed to accommodate progressions in user movement quality, and customizable systems were advocated to offer variety, thereby increasing user interest and engagement. The findings indicate that visual feedback representative of the user (ie, an avatar) should be used, supplemented with concise text or audible instructions to form a comprehensive, multimodal feedback system. Conclusions: The study provides insights from wearable technology experts on the use of consumer technologies for enhancing movement quality. The findings recommend the prioritization of user convenience and simplistic, multimodal feedback centered around visualizations, and an adaptable system suitable for a diverse audience. Emphasizing individualized feedback and user-centric design, this study provides valuable findings around the use of wearables and other consumer technologies to enhance movement quality among the general population. These findings, in conjunction with those of future research into user perspectives, should be applied in practical settings to evaluate their effectiveness in enhancing movement quality. %M 39269744 %R 10.2196/56784 %U https://formative.jmir.org/2024/1/e56784 %U https://doi.org/10.2196/56784 %U http://www.ncbi.nlm.nih.gov/pubmed/39269744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57633 %T A Clinical Decision Support Tool for Intimate Partner Violence Screening Among Women Veterans: Development and Qualitative Evaluation of Provider Perspectives %A Rossi,Fernanda S %A Wu,Justina %A Timko,Christine %A Nevedal,Andrea L %A Wiltsey Stirman,Shannon %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94304, United States, 1 650 721 3990, fsrossi@stanford.edu %K intimate partner violence %K clinical decision support %K intimate partner violence screening %K women veterans %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV), pointing to the critical need for IPV screening and intervention in the Veterans Health Administration (VHA). However, implementing paper-based IPV screening and intervention in the VHA has revealed substantial barriers, including health care providers’ inadequate IPV training, competing demands, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention. Objective: This study aimed to address IPV screening implementation barriers and hence developed and tested a novel IPV clinical decision support (CDS) tool for physicians in the Women’s Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Health Care System. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention. Methods: Informed by existing CDS development frameworks, developing the IPV CDS tool prototype involved six steps: (1) identifying the scope of the tool, (2) identifying IPV screening and intervention content, (3) incorporating IPV-related VHA and clinic resources, (4) identifying the tool’s components, (5) designing the tool, and (6) conducting initial tool revisions. We obtained preliminary physician feedback on user experience and clinical utility of the CDS tool via the System Usability Scale (SUS) and semistructured interviews with 6 WHC physicians. SUS scores were examined using descriptive statistics. Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements. Results: This study includes a detailed description of the IPV CDS tool. Findings indicated that the tool was generally well received by physicians, who indicated good tool usability (SUS score: mean 77.5, SD 12.75). They found the tool clinically useful, needed in their practice, and feasible to implement in primary care. They emphasized that it increased their confidence in managing patients reporting IPV but expressed concerns regarding its length, workflow integration, flexibility, and specificity of information. Several physicians, for example, found the tool too time consuming when encountering patients at high risk; they suggested multiple uses of the tool (eg, an educational tool for less-experienced health care providers and a checklist for more-experienced health care providers) and including more detailed information (eg, a list of local shelters). Conclusions: Physician feedback on the IPV CDS tool is encouraging and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to potentially enhance the quality and efficiency of their IPV screening and intervention process. Additional research is needed to determine the tool’s clinical utility in improving IPV screening and intervention rates and patient outcomes (eg, increased patient safety, reduced IPV risk, and increased referrals to mental health treatment). %M 39321455 %R 10.2196/57633 %U https://formative.jmir.org/2024/1/e57633 %U https://doi.org/10.2196/57633 %U http://www.ncbi.nlm.nih.gov/pubmed/39321455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49720 %T Assessing the Utility of a Patient-Facing Diagnostic Tool Among Individuals With Hypermobile Ehlers-Danlos Syndrome: Focus Group Study %A Goehringer,Jessica %A Kosmin,Abigail %A Laible,Natalie %A Romagnoli,Katrina %+ Department of Genomic Health, Geisinger, 100 North Academy Avenue, Dept of Genomic Health, Danville, PA, 17822, United States, 1 5702141005, jgoehringer@geisinger.edu %K diagnostic tool %K hypermobile Ehlers-Danlos syndrome %K patient experiences %K diagnostic odyssey %K affinity mapping %K mobile health app %K mobile phone %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypermobile Ehlers-Danlos syndrome (hEDS), characterized by joint hypermobility, skin laxity, and tissue fragility, is thought to be the most common inherited connective tissue disorder, with millions affected worldwide. Diagnosing this condition remains a challenge that can impact quality of life for individuals with hEDS. Many with hEDS describe extended diagnostic odysseys involving exorbitant time and monetary investment. This delay is due to the complexity of diagnosis, symptom overlap with other conditions, and limited access to providers. Many primary care providers are unfamiliar with hEDS, compounded by genetics clinics that do not accept referrals for hEDS evaluation and long waits for genetics clinics that do evaluate for hEDS, leaving patients without sufficient options. Objective: This study explored the user experience, quality, and utility of a prototype of a patient-facing diagnostic tool intended to support clinician diagnosis for individuals with symptoms of hEDS. The questions included within the prototype are aligned with the 2017 international classification of Ehlers-Danlos syndromes. This study explored how this tool may help patients communicate information about hEDS to their physicians, influencing the diagnosis of hEDS and affecting patient experience. Methods: Participants clinically diagnosed with hEDS were recruited from either a medical center or private groups on a social media platform. Interested participants provided verbal consent, completed questionnaires about their diagnosis, and were invited to join an internet-based focus group to share their thoughts and opinions on a diagnostic tool prototype. Participants were invited to complete the Mobile App Rating Scale (MARS) to evaluate their experience viewing the diagnostic tool. The MARS is a framework for evaluating mobile health apps across 4 dimensions: engagement, functionality, esthetics, and information quality. Qualitative data were analyzed using affinity mapping to organize information and inductively create themes that were categorized within the MARS framework dimensions to help identify strengths and weaknesses of the diagnostic tool prototype. Results: In total, 15 individuals participated in the internet-based focus groups; 3 (20%) completed the MARS. Through affinity diagramming, 2 main categories of responses were identified, including responses related to the user interface and responses related to the application of the tool. Each category included several themes and subthemes that mapped well to the 4 MARS dimensions. The analysis showed that the tool held value and utility among the participants diagnosed with hEDS. The shareable ending summary sheet provided by the tool stood out as a strength for facilitating communication between patient and provider during the diagnostic evaluation. Conclusions: The results provide insights on the perceived utility and value of the tool, including preferred phrasing, layout and design preferences, and tool accessibility. The participants expressed that the tool may improve the hEDS diagnostic odyssey and help educate providers about the diagnostic process. %M 39325533 %R 10.2196/49720 %U https://formative.jmir.org/2024/1/e49720 %U https://doi.org/10.2196/49720 %U http://www.ncbi.nlm.nih.gov/pubmed/39325533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53711 %T An Ontology to Bridge the Clinical Management of Patients and Public Health Responses for Strengthening Infectious Disease Surveillance: Design Science Study %A Lim,Sachiko %A Johannesson,Paul %+ Department of Computer and Systems Sciences, Stockholm University, Nodhuset, Borgarfjordsgatan 12, Kista, SE-164 07, Sweden, 46 0760968462, sachiko@dsv.su.se %K infectious disease %K ontology %K IoT %K infectious disease surveillance %K patient monitoring %K infectious disease management %K risk analysis %K early warning %K data integration %K semantic interoperability %K public health %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Novel surveillance approaches using digital technologies, including the Internet of Things (IoT), have evolved, enhancing traditional infectious disease surveillance systems by enabling real-time detection of outbreaks and reaching a wider population. However, disparate, heterogenous infectious disease surveillance systems often operate in silos due to a lack of interoperability. As a life-changing clinical use case, the COVID-19 pandemic has manifested that a lack of interoperability can severely inhibit public health responses to emerging infectious diseases. Interoperability is thus critical for building a robust ecosystem of infectious disease surveillance and enhancing preparedness for future outbreaks. The primary enabler for semantic interoperability is ontology. Objective: This study aims to design the IoT-based management of infectious disease ontology (IoT-MIDO) to enhance data sharing and integration of data collected from IoT-driven patient health monitoring, clinical management of individual patients, and disparate heterogeneous infectious disease surveillance. Methods: The ontology modeling approach was chosen for its semantic richness in knowledge representation, flexibility, ease of extensibility, and capability for knowledge inference and reasoning. The IoT-MIDO was developed using the basic formal ontology (BFO) as the top-level ontology. We reused the classes from existing BFO-based ontologies as much as possible to maximize the interoperability with other BFO-based ontologies and databases that rely on them. We formulated the competency questions as requirements for the ontology to achieve the intended goals. Results: We designed an ontology to integrate data from heterogeneous sources, including IoT-driven patient monitoring, clinical management of individual patients, and infectious disease surveillance systems. This integration aims to facilitate the collaboration between clinical care and public health domains. We also demonstrate five use cases using the simplified ontological models to show the potential applications of IoT-MIDO: (1) IoT-driven patient monitoring, risk assessment, early warning, and risk management; (2) clinical management of patients with infectious diseases; (3) epidemic risk analysis for timely response at the public health level; (4) infectious disease surveillance; and (5) transforming patient information into surveillance information. Conclusions: The development of the IoT-MIDO was driven by competency questions. Being able to answer all the formulated competency questions, we successfully demonstrated that our ontology has the potential to facilitate data sharing and integration for orchestrating IoT-driven patient health monitoring in the context of an infectious disease epidemic, clinical patient management, infectious disease surveillance, and epidemic risk analysis. The novelty and uniqueness of the ontology lie in building a bridge to link IoT-based individual patient monitoring and early warning based on patient risk assessment to infectious disease epidemic surveillance at the public health level. The ontology can also serve as a starting point to enable potential decision support systems, providing actionable insights to support public health organizations and practitioners in making informed decisions in a timely manner. %M 39325530 %R 10.2196/53711 %U https://formative.jmir.org/2024/1/e53711 %U https://doi.org/10.2196/53711 %U http://www.ncbi.nlm.nih.gov/pubmed/39325530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48695 %T Assessing the Feasibility of Using Parents’ Social Media Conversations to Inform Burn First Aid Interventions: Mixed Methods Study %A Bennett,Verity %A Spasić,Irena %A Filimonov,Maxim %A Muralidaran,Vigneshwaran %A Kemp,Alison Mary %A Allen,Stuart %A Watkins,William John %+ Children’s Social Care Research and Development Centre, School of Social Sciences, Cardiff University, SPARK Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom, 44 029 2251 2360, bennettcv@cardiff.ac.uk %K social media %K burn first aid %K health interventions %K parents %K burns %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Burns are common childhood injuries, which can lead to serious physical and psychological outcomes. Appropriate first aid is essential in managing the pain and severity of these injuries; hence, parents who need timely access to such information often seek it from the web. In particular, social media allow them to reach other parents, hence these conversations may provide insight to aid the design and evaluation of burn first aid interventions for parents. Objective: This study aims to determine the feasibility of finding, accessing, and analyzing parent burn first aid conversations on social media to inform intervention research. Methods: The initial choice of the relevant social media was made based on the results of a parent focus group and survey. We considered Facebook (Meta Platforms, Inc), Mumsnet (Mumsnet Limited), Netmums (Aufeminin Group), Twitter (subsequently rebranded as “X”; X Corp), Reddit (Reddit, Inc), and YouTube (Google LLC). To locate the relevant data on these platforms, we collated a taxonomy of search terms and designed a search strategy. A combination of natural language processing and manual inspection was used to filter out irrelevant data. The remaining data were analyzed manually to determine the length of conversations, the number of participants, the purpose of the initial post (eg, asking for or offering advice), burn types, and distribution of relevant keywords. Results: Facebook parenting groups were not accessed due to privacy, and public influencer pages yielded scant data. No relevant data were found on Reddit. Data were collected from Mumsnet, Netmums, YouTube, and Twitter. The amount of available data varied across these platforms and through time. Sunburn was identified as a topic across all 4 platforms. Conversations on the parenting forums Mumsnet and Netmums were started predominantly to seek advice (112/116, 96.6% and 25/25, 100%, respectively). Conversely, YouTube and Twitter were used mainly to provide advice (362/328, 94.8% and 126/197, 64%, respectively). Contact burns and sunburn were the most frequent burn types discussed on Mumsnet (30/94, 32% and 23/94, 25%, respectively) and Netmums (2/25, 8% and 14/26, 56%, respectively). Conclusions: This study provides a suite of bespoke search strategies, tailored to a range of social media platforms, for the extraction and analysis of burn first aid conversation data. Our methodology provides a template for other topics not readily accessible via a specific search term or hashtag. YouTube and Twitter show potential utility in measuring advice offered before and after interventions and extending the reach of messaging. Mumsnet and Netmums present the best opportunity for informing burn first aid intervention design via an in-depth qualitative investigation into parents’ knowledge, attitudes, and behaviors. %M 39326036 %R 10.2196/48695 %U https://formative.jmir.org/2024/1/e48695 %U https://doi.org/10.2196/48695 %U http://www.ncbi.nlm.nih.gov/pubmed/39326036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56510 %T The Automatic Context Measurement Tool (ACMT) to Compile Participant-Specific Built and Social Environment Measures for Health Research: Development and Usability Study %A Zhou,Weipeng %A Youngbloom,Amy %A Ren,Xinyang %A Saelens,Brian E %A Mooney,Sean D %A Mooney,Stephen J %+ Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, United States, 1 206 685 1643, sjm2186@uw.edu %K built environment %K social environment %K geocoding %K GIS %K geographic information systems %K ACMT %K automatic context measurement tool %K linkage %K privacy %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The environment shapes health behaviors and outcomes. Studies exploring this influence have been limited to research groups with the geographic information systems expertise required to develop built and social environment measures (eg, groups that include a researcher with geographic information system expertise). Objective: The goal of this study was to develop an open-source, user-friendly, and privacy-preserving tool for conveniently linking built, social, and natural environmental variables to study participant addresses. Methods: We built the automatic context measurement tool (ACMT). The ACMT comprises two components: (1) a geocoder, which identifies a latitude and longitude given an address (currently limited to the United States), and (2) a context measure assembler, which computes measures from publicly available data sources linked to a latitude and longitude. ACMT users access both of these components using an RStudio/RShiny-based web interface that is hosted within a Docker container, which runs on a local computer and keeps user data stored in local to protect sensitive data. We illustrate ACMT with 2 use cases: one comparing population density patterns within several major US cities, and one identifying correlates of cannabis licensure status in Washington State. Results: In the population density analysis, we created a line plot showing the population density (x-axis) in relation to distance from the center of the city (y-axis, using city hall location as a proxy) for Seattle, Los Angeles, Chicago, New York City, Nashville, Houston, and Boston with the distances being 1000, 2000, 3000, 4000, and 5000 m. We found the population density tended to decrease as distance from city hall increased except for Nashville and Houston, 2 cities that are notably more sprawling than the others. New York City had a significantly higher population density than the others. We also observed that Los Angeles and Seattle had similarly low population densities within up to 2500 m of City Hall. In the cannabis licensure status analysis, we gathered neighborhood measures such as age, sex, commute time, and education. We found the strongest predictive characteristic of cannabis license approval to be the count of female children aged 5 to 9 years and the proportion of females aged 62 to 64 years who were not in the labor force. However, after accounting for Bonferroni error correction, none of the measures were significantly associated with cannabis retail license approval status. Conclusions: The ACMT can be used to compile environmental measures to study the influence of environmental context on population health. The portable and flexible nature of ACMT makes it optimal for neighborhood study research seeking to attribute environmental data to specific locations within the United States. %M 39365663 %R 10.2196/56510 %U https://formative.jmir.org/2024/1/e56510 %U https://doi.org/10.2196/56510 %U http://www.ncbi.nlm.nih.gov/pubmed/39365663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54977 %T Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study %A Juhl,Marie Haase %A Soerensen,Ann Lykkegaard %A Vardinghus-Nielsen,Henrik %A Mortensen,Lea Sinding %A Kolding Kristensen,Jette %A Olesen,Anne Estrup %+ Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, Gartnerboligen, ground floor, Aalborg, 9000, Denmark, 45 26281305, aneso@dcm.aau.dk %K intervention development %K nursing home %K frontline professionals %K medication safety %K quality improvement %K patient safety culture %K experiential knowledge %K cocreation %K resilient health care systems %K safety II perspective %K human resources %K integrated knowledge translation %D 2024 %7 9.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. Objective: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. Methods: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. Results: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) “Medication safety reflexive spaces” focused on social and health care assistants. Conclusions: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. International Registered Report Identifier (IRRID): RR2-10.2196/43538 %M 39383532 %R 10.2196/54977 %U https://formative.jmir.org/2024/1/e54977 %U https://doi.org/10.2196/54977 %U http://www.ncbi.nlm.nih.gov/pubmed/39383532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59950 %T Evaluating the Psychometric Properties of a Physical Activity and Sedentary Behavior Identity Scale: Survey Study With Two Independent Samples of Adults in the United States %A Wen,Cheng K Fred %A Schneider,Stefan %A Junghaenel,Doerte U %A Toledo,Meynard John L %A Lee,Pey-Jiuan %A Smyth,Joshua M %A Stone,Arthur A %+ Dornsife Center for Self-Report Science, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-3332, United States, 1 213 821 1850, chengkuw@usc.edu %K physical activity %K sedentary behavior %K geriatrics %K exercise %K lifestyle %K physical health %K mental health %K social-cognitive approach %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging evidence suggests a positive association between relevant aspects of one’s psychological identity and physical activity engagement, but the current understanding of this relationship is primarily based on scales designed to assess identity as a person who exercises, leaving out essential aspects of physical activities (eg, incidental and occupational physical activity) and sedentary behavior. Objective: The goal of this study is to evaluate the validity of a new physical activity and sedentary behavior (PA/SB) identity scale using 2 independent samples of US adults. Methods: In study 1, participants answered 21 candidate items for the PA/SB identity scale and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Study 2 participants completed the same PA/SB identity items twice over a 1-week interval and completed the IPAQ-SF at the end. We performed factor analyses to evaluate the structure of the PA/SB identity scale, evaluated convergent validity and test-retest reliability (in study 2) of the final scale scores, and examined their discriminant validity using tests for differences in dependent correlations. Results: The final PA/SB identity measure was comprised of 3 scales: physical activity role identity (F1), physical activity belief (F2), and sedentary behavior role identity (F3). The scales had high test-retest reliability (Pearson correlation coefficient: F1, r=0.87; F2, r=0.75; F3, r=0.84; intraclass correlation coefficient [ICC]: F1: ICC=0.85; F2: ICC=0.75; F3: ICC=0.84). F1 and F2 were positively correlated with each other (study 1, r=0.76; study 2, r=0.69), while both were negatively correlated with F3 (Pearson correlation coefficient between F1 and F3: r=–0.58 for study 1 and r=–0.73 for study 2; F2 and F3: r=–0.46 for studies 1 and 2). Data from both studies also demonstrated adequate discriminant validity of the scale developed. Significantly larger correlations with time in vigorous and moderate activities and time walking and sitting assessed by IPAQ-SF with F1, compared with F2, were observed. Significantly larger correlations with time in vigorous and moderate activities with F1, compared with F3, were also observed. Similarly, a larger correlation with time in vigorous activities and a smaller correlation with time walking were observed with F2, compared with F3. Conclusions: This study provided initial empirical evidence from 2 independent studies on the reliability and validity of the PA/SB identity scales for adults. %M 39446463 %R 10.2196/59950 %U https://formative.jmir.org/2024/1/e59950 %U https://doi.org/10.2196/59950 %U http://www.ncbi.nlm.nih.gov/pubmed/39446463 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59623 %T Development and Initial Evaluation of a Digital Phenotype Collection System for Adolescents: Proof-of-Concept Study %A Cho,Minseo %A Park,Doeun %A Choo,Myounglee %A Kim,Jinwoo %A Han,Doug Hyun %+ College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea, 82 1050430876, hduk70@gmail.com %K adolescents %K adolescent mental health %K smartphone apps %K self-monitoring %K qualitative research %K phenotypes %K proof of concept %K digital phenotyping %K phenotype data %K ecological momentary assessment %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing concern on adolescent mental health calls for proactive early detection and intervention strategies. There is a recognition of the link between digital phenotypes and mental health, drawing attention to their potential use. However, the process of collecting digital phenotype data presents challenges despite its promising prospects. Objective: This study aims to develop and validate system concepts for collecting adolescent digital phenotypes that effectively manage inherent challenges in the process. Methods: In a formative investigation (N=34), we observed adolescent self-recording behaviors and conducted interviews to develop design goals. These goals were then translated into system concepts, which included planners resembling interfaces, simplified data input with tags, visual reports on behaviors and moods, and supportive ecological momentary assessment (EMA) prompts. A proof-of-concept study was conducted over 2 weeks (n=16), using tools that simulated the concepts to record daily activities and complete EMA surveys. The effectiveness of the system was evaluated through semistructured interviews, supplemented by an analysis of the frequency of records and responses. Results: The interview findings revealed overall satisfaction with the system concepts, emphasizing strong support for self-recording. Participants consistently maintained daily records throughout the study period, with no missing data. They particularly valued the recording procedures that aligned well with their self-recording goal of time management, facilitated by the interface design and simplified recording procedures. Visualizations during recording and subsequent report viewing further enhanced engagement by identifying missing data and encouraging deeper self-reflection. The average EMA compliance reached 72%, attributed to a design that faithfully reflected adolescents’ lives, with surveys scheduled at convenient times and supportive messages tailored to their daily routines. The high compliance rates observed and positive feedback from participants underscore the potential of our approach in addressing the challenges of collecting digital phenotypes among adolescents. Conclusions: Integrating observations of adolescents’ recording behavior into the design process proved to be beneficial for developing an effective and highly compliant digital phenotype collection system. %M 39446465 %R 10.2196/59623 %U https://formative.jmir.org/2024/1/e59623 %U https://doi.org/10.2196/59623 %U http://www.ncbi.nlm.nih.gov/pubmed/39446465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58418 %T Aligning Large Language Models for Enhancing Psychiatric Interviews Through Symptom Delineation and Summarization: Pilot Study %A So,Jae-hee %A Chang,Joonhwan %A Kim,Eunji %A Na,Junho %A Choi,JiYeon %A Sohn,Jy-yong %A Kim,Byung-Hoon %A Chu,Sang Hui %+ Department of Applied Statistics, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 2472, jysohn1108@gmail.com %K large language model %K psychiatric interview %K interview summarization %K symptom delineation %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advancements in large language models (LLMs) have accelerated their use across various domains. Psychiatric interviews, which are goal-oriented and structured, represent a significantly underexplored area where LLMs can provide substantial value. In this study, we explore the application of LLMs to enhance psychiatric interviews by analyzing counseling data from North Korean defectors who have experienced traumatic events and mental health issues. Objective: This study aims to investigate whether LLMs can (1) delineate parts of the conversation that suggest psychiatric symptoms and identify those symptoms, and (2) summarize stressors and symptoms based on the interview dialogue transcript. Methods: Given the interview transcripts, we align the LLMs to perform 3 tasks: (1) extracting stressors from the transcripts, (2) delineating symptoms and their indicative sections, and (3) summarizing the patients based on the extracted stressors and symptoms. These 3 tasks address the 2 objectives, where delineating symptoms is based on the output from the second task, and generating the summary of the interview incorporates the outputs from all 3 tasks. In this context, the transcript data were labeled by mental health experts for the training and evaluation of the LLMs. Results: First, we present the performance of LLMs in estimating (1) the transcript sections related to psychiatric symptoms and (2) the names of the corresponding symptoms. In the zero-shot inference setting using the GPT-4 Turbo model, 73 out of 102 transcript segments demonstrated a recall mid-token distance d<20 for estimating the sections associated with the symptoms. For evaluating the names of the corresponding symptoms, the fine-tuning method demonstrates a performance advantage over the zero-shot inference setting of the GPT-4 Turbo model. On average, the fine-tuning method achieves an accuracy of 0.82, a precision of 0.83, a recall of 0.82, and an F1-score of 0.82. Second, the transcripts are used to generate summaries for each interviewee using LLMs. This generative task was evaluated using metrics such as Generative Evaluation (G-Eval) and Bidirectional Encoder Representations from Transformers Score (BERTScore). The summaries generated by the GPT-4 Turbo model, utilizing both symptom and stressor information, achieve high average G-Eval scores: coherence of 4.66, consistency of 4.73, fluency of 2.16, and relevance of 4.67. Furthermore, it is noted that the use of retrieval-augmented generation did not lead to a significant improvement in performance. Conclusions: LLMs, using either (1) appropriate prompting techniques or (2) fine-tuning methods with data labeled by mental health experts, achieved an accuracy of over 0.8 for the symptom delineation task when measured across all segments in the transcript. Additionally, they attained a G-Eval score of over 4.6 for coherence in the summarization task. This research contributes to the emerging field of applying LLMs in psychiatric interviews and demonstrates their potential effectiveness in assisting mental health practitioners. %M 39447159 %R 10.2196/58418 %U https://formative.jmir.org/2024/1/e58418 %U https://doi.org/10.2196/58418 %U http://www.ncbi.nlm.nih.gov/pubmed/39447159 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55715 %T Exploring the Potential of Electronic Patient-Generated Health Data for Evaluating Treatment Response to Intramuscular Steroids in Rheumatoid Arthritis: Case Series %A Al-Attar,Mariam %A Assawamartbunlue,Kesmanee %A Gandrup,Julie %A van der Veer,Sabine N %A Dixon,William G %+ Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9GB, United Kingdom, 44 161 306 7876, mariam.al-attar@manchester.ac.uk %K patient-reported outcome measures %K remote monitoring %K patient-generated health data %K mobile health %K intramuscular steroid injections %K rheumatoid arthritis %K app %K remote monitoring %K case series %K symptom tracking %K pain score %D 2024 %7 28.10.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Mobile health devices are increasingly available, presenting exciting opportunities to remotely collect high-frequency, electronic patient-generated health data (ePGHD). This novel data type may provide detailed insights into disease activity outside usual clinical settings. Assessing treatment responses, which can be hampered by the infrequency of appointments and recall bias, is a promising, novel application of ePGHD. Drugs with short treatment effects, such as intramuscular steroid injections, illustrate the challenge, as patients are unlikely to accurately recall treatment responses at follow-ups, which often occur several months later. Retrospective assessment means that responses may be over- or underestimated. High-frequency ePGHD, such as daily, app-collected, patient-reported symptoms between clinic appointments, may bridge this gap. However, the potential of ePGHD remains untapped due to the absence of established definitions for treatment response using ePGHD or established methodological approaches for analyzing this type of data. Objective: This study aims to explore the feasibility of evaluating treatment responses to intramuscular steroid therapy in a case series of patients with rheumatoid arthritis tracking daily symptoms using a smartphone app. Methods: We report a case series of patients who collected ePGHD through the REmote Monitoring Of Rheumatoid Arthritis (REMORA) smartphone app for daily remote symptom tracking. Symptoms were tracked on a 0-10 scale. We described the patients’ longitudinal pain scores before and after intramuscular steroid injections. The baseline pain score was calculated as the mean pain score in the 10 days prior to the injection. This was compared to the pain scores in the days following the injection. “Response” was defined as any improvement from the baseline score on the first day following the injection. The response end time was defined as the first date when the pain score exceeded the pre-steroid baseline. Results: We included 6 patients who, between them, received 9 steroid injections. Average pre-injection pain scores ranged from 3.3 to 9.3. Using our definitions, 7 injections demonstrated a response. Among the responders, the duration of response ranged from 1 to 54 days (median 9, IQR 7-41), average pain score improvement ranged from 0.1 to 5.3 (median 3.3, IQR 2.2-4.0), and maximum pain score improvement ranged from 0.1 to 7.0 (median 4.3, IQR 1.7 to 6.0). Conclusions: This case series demonstrates the feasibility of using ePGHD to evaluate treatment response and is an important exploratory step toward developing more robust methodological approaches for analysis of this novel data type. Issues highlighted by our analysis include the importance of accounting for one-off data points, varying response start times, and confounders such as other medications. Future analysis of ePGHD across a larger population is required to address issues highlighted by our analysis and to develop meaningful consensus definitions for treatment response in time-series data. %M 39467551 %R 10.2196/55715 %U https://formative.jmir.org/2024/1/e55715 %U https://doi.org/10.2196/55715 %U http://www.ncbi.nlm.nih.gov/pubmed/39467551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55218 %T A Food Intake Estimation System Using an Artificial Intelligence–Based Model for Estimating Leftover Hospital Liquid Food in Clinical Environments: Development and Validation Study %A Tagi,Masato %A Hamada,Yasuhiro %A Shan,Xiao %A Ozaki,Kazumi %A Kubota,Masanori %A Amano,Sosuke %A Sakaue,Hiroshi %A Suzuki,Yoshiko %A Konishi,Takeshi %A Hirose,Jun %+ Medical Informatics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 7708503, Japan, 81 88 633 9178, tagi@tokushima-u.ac.jp %K artificial intelligence %K machine learning %K system development %K food intake %K dietary intake %K dietary assessment %K food consumption %K image visual estimation %K AI estimation %K direct visual estimation %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical staff often conduct assessments, such as food intake and nutrient sufficiency ratios, to accurately evaluate patients’ food consumption. However, visual estimations to measure food intake are difficult to perform with numerous patients. Hence, the clinical environment requires a simple and accurate method to measure dietary intake. Objective: This study aims to develop a food intake estimation system through an artificial intelligence (AI) model to estimate leftover food. The accuracy of the AI’s estimation was compared with that of visual estimation for liquid foods served to hospitalized patients. Methods: The estimations were evaluated by a dietitian who looked at the food photo (image visual estimation) and visual measurement evaluation was carried out by a nurse who looked directly at the food (direct visual estimation) based on actual measurements. In total, 300 dishes of liquid food (100 dishes of thin rice gruel, 100 of vegetable soup, 31 of fermented milk, and 18, 12, 13, and 26 of peach, grape, orange, and mixed juices, respectively) were used. The root-mean-square error (RMSE) and coefficient of determination (R2) were used as metrics to determine the accuracy of the evaluation process. Corresponding t tests and Spearman rank correlation coefficients were used to verify the accuracy of the measurements by each estimation method with the weighing method. Results: The RMSE obtained by the AI estimation approach was 8.12 for energy. This tended to be smaller and larger than that obtained by the image visual estimation approach (8.49) and direct visual estimation approach (4.34), respectively. In addition, the R2 value for the AI estimation tended to be larger and smaller than the image and direct visual estimations, respectively. There was no difference between the AI estimation (mean 71.7, SD 23.9 kcal, P=.82) and actual values with the weighing method. However, the mean nutrient intake from the image visual estimation (mean 75.5, SD 23.2 kcal, P<.001) and direct visual estimation (mean 73.1, SD 26.4 kcal, P=.007) were significantly different from the actual values. Spearman rank correlation coefficients were high for energy (ρ=0.89-0.97), protein (ρ=0.94-0.97), fat (ρ=0.91-0.94), and carbohydrate (ρ=0.89-0.97). Conclusions: The measurement from the food intake estimation system by an AI-based model to estimate leftover liquid food intake in patients showed a high correlation with the actual values with the weighing method. Furthermore, it also showed a higher accuracy than the image visual estimation. The errors of the AI estimation method were within the acceptable range of the weighing method, which indicated that the AI-based food intake estimation system could be applied in clinical environments. However, its lower accuracy than that of direct visual estimation was still an issue. %M 39500491 %R 10.2196/55218 %U https://formative.jmir.org/2024/1/e55218 %U https://doi.org/10.2196/55218 %U http://www.ncbi.nlm.nih.gov/pubmed/39500491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57165 %T Insights From the Development of a Dynamic Consent Platform for the Australians Together Health Initiative (ATHENA) Program: Interview and Survey Study %A Xiong,Eddy %A Bonner,Carissa %A King,Amanda %A Bourne,Zoltan Maxwell %A Morgan,Mark %A Tolosa,Ximena %A Stanton,Tony %A Greaves,Kim %+ The Australians Together Health Initiative Program (The ATHENA Program), Sunshine Coast University Hospital, Queensland Health, 6 Doherty Street, Birtinya, Queensland, 4575, Australia, 61 0427389900, kim.greaves@health.qld.gov.au %K dynamic consent %K research %K clinical trials %K consumer engagement %K digital consent %K development %K decision making %K decision %K feedback %K user platform %K users %K communication %D 2024 %7 6.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dynamic consent has the potential to address many of the issues facing traditional paper-based or electronic consent, including enrolling informed and engaged participants in the decision-making process. The Australians Together Health Initiative (ATHENA) program aims to connect participants across Queensland, Australia, with new research opportunities. At its core is dynamic consent, an interactive and participant-centric digital platform that enables users to view ongoing research activities, update consent preferences, and have ongoing engagement with researchers. Objective: This study aimed to describe the development of the ATHENA dynamic consent platform within the framework of the ATHENA program, including how the platform was designed, its utilization by participants, and the insights gained. Methods: One-on-one interviews were undertaken with consumers, followed by a workshop with health care staff to gain insights into the dynamic consent concept. Five problem statements were developed, and solutions were posed, from which a dynamic consent platform was constructed, tested, and used for implementation in a clinical trial. Potential users were randomly recruited from a pre-existing pool of 615 participants in the ATHENA program. Feedback on user platform experience was gained from a survey hosted on the platform. Results: In the 13 consumer interviews undertaken, participants were positive about dynamic consent, valuing privacy, ease of use, and adequate communication. Motivators for registration were feedback on data usage and its broader community benefits. Problem statements were security, trust and governance, ease of use, communication, control, and need for a scalable platform. Using the newly constructed dynamic consent platform, 99 potential participants were selected, of whom 67 (68%) were successfully recontacted. Of these, 59 (88%) agreed to be sent the platform, 44 (74%) logged on (indicating use), and 22 (57%) registered for the clinical trial. Survey feedback was favorable, with an average positive rating of 78% across all questions, reflecting satisfaction with the clarity, brevity, and flexibility of the platform. Barriers to implementation included technological and health literacy. Conclusions: This study describes the successful development and testing of a dynamic consent platform that was well-accepted, with users recognizing its advantages over traditional methods of consent regarding flexibility, ease of communication, and participant satisfaction. This information may be useful to other researchers who plan to use dynamic consent in health care research. %M 39504120 %R 10.2196/57165 %U https://formative.jmir.org/2024/1/e57165 %U https://doi.org/10.2196/57165 %U http://www.ncbi.nlm.nih.gov/pubmed/39504120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54022 %T Patterns and Perceptions of Standard Order Set Use Among Physicians Working Within a Multihospital System: Mixed Methods Study %A Naicker,Sundresan %A Tariq,Amina %A Donovan,Raelene %A Magon,Honor %A White,Nicole %A Simmons,Joshua %A McPhail,Steven M %+ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059, Australia, 61 449876034, sundresan.naicker@qut.edu.au %K medical informatics %K adoption and implementation %K behavior %K health systems %K testing %K electronic medical records %K behavioral model %K quantitative data %K semistructured interview %K clinical practice %K user preference %K user %K user experience %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic standard order sets automate the ordering of specific treatment, testing, and investigative protocols by physicians. These tools may help reduce unwarranted clinical variation and improve health care efficiency. Despite their routine implementation within electronic medical records (EMRs), little is understood about how they are used and what factors influence their adoption in practice. Objective: This study aims to (1) describe the patterns of use of standard order sets implemented in a widely used EMR (PowerPlans and Cerner Millennium) within a multihospital digital health care system; (2) explore the experiences and perceptions of implementers and users regarding the factors contributing to the use of these standard order sets; and (3) map these findings to the Capability, Opportunity, and Motivation Behavior (COM-B) model of behavior change to assist those planning to develop, improve, implement, and iterate the use of standard order sets in hospital settings. Methods: Quantitative data on standard order set usage were captured from 5 hospitals over 5-month intervals for 3 years (2019, 2020, and 2021). Qualitative data, comprising unstructured and semistructured interviews (n=15), were collected and analyzed using a reflexive thematic approach. Interview themes were then mapped to a theory-informed model of behavior change (COM-B) to identify determinants of standard order set usage in routine clinical practice. The COM-B model is an evidence-based, multicomponent framework that posits that human actions result from multiple contextual influences, which can be categorized across 3 dimensions: capability, opportunity, and motivation, all of which intersect. Results: The total count of standard order set usage across the health system during the 2019 observation period was 267,253, increasing to 293,950 in 2020 and 335,066 in 2021. There was a notable shift toward using specialty order sets that received upgrades during the study period. Four emergent themes related to order set use were derived from clinician interviews: (1) Knowledge and Skills; (2) Perceptions; (3) Technical Dependencies; and (4) Unintended Consequences, all of which were mapped to the COM-B model. Findings indicate a user preference for customized order sets that respond to local context and user experience. Conclusions: The study findings suggest that ongoing investment in the development and functionality of specialty order sets has the potential to enhance usage as these sets continue to be customized in response to local context and user experience. Sustained and continuous uptake of appropriate Computerized Provider Order Entry use may require implementation strategies that address the capability, opportunity, and motivational influencers of behavior. %M 39514274 %R 10.2196/54022 %U https://formative.jmir.org/2024/1/e54022 %U https://doi.org/10.2196/54022 %U http://www.ncbi.nlm.nih.gov/pubmed/39514274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54792 %T Associations Among Cardiometabolic Risk Factors, Sleep Duration, and Obstructive Sleep Apnea in a Southeastern US Rural Community: Cross-Sectional Analysis From the SLUMBRx-PONS Study %A Knowlden,Adam P %A Winchester,Lee J %A MacDonald,Hayley V %A Geyer,James D %A Higginbotham,John C %+ Department of Health Science, The University of Alabama, Russell Hall 104, Box 870313, Tuscaloosa, AL, 35487, United States, 1 2053481625, apknowlden@ua.edu %K obstructive sleep apnea %K obesity %K adiposity %K cardiometabolic %K cardiometabolic disease %K risk factors %K sleep %K sleep duration %K sleep apnea %K Short Sleep Undermines Cardiometabolic Health-Public Health Observational study %K SLUMBRx study %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Short sleep and obstructive sleep apnea are underrecognized strains on the public health infrastructure. In the United States, over 35% of adults report short sleep and more than 80% of individuals with obstructive sleep apnea remain undiagnosed. The associations between inadequate sleep and cardiometabolic disease risk factors have garnered increased attention. However, challenges persist in modeling sleep-associated cardiometabolic disease risk factors. Objective: This study aimed to report early findings from the Short Sleep Undermines Cardiometabolic Health-Public Health Observational study (SLUMBRx-PONS). Methods: Data for the SLUMBRx-PONS study were collected cross-sectionally and longitudinally from a nonclinical, rural community sample (n=47) in the southeast United States. Measures included 7 consecutive nights of wrist-based actigraphy (eg, mean of 7 consecutive nights of total sleep time [TST7N]), 1 night of sleep apnea home testing (eg, apnea-hypopnea index [AHI]), and a cross-sectional clinical sample of anthropometric (eg, BMI), cardiovascular (eg, blood pressure), and blood-based biomarkers (eg, triglycerides and glucose). Correlational analyses and regression models assessed the relationships between the cardiometabolic disease risk factors and the sleep indices (eg, TST7N and AHI). Linear regression models were constructed to examine associations between significant cardiometabolic indices of TST7N (model 1) and AHI (model 2). Results: Correlational assessment in model 1 identified significant associations between TST7N and AHI (r=–0.45, P=.004), BMI (r=–0.38, P=.02), systolic blood pressure (r=0.40, P=.01), and diastolic blood pressure (r=0.32, P=.049). Pertaining to model 1, composite measures of AHI, BMI, systolic blood pressure, and diastolic blood pressure accounted for 25.1% of the variance in TST7N (R2adjusted=0.25; F2,38=7.37; P=.002). Correlational analyses in model 2 revealed significant relationships between AHI and TST7N (r=–0.45, P<.001), BMI (r=0.71, P<.001), triglycerides (r=0.36, P=.03), and glucose (r=0.34, P=.04). Results from model 2 found that TST7N, triglycerides, and glucose accounted for 37.6% of the variance in the composite measure of AHI and BMI (R2adjusted=0.38; F3,38=8.63; P<.001). Conclusions: Results from the SLUMBRx-PONS study highlight the complex interplay between sleep-associated risk factors for cardiometabolic disease. Early findings underscore the need for further investigations incorporating the collection of clinical, epidemiological, and ambulatory measures to inform public health, health promotion, and health education interventions addressing the cardiometabolic consequences of inadequate sleep. International Registered Report Identifier (IRRID): RR2-10.2196/27139 %M 39514856 %R 10.2196/54792 %U https://formative.jmir.org/2024/1/e54792 %U https://doi.org/10.2196/54792 %U http://www.ncbi.nlm.nih.gov/pubmed/39514856 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59155 %T Collecting Real-Time Patient-Reported Outcome Data During Latent Labor: Feasibility Study of the MyCap Mobile App in Prospective Person-Centered Research %A Kissler,Katherine %A Phillippi,Julia C %A Erickson,Elise %A Holmes,Leah %A Tilden,Ellen %+ College of Nursing, Anschutz Medical Campus, University of Colorado, 13120 E 19th Ave., Mailstop C288, Aurora, CO, 80045, United States, 1 3037244769, katherine.kissler@cuanschutz.edu %K patient-reported outcomes %K survey methods %K smartphone %K labor onset %K prodromal symptoms %K prospective studies %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing emphasis on patient experience in medical research has increased the focus on patient-reported outcomes and symptom measures. However, patient-reported outcomes data are subject to recall bias, limiting reliability. Patient-reported data are most valid when reported by patients in real time; however, this type of data is difficult to collect from patients experiencing acute health events such as labor. Mobile technologies such as the MyCap app, integrated with the REDCap (Research Electronic Data Capture) platform, have emerged as tools for collecting patient-generated health data in real time offering potential improvements in data quality and relevance. Objective: This study aimed to evaluate the feasibility of using MyCap for real-time, patient-reported data collection during latent labor. The objective was to assess the usability of MyCap in characterizing patient experiences during this acute health event and to identify any challenges in data collection that could inform future research. Methods: In this descriptive cohort study, we quantified and characterized data collected prospectively through MyCap and the extent to which participants engaged with the app as a research tool for collecting patient-reported data in real time. Longitudinal quantitative and qualitative surveys were sent to (N=18) enrolled patients with term pregnancies planning vaginal birth at Oregon Health Sciences University. Participants were trained in app use prenatally. Then participants were invited to initiate the research survey on their personal smartphone via MyCap when they experienced labor symptoms and were asked to return to MyCap every 3 hours to provide additional longitudinal symptom data. Results: Out of 18 enrolled participants, 17 completed the study. During latent labor, 13 (76.5%) participants (all those who labored at home and two-thirds of those who were induced) recorded at least 1 symptom report during latent labor. A total of 191 quantitative symptom reports (mean of 10 per participant) were recorded. The most commonly reported symptoms were fatigue, contractions, and pain, with nausea and diarrhea being less frequent but more intense. Four participants recorded qualitative data during labor and 14 responded to qualitative prompts in the postpartum period. The study demonstrated that MyCap could effectively capture real-time patient-reported data during latent labor, although qualitative data collection during active symptoms was less robust. Conclusions: MyCap is a feasible tool for collecting prospective data on patient-reported symptoms during latent labor. Participants engaged actively with quantitative symptom reporting, though qualitative data collection was more challenging. The use of MyCap appears to reduce recall bias and facilitate more accurate data collection for patient-reported symptoms during acute health events outside of health care settings. Future research should explore strategies to enhance qualitative data collection and assess the tool’s usability across more diverse populations and disease states. %M 39515816 %R 10.2196/59155 %U https://formative.jmir.org/2024/1/e59155 %U https://doi.org/10.2196/59155 %U http://www.ncbi.nlm.nih.gov/pubmed/39515816 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60673 %T Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study %A Scaramozza,Matthew %A Ruet,Aurélie %A Chiesa,Patrizia A %A Ahamada,Laïtissia %A Bartholomé,Emmanuel %A Carment,Loïc %A Charre-Morin,Julie %A Cosne,Gautier %A Diouf,Léa %A Guo,Christine C %A Juraver,Adrien %A Kanzler,Christoph M %A Karatsidis,Angelos %A Mazzà,Claudia %A Penalver-Andres,Joaquin %A Ruiz,Marta %A Saubusse,Aurore %A Simoneau,Gabrielle %A Scotland,Alf %A Sun,Zhaonan %A Tang,Minao %A van Beek,Johan %A Zajac,Lauren %A Belachew,Shibeshih %A Brochet,Bruno %A Campbell,Nolan %+ Biogen, 225 Binney St, Cambridge, MA, 02142, United States, 1 781 464 2000, matt.scaramozza@biogen.com %K multiple sclerosis %K sensor-derived measure %K smartphone %K cognitive function %K motor function %K digital biomarkers %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective: This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods: The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results: A total of 16 (34%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95% CI 19%-35%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |ρ|>0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25≤|ρ|<0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25≤|ρ|<0.5) or were not correlated (|ρ|<0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5<|ρ|≤0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|ρ|>0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions: Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials. %M 39515815 %R 10.2196/60673 %U https://formative.jmir.org/2024/1/e60673 %U https://doi.org/10.2196/60673 %U http://www.ncbi.nlm.nih.gov/pubmed/39515815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59800 %T Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis %A Johnson,Amy K %A Devlin,Samantha A %A Pyra,Maria %A Etshokin,Eriika %A Ducheny,Kelly %A Friedman,Eleanor E %A Hirschhorn,Lisa R %A Haider,Sadia %A Ridgway,Jessica P %+ Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5837 S Maryland Ave, Rm L-038, Chicago, IL, 60637, United States, 1 773 702 9016, sdevlin1@bsd.uchicago.edu %K pre-exposure prophylaxis %K PrEP %K Consolidated Framework for Implementation Research %K CFIR %K Expert Recommendations for Implementing Change %K ERIC %K implementation science %K HIV prevention %K AIDS %K United States %K Black women %K women’s health %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Black cisgender women (hereafter referred to as “women”) experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). Objective: This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. Methods: We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Results: Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Conclusions: Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, “POWER Up”) to improve PrEP uptake among women. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0285858 %M 39546769 %R 10.2196/59800 %U https://formative.jmir.org/2024/1/e59800 %U https://doi.org/10.2196/59800 %U http://www.ncbi.nlm.nih.gov/pubmed/39546769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64476 %T The Effect of Virtual Laboratories on the Academic Achievement of Undergraduate Chemistry Students: Quasi-Experimental Study %A Bazie,Hiwot %A Lemma,Bekele %A Workneh,Anteneh %A Estifanos,Ashebir %+ Department of Chemistry, College of Natural and Computational Science, Hawassa University, Hawassa University Main Campus, Hawassa, 1530, Ethiopia, 251 918778422, baziebe@gmail.com %K virtual laboratory %K practical chemistry %K student achievement %K undergraduate student %K Dilla University %K simulation %K chemistry education %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Experimentation is crucial in chemistry education as it links practical experience with theoretical concepts. However, practical chemistry courses typically rely on real laboratory experiments and often face challenges such as limited resources, equipment shortages, and logistical constraints in university settings. To address these challenges, computer-based laboratories have been introduced as a potential solution, offering electronic simulations that replicate real laboratory experiences. Objective: This study examines the effect of virtual laboratories on the academic achievement of undergraduate chemistry students and evaluates their potential as a viable alternative or complement to traditional laboratory-based instruction. Methods: A quasi-experimental design was implemented to examine the cause-and-effect relationship between instructional methods and student outcomes. The study involved 60 fourth-year BSc chemistry students from Dilla University, divided into 3 groups: a real laboratory group (n=20), which performed real laboratory experiments; a virtual group (n=20), which used virtual laboratory simulations; and a lecture group (n=20), which received lecture-based instruction. Quantitative data were collected through tests administered before and after the intervention to assess academic performance. The data analysis used descriptive and inferential statistics, such as means and SDs, 1-way ANOVA, the Tukey honestly significant difference test, and independent-sample t tests (2-tailed), with a P value of .05 set for determining statistical significance. Results: Before the intervention, the results indicated no significant differences in academic achievement among the 3 groups (P=.99). However, after the intervention, notable differences were observed in student performance across the methods. The real laboratory group had the highest mean posttest score (mean 62.6, SD 10.7), followed by the virtual laboratory group (mean 55.5, SD 6.8) and the lecture-only group, which had the lowest mean score (mean 43.7, SD 11.5). ANOVA results confirmed significant differences between the groups (F2,57=18.429; P<.001). The Tukey post hoc test further revealed that the real laboratory group significantly outperformed the lecture-only group (mean difference 18.88; P<.001), while the virtual laboratory group also performed significantly better than the lecture-only group (mean difference 11.7; P=.001). However, no statistically significant difference was found between the real laboratory and virtual laboratory groups (mean difference 7.12; P=.07). In addition, gender did not significantly influence performance in the virtual laboratory group (P=.21), with no substantial difference in posttest scores between male and female students. Conclusions: These findings suggest that computer-based laboratories are a viable and effective alternative when real laboratories are unavailable, enhancing learning outcomes when compared with traditional lecture-based methods. Therefore, universities should consider integrating computer-based laboratories into their practical chemistry curricula to provide students with interactive and engaging learning experiences, especially when physical laboratories are inaccessible. %M 39546770 %R 10.2196/64476 %U https://formative.jmir.org/2024/1/e64476 %U https://doi.org/10.2196/64476 %U http://www.ncbi.nlm.nih.gov/pubmed/39546770 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65199 %T Measuring Technology-Facilitated Sexual Violence and Abuse in the Chinese Context: Development Study and Content Validity Analysis %A Pak,Sharon Hoi Lam %A Wu,Chanchan %A Choi,Kitty Wai Ying %A Choi,Edmond Pui Hang %+ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176972, h0714919@connect.hku.hk %K technology-facilitated sexual violence and abuse %K TFSVA %K image-based sexual abuse %K sexual abuse %K content validity %K measurement %K questionnaire %K China %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Technology-facilitated sexual violence and abuse (TFSVA) encompasses a range of behaviors where digital technologies are used to enable both virtual and in-person sexual violence. Given that TFSVA is an emerging and continually evolving form of sexual abuse, it has been challenging to establish a universally accepted definition or to develop standardized measures for its assessment. Objective: This study aimed to address the significant gap in research on TFSVA within the Chinese context. Specifically, it sought to develop a TFSVA measurement tool with robust content validity, tailored for use in subsequent epidemiological studies within the Chinese context. Methods: The first step in developing the measurement approach for TFSVA victimization and perpetration was to conduct a thorough literature review of existing empirical research on TFSVA and relevant measurement tools. After the initial generation of items, all the items were reviewed by an expert panel to assess the face validity. The measurement items were further reviewed by potential research participants, who were recruited through snowball sampling via online platforms. The assessment results were quantified by computing the content validity index (CVI). The participants were asked to rate each scale item in terms of its relevance, appropriateness, and clarity regarding the topic. Results: The questionnaire was reviewed by 24 lay experts, with a mean age of 27.96 years. They represented different genders and sexual orientations. The final questionnaire contained a total of 89 items. Three key domains were identified to construct the questionnaire, which included image-based sexual abuse, nonimage-based TFSVA, and online-initiated physical sexual violence. The overall scale CVI values of relevance, appropriateness, and clarity for the scale were 0.90, 0.96, and 0.97, respectively, which indicated high content validity for all the instrument items. To ensure the measurement accurately reflects the experiences of diverse demographic groups, the content validity was further analyzed by gender and sexual orientation. This analysis revealed variations in item validity among participants from different genders and sexual orientations. For instance, heterosexual male respondents showed a particularly low CVI for relevance of 0.20 in the items related to nudity, including “male’s chest/nipples are visible” and “the person is sexually suggestive.” This underscored the importance of an inclusive approach when developing a measurement for TFSVA. Conclusions: This study greatly advances the assessment of TFSVA by examining the content validity of our newly developed measurement. The findings revealed that our measurement tool demonstrated adequate content validity, thereby providing a strong foundation for assessing TFSVA within the Chinese context. Implementing this tool is anticipated to enhance our understanding of TFSVA and aid in the development of effective interventions to combat this form of abuse. %M 39561365 %R 10.2196/65199 %U https://formative.jmir.org/2024/1/e65199 %U https://doi.org/10.2196/65199 %U http://www.ncbi.nlm.nih.gov/pubmed/39561365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64844 %T Comparative Analysis of Diagnostic Performance: Differential Diagnosis Lists by LLaMA3 Versus LLaMA2 for Case Reports %A Hirosawa,Takanobu %A Harada,Yukinori %A Tokumasu,Kazuki %A Shiraishi,Tatsuya %A Suzuki,Tomoharu %A Shimizu,Taro %+ Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-cho, Shimotsuga, 321-0293, Japan, 81 0282861111, hirosawa@dokkyomed.ac.jp %K artificial intelligence %K clinical decision support system %K generative artificial intelligence %K large language models %K natural language processing %K NLP %K AI %K clinical decision making %K decision support %K decision making %K LLM: diagnostic %K case report %K diagnosis %K generative AI %K LLaMA %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Generative artificial intelligence (AI), particularly in the form of large language models, has rapidly developed. The LLaMA series are popular and recently updated from LLaMA2 to LLaMA3. However, the impacts of the update on diagnostic performance have not been well documented. Objective: We conducted a comparative evaluation of the diagnostic performance in differential diagnosis lists generated by LLaMA3 and LLaMA2 for case reports. Methods: We analyzed case reports published in the American Journal of Case Reports from 2022 to 2023. After excluding nondiagnostic and pediatric cases, we input the remaining cases into LLaMA3 and LLaMA2 using the same prompt and the same adjustable parameters. Diagnostic performance was defined by whether the differential diagnosis lists included the final diagnosis. Multiple physicians independently evaluated whether the final diagnosis was included in the top 10 differentials generated by LLaMA3 and LLaMA2. Results: In our comparative evaluation of the diagnostic performance between LLaMA3 and LLaMA2, we analyzed differential diagnosis lists for 392 case reports. The final diagnosis was included in the top 10 differentials generated by LLaMA3 in 79.6% (312/392) of the cases, compared to 49.7% (195/392) for LLaMA2, indicating a statistically significant improvement (P<.001). Additionally, LLaMA3 showed higher performance in including the final diagnosis in the top 5 differentials, observed in 63% (247/392) of cases, compared to LLaMA2’s 38% (149/392, P<.001). Furthermore, the top diagnosis was accurately identified by LLaMA3 in 33.9% (133/392) of cases, significantly higher than the 22.7% (89/392) achieved by LLaMA2 (P<.001). The analysis across various medical specialties revealed variations in diagnostic performance with LLaMA3 consistently outperforming LLaMA2. Conclusions: The results reveal that the LLaMA3 model significantly outperforms LLaMA2 per diagnostic performance, with a higher percentage of case reports having the final diagnosis listed within the top 10, top 5, and as the top diagnosis. Overall diagnostic performance improved almost 1.5 times from LLaMA2 to LLaMA3. These findings support the rapid development and continuous refinement of generative AI systems to enhance diagnostic processes in medicine. However, these findings should be carefully interpreted for clinical application, as generative AI, including the LLaMA series, has not been approved for medical applications such as AI-enhanced diagnostics. %M 39561356 %R 10.2196/64844 %U https://formative.jmir.org/2024/1/e64844 %U https://doi.org/10.2196/64844 %U http://www.ncbi.nlm.nih.gov/pubmed/39561356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57747 %T Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment %A Afolabi,Aliyyat %A Cheung,Elaine %A Lyu,Joanne Chen %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143-1390, United States, 1 4155148627, Pamela.Ling@ucsf.edu %K health communication %K video informed consent %K randomized experiment %K informed consent %K adolescent %K video %K consent %K e-cigarette %K vaping %K health research %K social media %K vaping cessation %K smoking cessation %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults have the highest prevalence of e-cigarette use (“vaping”), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people. Objective: This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults. Methods: We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media–based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups. Results: In total, 435 cases comprised the final analytic sample (video: n=215, 49.4%; written: n=220, 50.6%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study. Conclusions: Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research. %M 39576682 %R 10.2196/57747 %U https://formative.jmir.org/2024/1/e57747 %U https://doi.org/10.2196/57747 %U http://www.ncbi.nlm.nih.gov/pubmed/39576682 %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 %@ 2561-326X %I JMIR Publications %V 8 %N %P e60731 %T Minimal Clinically Important Differences With the Outcomes of the App-Based Japanese Allergic Conjunctival Diseases Quality of Life Questionnaire: Cross-Sectional Observational Study %A Nagino,Ken %A Sung,Jaemyoung %A Midorikawa-Inomata,Akie %A Akasaki,Yasutsugu %A Adachi,Takeya %A Ebihara,Nobuyuki %A Fukuda,Ken %A Fukushima,Atsuki %A Fujio,Kenta %A Okumura,Yuichi %A Eguchi,Atsuko %A Fujimoto,Keiichi %A Shokirova,Hurramhon %A Yee,Alan %A Morooka,Yuki %A Huang,Tianxiang %A Hirosawa,Kunihiko %A Nakao,Shintaro %A Kobayashi,Hiroyuki %A Inomata,Takenori %+ Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 1130033, Japan, 81 338133111, tinoma@juntendo.ac.jp %K allergic conjunctivitis %K hay fever %K Japanese Allergic Conjunctival Disease Quality of Life Questionnaire %K minimal clinically important difference %K pollinosis %K telemedicine %K mobile phone %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Assessing changes in quality of life in patients with hay fever–related allergic conjunctivitis requires validated and clinically meaningful metrics. A minimal clinically important difference (MCID) that can be applied to assess Domain II of the Japanese Allergic Conjunctival Disease Quality of Life Questionnaire (JACQLQ) in a smartphone app setting has yet to be determined. Objective: This cross-sectional observational study aimed to determine MCIDs for the app-based JACQLQ in assessing hay fever–related allergic conjunctivitis. Methods: This study used data from a crowdsourced, cross-sectional, observational study conducted via the smartphone app “AllerSearch” between February 1, 2018, and May 1, 2020. Participants were recruited through digital media and social networking platforms and voluntarily provided electronic informed consent. Participants completed the JACQLQ, which includes items on daily activity and psychological well-being, as well as a visual analog scale to measure stress levels related to hay fever. Data were collected through the app, ensuring comprehensive user input. MCIDs were determined using both anchor- and distribution-based methods. The face scale of the JACQLQ Domain III and stress level scale for hay fever were used as anchors to estimate the MCID; ranges were derived from these MCID estimates. In the distribution-based method, MCIDs were calculated using half the SD and SE of the JACQLQ Domain II scores. SEs were derived from the intraclass correlation coefficient of an app-based JACQLQ test-retest reliability metric. Results: A total of 17,597 individuals were identified, of which 15,749 individuals provided electronic consent. After excluding those with incomplete data, 7590 participants with hay fever were included in the study (mean age 35.3, SD 13.9 years; n=4331, 57.1% of women). MCID ranges calculated using the anchor-based method were 1.0-6.9, 1.2-5.6, and 2.1-12.6 for daily activity, psychological well-being, and total JACQLQ Domain II scores, respectively. Using the distribution-based method, the intraclass correlation coefficients were odds ratio (OR) 0.813 (95% CI 0.769-0.849) for daily activity, OR 0.791 (95% CI 0.743-0.832) for psychological well-being, and OR 0.841 (95% CI 0.791-0.864) for total JACQLQ Domain II scores. In addition, the distribution-based method resulted in 2 MCIDs based on half the SD and SE of measurement for daily activity (4.8 and 4.2), psychological well-being (3.4 and 3.1), and total JACQLQ Domain II (7.8 and 6.4) scores. The final suggested MCID ranges for daily activity, psychological well-being, and total JACQLQ Domain II scores were 4.2-6.0, 3.1-4.7, and 6.4-10.5, respectively. Conclusions: MCID ranges for the JACQLQ estimation could help to standardize the app-based quality of life assessment for patients with hay fever–related allergic conjunctivitis. These MCIDs enhanced the precision of remote symptom monitoring and facilitated timely, data-driven interventions, ultimately improving the overall management and outcomes of allergic conjunctivitis through mobile health platforms. %M 39591609 %R 10.2196/60731 %U https://formative.jmir.org/2024/1/e60731 %U https://doi.org/10.2196/60731 %U http://www.ncbi.nlm.nih.gov/pubmed/39591609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60759 %T Relationship Between Heart Rate and Perceived Stress in Intensive Care Unit Residents: Exploratory Analysis Using Fitbit Data %A Wang,Ruijing %A Rezaeian,Olya %A Asan,Onur %A Zhang,Linghan %A Liao,Ting %+ Department of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 2012168643, tliao@stevens.edu %K stress %K perceived stress %K heart rate %K Fitbit %K wearable %K provider %K occupational health %K resident %K trainee %K physician %K health care worker %K intensive care unit %K secondary data analysis %K mental health %K self-reported %D 2024 %7 27.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Intensive care unit (ICU) residents are exposed to high stress levels due to the intense nature of their work, which can impact their mental health and job performance. Heart rate measured through wearable devices has the potential to provide insights into residents’ self-reported stress and aid in developing targeted interventions. Objective: This exploratory study aims to analyze continuous heart rate data and self-reported stress levels and stressors in ICU residents to examine correlations between physiological responses, stress levels, and daily stressors reported. Methods: A secondary data analysis was conducted on heart rate measurements and stress assessments collected from 57 ICU residents over a 3-week period using Fitbit Charge 3 devices. These devices captured continuous physiological data alongside daily surveys that assessed stress levels and identified stressors. The study used Spearman rank correlation, point-biserial correlation analysis, 2-tailed paired t tests, and mixed-effect models to analyze the relationship between heart rate features and stress indicators. Results: The findings reveal complex interactions between stress levels and heart rate patterns. The correlation analysis between stress levels and median heart rate values across different percentile ranges showed that lower percentile heart rates (bottom 5%, 10%, 25%, and 50%) had modest correlations with stress, whereas higher percentiles (top 50%, 25%, 10%, and 5%) did not correlate significantly (all P>.05). The 2-tailed paired t test indicated significant differences in stress levels reported in midday versus end-of-day surveys (P<.001), although these changes in stress levels were not consistently reflected in heart rate patterns. Additionally, we explored and found that stressors related to “other health” issues had the highest positive correlation with stress level changes from midday to end-of-day surveys. However, the weak effect of these stressors on peak heart rate suggests that their impact on physiological measures like heart rate is not yet clear. According to our mixed-effects model, stress levels significantly influenced heart rate variations when hierarchical data were taken into account (P=.03), meaning that as the stress level increased, there was a significant increase in mean heart rate. Conclusions: This study highlights the complexity of using heart rate as an indicator of stress, particularly in high-stress environments like the ICU. Our findings suggest that while heart rate is found to correlate with self-reported stress in the mixed-effect model, its impact is modest, and it should be combined with other physiological and psychological measures to obtain a more accurate and comprehensive assessment of residents’ stress levels. %M 39602805 %R 10.2196/60759 %U https://formative.jmir.org/2024/1/e60759 %U https://doi.org/10.2196/60759 %U http://www.ncbi.nlm.nih.gov/pubmed/39602805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57312 %T A 360° Approach to Personalize Lifestyle Treatment in Primary Care for People With Type 2 Diabetes: Feasibility Study %A Harakeh,Zeena %A de Hoogh,Iris %A Krijger-Dijkema,Anne-Margreeth %A Berbée,Susanne %A Kalkman,Gino %A van Empelen,Pepijn %A Otten,Wilma %+ Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Sylviusweg 71, Leiden, 2333 BE, Netherlands, 31 611615907, zeena.harakeh@tno.nl %K type 2 diabetes %K diagnostic tool %K holistic approach %K personalized treatment %K shared decision-making %K health professionals %K intervention %K feasibility study %K primary care %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the multifactorial nature of type 2 diabetes (T2D), health care for this condition would benefit from a holistic approach and multidisciplinary consultation. To address this, we developed the web-based 360-degree (360°) diagnostic tool, which assesses 4 key domains: “body” (physical health parameters), “thinking and feeling” (eg, mental health and stress), “behavior” (lifestyle factors), and “environment” (eg, work and housing conditions). Objective: This work examines the acceptability, implementation, and potential effects of the 360° diagnostic tool and subsequent tailored treatment (360° approach) in a 6-month intervention and feasibility study conducted in standard primary health care settings in the Netherlands. Methods: A single-group design with baseline, 3-month, and 6-month follow-ups was used. A total of 15 people with T2D and their health care providers from 2 practices participated in a 6-month intervention, which included the 360° diagnosis, tailored treatment, and both individual and group consultations. The 360° diagnosis involved clinical measurements for the “body” domain and self-reports for the “thinking and feeling,” “behavior,” and “environment” domains. After multidisciplinary consultations involving the general practitioner, pharmacist, nurse practitioner (NP), and dietitian, the NP and dietitian provided tailored advice, lifestyle treatment, and ongoing support. At the end of the intervention, face-to-face semistructured interviews were conducted with health care professionals (n=6) and participants (n=13) to assess the acceptability and implementation of the 360° approach in primary health care. Additionally, data from 14 participants on the “thinking and feeling” and “behavior” domains at baseline, 3 months, and 6 months were analyzed to assess changes over time. Results: The semistructured interviews revealed that both participants with T2D and health care professionals were generally positive about various aspects of the 360° approach, including onboarding, data collection with the 360° diagnosis, consultations and advice from the NP and dietitian, the visual representation of parameters in the profile wheel, counseling during the intervention (including professional collaboration), and the group meetings. The interviews also identified factors that promoted or hindered the implementation of the 360° approach. Promoting factors included (1) the care, attention, support, and experience of professionals; (2) the multidisciplinary team; (3) social support; and (4) the experience of positive health effects. Hindering factors included (1) too much information, (2) survey-related issues, and (3) time-consuming counseling. In terms of effects over time, improvements were observed at 3 months in mental health, diabetes-related problems, and fast-food consumption. At 6 months, there was a reduction in perceived stress and fast-food consumption. Additionally, fruit intake decreased at both 3 and 6 months. Conclusions: Our findings suggest that the 360° approach is acceptable to both people with T2D and health care professionals, implementable, and potentially effective in fostering positive health changes. Overall, it appears feasible to implement the 360° approach in standard primary health care. Trial Registration: Netherlands Trial Register NL-7509/NL-OMON45788; https://onderzoekmetmensen.nl/nl/trial/45788 %M 39631068 %R 10.2196/57312 %U https://formative.jmir.org/2024/1/e57312 %U https://doi.org/10.2196/57312 %U http://www.ncbi.nlm.nih.gov/pubmed/39631068 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55827 %T Evaluation of RMES, an Automated Software Tool Utilizing AI, for Literature Screening with Reference to Published Systematic Reviews as Case-Studies: Development and Usability Study %A Sugiura,Ayaka %A Saegusa,Satoshi %A Jin,Yingzi %A Yoshimoto,Riki %A Smith,Nicholas D %A Dohi,Koji %A Higuchi,Tadashi %A Kozu,Tomotake %+ Deloitte Analytics, Deloitte Tohmatsu Risk Advisory LLC, 3-2-3 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan, 81 80 3456 4991, yingzi.jin@tohmatsu.co.jp %K artificial intelligence %K automated literature screening %K natural language processing %K randomized controlled trials %K Rapid Medical Evidence Synthesis %K RMES %K systematic reviews %K text mining %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Systematic reviews and meta-analyses are important to evidence-based medicine, but the information retrieval and literature screening procedures are burdensome tasks. Rapid Medical Evidence Synthesis (RMES; Deloitte Tohmatsu Risk Advisory LLC) is a software designed to support information retrieval, literature screening, and data extraction for evidence-based medicine. Objective: This study aimed to evaluate the accuracy of RMES for literature screening with reference to published systematic reviews. Methods: We used RMES to automatically screen the titles and abstracts of PubMed-indexed articles included in 12 systematic reviews across 6 medical fields, by applying 4 filters: (1) study type; (2) study type + disease; (3) study type + intervention; and (4) study type + disease + intervention. We determined the numbers of articles correctly included by each filter relative to those included by the authors of each systematic review. Only PubMed-indexed articles were assessed. Results: Across the 12 reviews, the number of articles analyzed by RMES ranged from 46 to 5612. The number of PubMed-cited articles included in the reviews ranged from 4 to 47. The median (range) percentage of articles correctly labeled by RMES using filters 1-4 were: 80.9% (57.1%-100%), 65.2% (34.1%-81.8%), 70.5% (0%-100%), and 58.6% (0%-81.8%), respectively. Conclusions: This study demonstrated good performance and accuracy of RMES for the initial screening of the titles and abstracts of articles for use in systematic reviews. RMES has the potential to reduce the workload involved in the initial screening of published studies. %M 39652380 %R 10.2196/55827 %U https://formative.jmir.org/2024/1/e55827 %U https://doi.org/10.2196/55827 %U http://www.ncbi.nlm.nih.gov/pubmed/39652380 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54664 %T Developing Components of an Integrated mHealth Dietary Intervention for Mexican Immigrant Farmworkers: Feasibility Usability Study of a Food Photography Protocol for Dietary Assessment %A Fernandez,Isabel Diana %A Yang,Yu-Ching %A Chang,Wonkyung %A Kautz,Amber %A Farchaus Stein,Karen %+ Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642-0644, United States, 1 585 275 9554, Diana_fernandez@urmc.rochester.edu %K Mexican immigrant farmworker %K diet-related noncommunicable diseases %K mHealth %K dietary assessment %K image-based %K healthcare disparities %K minority %K feasibility study %K food photography %K rural health %K health literacy %K culutural adaptation %K women %K technology acceptance %K mobile health %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non–text-based dietary intervention. Objective: This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed. Methods: We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls. Results: In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol. Conclusions: Dietary assessment through food photography is feasible among Mexican immigrant farmworker women. For future protocols, substantive adjustments will be introduced to reduce the frequency of missing foods and meals. Our preliminary studies are a step in the right direction to extend the benefits of mHealth technologies to a hard-to-reach group and contribute to the prevention and control of diet-related noncommunicable diseases. %M 39671581 %R 10.2196/54664 %U https://formative.jmir.org/2024/1/e54664 %U https://doi.org/10.2196/54664 %U http://www.ncbi.nlm.nih.gov/pubmed/39671581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63680 %T Exploring Individuals’ Views and Feedback on a Nutritional Screening Mobile App: Qualitative Focus Group Study %A Jones,Debra %A Sowerbutts,Anne Marie %A Burden,Sorrel %+ School of Health Sciences, University of Manchester, Jean McFarlane Building, 5th Floor, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613061508, debra.jones@manchester.ac.uk %K malnutrition %K malnutrition risk %K malnutrition screening %K MUST %K mobile application %K mHealth app %K malnutrition universal screening tool %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Malnutrition is a major global health challenge. Worldwide, approximately 390 million adults are underweight, while 2.5 billion are overweight. The Malnutrition Universal Screening Tool (MUST) has been implemented successfully in the United Kingdom to assess the nutritional status of patients in health care settings. Currently, MUST is available as a web-based tool or as a paper-based version, However, the paper tool can lead to calculation errors, and web-based tools require internet access, limiting use in some communities. The MUST app uses clear and simple navigation and processes information precisely, so could potentially improve the accuracy and accessibility of malnutrition screening for health care professionals (HCP) in all settings. Objective: This study aimed to explore the views of HCPs on the content, functionality, and usability of a newly developed mobile app for MUST. Methods: We performed a qualitative study using deductive and inductive framework analysis. A series of online focus groups (~1 hour each) were conducted, exploring potential users’ views on the app’s content design, functionality, and usefulness, which was set in demonstration mode and not available for direct use with patients. Each focus group used a semistructured approach and predefined topic guide. Participants were recruited consecutively and United Kingdom–wide using advertisements through emails, newsletters, and on social media across appropriate local and national networks. Participants had the opportunity to look at the app on their phones before giving feedback and an on-screen demonstration of the app was provided during the focus group. Data were analyzed using deductive and inductive framework analysis. Results: In total, 8 online focus groups were conducted between August 2022 and January 2023. Participants (n=32) were dietetic and nutrition HCPs or educators with experience in using MUST in clinical or community settings. Data analysis revealed three broad themes: (1) improving the app for better use in practice, (2) user experience of design, and (3) barriers and facilitators in different settings. Overall feedback for the app was positive with potential users considering it to be very useful for improving routine and accurate screening, particularly in the community, and mainly because of the automatic calculation feature, which may help with improving discrepancies. Participants generally considered the app to be for professional use only, stating that patients may find it too clinical or technical. Participants also made suggestions for app sustainability and improvements, such as incentives to complete the demographics section or the option to skip questions, and the addition of more subjective measures and instructions on measuring ulna length. Conclusions: The MUST app was positively evaluated by potential users, who reported it was user-friendly and an accessible way to screen for malnutrition risk, whilst improving the accuracy of screening and availability in community settings. %M 39693128 %R 10.2196/63680 %U https://formative.jmir.org/2024/1/e63680 %U https://doi.org/10.2196/63680 %U http://www.ncbi.nlm.nih.gov/pubmed/39693128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65882 %T Identifying the Relative Importance of Factors Influencing Medication Compliance in General Patients Using Regularized Logistic Regression and LightGBM: Web-Based Survey Analysis %A Iino,Haru %A Kizaki,Hayato %A Imai,Shungo %A Hori,Satoko %+ Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30 Shibakoen Minato-ku, Tokyo, 105-8512, Japan, 81 354002650, satokoh@keio.jp %K medication adherence %K pharmacological management %K medication compliance %K Japan %K drugs %K dose %K psychological %K questionnaire survey %K LightGBM %K logistic regression model %K regularization %K machine learning %K AI %K artificial intelligence %D 2024 %7 23.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication compliance, which refers to the extent to which patients correctly adhere to prescribed regimens, is influenced by various psychological, behavioral, and demographic factors. When analyzing these factors, challenges such as multicollinearity and variable selection often arise, complicating the interpretation of results. To address the issue of multicollinearity and better analyze the importance of each factor, machine learning methods are considered to be useful. Objective: This study aimed to identify key factors influencing medication compliance by applying regularized logistic regression and LightGBM. Methods: A questionnaire survey was conducted among 638 adult patients in Japan who had been continuously taking medications for at least 3 months. The survey collected data on demographics, medication habits, psychological adherence factors, and compliance. Logistic regression with regularization was used to handle multicollinearity, while LightGBM was used to calculate feature importance. Results: The regularized logistic regression model identified significant predictors, including “using the drug at approximately the same time each day” (coefficient 0.479; P=.02), “taking meals at approximately the same time each day” (coefficient 0.407; P=.02), and “I would like to have my medication reduced” (coefficient –0.410; P=.01). The top 5 variables with the highest feature importance scores in the LightGBM results were “Age” (feature importance 179.1), “Using the drug at approximately the same time each day” (feature importance 148.4), “Taking meals at approximately the same time each day” (feature importance 109.0), “I would like to have my medication reduced” (feature importance 77.48), and “I think I want to take my medicine” (feature importance 70.85). Additionally, the feature importance scores for the groups of medication adherence–related factors were 77.92 for lifestyle-related items, 52.04 for awareness of medication, 20.30 for relationships with health care professionals, and 5.05 for others. Conclusions: The most significant factors for medication compliance were the consistency of medication and meal timing (mean of feature importance), followed by the number of medications and patient attitudes toward their treatment. This study is the first to use a machine learning model to calculate and compare the relative importance of factors affecting medication adherence. Our findings demonstrate that, in terms of relative importance, lifestyle habits are the most significant contributors to medication compliance among the general patient population. The findings suggest that regularization and machine learning methods, such as LightGBM, are useful for better understanding the numerous adherence factors affected by multicollinearity. %M 39715551 %R 10.2196/65882 %U https://formative.jmir.org/2024/1/e65882 %U https://doi.org/10.2196/65882 %U http://www.ncbi.nlm.nih.gov/pubmed/39715551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57608 %T Implementation and User Satisfaction of a Comprehensive Telemedicine Approach for SARS-CoV-2 Self-Sampling: Monocentric, Prospective, Interventional, Open-Label, Controlled, Two-Arm Feasibility Study %A Voit,Florian %A Erber,Johanna %A Egert-Schwender,Silvia %A Hanselmann,Michael %A Laxy,Michael %A Kehl,Victoria %A Hoffmann,Dieter %A Jeske,Samuel D %A Michler,Thomas %A Protzer,Ulrike %A Kohlmayer,Florian %A Schmid,Roland M %A Spinner,Christoph D %A Weidlich,Simon %K telemedicine %K self-sampling %K SARS-CoV-2 %K user satisfaction %K user %K implementation %K acute respiratory syndrome %K respiratory syndrome %K coronavirus %K self-sampling %K monocentric %K prospective %K interventional %K open-label %K two-arm feasibility study %K innovative %K application %K healthcare %K treatment %K mobile phone %K pandemic control %K health care %D 2024 %7 11.12.2024 %9 %J JMIR Form Res %G English %X Background: The universal availability of smartphones has created new opportunities for innovative telemedicine applications in health care. The COVID-19 pandemic has heightened the demand for contactless health care services, making SARS-CoV-2 polymerase chain reaction (PCR) testing a crucial component of pandemic containment. Objective: This feasibility study aimed to examine a comprehensive telemedicine approach for SARS-CoV-2 testing, focusing on the practicality, user satisfaction, and economic implications of self-sampling guided by a telemedicine platform. Methods: The study process involved shipping self-sampling kits, providing instructions for at-home sample collection, processing biomaterials (swabs and capillary blood), communicating test results, and providing interoperable data for clinical routine and research through a medical mobile app. A total of 100 individuals were randomly assigned to either the conventional health care professional (HCP)–performed SARS-CoV-2 testing group (conventional testing group, CG) or the telemedicine-guided SARS-CoV-2 self-sampling approach (telemedicine group, TG). Feasibility of the TG approach, user satisfaction, user-centered outcomes, and economic aspects were assessed and compared between the groups. Results: In the TG group, 47 out of 49 (95%) individuals received a self-sampling kit via mail, and 37out of 49 (76%) individuals successfully returned at least one sample for diagnostics. SARS-CoV-2 PCR tests were conducted in 95% (35/37) of TG cases compared with 88% (44/50) in the CG. Users in the TG reported high satisfaction levels with ease of use (5.2/7), interface satisfaction (5.2/7), and usefulness (4.3/7). A microcosting model indicated a slightly higher cost for the TG approach than the CG approach. The TG demonstrated the potential to facilitate interoperable data transmission by providing anonymized, standardized datasets for extraction using Health Level 7-Fast Healthcare Interoperability Resources. This supports the national COVID-19 Data Exchange Platform and facilitates epidemiological evaluation based on the German COVID Consensus dataset. Conclusion: These preliminary findings suggest that a telemedicine-based approach to SARS-CoV-2 testing is feasible and could be integrated into existing hospital data infrastructures. This model has the potential for broader application in medical care, offering a scalable solution that could improve user satisfaction and treatment quality in the future. Trial Registration: Deutsches Register Klinischer Studien (DRKS) DRKS00027093; https://www.drks.de/search/de/trial/DRKS00027093 %R 10.2196/57608 %U https://formative.jmir.org/2024/1/e57608 %U https://doi.org/10.2196/57608 %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 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 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 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 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 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 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 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 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 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 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 %@ 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 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 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 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 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 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 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 %@ 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 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 %@ 2561-326X %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 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 %@ 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 %@ 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 %@ 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 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 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 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 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 %@ 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 e60193 %T Impact of Providing a Personalized Data Dashboard on Ecological Momentary Assessment Compliance Among College Students Who Use Substances: Pilot Microrandomized Trial %A Linden-Carmichael,Ashley %A Stull,Samuel W %A Wang,Danny %A Bhandari,Sandesh %A Lanza,Stephanie T %+ The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 320E Biobehavioral Health Building, University Park, PA, 16802, United States, 1 541 346 1978, AshleyLC@uoregon.edu %K ecological momentary assessment %K data dashboard %K study compliance %K substance use %K substance use behavior %K college student %K alcohol %K cannabis %K cannabis use %K personalized data dashboard %K EMA protocol %K EMA %K health behaviors %K survey %K compliance %K self-reported %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant compliance in the study protocol, representing a significant challenge for researchers. Objective: This study aimed to evaluate the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study. Methods: Participants (N=91; 61/91, 67% female and 84/91, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/d (EMA Group) or complete the same EMA protocol with 1 personalized message and a DD indicating multiple metrics of progress in the study, delivered at 1 randomly selected prompt/d (EMA+DD Group) via a microrandomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups. Results: Levels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study (P=.047 and P=.03, respectively). Although nonsignificant, small-to-medium effect sizes were observed when comparing the groups in terms of compensation level (P=.08; Cohen w=0.19) and perceived burden (P=.09; Cohen d=-0.36). Qualitative findings revealed that EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment level did not significantly impact participants’ likelihood of completing the EMA or completion time at that particular prompt (all P>.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 e59426 %T Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach %A Nuseibeh,Betsey Zenk %A Johns,Shelley A %A Shih,Patrick C %A Lewis,Gregory F %A Gowan,Tayler M %A Jordan,Evan J %+ School of Public Health, Indiana University, 1025 East Seventh Street, Bloomington, IN, 47405, United States, 1 5132255577, bznuseib@iu.edu %K breast cancer survivors %K acceptance and commitment therapy %K mHealth app %K user-centered design %K depression %K anxiety %K therapy %K app %K breast cancer %K expert %K designer %K psychosocial %K need %K co-design %K MOSAIC %K mobile acceptance and commitment therapy stress intervention %K interviews %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the world’s most prevalent cancer. Although the 5-year survival rate for breast cancer in the United States is 91%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. Objective: This study aimed to engage breast cancer survivors and acceptance and commitment therapy (ACT) content experts in user-centered design (UCD) to develop a mobile health app (MOSAIC [Mobile Acceptance and Commitment Therapy Stress Intervention]) using stress intervention strategies. Methods: We held 5 UCD sessions with 5 breast cancer survivors, 3 ACT content experts, 2 user experience design experts, and 1 stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the 5-step UCD process (eg, problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the 5 breast cancer survivors and 3 ACT experts using the System Usability Scale, Acceptability E-scale, and a brief set of semistructured interview questions. Results: The 10 co-designers were present for each of the 5 co-design sessions. Co-designers identified 5 design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill-building exercises, and social support. A total of 4 features were also identified as critical to the use of the tool: an ACT and breast cancer–specific onboarding process, clean navigation tools, clear organization of the interventions, and once-per-week behavioral nudges. These requirements created the foundation for the app prototype. The 5 breast cancer survivors and 3 ACT co-designers evaluated the app prototype for 1 week, using an Android smartphone. They rated the app as usable (mean 79.29, SD 19.83) on the System Usability Scale (a priori mean cutoff score=68) and acceptable (mean 24.28, SD 2.77) on the Acceptability E-scale (a priori mean cutoff score=24). Conclusions: Through the UCD process, we created an ACT app prototype with 5 breast cancer survivors, 3 ACT experts, and 2 UCD designers. The next step in our research is to continue the assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot-test the app to examine the feasibility of a large-scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings. %R 10.2196/59426 %U https://formative.jmir.org/2024/1/e59426 %U https://doi.org/10.2196/59426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52651 %T Promoting Comprehensive Sexuality Education in Pakistan Using a Cocreated Social Media Intervention: Development and Pilot Testing Study %A Ahmed,Furqan %A Ahmad,Ghufran %A Eisinger,Katharina %A Khan,Muhammad Asad %A Brand,Tilman %+ Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 (0)421 21856913, ahmedf@leibniz-bips.de %K digital health interventions %K sexuality education %K social media %K influencer marketing %K community readiness %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Comprehensive sexuality education (CSE) is a curriculum-based approach to learning and teaching about sexuality that focuses on the cognitive, emotional, physical, and social domains. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) CSE guideline emphasizes gender issues and is firmly rooted in a human rights–based approach to sexuality. A recent cross-sectional community readiness assessment in Islamabad, Pakistan, found that the community is at the denial or resistant stage when it comes to implementing school-based sexuality education. The reluctance was attributed to a lack of understanding and widespread misconceptions about CSE. Objective: This study aims to use the cocreation process to develop, pilot, and evaluate an intervention based on community readiness level to respond to community resistance by introducing CSE content, its anticipated benefits, and addressing prevalent misconceptions through awareness and promotion content for digital social media platforms. Methods: For the development of the intervention (audio-video content), focus group discussion sessions with key stakeholders were held. Two videos were created in partnership with social media influencers and subsequently shared on Facebook, YouTube, and Instagram. A comprehensive process and performance evaluation of the videos and intervention development phase was conducted to evaluate audience exposure, reach, engagement, demographics, retention, and in-depth insights. The videos were uploaded to social media platforms in June and July 2021, and the data used to assess their performance was obtained in February 2022. Results: With a total reach (number of people who have contact with the videos) of 432,457 and 735,563 for the first and second videos, respectively, on all social media platforms, we concluded that social media platforms provide an opportunity to communicate, promote, and engage with important stakeholders to raise awareness and obtain support for CSE. According to the findings, the public is responsive to CSE promotion content developed for social media platforms, with a total engagement (the number of people who participate in creating, sharing, and using the content) of 11,578. The findings revealed that male viewers predominated across all social media platforms. Punjab province had the largest audience share on Instagram (51.9% for the first video, 52.7% for the second) and Facebook (44.3% for the first video and 48.4% for the second). YouTube had the highest audience retention, with viewers watching an average of 151 seconds (45%) of the first video and 163 seconds (38%) of the second. With a net sentiment score of 0.83 (minimum=−3, maximum=5), end-user participation was also positive, and audience feedback highlighted the reasons for positive and negative criticism. Conclusions: To promote sexuality education in Pakistan, it is vital to overcome opposition through sensitizing the society, and digital social media platforms offer a unique, though underused, chance to do so through reliable influencer marketing. %M 39705696 %R 10.2196/52651 %U https://formative.jmir.org/2024/1/e52651 %U https://doi.org/10.2196/52651 %U http://www.ncbi.nlm.nih.gov/pubmed/39705696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53453 %T Changepoint Detection in Heart Rate Variability Indices in Older Patients Without Cancer at End of Life Using Ballistocardiography Signals: Preliminary Retrospective Study %A Yanagisawa,Naotake %A Nishizaki,Yuji %A Yao,Bingwei %A Zhang,Jianting %A Kasai,Takatoshi %+ Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, 81 338133111, kasai-t@mx6.nisiq.net %K ballistocardiography %K BCG %K nonnvasive monitoring %K heart rate variability %K end-of-life care %K prognosis prediction %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In an aging society such as Japan, where the number of older people continues to increase, providing in-hospital end-of-life care for all deaths, and end-of-life care outside of hospitals, such as at home or in nursing homes, will be difficult. In end-of-life care, monitoring patients is important to understand their condition and predict survival time; this information gives family members and caregivers time to prepare for the end of life. However, with no clear indicators, health care providers must subjectively decide if an older patient is in the end-of-life stage, considering factors such as condition changes and decreased food intake. This complicates decisions for family members, especially during home-based care. Objective: The purpose of this preliminary retrospective study was to determine whether and how changes in heart rate variability (HRV) indices estimated from ballistocardiography (BCG) occur before the date of death in terminally ill older patients, and ultimately to predict the date of death from the changepoint. Methods: This retrospective pilot study assessed the medical records of 15 older patients admitted to a special nursing home between August 2019 and December 2021. Patient characteristics and time-domain HRV indices such as the average normal-to-normal (ANN) interval, SD of the normal-to-normal (SDNN) interval, and root mean square of successive differences (RMSSD) from at least 2 months before the date of death were collected. Overall trends of indices were examined by drawing a restricted cubic spline curve. A repeated measures ANOVA was performed to evaluate changes in the indices over the observation period. To explore more detailed changes in HRV, a piecewise regression analysis was conducted to estimate the changepoint of HRV indices. Results: The 15 patients included 8 men and 7 women with a median age of 93 (IQR 91-96) years. The cubic spline curve showed a gradual decline of indices from approximately 30 days before the patients’ deaths. The repeated measures ANOVA showed that when compared with 8 weeks before death, the ratio of the geometric mean of ANN (0.90, 95% CI 0.84-0.98; P=.005) and RMSSD (0.83, 95% CI 0.70-0.99; P=.03) began to decrease 3 weeks before death. The piecewise regression analysis estimated the changepoints for ANN, SDNN, and RMSSD at –34.5 (95% CI –42.5 to –26.5; P<.001), –33.0 (95% CI –40.9 to –25.1; P<.001), and –35.0 (95% CI –42.3 to –27.7; P<.001) days, respectively, before death. Conclusions: This preliminary study identified the changepoint of HRV indices before death in older patients at end of life. Although few data were examined, our findings indicated that HRV indices from BCG can be useful for monitoring and predicting survival time in older patients at end of life. The study and results suggest the potential for more objective and accurate prognostic tools in predicting end-of-life outcomes. %M 38345857 %R 10.2196/53453 %U https://formative.jmir.org/2024/1/e53453 %U https://doi.org/10.2196/53453 %U http://www.ncbi.nlm.nih.gov/pubmed/38345857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51604 %T Engaging Cancer Care Physicians in Off-Label Drug Clinical Trials: Human-Centered Design Approach %A Parsell,Maren C %A Greenleaf,Morgan N %A Kombara,Greeshma G %A Sukhatme,Vikas P %A Lam,Wilbur A %+ Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Emory University, 1440 Clifton Road, Atlanta, GA, 30322, United States, 1 4048896149, maren.parsell@emory.edu %K human-centered design %K clinical trial design %K design methods %K clinical trial %K trial methodology %K barriers %K off-label drugs %K stakeholders %K cancer %K medications %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Using a human-centered design (HCD) approach can provide clinical trial design teams with a better understanding of the needs, preferences, and attitudes of clinical trial stakeholders. It can also be used to understand the challenges and barriers physician stakeholders face in initiating and completing clinical trials, especially for using off-label drugs (OLDs) to treat unmet clinical needs in cancer treatment. However, the HCD approach is not commonly taught in the context of clinical trial design, and few step-by-step guides similar to this study are available to demonstrate its application. Objective: This study aims to demonstrate the feasibility and process of applying an HCD approach to creating clinical trial support resources for physician stakeholders to overcome barriers to pursuing clinical trials for OLDs to treat cancer. Methods: An HCD approach was used to develop OLD clinical trial support concepts. In total, 45 cancer care physicians were contacted, of which 15 participated in semistructured interviews to identify barriers to prescribing OLDs or participating in cancer OLD clinical trials. Design research is qualitative—it seeks to answer “why” and “how” questions; thus, a sample size of 15 was sufficient to provide insight saturation to address the design problem. The team used affinity mapping and thematic analysis of qualitative data gathered from the interviews to inform subsequent web-based co-design sessions, which included creative matrix exercises and voting to refine and prioritize the ideas used in the final 3 recommended concepts. Results: The findings demonstrate the potential of HCD methods to uncover important insights into the barriers physicians face in participating in OLD clinical trials or prescribing OLDs, such as recruitment challenges, low willingness to prescribe without clinical data, and stigma. Notably, only palliative care participants self-identified as “frequent prescribers” of OLDs, despite high national OLD prescription rates among patients with cancer. Participants found the HCD approach engaging, with 60% (9/15) completing this study; scheduling conflicts caused most of the dropouts. Over 150 ideas were generated in 3 co-design sessions, with the groups voting on 15 priority ideas that the design team then refined into 3 final recommendations, especially focused on increasing the participation of physicians in OLD clinical trials. Conclusions: Using participatory HCD methods, we delivered 3 concepts for clinical trial support resources to help physician stakeholders overcome barriers to pursuing clinical trials for OLDs to treat cancer. Overall, integrating the HCD approach can aid in identifying important stakeholders, such as prescribing physicians; facilitating their engagement; and incorporating their perspectives and needs into the solution design process. This paper highlights the process, methods, and potential of HCD to improve cancer clinical trial design. Future work is needed to train clinical trial designers in the HCD approach and encourage adoption in the field. %M 38358789 %R 10.2196/51604 %U https://formative.jmir.org/2024/1/e51604 %U https://doi.org/10.2196/51604 %U http://www.ncbi.nlm.nih.gov/pubmed/38358789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54077 %T Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report %A Eldridge,Lori Ann %A Meyerson,Beth E %A Agley,Jon %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E 9th Street, Bloomington, IN, 47405, United States, 1 812 855 3123, jagley@indiana.edu %K naloxone %K Narcan %K pharmacy %K harm reduction %K PharmNet %K overdose %K opioids %K implementation %K pragmatic trial %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies’ ubiquity and pharmacists’ extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education. Objective: In 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team’s control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the “file-drawer” (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors’ hypotheses. Methods: This paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies. Results: Retrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive. Conclusions: Community pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study. International Registered Report Identifier (IRRID): RR2-10.2196/42373 %M 38498037 %R 10.2196/54077 %U https://formative.jmir.org/2024/1/e54077 %U https://doi.org/10.2196/54077 %U http://www.ncbi.nlm.nih.gov/pubmed/38498037 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52344 %T Machine Learning–Based Prediction of Changes in the Clinical Condition of Patients With Complex Chronic Diseases: 2-Phase Pilot Prospective Single-Center Observational Study %A Alvarez-Romero,Celia %A Polo-Molina,Alejandro %A Sánchez-Úbeda,Eugenio Francisco %A Jimenez-De-Juan,Carlos %A Cuadri-Benitez,Maria Pastora %A Rivas-Gonzalez,Jose Antonio %A Portela,Jose %A Palacios,Rafael %A Rodriguez-Morcillo,Carlos %A Muñoz,Antonio %A Parra-Calderon,Carlos Luis %A Nieto-Martin,Maria Dolores %A Ollero-Baturone,Manuel %A Hernández-Quiles,Carlos %+ Internal Medicine Department, Virgen del Rocio University Hospital, Av Manuel Siurot s/n, Sevilla, 41013, Spain, 34 697950012, quiles_es@yahoo.es %K patients with complex chronic diseases %K functional impairment %K Barthel Index %K artificial intelligence %K machine learning %K prediction model %K pilot study %K chronic patients %K chronic %K development study %K prognostic %K diagnostic %K therapeutic %K wearable %K wearables %K wearable activity tracker %K mobility device %K device %K physical activity %K caregiver %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Functional impairment is one of the most decisive prognostic factors in patients with complex chronic diseases. A more significant functional impairment indicates that the disease is progressing, which requires implementing diagnostic and therapeutic actions that stop the exacerbation of the disease. Objective: This study aimed to predict alterations in the clinical condition of patients with complex chronic diseases by predicting the Barthel Index (BI), to assess their clinical and functional status using an artificial intelligence model and data collected through an internet of things mobility device. Methods: A 2-phase pilot prospective single-center observational study was designed. During both phases, patients were recruited, and a wearable activity tracker was allocated to gather physical activity data. Patients were categorized into class A (BI≤20; total dependence), class B (2060; moderate or mild dependence, or independent). Data preprocessing and machine learning techniques were used to analyze mobility data. A decision tree was used to achieve a robust and interpretable model. To assess the quality of the predictions, several metrics including the mean absolute error, median absolute error, and root mean squared error were considered. Statistical analysis was performed using SPSS and Python for the machine learning modeling. Results: Overall, 90 patients with complex chronic diseases were included: 50 during phase 1 (class A: n=10; class B: n=20; and class C: n=20) and 40 during phase 2 (class B: n=20 and class C: n=20). Most patients (n=85, 94%) had a caregiver. The mean value of the BI was 58.31 (SD 24.5). Concerning mobility aids, 60% (n=52) of patients required no aids, whereas the others required walkers (n=18, 20%), wheelchairs (n=15, 17%), canes (n=4, 7%), and crutches (n=1, 1%). Regarding clinical complexity, 85% (n=76) met patient with polypathology criteria with a mean of 2.7 (SD 1.25) categories, 69% (n=61) met the frailty criteria, and 21% (n=19) met the patients with complex chronic diseases criteria. The most characteristic symptoms were dyspnea (n=73, 82%), chronic pain (n=63, 70%), asthenia (n=62, 68%), and anxiety (n=41, 46%). Polypharmacy was presented in 87% (n=78) of patients. The most important variables for predicting the BI were identified as the maximum step count during evening and morning periods and the absence of a mobility device. The model exhibited consistency in the median prediction error with a median absolute error close to 5 in the training, validation, and production-like test sets. The model accuracy for identifying the BI class was 91%, 88%, and 90% in the training, validation, and test sets, respectively. Conclusions: Using commercially available mobility recording devices makes it possible to identify different mobility patterns and relate them to functional capacity in patients with polypathology according to the BI without using clinical parameters. %M 38640473 %R 10.2196/52344 %U https://formative.jmir.org/2024/1/e52344 %U https://doi.org/10.2196/52344 %U http://www.ncbi.nlm.nih.gov/pubmed/38640473 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54343 %T Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment %A Hawa,Saadiya %A Bane,Shalmali %A Kinsler,Kayla %A Rector,Amadeia %A Chaichian,Yashaar %A Falasinnu,Titilola %A Simard,Julia F %+ Department of Epidemiology and Population Health, Stanford School of Medicine, Alway Building, 300 Pasteur Drive, M121L, MC: 5405, Stanford, CA, 94305, United States, 1 650 7239680, jsimard@stanford.edu %K internet survey %K incentive %K physician recruitment %K internet surveys %K online survey %K online surveys %K web-based survey %K web-based surveys %K survey %K surveys %K incentives %K monetary incentive %K monetary incentives %K physician participation %K physician participant %K physician participants %K physician %K physicians %K doctor participation %K doctor participant %K doctor participants %K doctor %K doctors %K neurologist %K neurologists %D 2024 %7 14.5.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion. Objective: This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States. Methods: We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion. Results: For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10). Conclusions: As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation. %M 38743466 %R 10.2196/54343 %U https://formative.jmir.org/2024/1/e54343 %U https://doi.org/10.2196/54343 %U http://www.ncbi.nlm.nih.gov/pubmed/38743466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48076 %T Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study %A Ormiston,Cameron K %A Villalobos,Kevin %A Montiel Ishino,Francisco Alejandro %A Williams,Faustine %+ National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, Rockville, MD, 20852, United States, 1 301 827 2727, cameron.ormiston@icahn.mssm.edu %K depressive symptoms %K everyday discrimination %K COVID-19 pandemic %K Hispanic and Latino %K immigrant health %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. Objective: This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. Methods: Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. Results: Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. Conclusions: Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity. %M 38843512 %R 10.2196/48076 %U https://formative.jmir.org/2024/1/e48076 %U https://doi.org/10.2196/48076 %U http://www.ncbi.nlm.nih.gov/pubmed/38843512 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58465 %T Visual Function and Driving Performance Under Different Lighting Conditions in Older Drivers: Preliminary Results From an Observational Study %A Yang,Jingzhen %A Alshaikh,Enas %A Yu,Deyue %A Kerwin,Thomas %A Rundus,Christopher %A Zhang,Fangda %A Wrabel,Cameron G %A Perry,Landon %A Lu,Zhong-Lin %+ Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, 700 Children's Drive, Columbus, OH, 43205, United States, 1 6143555852, Ginger.Yang@nationwidechildrens.org %K nighttime driving %K functional vision %K driving simulation %K older drivers %K visual functions %K photopic %K mesopic %K glare %K driving simulator %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Age-related vision changes significantly contribute to fatal crashes at night among older drivers. However, the effects of lighting conditions on age-related vision changes and associated driving performance remain unclear. Objective: This pilot study examined the associations between visual function and driving performance assessed by a high-fidelity driving simulator among drivers 60 and older across 3 lighting conditions: daytime (photopic), nighttime (mesopic), and nighttime with glare. Methods: Active drivers aged 60 years or older participated in visual function assessments and simulated driving on a high-fidelity driving simulator. Visual acuity (VA), contrast sensitivity function (CSF), and visual field map (VFM) were measured using quantitative VA, quantitative CSF, and quantitative VFM procedures under photopic and mesopic conditions. VA and CSF were also obtained in the presence of glare in the mesopic condition. Two summary metrics, the area under the log CSF (AULCSF) and volume under the surface of VFM (VUSVFM), quantified CSF and VFM. Driving performance measures (average speed, SD of speed [SDspeed], SD of lane position (SDLP), and reaction time) were assessed under daytime, nighttime, and nighttime with glare conditions. Pearson correlations determined the associations between visual function and driving performance across the 3 lighting conditions. Results: Of the 20 drivers included, the average age was 70.3 years; 55% were male. Poor photopic VA was significantly correlated with greater SDspeed (r=0.26; P<.001) and greater SDLP (r=0.31; P<.001). Poor photopic AULCSF was correlated with greater SDLP (r=–0.22; P=.01). Poor mesopic VUSFVM was significantly correlated with slower average speed (r=–0.24; P=.007), larger SDspeed (r=–0.19; P=.04), greater SDLP (r=–0.22; P=.007), and longer reaction times (r=–0.22; P=.04) while driving at night. For functional vision in the mesopic condition with glare, poor VA was significantly correlated with longer reaction times (r=0.21; P=.046) while driving at night with glare; poor AULCSF was significantly correlated with slower speed (r=–0.32; P<.001), greater SDLP (r=–0.26; P=.001) and longer reaction times (r=–0.2; P=.04) while driving at night with glare. No other significant correlations were observed between visual function and driving performance under the same lighting conditions. Conclusions: Visual functions differentially affect driving performance in different lighting conditions among older drivers, with more substantial impacts on driving during nighttime, especially in glare. Additional research with larger sample sizes is needed to confirm these results. %M 38922681 %R 10.2196/58465 %U https://formative.jmir.org/2024/1/e58465 %U https://doi.org/10.2196/58465 %U http://www.ncbi.nlm.nih.gov/pubmed/38922681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57519 %T The Feasibility and Acceptability of Sharing Video Recordings of Amyotrophic Lateral Sclerosis Clinical Encounters With Patients and Their Caregivers: Pilot Randomized Clinical Trial %A Bratches,Reed W R %A Cohen,Jeffrey %A Carpenter-Song,Elizabeth %A Mistler,Lisa %A Barr,Paul J %+ School of Nursing, University of Alabama at Birmingham, 1720 University Boulevard, Birmingham, AL, 35222, United States, 1 2059316655, rbratches@gmail.com %K feasibility %K acceptability %K amyotrophic lateral sclerosis %K digital intervention %K ALS %K video recording %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multidisciplinary clinics (MDCs) provide benefits to patients with amyotrophic lateral sclerosis (ALS) and their caregivers, but MDC visits are information-heavy and can last 4 hours, with patients and caregivers meeting with multiple specialists within each MDC visit. There are questions about the effectiveness of current methods of sharing information from MDCs with patients. Video recordings are a promising new method of sharing information that may allow patients and caregivers to revisit the MDC and remind them of clinical recommendations and conversations. Objective: The objective of this trial is to determine the feasibility and acceptability of sharing information through video recordings of ALS MDC visits with patients and caregivers. Methods: This study was a randomized, controlled pilot trial with 3 months of follow-up from April 2021 to March 2022 in a rural multidisciplinary neurology clinic. We recruited patients with ALS, their caregivers, and their clinicians. Patients and their caregivers were randomized to either receive their normal after-visit summary (treatment as usual) or to receive their normal after-visit summary and a video recording of their MDC visit (video). Each specialist visit had its own recording and was accessible by patients and caregivers using a secure web-based platform called HealthPAL over a 3-month follow-up period. Primary study outcomes were feasibility and acceptability of the video intervention measured by recruitment rate (target: 70%), percentage of participants watching videos (target: 75%), and the Feasibility of Intervention Measure and Acceptability of Intervention Measure (targets: 3/5). We hypothesized that video recording would be feasible and acceptable to patients and their caregivers. Results: Of the 30 patients approached, 24 were recruited, while all caregivers (n=21) and clinicians (n=34) approached were recruited. A total of 144 specialist visits were recorded, approximately 12 specialist visits at a median of one MDC visit per patient. Of the recorded patients, 75% (9/12) viewed videos. High median intervention feasibility (4, SD 0.99) and acceptability (4, SD 1.22) of intervention measures were reported by patients and caregivers in the intervention arm. High median intervention feasibility (5, SD 0.21) and acceptability (4.88, SD 0.4) were reported by clinicians. Of the 24 patients, 50% (n=12) did not complete a 3-month follow-up, primarily due to death (n=10). Conclusions: Video recording is highly feasible and acceptable for patients, caregivers, and clinicians at a rural ALS clinic. Our level of attrition is a useful benchmark for future studies in MDC populations. Despite high rates of patient death, 1-week assessments highlight the value of recordings for both patients and caregivers. Trial Registration: ClinicalTrials.gov NCT04719403; https://clinicaltrials.gov/study/NCT04719403 %M 38924779 %R 10.2196/57519 %U https://formative.jmir.org/2024/1/e57519 %U https://doi.org/10.2196/57519 %U http://www.ncbi.nlm.nih.gov/pubmed/38924779 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59121 %T Characterizing Mental Health Status and Service Utilization in Chinese Americans With Type 2 Diabetes in New York City: Cross-Sectional Study %A Shi,Yun %A Wu,Bei %A Islam,Nadia %A Sevick,Mary Ann %A Shallcross,Amanda J %A Levy,Natalie %A Tamura,Kosuke %A Bao,Han %A Lieu,Ricki %A Xu,Xinyi %A Jiang,Yulin %A Hu,Lu %+ Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, 180 Madison Ave, 7th floor, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyulangone.org %K mental health %K diabetes distress %K depression %K anxiety %K service utilization %K psychological distress %K type 2 diabetes %K diabetes %K United States %K mental health burden %K Chinese American %K cross-sectional %K telephone survey %K stress %K depressive symptoms %K mental health care %K mental health screening %D 2024 %7 2.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging evidence indicates that individuals with type 2 diabetes (T2D) are more prone to mental health issues than the general population; however, there is a significant lack of data concerning the mental health burden in Chinese Americans with T2D. Objective: The aim of this study was to explore the comorbid mental health status, health-seeking behaviors, and mental service utilization among Chinese Americans with T2D. Methods: A cross-sectional telephone survey was performed among 74 Chinese Americans with T2D in New York City. We used standardized questionnaires to assess mental health status and to gather data on mental health–seeking behaviors and service utilization. Descriptive statistics were applied for data analysis. Results: A total of 74 Chinese Americans with T2D completed the survey. Most participants (mean age 56, SD 10 years) identified as female (42/74, 57%), were born outside the United States (73/74, 99%), and had limited English proficiency (71/74, 96%). Despite nearly half of the participants (34/74, 46%) reporting at least one mental health concern (elevated stress, depressive symptoms, and/or anxiety), only 3% (2/74) were currently using mental health services. Common reasons for not seeking care included no perceived need, lack of information about Chinese-speaking providers, cost, and time constraints. The cultural and language competence of the provider was ranked as the top factor related to seeking mental health care. Conclusions: Chinese Americans with T2D experience relatively high comorbid mental health concerns yet have low service utilization. Clinicians may consider team-based care to incorporate mental health screening and identify strategies to provide culturally and linguistically concordant mental health services to engage Chinese Americans with T2D. %M 38954806 %R 10.2196/59121 %U https://formative.jmir.org/2024/1/e59121 %U https://doi.org/10.2196/59121 %U http://www.ncbi.nlm.nih.gov/pubmed/38954806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58322 %T Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research %A Rulison,Kelly %A Weaver,GracieLee %A Milroy,Jeffrey %A Beamon,Emily %A Kelly,Samantha %A Ameeni,Ali %A Juma,Amina %A Abualgasim,Fadhel %A Husain,Jaafar %A Wyrick,David %+ Prevention Strategies, 9 Provence Ct, Greensboro, NC, 27410, United States, 1 3366885770, kelly@preventionstrategies.com %K Antiextremism %K peaceful coexistence %K intervention %K evaluation %K international %K multiphase optimization strategy %K preparation phase %K extremism %K extremist %K peace %K peaceful %K resistance %K violent %K violence %K radical %K radicalism %K Bahrain %K education %K educational %K school %K schools %K student %K students %K drug %K drugs %K abuse %K substance %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. Objective: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. Methods: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. Results: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). Conclusions: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons. %M 39018090 %R 10.2196/58322 %U https://formative.jmir.org/2024/1/e58322 %U https://doi.org/10.2196/58322 %U http://www.ncbi.nlm.nih.gov/pubmed/39018090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54288 %T Measuring Population-Level Adolescent Mental Health Using a Single-Item Indicator of Experiences of Sadness and Hopelessness: Cross-Sectional Study %A Verlenden,Jorge %A Pampati,Sanjana %A Heim Viox,Melissa %A Brener,Nancy %A Licitis,Laima %A Dittus,Patricia %A Ethier,Kathleen %+ Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee Campus, 4770 Buford Highway, Atlanta, GA, 30341, United States, 1 404 498 6018, nlx7@cdc.gov %K adolescents %K mental health %K surveillance %K teens %K sadness %K hopelessness %D 2024 %7 26.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Population-level monitoring of adolescent mental health is a critical public health activity used to help define local, state, and federal priorities. The Youth Risk Behavior Surveillance System includes a single-item measure of experiences of sadness or hopelessness as an indicator of risk to mental health. In 2021, 42% of high school students reported having felt sad or hopeless for 2 weeks or more during the past 12 months. The high prevalence of US high school students with this experience has been highlighted in recent studies and media reports. Objective: This study seeks to examine associations between this single-item measure of experiences of sadness or hopelessness with other indicators of poor mental health including frequent mental distress and depressive symptoms. Methods: We analyzed survey data from a national sample of 737 adolescents aged 15-19 years as a part of the Teen and Parent Surveys of Health. Participants were recruited from AmeriSpeak, a probability-based panel designed to be representative of the US household population. Feeling sad or hopeless was operationalized as a “yes” response to the item, “During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?” Unadjusted and adjusted prevalence ratios (aPRs) were calculated to examine associations between the single-item measure of having felt sad or hopeless almost every day for 2 weeks with moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health. Adjusted models controlled for age, race and ethnicity, sex assigned at birth, and sexual identity. Results: Overall, 17.3% (unweighted: 138/735) of adolescents reported that they felt sad or hopeless for 2 weeks or more during the past 12 months, 30.2% (unweighted: 204/716) reported moderate to severe depressive symptoms, 18.4% (unweighted: 126/732) reported frequent mental distress, and 15.4% (unweighted: 107/735) reported functional limitation due to poor mental health. After adjusting for demographics, adolescents who reported that they felt sad or hopeless for 2 weeks or more were 3.3 times as likely to report moderate to severe depressive symptoms (aPR 3.28, 95% CI 2.39-4.50), 4.8 times as likely to indicate frequent mental distress (aPR 4.75, 95% CI 2.92-7.74), and 7.8 times as likely to indicate mental health usually or always interfered with their ability to do things (aPR 7.78, 95% CI 4.88-12.41). Conclusions: Associations between having felt sad or hopeless for 2 weeks or more and moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health suggest the single-item indicator may represent relevant symptoms associated with poor mental health and be associated with unmet health needs. Findings suggest the single-item indicator provides a population-level snapshot of adolescent experiences of poor mental health. %M 39059010 %R 10.2196/54288 %U https://formative.jmir.org/2024/1/e54288 %U https://doi.org/10.2196/54288 %U http://www.ncbi.nlm.nih.gov/pubmed/39059010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58802 %T Degenerative Cervical Myelopathy Awareness in Primary Care: UK National Cross-Sectional Survey of General Practitioners %A Rufus-Toye,Remi M %A Rafati Fard,Amir %A Mowforth,Oliver D %A McCarron,Luke V %A Chan,Kayen %A Hirayama,Yuri %A Smith,Emma K %A Veremu,Munashe %A Davies,Benjamin M %A Brannigan,Jamie F M %+ Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom, 44 7825545404, Jamie.brannigan@medsci.ox.ac.uk %K cervical spine %K degeneration %K general practice %K myelopathy %K neurology %K neurosurgery %K medical education %K cervical myelopathy %K primary care %K misdiagnosis %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a progressive neurological condition, characterized by spinal cord injury secondary to degenerative changes in the spine. Misdiagnosis in primary care forms part of a complex picture leading to an average diagnostic delay of 2 years. This leads to potentially preventable and permanent disability. A lack of awareness secondary to deficits in postgraduate education may contribute to these delays. Objective: This study aims to assess the awareness of DCM in the setting of general practice. Methods: General practitioners completed a quantitative web-based cross-sectional questionnaire. The 17-item questionnaire captured data regarding demographics, subjective awareness, and objective knowledge. The questionnaire was disseminated via professional networks, including via practice managers and senior practice partners. Incentivization was provided via a bespoke DCM fact sheet for those that completed the survey. Results: A total of 54 general practitioners representing all 4 UK nations responded to the survey. General practitioners most commonly self-assessed that they had “limited awareness” of DCM (n=24, 51%). General practitioners felt most commonly “moderately able” to recognize a case of DCM (n=21, 46%). In total, 13% (n=6) of respondents reported that they would not be at all able to recognize a patient with DCM. Respondents most commonly reported that they were “moderately confident” in their ability to triage a patient with DCM (n=19, 41%). A quarter of respondents reported no prior introduction to DCM throughout their medical training (n=13, 25%). The mean score for knowledge-based questions was 42.6% (SD 3.96%) with the lowest performance observed in patient demographic and clinical recognition items. Conclusions: General practitioners lack confidence in the recognition and management of DCM. These findings are consistent with the diagnostic delays previously described in the literature at the primary care level. Further work to develop and implement educational interventions to general practitioner practices is a crucial step to improving patient outcomes in DCM. %M 39158957 %R 10.2196/58802 %U https://formative.jmir.org/2024/1/e58802 %U https://doi.org/10.2196/58802 %U http://www.ncbi.nlm.nih.gov/pubmed/39158957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59914 %T Assessment of Clinical Metadata on the Accuracy of Retinal Fundus Image Labels in Diabetic Retinopathy in Uganda: Case-Crossover Study Using the Multimodal Database of Retinal Images in Africa %A Arunga,Simon %A Morley,Katharine Elise %A Kwaga,Teddy %A Morley,Michael Gerard %A Nakayama,Luis Filipe %A Mwavu,Rogers %A Kaggwa,Fred %A Ssempiira,Julius %A Celi,Leo Anthony %A Haberer,Jessica E %A Obua,Celestino %+ Massachusetts General Hospital Center for Global Health, Department of Medicine, Harvard Medical School, 125 Nashua St., Boston, MA, 02114, United States, 1 617 726 2000, kemorley@mgh.harvard.edu %K image labeling %K metadata %K diabetic retinopathy %K assessment %K bias %K multimodal database %K retinal images %K Africa %K African %K artificial intelligence %K AI %K screening algorithms %K screening %K algorithms %K diabetic %K diabetes %K treatment %K sensitivity %K clinical images %D 2024 %7 18.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Labeling color fundus photos (CFP) is an important step in the development of artificial intelligence screening algorithms for the detection of diabetic retinopathy (DR). Most studies use the International Classification of Diabetic Retinopathy (ICDR) to assign labels to CFP, plus the presence or absence of macular edema (ME). Images can be grouped as referrable or nonreferrable according to these classifications. There is little guidance in the literature about how to collect and use metadata as a part of the CFP labeling process. Objective: This study aimed to improve the quality of the Multimodal Database of Retinal Images in Africa (MoDRIA) by determining whether the availability of metadata during the image labeling process influences the accuracy, sensitivity, and specificity of image labels. MoDRIA was developed as one of the inaugural research projects of the Mbarara University Data Science Research Hub, part of the Data Science for Health Discovery and Innovation in Africa (DS-I Africa) initiative. Methods: This is a crossover assessment with 2 groups and 2 phases. Each group had 10 randomly assigned labelers who provided an ICDR score and the presence or absence of ME for each of the 50 CFP in a test image with and without metadata including blood pressure, visual acuity, glucose, and medical history. Specificity and sensitivity of referable retinopathy were based on ICDR scores, and ME was calculated using a 2-sided t test. Comparison of sensitivity and specificity for ICDR scores and ME with and without metadata for each participant was calculated using the Wilcoxon signed rank test. Statistical significance was set at P<.05. Results: The sensitivity for identifying referrable DR with metadata was 92.8% (95% CI 87.6-98.0) compared with 93.3% (95% CI 87.6-98.9) without metadata, and the specificity was 84.9% (95% CI 75.1-94.6) with metadata compared with 88.2% (95% CI 79.5-96.8) without metadata. The sensitivity for identifying the presence of ME was 64.3% (95% CI 57.6-71.0) with metadata, compared with 63.1% (95% CI 53.4-73.0) without metadata, and the specificity was 86.5% (95% CI 81.4-91.5) with metadata compared with 87.7% (95% CI 83.9-91.5) without metadata. The sensitivity and specificity of the ICDR score and the presence or absence of ME were calculated for each labeler with and without metadata. No findings were statistically significant. Conclusions: The sensitivity and specificity scores for the detection of referrable DR were slightly better without metadata, but the difference was not statistically significant. We cannot make definitive conclusions about the impact of metadata on the sensitivity and specificity of image labels in our study. Given the importance of metadata in clinical situations, we believe that metadata may benefit labeling quality. A more rigorous study to determine the sensitivity and specificity of CFP labels with and without metadata is recommended. %R 10.2196/59914 %U https://formative.jmir.org/2024/1/e59914 %U https://doi.org/10.2196/59914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56878 %T Ascertaining Out-of-Pocket Costs of Dementia Care: Feasibility Study of a Web-Based Weekly Survey %A Dawson,Walter D %A Mattek,Nora %A Gothard,Sarah %A Kaye,Jeffrey %A Lindauer,Allison %+ Oregon Alzheimer’s Disease Research Center, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR131, Portland, OR, 97239, United States, 1 5034946976, dawsonw@ohsu.edu %K Alzheimer disease %K caregiving %K out-of-pocket costs %K behavioral and psychological symptoms of dementia %K technological interventions %K clinical trials %K dementias %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caring for a family member living with dementia is costly. A major contributor to care demands, and therefore to the costs, are the behavioral symptoms of dementia. Here, we examine the feasibility of ascertaining costs related to caregiving from weekly web-based surveys collected during a telehealth-based behavioral intervention study—Support via Technology: Living and Learning with Advancing Alzheimer Disease. Objective: This study aims to determine the feasibility and acceptability of using a web-based weekly survey to capture real-time data on out-of-pocket caregiving expenses and time commitments associated with dementia care. To examine relationships between behavioral symptoms, care partner reactivity, burden, and out-of-pocket dementia care costs. Methods: Feasibility was measured by accrual, retention, and data completion by participating care partners. Behavioral symptoms, care partner reactivity, and burden were collected before and after the intervention from 13 care partners. Weekly web-based surveys queried Support via Technology: Living and Learning with Advancing Alzheimer Disease care partners about their out-of-pocket costs associated with care-related activities. The surveys included questions on out-of-pocket costs care partners incurred from hospitalizations and emergency department use, primary care provider visits, use of paid in-home care or respite services, use of prescription medications, and use of over-the-counter medications. The surveys also queried the amount of time care partners devoted to these specific care–related activities. Results: Out-of-pocket costs of dementia care were collected via a web-based weekly survey for up to 18 months. In-home assistance was the most frequently reported type of out-of-pocket care expense and the costliest. care partners who paid for in-home assistance or respite reported more behavioral and psychological symptoms of dementia behaviors, higher reactivity, and higher burden than those who did not. Conclusions: This novel web-based weekly survey–based approach offers lessons for designing and implementing future cost-focused studies and care partner–supportive telehealth-based interventions for Alzheimer disease and related dementias (ADRD). The results correspond with the existing understanding of ADRD in that high family-related out-of-pocket costs are a typical part of the caregiving experience, and those costs likely increase with dementia severity. The results may also offer potential insights to health systems and policy makers as they seek to implement telehealth-based and related interventions that seek to better support people living with ADRD and their family care partners. Trial Registration: ClinicalTrials.gov NCT04335110; https://clinicaltrials.gov/ct2/show/NCT04335110 %M 39321453 %R 10.2196/56878 %U https://formative.jmir.org/2024/1/e56878 %U https://doi.org/10.2196/56878 %U http://www.ncbi.nlm.nih.gov/pubmed/39321453 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56411 %T Tailoring HIV Care for Black Populations: A Pilot Feasibility Prospective Cohort Study %A Young,BreAnne %A Carrasquillo,Olveen %A Jones,Deborah L %A Pan,Yue %A Kenya,Sonjia %+ Department of Medicine, University of Miami Miller School of Medicine, Clinical Research Center, 1120 NW 14th St, Miami, FL, 33136, United States, 1 3052435505, b.young4@umiami.edu %K community health workers %K CHWs %K society %K social determinants of health %K social factor %K social disparity %K social inequality %K social inequity %K HIV disparities %K HIV %K human immunodeficiency virus %K AIDS %K feasibility %K care continuum %K Black %K African American %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research has shown that integrating community health workers (CHWs) into the formal health care system can improve outcomes for people living with HIV, yet there is limited literature exploring this framework among marginalized minority populations. Objective: Herein, we discuss the feasibility of a clinic-embedded CHW strategy to improve antiretroviral therapy adherence among Black people living with HIV in Miami-Dade County, Florida, a designated priority region for the US Department of Health and Human Services’ Ending the HIV Epidemic Initiative. Methods: From December 2022 to September 2023, three CHWs were trained and integrated into the hospital workflow to provide support as members of the clinical team. Ten Black adults with an HIV viral load over 200 copies/mL were enrolled to received 3 months of CHW support focused on navigating the health system and addressing poor social determinants of health. Intervention feasibility was based on 4 criteria: recruitment rate, demographic composition, study fidelity, and qualitative feedback on CHW perceptions. Results: Participants were recruited at a rate of 5.7 participants per month, with the sample evenly distributed between men and women. Retention was moderately strong, with 7 (70%) of the 10 participants attending more than 75% of CHW sessions. Qualitative feedback reflected CHW perceptions on clinical interactions and intervention length. Conclusions: Outcomes indicate that a clinic-integrated CHW approach is a feasible and acceptable methodology to address adverse social determinants and improve HIV treatment adherence. By offering targeted social and clinical support, CHWs may be a promising solution to achieve sustained viral suppression and care engagement for Black people living with HIV. %M 39365989 %R 10.2196/56411 %U https://formative.jmir.org/2024/1/e56411 %U https://doi.org/10.2196/56411 %U http://www.ncbi.nlm.nih.gov/pubmed/39365989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60939 %T Ensuring Accuracy and Equity in Vaccination Information From ChatGPT and CDC: Mixed-Methods Cross-Language Evaluation %A Joshi,Saubhagya %A Ha,Eunbin %A Amaya,Andee %A Mendoza,Melissa %A Rivera,Yonaira %A Singh,Vivek K %+ School of Communication & Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 848 932 7588, v.singh@rutgers.edu %K vaccination %K health equity %K multilingualism %K language equity %K health literacy %K online health information %K conversational agents %K artificial intelligence %K large language models %K health information %K public health %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the digital age, large language models (LLMs) like ChatGPT have emerged as important sources of health care information. Their interactive capabilities offer promise for enhancing health access, particularly for groups facing traditional barriers such as insurance and language constraints. Despite their growing public health use, with millions of medical queries processed weekly, the quality of LLM-provided information remains inconsistent. Previous studies have predominantly assessed ChatGPT’s English responses, overlooking the needs of non–English speakers in the United States. This study addresses this gap by evaluating the quality and linguistic parity of vaccination information from ChatGPT and the Centers for Disease Control and Prevention (CDC), emphasizing health equity. Objective: This study aims to assess the quality and language equity of vaccination information provided by ChatGPT and the CDC in English and Spanish. It highlights the critical need for cross-language evaluation to ensure equitable health information access for all linguistic groups. Methods: We conducted a comparative analysis of ChatGPT’s and CDC’s responses to frequently asked vaccination-related questions in both languages. The evaluation encompassed quantitative and qualitative assessments of accuracy, readability, and understandability. Accuracy was gauged by the perceived level of misinformation; readability, by the Flesch-Kincaid grade level and readability score; and understandability, by items from the National Institutes of Health’s Patient Education Materials Assessment Tool (PEMAT) instrument. Results: The study found that both ChatGPT and CDC provided mostly accurate and understandable (eg, scores over 95 out of 100) responses. However, Flesch-Kincaid grade levels often exceeded the American Medical Association’s recommended levels, particularly in English (eg, average grade level in English for ChatGPT=12.84, Spanish=7.93, recommended=6). CDC responses outperformed ChatGPT in readability across both languages. Notably, some Spanish responses appeared to be direct translations from English, leading to unnatural phrasing. The findings underscore the potential and challenges of using ChatGPT for health care access. Conclusions: ChatGPT holds potential as a health information resource but requires improvements in readability and linguistic equity to be truly effective for diverse populations. Crucially, the default user experience with ChatGPT, typically encountered by those without advanced language and prompting skills, can significantly shape health perceptions. This is vital from a public health standpoint, as the majority of users will interact with LLMs in their most accessible form. Ensuring that default responses are accurate, understandable, and equitable is imperative for fostering informed health decisions across diverse communities. %M 39476380 %R 10.2196/60939 %U https://formative.jmir.org/2024/1/e60939 %U https://doi.org/10.2196/60939 %U http://www.ncbi.nlm.nih.gov/pubmed/39476380 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59572 %T Factors Influencing Poststroke Cognitive Dysfunction: Cross-Sectional Analysis %A Zhou,Wu %A Feng,HaiXia %A Tao,Hua %A Sun,Hui %A Zhang,TianTian %A Wang,QingXia %A Zhang,Li %+ School of Medicine, Southeast University, 87 Dingjiaqiao, Gulou District, Jiangsu Province, Nanjing, 210009, China, 86 02583272077, xrzfhx@163.com %K stroke %K cognitive dysfunction %K analysis of associated factors %K MMSE %K Mini-Mental State Examination %K status survey %K cognitive %K survey %K cognitive impairment %K cross-sectional study %K cross sectional %K stroke patients %K cognition %K education %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poststroke cognitive impairment (PSCI) is a common and debilitating complication that affects stroke survivors, impacting memory, attention, and executive function. Despite its prevalence, the factors contributing to PSCI remain unclear, with limited insights into how demographic and clinical variables influence cognitive outcomes. Objective: This study investigates the incidence of cognitive impairment in patients with stroke and examines key demographic and clinical factors, such as age, gender, and education level, which contribute to cognitive decline. The aim is to provide a deeper understanding of PSCI to inform early intervention strategies for improving patient outcomes. Methods: A cross-sectional study was conducted on 305 patients with ischemic stroke admitted to Zhongda Hospital, Southeast University, from January 2019 to September 2022. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) within 72 hours of hospital admission. Demographic information, including age, gender, and education level, were collected. Statistical analyses were performed using chi-square tests, independent t tests, and multivariate regression to assess the relationship between cognitive function and key variables. Pearson correlation analysis explored associations among age, education, and MMSE scores. Results: Among the 305 patients with stroke, 16.7% (n=51) were diagnosed with cognitive impairment based on MMSE scores. The prevalence of cognitive impairment was slightly higher in males (17.6%, n=159) than females (15.8%, n=146), but this difference was not statistically significant. A strong negative correlation was found between MMSE scores and age (r=–0.32; P<.01), indicating that older patients had lower cognitive function. Education level showed a positive correlation with MMSE scores (r=0.41; P<.01), with patients with higher educational attainment demonstrating better cognitive outcomes. Cognitive function showed a marked decline in patients older than 60 years, particularly in domains such as memory, attention, and language skills. Conclusions: This study confirms that age and education are significant factors in determining cognitive outcomes after stroke. The results align with existing literature showing that cognitive function declines with age, while higher educational attainment serves as a protective factor. The findings suggest that individuals with greater cognitive reserve, often linked to higher education, are better equipped to cope with the impact of brain injury. However, the study’s reliance on MMSE may have limited its ability to detect domain-specific impairments. Future studies should consider using more sensitive cognitive tools, such as the Montreal Cognitive Assessment (MoCA), to provide a more comprehensive evaluation of PSCI. Cognitive impairment is prevalent among stroke survivors, with age and education level being key factors influencing outcomes. These findings underscore the importance of early detection and targeted interventions to mitigate cognitive decline. Further research with larger samples and more sensitive cognitive assessments is needed to fully understand PSCI and improve rehabilitation strategies for patients with stroke. %M 39560985 %R 10.2196/59572 %U https://formative.jmir.org/2024/1/e59572 %U https://doi.org/10.2196/59572 %U http://www.ncbi.nlm.nih.gov/pubmed/39560985 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60674 %T Evaluating a Virtual Reality Game to Enhance Teen Distracted Driving Education: Mixed Methods Pilot Study %A Peterson,Colleen M %A Visclosky,Timothy %A Flannagan,Carol A %A Mahajan,Prashant %A Gabanyicz,Andrew %A Bouchard,Jean-Jacques %A Cervantes,Vincent %A Gribbin,William %A Hashikawa,Andrew Nobuhide %+ Michigan Medicine-Department of Emergency Medicine, University of Michigan, NCRC B10-G080, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, United States, 1 734 936 9312, drewhash@umich.edu %K safety %K virtual reality %K VR %K distracted driving %K intervention %K inattention %K smartphone %K novice drivers %K risky driving %K mobile phone %K awareness %K game %K driving education %K gamification %K adolescent %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Inexperienced adolescent drivers are particularly susceptible to engaging in distracted driving behaviors (DDBs) such as texting while driving (TWD). Traditional driver education approaches have shown limited success in reducing motor vehicle crashes among young drivers. Objective: We tested an innovative approach to help address the critical issue of DDB among teenagers. We investigated the effectiveness of using a novel virtual reality (VR) game “Distracted Navigator” to educate novice teenage drivers about DDB. Methods: The game consisted of maneuvering a spaceship around asteroids while engaging in simulated DDB (eg, inputting numbers into a keypad). A physician-facilitated discussion, based on the theory of planned behavior, linked gameplay to real-life driving. Teenagers were recruited for the in-person study and randomly assigned at the block level to intervention (VR gameplay or discussion) and control groups (discussion only), approximating a 2:1 ratio. Unblinded, bivariate statistical analyses (all 2-tailed t tests or chi-square tests) and regression analyses measured programming impact on TWD-related beliefs and intentions. Content analysis of focus group interviews identified thematic feedback on the programming. Results: Of the 24 participants, 15 (63%) were male; their ages ranged from 14 to 17 (mean 15.8, SD 0.92) years, and all owned cell phones. Compared to the control group (n=7, 29%), the intervention group (n=17, 71%) was more likely to report that the programming had positively changed how they felt about texting and driving (?218=–8.3; P=.02). However, specific TWD attitudes and intentions were not different by treatment status. Irrespective of treatment, pre- and postintervention scores indicated reduced confidence in safely TWD (ie, perceived behavioral control; β=–.78; t46=–2.66; P=.01). Thematic analysis revealed the following: (1) the VR gameplay adeptly portrayed real-world consequences of texting and driving, (2) participants highly valued the interactive nature of the VR game and discussion, (3) both the VR game and facilitated discussion were deemed as integral and complementary components, and (4) feedback for improving the VR game and discussion. Conclusions: Our findings show that the novel use of immersive VR experiences with interactive discussions can raise awareness of DDB consequences and is a promising method to enhance driving safety education. The widespread accessibility of VR technology allows for scalable integration into driver training programs, warranting a larger, prospective, randomized study. %M 39591605 %R 10.2196/60674 %U https://formative.jmir.org/2024/1/e60674 %U https://doi.org/10.2196/60674 %U http://www.ncbi.nlm.nih.gov/pubmed/39591605 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e66430 %T Psychedelic Art and Implications for Mental Health: Randomized Pilot Study %A Peng,Mary L %A Monin,Joan %A Ovchinnikova,Polina %A Levi,Amanda %A McCall,Terika %+ Department of Orthopedics and Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 (617) 355 6021, marypeng@hms.harvard.edu %K digital art %K mental health %K psychedelic art %K well-being %K pilot trial %K digital health tool %K art therapy %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychedelic art (PA) emerged in the 1960s during the psychedelic era; then characterized by visuals induced by the ingestion of psychedelic drugs, it is now an art form known for its vibrant colors, distorted forms, and intricate patterns. Building upon the existing research on art viewing as an effective means to improving physiological and psychological well-being, viewing PA is postulated to evoke positive emotions and provide a meditative experience, contributing to improved mental well-being. Objective: This study aims to investigate how digitally rendered PA influences viewers’ perceived emotional, mental, and physical states compared to imagery of natural scenery, offering insights into potential applications in mental health care and well-being. Methods: Overall, 102 participants age 18 to 35 years were randomly assigned to either the experimental group viewing 300 seconds of PA imagery (50/102, 49%) or the control group viewing 300 seconds of scenic imagery (52/102, 51%), after which every participant completed a survey that gathered qualitative data on the perceived impact of viewing their given imagery on their physical, mental, and emotional states through open-ended questions. Thematic analysis was conducted to identify the patterns of experiences reported by the participants. Results: Qualitative analysis unveiled a greater intensity and diversity of emotional, mental, and physical impacts induced by PA compared to natural scenery, including the sense of relaxation and peace, anxiety and stress alleviation, joy, thrill and sense of euphoria, sensations of awe and wonder, hypnotizing effect, holistic meditative effect, provocation of creative thoughts, induced hyperawareness of bodily states, and transitions from induced overstimulation or anxious thoughts to feelings of calmness. Conclusions: The preliminary findings of this study suggest that PA is a rich and complex form of visual art that has the potential to facilitate healing and promote well-being and mental health. PA presents promising avenues for integration into mental health care, therapeutic practices, digital health, health care environment, and medical research. %M 39626224 %R 10.2196/66430 %U https://formative.jmir.org/2024/1/e66430 %U https://doi.org/10.2196/66430 %U http://www.ncbi.nlm.nih.gov/pubmed/39626224 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45573 %T Privacy Concerns About Sharing General and Specific Health Information on Twitter: Quantitative Study %A Esmaeilzadeh,Pouyan %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A. Maidique Campus 11200 S.W. 8th St, RB 261 B, Miami, FL, 33199, United States, 1 3053483302, pesmaeil@fiu.edu %K concern for information privacy %K CFIP %K peer privacy concern %K PrPC %K health information disclosure %K Twitter %K empirical study %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Twitter is a common platform for people to share opinions, discuss health-related topics, and engage in conversations with a wide audience. Twitter users frequently share health information related to chronic diseases, mental health, and general wellness topics. However, sharing health information on Twitter raises privacy concerns as it involves sharing personal and sensitive data on a web-based platform. Objective: This study aims to adopt an interactive approach and develop a model consisting of privacy concerns related to web-based vendors and web-based peers. The research model integrates the 4 dimensions of concern for information privacy that express concerns related to the practices of companies and the 4 dimensions of peer privacy concern that reflect concerns related to web-based interactions with peers. This study examined how this interaction may affect individuals’ information-sharing behavior on Twitter. Methods: Data were collected from 329 Twitter users in the United States using a web-based survey. Results: Results suggest that privacy concerns related to company practices might not significantly influence the sharing of general health information, such as details about hospitals and medications. However, privacy concerns related to companies and third parties can negatively shape the disclosure of specific health information, such as personal medical issues (β=−.43; P<.001). Findings show that peer-related privacy concerns significantly predict sharing patterns associated with general (β=−.38; P<.001) and specific health information (β=−.72; P<.001). In addition, results suggest that people may disclose more general health information than specific health information owing to peer-related privacy concerns (t165=4.72; P<.001). The model explains 41% of the variance in general health information disclosure and 67% in specific health information sharing on Twitter. Conclusions: The results can contribute to privacy research and propose some practical implications. The findings provide insights for developers, policy makers, and health communication professionals about mitigating privacy concerns in web-based health information sharing. It particularly underlines the importance of addressing peer-related privacy concerns. The study underscores the need to build a secure and trustworthy web-based environment, emphasizing the significance of peer interactions and highlighting the need for improved regulations, clear data handling policies, and users’ control over their own data. %M 38214964 %R 10.2196/45573 %U https://formative.jmir.org/2024/1/e45573 %U https://doi.org/10.2196/45573 %U http://www.ncbi.nlm.nih.gov/pubmed/38214964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46195 %T Evaluation of the Effectiveness of Suicide.ca, Quebec’s Digital Suicide Prevention Strategy Platform: Cross-Sectional Descriptive Study %A Côté,Louis-Philippe %A Lane,Julie %+ Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life practices, Université du Québec à Montréal, 100 rue Sherbrooke Ouest, Montreal, QC, H2X 3P2, Canada, 1 (514) 987 4832, cote.louis-philippe.3@courrier.uqam.ca %K suicide prevention %K public health %K information and communication technology %K digital mental health %K helpline %K digital strategy %K communication technology %K information technology %K suicide %K psychoeducation %K mobile app %K suicide risk %K risk factor %K users %K mental health %K text %K website %K prevention strategy %K prevention %K Google Analytics %K Canada %K Quebec %K questionnaire %K mobile phone %D 2024 %7 6.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2017, the Quebec government assigned the Association québécoise de prévention du suicide (AQPS) to develop a digital suicide prevention strategy (DSPS). The AQPS responded by creating a centralized website that provides information on suicide and mental health, identifies at-risk individuals on the internet, and offers direct crisis intervention support via chat and text. Objective: This study aims to evaluate the effectiveness of suicide.ca, Quebec’s DSPS platform. Methods: This study used a cross-sectional descriptive design. The study population comprised internet users from Quebec, Canada, who visited the suicide.ca platform between October 2020 and October 2021. Various data sources, such as Google Analytics, Firebase Console, and Customer Relation Management data, were analyzed to document the use of the platform. To understand the profile of suicide.ca users, frequency analyses were conducted using data from the self-assessment module questionnaires, the intervention service’s triage questionnaire, and the counselors’ intervention reports. The effectiveness of the platform’s promotional activities on social media was assessed by examining traffic peaks. Google Analytics was used to evaluate the effectiveness of AQPS’ strategy for identifying at-risk internet users. The impact of the intervention service was evaluated through an analysis of counselors’ intervention reports and postintervention survey results. Results: The platform received traffic from a diverse range of sources, with promotional efforts on social media directly contributing to the increased traffic. The requirement of a user account posed a barrier to the use of the mobile app, and a triage question that involved personal information led to a substantial number of dropouts during the intervention service triage. AdWords campaigns and fact sheets addressing suicide risk factors played a crucial role in driving traffic to the platform. With regard to the profile of suicide.ca users, the findings revealed that the platform engaged individuals with diverse levels of suicidal risk. Notably, users of the chat service displayed a higher suicide risk than those who used the self-assessment module. Crisis chat counselors reported a positive impact on approximately half of the contacts, and overall, intervention service users expressed satisfaction with the support they received. Conclusions: A centralized digital platform can be used to implement a DSPS, effectively reaching the general population, individuals with risk factors for suicide, and those facing suicidal issues. %M 38446536 %R 10.2196/46195 %U https://formative.jmir.org/2024/1/e46195 %U https://doi.org/10.2196/46195 %U http://www.ncbi.nlm.nih.gov/pubmed/38446536 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53336 %T Professional Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Questionnaire-Based Study %A Youssef,Yasmin %A Gehlen,Tobias %A Ansorg,Jörg %A Back,David Alexander %A Scherer,Julian %+ Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 762030775, julian.scherer@usz.ch %K social media %K digitalization %K digital communication %K orthopedics %K traumatology %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has been recognized as a professional communication tool in the field of orthopedic and trauma surgery that can enhance communication with patients and peers, and increase the visibility of research and offered services. The specific purposes of professional SM use and the benefits and concerns among orthopedic and trauma surgeons, however, remain unexplored. Objective: This study aims to demonstrate the specific uses of different SM platforms among orthopedic and trauma surgeons in Germany as well as the advantages and concerns. Methods: A web-based questionnaire was developed on the use of SM in a professional context by considering the current literature and the authors’ topics of interest. The final questionnaire consisted of 33 questions and was distributed among German orthopedic and trauma surgeons via the mail distributor of the Berufsverband für Orthopädie und Unfallchirurgie (Professional Association of Orthopaedic Surgeons in Germany). The study was conducted between June and July 2022. A subgroup analysis was performed for sex (male vs female), age (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Results: A total of 208 participants answered the questionnaire (male: n=166, 79.8%; younger than 60 years: n=146, 70.2%). In total, all of the participants stated that they use SM for professional purposes. In contrast, the stated specific uses of SM were low. Overall, the most used platforms were employment-oriented SM, messenger apps, and Facebook. Instagram emerged as a popular choice among female participants and participants working in hospital settings. The highest specific use of SM was for professional networking, followed by receiving and sharing health-related information. The lowest specific use was for education and the acquisition of patients. Conventional websites occupied a dominating position, exceeding the use of SM across all specific uses. The key benefit of SM was professional networking. Under 50% of the participants stated that SM could be used to enhance communication with their patients, keep up-to-date, or increase their professional visibility. In total, 65.5% (112/171) of participants stated that SM use was time-consuming, 43.9% (76/173) stated that they lacked application knowledge, and 45.1% (78/173) stated that they did not know what content to post. Additionally, 52.9% (91/172) mentioned medicolegal concerns. Conclusions: Overall, SM did not seem to be used actively in the professional context among orthopedic and trauma surgeons in Germany. The stated advantages were low, while the stated concerns were high. Adequate education and information material are needed to elucidate the possible professional applications of SM and to address legal concerns. %M 38639987 %R 10.2196/53336 %U https://formative.jmir.org/2024/1/e53336 %U https://doi.org/10.2196/53336 %U http://www.ncbi.nlm.nih.gov/pubmed/38639987 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52503 %T Social Media Authentication and Users’ Assessments of Health Information: Random Assignment Survey Experiment %A Neely,Stephen %A Witkowski,Kaila %+ School of Public Affairs, University of South Florida, 4202 E. Fowler Ave, SOC 107, Tampa, FL, 33620, United States, 1 412 335 5055, srneely@usf.edu %K social media %K verification markers %K vaccine efficacy %K health communication %K trust %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In an effort to signal the authenticity of user accounts, social networking sites (SNSs) such as Facebook and X, formerly known as Twitter, use visual heuristics (blue checkmarks) to signify whether accounts are verified. While these verification badges are generally well recognized (and often coveted) by SNS users, relatively little is known about how they affect users’ perceptions of accuracy or their likelihood of engaging with web-based information. This is particularly true in the case of information posted by medical experts and health care professionals. Objective: This study aims to use an experimental survey design to assess the effect of these verification badges on SNS users’ assessments of information accuracy as well as their proclivity to recirculate health information or follow verified medical experts in their social network. Methods: A survey experiment using random assignment was conducted on a representative sample of 534 adult SNS users in Florida, United States. A total of 2 separate experimental scenarios exposed users to vaccine-related posts from verified medical experts on X. In each case, the original post contained a platform-issued verification badge (treatment group), which was subsequently edited out of the image as an experimental control. For each scenario, respondents were randomly assigned to either the treatment or control group, and responses to 3 follow-up questions were assessed through a series of chi-square analyses and 2 logit regression models. Responses were fielded using a stratified quota sampling approach to ensure representativeness of the state’s population based on age, sex, race, ethnicity, and political affiliation. Results: Users’ assessments of information accuracy were not significantly impacted by the presence or absence of verification badges, and users exposed to the experimental treatment (verification badge) were not any more likely to repost the message or follow the author. While verification badges did not influence users’ assessments or subsequent behaviors, reliance on social media for health-related information and political affiliation were substantial predictors of accuracy assessments in both experimental scenarios. In scenario 1, which included a post addressing COVID-19 vaccine efficacy, users who relied on social media “a great deal” for health information were 2 times more likely to assess the post as accurate (odds ratio 2.033, 95% CI 1.129-3.661; P=.01). In scenario 2, which included a post about measles vaccines, registered Republicans were nearly 6 times less likely to assess the post as accurate (odds ratio 0.171, 95% CI 0.097-0.299; P<.001). Conclusions: For health professionals and medical experts wishing to leverage social networks to combat misinformation and spread reliable health-related content, account verification appears to offer little by way of added value. On the basis of prior research, other heuristics and communication strategies are likely to yield better results. %M 38980714 %R 10.2196/52503 %U https://formative.jmir.org/2024/1/e52503 %U https://doi.org/10.2196/52503 %U http://www.ncbi.nlm.nih.gov/pubmed/38980714 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49759 %T Architecture and Development Framework for a Web-Based Risk Assessment and Management Platform Developed on WordPress to Address Opioid Overdose %A Kazemi,Alireza %A Boyd,Marisha %A Choi,Fiona %A Tai,Andy Man Yeung %A Tsang,Vivian WL %A To,Tam %A Kim,Jane %A Jang,Kerry %A Shams,Farhud %A Schreiter,Stefanie %A Cabanis,Maurice %A Krausz,Reinhard Michael %+ Institute of Mental Health, Department of Psychiatry, University of British Columbia, 4th Floor, Room 430, David Strangway Building, 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada, 1 236 888 8330, alireza.kazemi@ubc.ca %K software designs %K risks management %K risk assessments %K opioid overdose %K crisis intervention %K substance related disorders %D 2024 %7 11.3.2024 %9 Viewpoint %J JMIR Form Res %G English %X The number of overdose-related fatalities continues to reach historic levels across Canada, despite ongoing efforts by authorities. To reduce mortality, a clinical trajectory ranging from preventative measures to crisis intervention, skill training to treatment, and risk assessment to risk management needs to be supported. The web-based Risk Assessment and Management Platform (RAMP) was developed to realize this concept and to empower people who use drugs through an integrated tool that allows them to better understand and manage their risk of overdose. This paper outlines the architecture and development of RAMP, which is built on the WordPress platform. WordPress components are mapped onto a 3-tier architecture that consists of presentation, application, and database layers. The architecture facilitates the development of a modular software that includes several features that are independent in functionality but interact with each other in an integrated platform. The relatively low coupling and high coherence of the features may reduce the cost of maintenance and increase flexibility of future developments. RAMP’s architecture comprises a user interface, conceptual framework, and backend layers. The RAMP front end effectively uses some of the WordPress’ features such as HTML5, CSS, and JavaScript to create a mobile, friendly, and scalable user interface. The RAMP backend uses several standard and custom WordPress plug-ins to support risk assessment and monitoring, with the goal of mitigating the impacts and eliminating risks together. A rule-based decision support system has been hard-coded to suggest relevant modules and goals to complement each user’s lifestyle and goals based on their risk assessment. Finally, the backend uses the MySQL database management system and communicates with the RAMP framework layer via the data access layer to facilitate a timely and secure handling of information. Overall, RAMP is a modular system developed to identify and manage the risk of opioid overdose in the population of people who use drugs. Its modular design uses the WordPress architecture to efficiently communicate between layers and provide a base for external plug-ins. There is potential for the current system to adopt and address other related fields such as suicide, anxiety, and trauma. Broader implementation will support this concept and lead to the next level of functionality. %M 38466977 %R 10.2196/49759 %U https://formative.jmir.org/2024/1/e49759 %U https://doi.org/10.2196/49759 %U http://www.ncbi.nlm.nih.gov/pubmed/38466977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52740 %T Decentralizing Health Care: History and Opportunities of Web3 %A Narayan,Aditya %A Weng,Kydo %A Shah,Nirav %+ Clinical Excellence Research Center, 453 Quarry Road, Palo Alto, CA, 94304, United States, 1 7039159597, aditnara@stanford.edu %K Web3 %K health care %K patient-centric %K data ownership %K decentralization %K interoperability %K electronic health record (EHR) %K privacy %K blockchain %K digital transformation %K digital health care %K digital health %K patient %K patients %K technological framework %K security and privacy %K security %K privacy %D 2024 %7 27.3.2024 %9 Viewpoint %J JMIR Form Res %G English %X This paper explores the relationship between the development of the internet and health care, highlighting their parallel growth and mutual influence. It delves into the transition from the early, static days of Web 1.0, akin to siloed physician expertise in health care, to the more interactive and patient-centric era of Web 2.0, which was accompanied by advancements in medical technologies and patient engagement. This paper then focuses on the emerging era of Web3—the decentralized web—which promises a transformative shift in health care, particularly in how patient data are managed, accessed, and used. This shift toward Web3 involves using blockchain technology for decentralized data storage to enhance patient data access, control, privacy, and value. This paper also examines current applications and pilot projects demonstrating Web3’s practical use in health care and discusses key questions and considerations for its successful implementation. %M 38536235 %R 10.2196/52740 %U https://formative.jmir.org/2024/1/e52740 %U https://doi.org/10.2196/52740 %U http://www.ncbi.nlm.nih.gov/pubmed/38536235 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52566 %T AI Analysis of General Medicine in Japan: Present and Future Considerations %A Aoki,Nozomi %A Miyagami,Taiju %A Saita,Mizue %A Naito,Toshio %+ Department of General Medicine, Juntendo University Faculty of Medicine, 2-1-1Hongo, Tokyo, 113-8421, Japan, 81 3 3813 3111, miya0829gami@gmail.com %K artificial intelligence %K physicians %K hospitalists %K polypharmacy %K sexism %K Japan %K AI %K artificial intelligence %K medicine %K Japan %K gender-biased %K physicians %K physician %K medical care %K gender %K polypharmacy %K women %K Pharmacology %K older adults %K geriatric %K elderly %K Japanese %D 2024 %7 29.3.2024 %9 Viewpoint %J JMIR Form Res %G English %X This paper presents an interpretation of artificial intelligence (AI)–generated depictions of the present and future of general medicine in Japan. Using text inputs, the AI tool generated fictitious images based on neural network analyses. We believe that our study makes a significant contribution to the literature because the direction of general medicine in Japan has long been unclear, despite constant discussion. Our AI analysis shows that Japanese medicine is currently plagued by issues with polypharmacy, likely because of the aging patient population. Additionally, the analysis indicated a distressed female physician and evoked a sense of anxiety about the future of female physicians. It discusses whether the ability to encourage the success of female physicians is a turning point for the future of medicine in Japan. %M 38551640 %R 10.2196/52566 %U https://formative.jmir.org/2024/1/e52566 %U https://doi.org/10.2196/52566 %U http://www.ncbi.nlm.nih.gov/pubmed/38551640 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50063 %T The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure %A Berglund,Aseel %A Jaarsma,Tiny %A Orädd,Helena %A Fallström,Johan %A Strömberg,Anna %A Klompstra,Leonie %A Berglund,Erik %+ Department of Computer and Information Science, Linköping University, Linköping, Sweden, 46 732703862, aseel.berglund@liu.se %K mobile health apps %K physical activity %K exergames %K player-centered design %K heart failure %K human-computer interaction %K mobile phone %D 2024 %7 7.8.2024 %9 Viewpoint %J JMIR Form Res %G English %X Reducing inactivity in patients with chronic disease is vital since it can decrease the risk of disease progression and mortality. Exergames are an innovative approach to becoming more physically active and positively affecting physical health outcomes. Serious games are designed for purposes beyond entertainment and exergames are serious games for physical activity. However, current commercial exergames might not optimally meet the needs of patients with special needs. Developing tailored exergames is challenging and requires an appropriate process. The primary goal of this viewpoint is to describe significant lessons learned from designing and developing an exergame for patients with chronic heart failure using the player-centered, iterative, interdisciplinary, and integrated (P-III) framework for serious games. Four of the framework’s pillars were used in the design and development of a mobile exergame: player-centered design, iterative development of the game, interdisciplinary teamwork, and integration of play and serious content. The mobile exergame was developed iteratively in 7 iterations by an interdisciplinary team involving users and stakeholders in all iterations. Stakeholders played various roles during the development process, making the team stay focused on the needs of the patients and creating an exergame that catered to these needs. Evaluations were conducted during each iteration by both the team and users or patients according to the player-centered design pillar. Since the exergame was created for a smartphone, the assessments were conducted both on the development computer and on the intended platforms. This required continuous deployment of the exergame to the platforms and smartphones that support augmented reality. Our findings show that the serious game P-III framework needs to be modified in order to be used for the design and development of exergames. In this viewpoint, we propose an updated version of the P-III framework for exergame development including (1) a separate and thorough design of the physical activity and physical interaction, and (2) early and continuous deployment of the exergame on the intended platform to enable evaluations and everyday life testing. %M 39110976 %R 10.2196/50063 %U https://formative.jmir.org/2024/1/e50063 %U https://doi.org/10.2196/50063 %U http://www.ncbi.nlm.nih.gov/pubmed/39110976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63832 %T Considerations When Designing Inclusive Digital Health Solutions for Older Adults Living With Frailty or Impairments %A Wegener,Emilie Kauffeldt %A Bergschöld,Jenny M %A Bergh,Sverre %A van Berlo,Ad %A Schmidt,Camilla Wong %A Konidari,Afroditi %A Kayser,Lars %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, København K, 1353, Denmark, 45 26202168, emilie.wegener@sund.ku.dk %K digital health services %K frameworks %K sociotechnical ecosystem %K older adults %K co-design %D 2024 %7 21.10.2024 %9 Viewpoint %J JMIR Form Res %G English %X This viewpoint is written by authors with industrial, clinical, and academic backgrounds within medical and social sciences. The purpose is to share our experiences with digital health innovation from a sociotechnical perspective. The audience for the viewpoint is innovators, researchers, service designers, and project managers with little or some experience with theory-informed programs, complex interventions, and implementation or reorganization of sociotechnical ecosystems in health care. In digital health innovation projects, barriers related to traditions and cultures among researchers, clinicians, and industry may arise. Moreover, the final digital solutions may not always fit into existing digital ecosystems and may thus require a reorganization of how health care is provided at horizontal and vertical levels. The collaborating researchers have experience working in the field of digital health innovation for more than a decade, and we have developed and used 4 frameworks and models that are particularly relevant for theory-based complex interventions and can be used to inform inclusive co-design of digital health solutions with a sociotechnical perspective. These are (1) the 4E, a matrix to include, engage, empower, and emancipate marginalized people; (2) the GO-TO model, which can be used as a design navigator; (3) the Epital Care Model, to inform infrastructure; and (4) the Readiness and Enablement Index for Health Technology instrument, to stratify service users. From January 2021 to September 2024, we had the opportunity to apply these into practice in 4 living labs located in Denmark, Norway, the Netherlands, and Canada as a part of a European Union–funded project on “Smart Inclusive Living Environments.” The goal was to cocreate a digital solution and reorganize health care services to reduce social isolation, increase health literacy, and enhance well-being for older adults living with frailty or impairments. Based on our experiences with the Smart Inclusive Living Environments project, we have formed a proposal for how design guidelines for sociotechnical innovation projects can be structured, backed up with reflections based on our experiences. With that, design guidelines should include three areas: (1) a common vocabulary including theories, frameworks, and models; (2) templates and protocols for methods, including detailed guidelines and templates for the planned development of the technologies; and (3) methods to implement and provide education and training of service users and informal and formal caregivers. In the design process, we emphasize the importance of involving relevant stakeholders in the implementation of the created design guidelines to obtain preparedness in the organizations, as well as including putative service users to ensure the likelihood of adoption. Moreover, it is important to align expectations, have a common understanding of the applied frameworks and methods, and have access to the necessary resources to reach successful results. %M 39432894 %R 10.2196/63832 %U https://formative.jmir.org/2024/1/e63832 %U https://doi.org/10.2196/63832 %U http://www.ncbi.nlm.nih.gov/pubmed/39432894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64494 %T Using Extended Reality to Enhance Effectiveness and Group Identification in Remote Group Therapy for Anxiety Disorders: A Critical Analysis %A Bouguettaya,Ayoub %A Aboujaoude,Elias %+ Program of Internet, Health, and Society, Biomedical Sciences, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, United States, 1 4152443724, elias.aboujaoude@cshs.org %K group therapy %K psychotherapy %K telepsychiatry %K mental health %K extended reality %K augmented reality %K virtual reality therapy %K anxiety %K cognitive behavioral therapy %D 2024 %7 4.11.2024 %9 Viewpoint %J JMIR Form Res %G English %X Group therapy is a scalable and effective treatment for anxiety disorders. However, when performed online, the reduced ability to identify with group members and the reduced interactivity can limit its appeal and effectiveness. Extended reality (XR) technology, including virtual reality and augmented reality, may help address these limitations, thereby enhancing the reach of online group therapy and the benefits that can be drawn from it. To understand how the incorporation of XR technology may improve online group therapy for anxiety disorders, this viewpoint paper examines evidence related to the treatment of anxiety disorders using offline group therapy, online group therapy, and virtual reality, as well as ways to increase social identification and interactivity with the platform, the therapist, and other users. This viewpoint paper suggests ways to integrate these research streams to leverage the strengths of XR platforms and improve group therapeutic offerings. %M 39496150 %R 10.2196/64494 %U https://formative.jmir.org/2024/1/e64494 %U https://doi.org/10.2196/64494 %U http://www.ncbi.nlm.nih.gov/pubmed/39496150 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60368 %T Strategies to Implement a Community-Based, Longitudinal Cohort Study: The Whole Communities-Whole Health Case Study %A Bouchacourt,Lindsay %A Smith,Sarah %A Mackert,Michael %A Almalki,Shoaa %A Awad,Germine %A Barczyk,Amanda %A Bearman,Sarah Kate %A Castelli,Darla %A Champagne,Frances %A de Barbaro,Kaya %A Garcia,Shirene %A Johnson,Karen %A Kinney,Kerry %A Lawson,Karla %A Nagy,Zoltan %A Quiñones Camacho,Laura %A Rodríguez,Lourdes %A Schnyer,David %A Thomaz,Edison %A Upshaw,Sean %A Zhang,Yan %+ Center for Health Communication, The University of Texas at Austin, 300 W Dean Keeton, Austin, TX, 78712, United States, 1 512 471 5775, lindsay.bouchacourt@austin.utexas.edu %K community-based %K longitudinal %K health disparities %K cohort study %K case study %K family health %K child %K children %K families %K child development %K mobile phone %D 2024 %7 5.12.2024 %9 Viewpoint %J JMIR Form Res %G English %X This paper discusses the implementation of the Whole Communities-Whole Health (WCWH) initiative, which is a community-based, longitudinal cohort study. WCWH seeks to better understand the impact of location on family health and child development while also providing support for families participating in the study. Implementing a longitudinal study that is both comprehensive in the data it is collecting and inclusive in the population it is representing is what makes WCWH extremely challenging. This paper highlights the learning process the initiative has gone through to identify effective strategies for implementing this type of research study and work toward building a new model for community-engaged research. Through iterative testing following the Plan-Do-Study-Act model, three main strategies for implementation were identified. These strategies are (1) creating a data collection schedule that balances participant burden and maintains temporality across data types; (2) facilitating multiple opportunities for qualitative and quantitative input from faculty, families, and nonparticipant community members; and (3) establishing an open-door policy for data analysis and interpretation. This paper serves as a guide and provides resources for other researchers wanting to implement a multidisciplinary and community-based cohort study. %M 39636676 %R 10.2196/60368 %U https://formative.jmir.org/2024/1/e60368 %U https://doi.org/10.2196/60368 %U http://www.ncbi.nlm.nih.gov/pubmed/39636676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54734 %T Continued Implementation and Use of a Digital Informal Care Support Platform Before and After COVID-19: Multimethod Study %A Sharma,Nikita %A Wrede,Christian %A Bastoni,Sofia %A Braakman-Jansen,Annemarie %A van Gemert-Pijnen,Lisette %K digital care platform %K eHealth %K implementation %K informal care %K new digital normal %K COVID %K Caren %K consolidated framework %D 2024 %7 31.12.2024 %9 %J JMIR Form Res %G English %X Background: With the growing need of support for informal caregivers (ICs) and care recipients (CRs) during COVID-19, the uptake of digital care collaboration platforms such as Caren increased. Caren is a platform designed to (1) improve communication and coordination between ICs and health care professionals, (2) provide a better overview of the care process, and (3) enhance safe information sharing within the care network. Insights on the impact of COVID-19 on the implementation and use of informal care platforms such as Caren are still lacking. Objective: This study aimed to (1) identify technology developers’ lessons learned from the continued implementation of Caren during COVID-19 and (2) examine pre-post COVID-19 changes in usage behavior and support functionality use of Caren. Methods: A focus group with developers of the Caren platform (N=3) was conducted to extract implementation lessons learned. Focus group data were first analyzed deductively, using the Consolidated Framework for Implementation Research domains (ie, individual characteristics, intervention characteristics, inner setting, and outer setting). Later, inductive analysis of overarching themes was performed. Furthermore, survey data were collected in 2019 (N=11,635) and 2022 (N=5573) among Caren platform users for comparing usage behavior and support functionality use. Data were analyzed using descriptive and inferential statistics. Results: Several lessons from the continued implementation of Caren during COVID-19 were identified. Those included, for example, alternative ways to engage with end users, incorporating automated user support and large-scale communication features, considering the fluctuation of user groups, and addressing data transparency concerns in health care. Quantitative results showed that the number of ICs and CRs who used Caren several times per day increased significantly (P<.001 for ICs and CRs) between 2019 (ICs: 23.8%; CRs: 23.2%) and 2022 (ICs: 35.2%; CRs: 37%), as well as the use of certain support functionalities such as a digital agenda to make and view appointments, a messaging function to receive updates and communicate with formal and informal caregivers, and digital notes to store important information. Conclusions: Our study offers insights into the influence of the COVID-19 pandemic on the usage and implementation of the digital informal care support platform Caren. The study shows how platform developers maintained the implementation during COVID-19 and which support functionalities gained relevance among ICs and CRs throughout the pandemic. The findings can be used to improve the design and implementation of current and future digital platforms to support informal care toward the “new digital normal.” %R 10.2196/54734 %U https://formative.jmir.org/2024/1/e54734 %U https://doi.org/10.2196/54734 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e42753 %T Assessment of Qatar’s Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study %A Waheed,Muhammad Atif %A Al Mannai,Lolwa %A Khudadad,Hanan %A Alenbawi,Jamil %A Mansaray,Mariama Aminata %A Al Abdulla,Samya %+ Primary Healthcare Corporation, Qatar, Al Mina Street, Doha, 40000, Qatar, 974 33015895, dratifwaheed@gmail.com %K COVID-19 %K COVID Response Service %K community call center %K virtual consultations %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization. Objective: This study aims to comprehensively examine the community call center’s operations and their significant role during the COVID-19 pandemic. Methods: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations. Results: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19–related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls. Conclusions: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises. %M 38085918 %R 10.2196/42753 %U https://formative.jmir.org/2024/1/e42753 %U https://doi.org/10.2196/42753 %U http://www.ncbi.nlm.nih.gov/pubmed/38085918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47441 %T A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use %A Swift,Jim %A O'Kelly,Noel %A Barker,Chris %A Woodward,Alex %A Ghosh,Sudip %+ Spirit Health, Spirit House, Saffron Way, Leicester, LE2 6UP, United Kingdom, 44 1162865000, jim.swift@spirit-health.com %K Covid-19 %K telemedicine %K digital technology %K home transition %K length of stay %K cost-effectiveness analysis %K cost %K costs %K economic %K economics %K telehealth %K hospitalization %K hospital %K hospitals %K hospitalizations %K resource %K resources %K hospital stay %K ward %K wards %K virtual care %K remote care %K financial %K finance %K finances %K remote %K respiratory %K SARS-CoV-2 %K pulmonary %K lung %K lungs %K service %K services %K delivery %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic stressed global health care systems’ acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England’s National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. Objective: The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. Methods: There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. Results: In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US $504,197 in net financial savings across the 2 key groups of patients—those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US $1850 and US $1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9%, which was below comparative data. The mean cost of the intervention was US $223.53 per patient, 12.1% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4% in the sensitivity analysis that the intervention was no longer cost saving. Conclusions: The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost. %M 38349716 %R 10.2196/47441 %U https://formative.jmir.org/2024/1/e47441 %U https://doi.org/10.2196/47441 %U http://www.ncbi.nlm.nih.gov/pubmed/38349716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49462 %T User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study %A Chou,Ya-Hsin %A Lin,Chemin %A Lee,Shwu-Hua %A Lee,Yen-Fen %A Cheng,Li-Chen %+ Department of Information and Finance Management, National Taipei University of Technology, 1, Sec 3, Zhongxiao E Rd, Taipei, 10608, Taiwan, 886 2771 2171, lijen.cheng@gmail.com %K geriatric psychiatry %K mental health %K loneliness %K chatbot %K user experience %K health promotion %K older adults %K technology-assisted interventions %K pandemic %K lonely %K gerontology %K elderly %K develop %K design %K development %K conversational agent %K geriatric %K geriatrics %K psychiatry %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. Objective: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Methods: Participants were older adults belonging to two age groups (≥65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot’s content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. Results: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74% (n=26) female and 26% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82% engaging with the chatbot daily. Loneliness significantly improved in the older group ≥65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. Conclusions: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic. %M 38477965 %R 10.2196/49462 %U https://formative.jmir.org/2024/1/e49462 %U https://doi.org/10.2196/49462 %U http://www.ncbi.nlm.nih.gov/pubmed/38477965 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43875 %T Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study %A Elliott,Mary %A Khallouf,Camille %A Hirsch,Jennifer %A de Camps Meschino,Diane %A Zamir,Orit %A Ravitz,Paula %+ Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C1, Canada, 1 416 946 2000, mary.elliott@uhn.ca %K COVID-19 %K pandemic %K health care worker %K resilience %K mental health %K burnout %K well-being %K mindfulness meditation %K web-based group %K drop-in %K mindfulness %K health care staff %K meditation %K worker %K job %K occupational health %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs. Objective: This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic. Methods: Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ≥1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave. Results: We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48%) attended >1 session. The study participants were predominantly female individuals (40/50, 80%) and comprised physicians (17/50, 34%), nurses (9/50, 18%), and other HCWs (24/50, 48%), who were largely from Ontario (41/50, 82%). Of 50 attendees, 26 (52%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92%). The most cited reasons for attending the program were to relax (38/48, 79%), manage stress or anxiety (36/48, 75%), wish for loving kindness or self-compassion (30/48, 64%), learn mindfulness (30/48, 64%), and seek help with emotional reactivity (25/48, 53%). Qualitative interviews with 15 out of 50 (30%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants’ needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate. Conclusions: The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs. %M 38180869 %R 10.2196/43875 %U https://formative.jmir.org/2024/1/e43875 %U https://doi.org/10.2196/43875 %U http://www.ncbi.nlm.nih.gov/pubmed/38180869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51331 %T Latino Parents’ Reactions to and Engagement With a Facebook Group–Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study %A González-Salinas,Anna I %A Andrade,Elizabeth L %A Abroms,Lorien C %A Gómez,Kaitlyn %A Favetto,Carla %A Gómez,Valeria M %A Collins,Karen K %+ George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 (202) 994 7400, agonzalez985@gwmail.gwu.edu %K COVID-19 %K misinformation %K social media %K Latino parents %K Spanish %K vaccines %K digital intervention %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. Objective: This study aims to assess participants’ reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. Methods: We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ≤18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants’ exposure, reactions, and engagement, we used participants’ responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Results: Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40%) or 4 to 6 (18/55, 33%) times per week and viewing 1 to 2 (23/55, 42%) or 3 to 4 (16/55, 29%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93%) and helpful (50/55, 91%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82%) and supportive (19/55, 35%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53%), understanding child risk levels (29/55, 53%), and the science behind COVID-19 (24/55, 44%). The preferred formats were educational posts that could be read (38/55, 69%) and videos, including expert (28/55, 51%) and instructional (26/55, 47%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29%) or 3 to 4 (15/55, 27%) times per week and commenting on posts 1 to 2 (16/55, 29%) or <1 (20/55, 36%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. Conclusions: With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine–related health promotion. %M 38483457 %R 10.2196/51331 %U https://formative.jmir.org/2024/1/e51331 %U https://doi.org/10.2196/51331 %U http://www.ncbi.nlm.nih.gov/pubmed/38483457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50181 %T Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study %A Blazek,E Susanne %A Bucher,Amy %+ Behavioral Reinforcement Learning Lab (BReLL), Lirio, 320 Corporate Drive, Knoxville, TN, 37923, United States, 1 865 839 5539, sblazek@lirio.com %K behavioral barriers %K benefits %K COVID-19 %K Marine Corps %K military %K vaccine reluctance %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. Objective: The purpose of this observational study was to examine Marines’ self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. Methods: As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines’ written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good (κ=0.81). Results: A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45%), low estimates of risk (33/235, 14%), and fear of physical discomfort (29/235, 12%). Resulting interventions directly targeted Marines’ self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). Conclusions: Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors. %M 38502179 %R 10.2196/50181 %U https://formative.jmir.org/2024/1/e50181 %U https://doi.org/10.2196/50181 %U http://www.ncbi.nlm.nih.gov/pubmed/38502179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51152 %T A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis %A Ullah,Nazifa %A Martin,Sam %A Poduval,Shoba %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 (0)20 3549 5969, s.poduval@ucl.ac.uk %K COVID-19 %K ethnic minorities %K vaccine %K hesitancy %K social media %K discourse %K minority groups %D 2024 %7 26.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). Objective: This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. Methods: Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a “snapshot” of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. Results: A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. Conclusions: Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities. %M 38530334 %R 10.2196/51152 %U https://formative.jmir.org/2024/1/e51152 %U https://doi.org/10.2196/51152 %U http://www.ncbi.nlm.nih.gov/pubmed/38530334 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53608 %T Factors Impacting Chinese Older Adults’ Intention to Prevent COVID-19 in the Post–COVID-19 Pandemic Era: Survey Study %A Guan,Huixin %A Wang,Wei %+ USC-SJTU Institute of Cultural and Creative Industry, Shanghai Jiao Tong University, No155. Tanjiatang Road, Shanghai, 200241, China, 86 13840128403, guan_hx@sjtu.edu.cn %K COVID-19 %K SARS-CoV-2 %K health protection %K social capital %K media exposure %K negative emotions %K structural influence model of communication %K SIM %K protect %K protection %K protective %K intent %K intention %K prevention %K preventative %K restriction %K restrictions %K public health measures %K safety %K news %K newspaper %K media %K radio %K health communication %K influence %K influencing %K infectious %K infection control %K pandemic %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K older person %K older people %K aging %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding the factors influencing individuals’ health decisions is a dynamic research question. Particularly, after China announced the deregulation of the COVID-19 epidemic, health risks escalated rapidly. The convergence of “no longer controlled” viruses and the infodemic has created a distinctive social period during which multiple factors may have influenced people’s decision-making. Among these factors, the precautionary intentions of older individuals, as a susceptible health group, deserve special attention. Objective: This study aims to examine the intention of older adults to engage in preventive behaviors and the influencing factors, including social, media, and individual factors, within the context of the postepidemic era. Drawing upon the structural influence model of communication, this study tests the potential mediating roles of 3 different types of media exposure between cognitive and structural social capital and protective behavior intention, as well as the moderating role of negative emotions between social capital and media exposure. Methods: In this study, a web survey was used to collect self-reported quantitative data on social capital, media exposure, negative emotions, and the intention to prevent COVID-19 among older adults aged ≥60 years (N=399) in China. Results: The results indicate that cognitive social capital significantly influenced protective behavior intention (P<.001), with cell phone exposure playing an additional impactful role (P<.001). By contrast, newspaper and radio exposure and television exposure mediated the influence of structural social capital on protective behavior intention (P<.001). Furthermore, negative emotions played a moderating role in the relationship between cognitive social capital and cell phone exposure (P<.001). Conclusions: This study suggests that using tailored communication strategies across various media channels can effectively raise health awareness among older adults dealing with major pandemics in China, considering their diverse social capital characteristics and emotional states. %M 38630517 %R 10.2196/53608 %U https://formative.jmir.org/2024/1/e53608 %U https://doi.org/10.2196/53608 %U http://www.ncbi.nlm.nih.gov/pubmed/38630517 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54326 %T Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey %A Wang,Di %A Li,Peifan %A Huang,Xiaoling %A Liu,Yixuan %A Mao,Shihang %A Yin,Haoning %A Wang,Na %A Luo,Yan %A Sun,Shan %+ Research Service Office, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China, 86 18917786102, shansun@fudan.edu.cn %K COVID-19 pandemic %K tinnitus %K ear-related symptoms %K online survey %K prevalence %K ear-related %K China %K cross-sectional %K complex %K heterogeneous %K symptom %K symptoms %K Chinese %K population %K investigate %K health care %K exploratory %K teen %K teens %K teenager %K teenagers %K older adult %K older adults %K elder %K elderly %K older person %K older people %K COVID-19 %K regression analysis %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. Objective: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. Methods: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection–related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. Results: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. Conclusions: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post–COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume. %R 10.2196/54326 %U https://formative.jmir.org/2024/1/e54326 %U https://doi.org/10.2196/54326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50303 %T Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study %A Gotra,Milena %A Lindberg,Katharine %A Jasinski,Nicholas %A Scarisbrick,David %A Reilly,Shannon %A Perle,Jonathan %A Miller,Liv %A Mahoney III,James %+ Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, 64 Medical Center Dr, Morgantown, WV, 26506, United States, 1 304 598 4740, nicholas.jasinski1@hsc.wvu.edu %K COVID-19 pandemic %K mental health %K social worker %K psychologist %K neuropsychologist %K academic medical center %K community mental health %K private practice %K Veteran’s Affairs hospital %K longitudinal questionnaire study %K COVID-19 %K implementation %K telemental health %K hybrid model %K availability %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. %M 38683653 %R 10.2196/50303 %U https://formative.jmir.org/2024/1/e50303 %U https://doi.org/10.2196/50303 %U http://www.ncbi.nlm.nih.gov/pubmed/38683653 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53056 %T Health Care Professionals’ Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study %A Cermak,Carly A %A Read,Heather %A Jeffs,Lianne %+ Science of Care Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada, 1 4165864800, carly.cermak@mail.utoronto.ca %K COVID-19 %K information and communication technology %K health care provider experiences %K web-based care %K interview %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. %M 38805250 %R 10.2196/53056 %U https://formative.jmir.org/2024/1/e53056 %U https://doi.org/10.2196/53056 %U http://www.ncbi.nlm.nih.gov/pubmed/38805250 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53574 %T Understanding COVID-19 Impacts on the Health Workforce: AI-Assisted Open-Source Media Content Analysis %A Pienkowska,Anita %A Ravaut,Mathieu %A Mammadova,Maleyka %A Ang,Chin-Siang %A Wang,Hanyu %A Ong,Qi Chwen %A Bojic,Iva %A Qin,Vicky Mengqi %A Sumsuzzman,Dewan Md %A Ajuebor,Onyema %A Boniol,Mathieu %A Bustamante,Juana Paola %A Campbell,James %A Cometto,Giorgio %A Fitzpatrick,Siobhan %A Kane,Catherine %A Joty,Shafiq %A Car,Josip %+ Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Clinical Sciences Building, Singapore, 308232, Singapore, 65 6513 8572, iva.bojic@ntu.edu.sg %K World Health Organization %K WHO %K public surveillance %K natural language processing %K NLP %K artificial intelligence %K AI %K COVID-19 %K SARS-COV-2 %K COVID-19 pandemic %K human-generated analysis %K decision-making %K strategic policy %K health workforce %K news article %K media content analysis %K news coverage %K health care worker %K mental health %K death risk %K intervention %K efficiency %K public health %K surveillance %K innovation %K innovative method %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support strategic policy dialogue, advocacy, and decision-making. Objective: This study aimed to explore the possibility of systematically scanning intelligence from media that are usually not captured or best gathered through structured academic channels and inform on the impacts of the COVID-19 pandemic on the health workforce, contributing factors to the pervasiveness of the impacts, and policy responses, as depicted in publicly available news articles. Our focus was to investigate the impacts of the COVID-19 pandemic and, concurrently, assess the feasibility of gathering health workforce insights from open sources rapidly. Methods: We conducted an NLP-assisted media content analysis of open-source news coverage on the COVID-19 pandemic published between January 2020 and June 2022. A data set of 3,299,158 English news articles on the COVID-19 pandemic was extracted from the World Health Organization Epidemic Intelligence through Open Sources (EIOS) system. The data preparation phase included developing rules-based classification, fine-tuning an NLP summarization model, and further data processing. Following relevancy evaluation, a deductive-inductive approach was used for the analysis of the summarizations. This included data extraction, inductive coding, and theme grouping. Results: After processing and classifying the initial data set comprising 3,299,158 news articles and reports, a data set of 5131 articles with 3,007,693 words was devised. The NLP summarization model allowed for a reduction in the length of each article resulting in 496,209 words that facilitated agile analysis performed by humans. Media content analysis yielded results in 3 sections: areas of COVID-19 impacts and their pervasiveness, contributing factors to COVID-19–related impacts, and responses to the impacts. The results suggest that insufficient remuneration and compensation packages have been key disruptors for the health workforce during the COVID-19 pandemic, leading to industrial actions and mental health burdens. Shortages of personal protective equipment and occupational risks have increased infection and death risks, particularly at the pandemic’s onset. Workload and staff shortages became a growing disruption as the pandemic progressed. Conclusions: This study demonstrates the capacity of artificial intelligence–assisted media content analysis applied to open-source news articles and reports concerning the health workforce. Adequate remuneration packages and personal protective equipment supplies should be prioritized as preventive measures to reduce the initial impact of future pandemics on the health workforce. Interventions aimed at lessening the emotional toll and workload need to be formulated as a part of reactive measures, enhancing the efficiency and maintainability of health delivery during a pandemic. %M 38869940 %R 10.2196/53574 %U https://formative.jmir.org/2024/1/e53574 %U https://doi.org/10.2196/53574 %U http://www.ncbi.nlm.nih.gov/pubmed/38869940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51292 %T How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study %A Peprah,Emmanuel %A Amesimeku,Etornam %A Angulo,Brian %A Chhetri,Himani %A Fordjuoh,Judy %A Ruan,Christina %A Wang,Cong %A Patena,John %A Vieira,Dorice %A Ryan,Nessa %A Iloegbu,Chukwuemeka %A Gyamfi,Joyce %A Odumegwu,Jonathan %+ Implementing Evidence-Based Interventions Through Engagement (ISEE) Lab, Department of Global and Environmental Health, New York University School of Global Public Health, 708 Broadway, New York, NY, 10012, United States, 1 212 992 6095, ep91@nyu.edu %K COVID-19 %K pandemic %K public health %K preventative %K prevention %K social distancing %K masks %K personal protective equipment %K cross-sectional %K surveys %K higher learning %K higher education %K university students %K information source %K web-based information %K health information %K dissemination %K awareness %K information spread %K young adults %K social media %K university %K postsecondary %K students %K young adult %K college %K concern %K worry %K anxiety %K perceptions %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The start of the COVID-19 pandemic resulted in the implementation of nonpharmaceutical interventions by US institutions of higher education at an unprecedented level. During the backdrop of an emerging pandemic, younger adults (eg, college students) had an overall lower risk for severe outcomes for SARS-CoV-2, making this population a potential source of transmission for age groups with high susceptibility and negative health outcomes. We examine how college students’ level of concern for COVID-19 was influenced by different sources of information, their living status, income level, and other demographic identifiers and its association with prevention behavior change. Objective: We sought to examine the level of concern, defined as the extent to which the participant would take corrective action to mitigate contracting or spreading the virus (to family or friends) by using personal protective equipment such as a face mask, practicing social distancing, and following other public health recommendations, among college students during the COVID-19 pandemic. Methods: A cross-sectional, web-based survey was conducted in 2021 among 185 college students aged 18-41 years, with most living in New York City and the United States (n=134, 72.4%). Out of 185 college students, 94 provided their zip codes, with 51 of those college students indicating they lived in New York City areas. The participants completed the survey via a QR code. Study participants who did not complete the full survey or were not college students in any US college or university were excluded. Analyses were conducted using R (version 4.2.2; R Foundation for Statistical Computing). Results: Of 185 respondents participated in the study, 25 (13.5.%) used emails from their schools, 51 (27.6%) used mainstream media, and 109 (58.9%) used social media and other sources to obtain information about COVID-19. Of the 109 participants who learned about the pandemic from social media, 91 (83.5%) were concerned; however, only 63% (32/51) and 60% (15/25) of the participants who sourced information from mainstream media and their schools’ email, respectively, were concerned. Further, the participants who received information from social media and other sources were about 3 times more likely to be concerned about COVID-19 than participants who received information from the university via email (P=.036; OR=3.07, 95% CI: 1.06-8.83).. Conclusions: College students who received information from social media and other sources were more likely to be concerned about COVID-19 than students who received information from their school via emails. %M 38885019 %R 10.2196/51292 %U https://formative.jmir.org/2024/1/e51292 %U https://doi.org/10.2196/51292 %U http://www.ncbi.nlm.nih.gov/pubmed/38885019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50751 %T Physician and Practice Characteristics Influencing Telemedicine Uptake Among Frontline Clinicians in the Early COVID-19 Pandemic Response: National Survey Study %A Hamline,Michelle Y %A Xing,Guibo %A Kravitz,Richard L %A Miller,Marykate %A Melnikow,Joy %+ Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, United States, 1 9167345387, mhamline@ucdavis.edu %K telemedicine %K telehealth %K COVID-19 pandemic %K frontline clinicians %K telemonitoring %K frontliners %K virtual care %K influence %K clinician %K physician %K pre-pandemic %K pandemic %K survey %K health outcome %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. Objective:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. Methods:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. Results:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. Conclusions:  Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies. %M 39018095 %R 10.2196/50751 %U https://formative.jmir.org/2024/1/e50751 %U https://doi.org/10.2196/50751 %U http://www.ncbi.nlm.nih.gov/pubmed/39018095 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53904 %T Partisan Media, Trust, and Media Literacy: Regression Analysis of Predictors of COVID-19 Knowledge %A Roschke,Kristy %A Koskan,Alexis M %A Sivanandam,Shalini %A Irby,Jonathan %+ Walter Cronkite School of Journalism and Mass Communication, Arizona State University, 555 North Central Avenue, Phoenix, AZ, 85004, United States, 1 602 496 8660, kristy.roschke@asu.edu %K COVID-19 %K misinformation %K media literacy %K news consumption %K institutional trust %K media %K trust %K prevention %K control %K health care professional %K health care %D 2024 %7 24.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic was a devastating public health event that spurred an influx of misinformation. The increase in questionable health content was aided by the speed and scale of digital and social media and certain news agencies’ and politicians’ active dissemination of misinformation about the virus. The popularity of certain COVID-19 myths created confusion about effective health protocols and impacted trust in the health care and government sectors deployed to manage the pandemic. Objective: This study explored how people’s information habits, their level of institutional trust, the news media outlets they consume and the technologies in which they access it, and their media literacy skills influenced their COVID-19 knowledge. Methods: We administered a web-based survey using Amazon Mechanical Turk (MTurk) to assess US adults’ (n=1498) COVID-19 knowledge, media and news habits, media literacy skills, and trust in government and health-related institutions. The data were analyzed using a hierarchical linear regression to examine the association between trust, media literacy, news use, and COVID-19 knowledge. Results: The regression model of demographic variables, political affiliation, trust in institutions, media literacy, and the preference for watching Fox or CNN was statistically significant (R2=0.464; F24,1434=51.653; P<.001; adjusted R2=0.455) in predicting COVID-19 knowledge scores. People who identified as politically conservative, watched Fox News, and reported lower levels of institutional trust and media literacy, scored lower on COVID-19 knowledge questions than those who identified as politically liberal, did not watch Fox News and reported higher levels of institutional trust and media literacy. Conclusions: This study suggests that the media outlets people turn to, their trust in institutions, and their perceived degree of agency to discern credible information can impact people’s knowledge of COVID-19, which has potential implications for managing communication in other public health events. %M 39047283 %R 10.2196/53904 %U https://formative.jmir.org/2024/1/e53904 %U https://doi.org/10.2196/53904 %U http://www.ncbi.nlm.nih.gov/pubmed/39047283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56000 %T Identifying Barriers to the Adoption of Digital Contact Tracing Apps in England: Semistructured Interview Study With Professionals Involved in the Pandemic Response %A Palmer,Anna %A Sharma,Shaishab %A Nagpal,Jayesh %A Kimani,Victor %A Mai,Florence %A Ahmed,Zara %+ Imperial College School of Medicine, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, United Kingdom, 44 7887691537, anna.palmer16@imperial.ac.uk %K COVID-19 %K global health %K public health %K qualitative study %K tracing %K England %K apps %K effectiveness %K contact tracing %K barrier %K digital health %K thematic analysis %K privacy %K communication %K social support %K tracing app %K digital illiteracy %K technology %K support %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The NHS (National Health Service) COVID-19 app was a digital contact tracing app (DCTA) used in England in response to the COVID-19 pandemic. The aim of which was to limit the spread of COVID-19 by providing exposure alerts. At the time of the pandemic, questions were raised regarding the effectiveness and cost of the NHS COVID-19 app and whether DCTAs have a role in future pandemics. Objective: This study aims to explore key barriers to DCTAs in England during the COVID-19 pandemic. Methods: This is a qualitative study using semistructured video interviews conducted with professionals in public health, digital health, clinicians, health care law, and health executives who had an active role in the COVID-19 pandemic. These interviews aimed to explore the perspective of different experts involved in the pandemic response and gauge their opinions on the key barriers to DCTAs in England during the COVID-19 pandemic. The initial use of maximum variation sampling combined with a snowball sampling approach ensured diversity within the cohort of interviewees. Interview transcripts were then analyzed using Braun and Clarke's 6 steps for thematic analysis. Results: Key themes that acted as barriers to DCTAs were revealed by interviewees such as privacy concerns, poor communication, technological accessibility, digital literacy, and incorrect use of the NHS COVID-19 app. Interviewees believed that some of these issues stemmed from poor governmental communication and a lack of transparency regarding how the NHS COVID-19 app worked, resulting in decreased public trust. Moreover, interviewees highlighted that a lack of social support integration within the NHS COVID-19 app and delayed app notification period also contributed to the poor adoption rates. Conclusions: Qualitative findings from interviews highlighted barriers to the NHS COVID-19 app, which can be applied to DCTAs more widely and highlight some important implications for the future use of DCTAS. There was no consensus among interviewees as to whether the NHS COVID-19 app was a success; however, all interviewees provided recommendations for improvements in creating and implementing DCTAs in the future. %M 39133910 %R 10.2196/56000 %U https://formative.jmir.org/2024/1/e56000 %U https://doi.org/10.2196/56000 %U http://www.ncbi.nlm.nih.gov/pubmed/39133910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52120 %T Promoting Collaborative Scholarship During the COVID-19 Pandemic Through an Innovative COVID-19 Data Explorer and Repository at Yale School of Medicine: Development and Usability Study %A Victoria-Castro,Angela Maria %A Arora,Tanima %A Simonov,Michael %A Biswas,Aditya %A Alausa,Jameel %A Subair,Labeebah %A Gerber,Brett %A Nguyen,Andrew %A Hsiao,Allen %A Hintz,Richard %A Yamamoto,Yu %A Soufer,Robert %A Desir,Gary %A Wilson,Francis Perry %A Villanueva,Merceditas %+ Section of Infectious Diseases, Yale School of Medicine, Yale University, 135 College St., Suite 323, New Haven, CT, 06510, United States, 1 203 737 6133, merceditas.villanueva@yale.edu %K COVID-19 %K database %K data access %K interdepartmental communication %K collaborative scholarship %K clinical data %K repository %K researchers %K large-scale database %K innovation %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic sparked a surge of research publications spanning epidemiology, basic science, and clinical science. Thanks to the digital revolution, large data sets are now accessible, which also enables real-time epidemic tracking. However, despite this, academic faculty and their trainees have been struggling to access comprehensive clinical data. To tackle this issue, we have devised a clinical data repository that streamlines research processes and promotes interdisciplinary collaboration. Objective: This study aimed to present an easily accessible up-to-date database that promotes access to local COVID-19 clinical data, thereby increasing efficiency, streamlining, and democratizing the research enterprise. By providing a robust database, a broad range of researchers (faculty and trainees) and clinicians from different areas of medicine are encouraged to explore and collaborate on novel clinically relevant research questions. Methods: A research platform, called the Yale Department of Medicine COVID-19 Explorer and Repository (DOM-CovX), was constructed to house cleaned, highly granular, deidentified, and continually updated data from over 18,000 patients hospitalized with COVID-19 from January 2020 to January 2023, across the Yale New Haven Health System. Data across several key domains were extracted including demographics, past medical history, laboratory values during hospitalization, vital signs, medications, imaging, procedures, and outcomes. Given the time-varying nature of several data domains, summary statistics were constructed to limit the computational size of the database and provide a reasonable data file that the broader research community could use for basic statistical analyses. The initiative also included a front-end user interface, the DOM-CovX Explorer, for simple data visualization of aggregate data. The detailed clinical data sets were made available for researchers after a review board process. Results: As of January 2023, the DOM-CovX Explorer has received 38 requests from different groups of scientists at Yale and the repository has expanded research capability to a diverse group of stakeholders including clinical and research-based faculty and trainees within 15 different surgical and nonsurgical specialties. A dedicated DOM-CovX team guides access and use of the database, which has enhanced interdepartmental collaborations, resulting in the publication of 16 peer-reviewed papers, 2 projects available in preprint servers, and 8 presentations in scientific conferences. Currently, the DOM-CovX Explorer continues to expand and improve its interface. The repository includes up to 3997 variables across 7 different clinical domains, with continued growth in response to researchers’ requests and data availability. Conclusions: The DOM-CovX Data Explorer and Repository is a user-friendly tool for analyzing data and accessing a consistently updated, standardized, and large-scale database. Its innovative approach fosters collaboration, diversity of scholarly pursuits, and expands medical education. In addition, it can be applied to other diseases beyond COVID-19. %M 39226547 %R 10.2196/52120 %U https://formative.jmir.org/2024/1/e52120 %U https://doi.org/10.2196/52120 %U http://www.ncbi.nlm.nih.gov/pubmed/39226547 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53978 %T Bridging Language Barriers in COVID-19 Research: Descriptive Study of AccesoCovid.com’s Reach and User Engagement %A Abascal Miguel,Lucía %A Forster,Maeve %A Gallalee,Sarah %A Carson,Mariam %A Fieldhouse,Jane K %A Keir,Alexandra %A Maya,Sigal %A Rahman,Sabahat %A Reid,Michael J A %A Vasilopoulos,Hariclea %A Lima Sanchez,Dania Nimbe %+ Institute for Global Health Sciences, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, United States, 1 (415) 476 5190, maeve.forster@ucsf.edu %K COVID-19 research dissemination %K multilingual scientific platform %K language barriers in science %K Spanish scientific communication %K equitable access to research %K global health equity %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic underscored the challenge of swiftly disseminating research findings to a global audience. Language barriers further exacerbated disparities in access to timely scientific information, particularly for non-English speaking communities. The majority of COVID-19 research was published in English, limiting accessibility for Spanish-speaking populations. Objective: This paper aims to assess the reach and effectiveness of AccesoCovid.com, a platform designed to disseminate up-to-date COVID-19 research in both English and Spanish, addressing the language gap in scientific communication. Methods: AccesoCovid.com was developed through a partnership between the University of California, San Francisco (UCSF) and Universidad Nacional Autónoma de México (UNAM). The website’s performance and user engagement were evaluated using Google Analytics over a span of 2 years. Key metrics included user language preference, geographical distribution, and site traffic. The website summarized and translated 1032 articles on various COVID-19 topics, such as “Pharmaceutical Interventions and Vaccines.” Results: From February 2021 to February 2023, the platform attracted 57,000 users. Of the 43,000 unique new visitors, 84.2% (n=36,219) hailed from Spanish-speaking regions. The majority accessed the site organically through search engines, with 88.4% (n=38,000) of users arriving this way, while 5000 (11.6%) users accessed the site directly. Most users (n=30,894, 72.1%) preferred the Spanish version of the site. The website’s most accessed category was “Pharmaceutical Interventions and Vaccines,” followed by “Clinical Presentation and Management” and “Mental Health.” Regarding language distribution, 72.1% (n=30,894) of users primarily used Spanish; 21.4% (n=9215) used English; and 6.7% (n=2891) spoke other languages, including Portuguese, Chinese, and German. Geographically, the website attracted visitors from 179 countries, with the highest visitor counts from Mexico (n=12,342, 28.7%), Spain (n=6405, 14.9%), the United States (n=4416, 10.3%), and Peru (n=3821, 8.9%). Conclusions: AccesoCovid.com successfully bridged a critical language gap in the dissemination of COVID-19 research. Its success underscores the pressing need for multilingual scientific resources. The platform demonstrated significant user engagement and reach, particularly in Spanish-speaking countries. This highlights the potential for similar platforms to ensure equitable access to scientific knowledge across diverse linguistic communities. Future efforts should focus on expanding to other languages and conducting formal evaluations to enhance user satisfaction and impact. %M 39250219 %R 10.2196/53978 %U https://formative.jmir.org/2024/1/e53978 %U https://doi.org/10.2196/53978 %U http://www.ncbi.nlm.nih.gov/pubmed/39250219 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51237 %T Patient Engagement With and Perceptions of the COVIDA Project, a Volunteer-Led Telemonitoring and Teleorientation Service for COVID-19 Community Management: Mixed Methods Study %A Escobar-Agreda,Stefan %A Silva-Valencia,Javier %A Soto-Becerra,Percy %A Reategui-Rivera,C Mahony %A De la Cruz-Torralva,Kelly %A Chahuara-Rojas,Max %A Hernandez-Iriarte,Bruno %A Espinoza-Herrera,Daniel Hector %A Delgado,Carlos Alberto %A Matassini,Silvana %A Vargas-Herrera,Javier %A Rojas-Mezarina,Leonardo %+ Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Grau Avenue, 775, Lima, 15001, Peru, 51 619 7000 ext 4650, jvargash@unmsm.edu.pe %K telemonitoring %K volunteers %K engagement %K COVID-19 %K Peru %K telehealth %K perceptions %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the pandemic in Peru, the COVIDA (Collaboration Network of Volunteer Brigade Members for the Investigation, Detection, and Primary Management of Community Cases Affected by COVID-19) project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 patients, led by health care student volunteers. However, it has not been described how this interaction is perceived from the patient’s perspective and which factors increase their engagement with this service. Objective: The aim of this study is to describe the perceptions of patients about COVIDA and identify factors associated with their engagement with this service. Methods: A mixed methods study was conducted to evaluate perceptions of patients that participated in the COVIDA project. This telehealth intervention organized by the National University of San Marcos was implemented in Peru from August to December 2020. The service involved daily phone calls by volunteer students to monitor registered COVID-19 patients until the completion of the 14th day of the illness or if a warning sign was identified. The volunteers also provided teleorientation to address the patients’ needs and concerns. Quantitative analysis was performed to describe the characteristics of the patients and to assess the factors related to their engagement with the service, which was defined by the percentage of participants who completed the follow-up according to their individual schedule. Qualitative analysis through semistructured interviews evaluated the patients’ perceptions of the service regarding the aspects of communication, interaction, and technology. Results: Of the 770 patients enrolled in COVIDA, 422 (55.7%) were female; the median age was 39 (IQR 28-52) years. During the monitoring, 380 patients (49.4%) developed symptoms, and 471 (61.2%) showed warning signs of COVID-19. The overall median for engagement was 93% (IQR 35.7%-100%). Among those patients who did not develop warning signs, engagement was associated with the presence of symptoms (OR 3.04, 95% CI 2.22-4.17), a positive COVID-19 test at the start of follow-up (OR 1.97, 95% CI 1.48-2.61), and the presence of comorbidities (OR 1.83, 95% CI 1.29-2.59). Patients reported that the volunteers provided clear and valuable information and emotional support. Communication via phone calls took place smoothly and without interruptions. Conclusions: COVIDA represents a well-accepted and well-perceived alternative model for student volunteers to provide telemonitoring, teleorientation, and emotional support to patients with COVID-19 in the context of overwhelmed demand for health care services. The deployment of this kind of intervention should be prioritized among patients with symptoms and comorbidities, as they show more engagement with these services. %M 39269741 %R 10.2196/51237 %U https://formative.jmir.org/2024/1/e51237 %U https://doi.org/10.2196/51237 %U http://www.ncbi.nlm.nih.gov/pubmed/39269741 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53767 %T Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A Sanz-Gomez,Sergio %A González Ramírez,Leivy Patricia %A Herdoiza-Arroyo,Paulina Erika %A Trevino Garcia,Lorena Edith %A de la Rosa-Gómez,Anabel %A González-Cantero,Joel Omar %A Macias-Aguinaga,Valeria %A Arenas Landgrave,Paulina %A Chávez-Valdez,Sarah Margarita %+ School of Medicine and Health Sciences, Tecnologico de Monterrey, Avenue Gral Ramón Corona #2514, Colonia Nuevo México, Zapopan, 45201, Mexico, 52 3336693000, leivy@tec.mx %K self-guided web-based intervention %K chat support %K depression %K anxiety %K COVID-19 %K opinion %K usability %K randomized control trial %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. Objective: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants’ symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants’ satisfaction and acceptability. Methods: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. Results: A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. Conclusions: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention’s usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users’ perceived utility of the intervention, among other issues identified in the study. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results International Registered Report Identifier (IRRID): RR2-10.2196/23117 %M 39348893 %R 10.2196/53767 %U https://formative.jmir.org/2024/1/e53767 %U https://doi.org/10.2196/53767 %U http://www.ncbi.nlm.nih.gov/pubmed/39348893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58242 %T Habit and Help—Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults %A Kilaberia,Tina R %A Hu,Yuanyuan %A Bell,Janice F %+ Silver School of Social Work, New York University, 1 Washington Square North, Room 315, New York, NY, 10003, United States, 1 212 998 5938, tk3127@nyu.edu %K pandemic %K older people %K technology habit %K subjective experience %K acceptance of technology %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways. Objective: This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower. Methods: A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire. Results: Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery. Conclusions: Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults’ prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic. %M 39422990 %R 10.2196/58242 %U https://formative.jmir.org/2024/1/e58242 %U https://doi.org/10.2196/58242 %U http://www.ncbi.nlm.nih.gov/pubmed/39422990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60000 %T The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study %A Chen,En-ling %A Bai,Chyi-Huey %A Kocis,Paul T %A Hwang,Wenke %+ Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Suite 2200, Hershey, PA, 17033, United States, 1 717 531 7070, whwang@psu.edu %K name-based rationing system %K NBRS %K community pharmacy %K community pharmacist %K COVID-19 %K SARS-CoV-2 %K KAP %K knowledge, attitude, and practices %K public health %K health emergencies %K government strategy %K mobile phone %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Taiwan’s public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. Objective: This study aimed to investigate (1) Taiwanese pharmacists’ knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19–related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual’s KAP and corresponding perspectives toward the NBRS. Methods: A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists’ KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument’s internal consistency reliability was ascertained using Cronbach α (0.819), and its content validity was verified by field experts. Results: Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19–related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19–testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. Conclusions: The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan’s COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises. %M 39447161 %R 10.2196/60000 %U https://formative.jmir.org/2024/1/e60000 %U https://doi.org/10.2196/60000 %U http://www.ncbi.nlm.nih.gov/pubmed/39447161 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60574 %T Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey %A Charles,Lesley %A Tang,Eileen %A Tian,Peter George Jaminal %A Chan,Karenn %A Brémault-Phillips,Suzette %A Dobbs,Bonnie %A Vokey,Camelia %A Polard,Sharna %A Parmar,Jasneet %+ Division of Care of the Elderly, Department of Family Medicine, University of Alberta, 5-10 University Terrace, University of Alberta 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada, 1 780 735 8882, LCharles@ualberta.ca %K decision making capacity %K mental competency %K aged %K mobile applications %K mobile phone %K Canada %K covid-19 %K pandemics %K dementia %K survey %K virtual capacity assessment %K characteristics %K barriers %K facilitators %K virtual decision making %K assessment %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2%, 14/31), occupational therapists (29%, 9/31), and social workers (16.1%, 5/31), with a majority (93.6%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2%, 16/29) being associated primarily with acute care services. Furthermore, 54.8% (17/31) were interested in conducting DMCAs virtually; however, only 25.8% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients’ characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client’s and assessor’s sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors’ ability to perform DMCA’s virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. %M 39585735 %R 10.2196/60574 %U https://formative.jmir.org/2024/1/e60574 %U https://doi.org/10.2196/60574 %U http://www.ncbi.nlm.nih.gov/pubmed/39585735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58397 %T Correction: Improving the Engagement of Underrepresented People in Health Research Through Equity-Centered Design Thinking: Qualitative Study and Process Evaluation for the Development of the Grounding Health Research in Design Toolkit %A Bazzano,Alessandra N %A Noel,Lesley-Ann %A Patel,Tejal %A Dominique,C Chantel %A Haywood,Catherine %A Moore,Shenitta %A Mantsios,Andrea %A Davis,Patricia A %+ Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, United States, 1 5049882338, abazzano@tulane.edu %D 2024 %7 4.4.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38574353 %R 10.2196/58397 %U https://formative.jmir.org/2024/1/e58397 %U https://doi.org/10.2196/58397 %U http://www.ncbi.nlm.nih.gov/pubmed/38574353 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59427 %T Correction: Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report %A Eldridge,Lori Ann %A Meyerson,Beth E %A Agley,Jon %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E 9th Street, Bloomington, IN, 47405, United States, 1 812 855 3123, jagley@indiana.edu %D 2024 %7 11.4.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38604612 %R 10.2196/59427 %U https://formative.jmir.org/2024/1/e59427 %U https://doi.org/10.2196/59427 %U http://www.ncbi.nlm.nih.gov/pubmed/38604612 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60644 %T Correction: Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study %A Zhou,Ying %A Zhou,Yaxu %A Xu,Di %A Min,Jie %A Du,Yu %A Duan,Qi %A Bao,Wen %A Sun,Yingying %A Xi,Huiqin %A Wang,Chunming %A Bischof,Evelyne %+ Smart Hospital Development Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, No160 Pujian Road, Shanghai, 200127, China, 86 2168383408, wangchunming@renji.com %D 2024 %7 27.5.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38801763 %R 10.2196/60644 %U https://formative.jmir.org/2024/1/e60644 %U https://doi.org/10.2196/60644 %U http://www.ncbi.nlm.nih.gov/pubmed/38801763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59349 %T Addendum: Using #ActuallyAutistic on Twitter for Precision Diagnosis of Autism Spectrum Disorder: Machine Learning Study %A Jaiswal,Aditi %A Shah,Aekta %A Harjadi,Christopher %A Windgassen,Erik %A Washington,Peter %+ Department of Information and Computer Sciences, University of Hawaii at Manoa, 1680 East-West Road, Honolulu, HI, 96822, United States, 1 8088296359, pyw@hawaii.edu %D 2024 %7 17.7.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %R 10.2196/59349 %U https://formative.jmir.org/2024/1/e59349 %U https://doi.org/10.2196/59349 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e67607 %T Correction: Views and Needs of Students, Parents, and Teachers on Closed-Circuit Television, Proximity Trackers, and Access Cards to Facilitate COVID-19 Contact Tracing in Schools: Thematic Analysis of Focus Groups and Interviews %A Chantziara,Sofia %A Craddock,Ian J %A McCallum,Claire H %A Brigden,Amberly L C %+ Faculty of Engineering, University of Bristol, Merchant Venturers Building, Bristol, BS8 1UB, United Kingdom, 44 44 0117 928 ext 900, amberly.brigden@bristol.ac.uk %D 2024 %7 5.11.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 39499923 %R 10.2196/67607 %U https://formative.jmir.org/2024/1/e67607 %U https://doi.org/10.2196/67607 %U http://www.ncbi.nlm.nih.gov/pubmed/39499923 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56570 %T Correction: Evaluating the Clinical Feasibility of an Artificial Intelligence–Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study %A Popescu,Christina %A Golden,Grace %A Benrimoh,David %A Tanguay-Sela,Myriam %A Slowey,Dominique %A Lundrigan,Eryn %A Williams,Jérôme %A Desormeau,Bennet %A Kardani,Divyesh %A Perez,Tamara %A Rollins,Colleen %A Israel,Sonia %A Perlman,Kelly %A Armstrong,Caitrin %A Baxter,Jacob %A Whitmore,Kate %A Fradette,Marie-Jeanne %A Felcarek-Hope,Kaelan %A Soufi,Ghassen %A Fratila,Robert %A Mehltretter,Joseph %A Looper,Karl %A Steiner,Warren %A Rej,Soham %A Karp,Jordan F %A Heller,Katherine %A Parikh,Sagar V %A McGuire-Snieckus,Rebecca %A Ferrari,Manuela %A Margolese,Howard %A Turecki,Gustavo %+ Aifred Health Inc., 1250 Rue Guy Suite #600, Montreal, QC, H3H 2T4, Canada, 1 5144637813, david.benrimoh@mail.mcgill.com %D 2024 %7 24.1.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38266244 %R 10.2196/56570 %U https://formative.jmir.org/2024/1/e56570 %U https://doi.org/10.2196/56570 %U http://www.ncbi.nlm.nih.gov/pubmed/38266244 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58733 %T Correction: The Influence of Human Connections and Collaboration on Research Grant Success at Various Career Stages: Regression Analysis %A Hashiguchi,Akiko %A Asashima,Makoto %A Takahashi,Satoru %+ Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan, 81 298537276, hashiguchi.akiko.ge@u.tsukuba.ac.jp %D 2024 %7 5.4.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38579278 %R 10.2196/58733 %U https://formative.jmir.org/2024/1/e58733 %U https://doi.org/10.2196/58733 %U http://www.ncbi.nlm.nih.gov/pubmed/38579278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59671 %T Correction: Tumor Immunotherapy–Related Information on Internet-Based Videos Commonly Used by the Chinese Population: Content Quality Analysis %A Ni,Chen-xu %A Fei,Yi-bo %A Wu,Ran %A Cao,Wen-xiang %A Liu,Wenhao %A Huang,Fang %A Shen,Fu-ming %A Li,Dong-jie %+ Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, China, 86 021 66302570, djli@tongji.edu.cn %D 2024 %7 2.5.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38696774 %R 10.2196/59671 %U https://formative.jmir.org/2024/1/e59671 %U https://doi.org/10.2196/59671 %U http://www.ncbi.nlm.nih.gov/pubmed/38696774 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59722 %T Correction: Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study %A O'Kane,Kiarah M K %A Otamendi,Thalia %A Silverberg,Noah D %A Choi,Esther %A Sicard,Veronik %A Zemek,Roger %A Healey,Katherine %A Brown,Olivier %A Butterfield,Lauren %A Smith,Andra %A Goldfield,Gary %A Kardish,Rachel %A Saab,Bechara J %A Ledoux,Andrée-Anne %A Cairncross,Molly %+ Department of Psychology, Simon Fraser University, 8888 University Drive, Robert C. Brown Hall 7321, Burnaby, BC, V5A 1S6, Canada, 1 778 782 7458, molly_cairncross@sfu.ca %D 2024 %7 7.5.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38713906 %R 10.2196/59722 %U https://formative.jmir.org/2024/1/e59722 %U https://doi.org/10.2196/59722 %U http://www.ncbi.nlm.nih.gov/pubmed/38713906 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60872 %T Correction: Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study %A Teh,Pei-Lee %A Kwok,Andrei O J %A Cheong,Wing Loong %A Lee,Shaun %+ School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, , Malaysia, 60 355145890, shaun.lee@monash.edu %D 2024 %7 28.5.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 38805701 %R 10.2196/60872 %U https://formative.jmir.org/2024/1/e60872 %U https://doi.org/10.2196/60872 %U http://www.ncbi.nlm.nih.gov/pubmed/38805701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64385 %T Correction: Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study %A Werkmeister,Benjamin %A Haase,Anne M %A Fleming,Theresa %A Officer,Tara N %+ School of Health, Te Herenga Waka, Victoria University of Wellington, Kelburn Parade, Kelburn, PO Box 600, Wellington, 6140, New Zealand, 64 4 463 6575, benjamin.werkmeister@vuw.ac.nz %D 2024 %7 30.7.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %M 39079109 %R 10.2196/64385 %U https://formative.jmir.org/2024/1/e64385 %U https://doi.org/10.2196/64385 %U http://www.ncbi.nlm.nih.gov/pubmed/39079109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65416 %T Correction: Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design %A Hall,Evelyn %A Keyser,Laura %A McKinney,Jessica %A Pulliam,Samantha %A Weinstein,Milena %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Ste 400, San Francisco, CA, 94158, United States, 1 866 657 5382, laura.keyser@ucsf.edu %D 2024 %7 27.8.2024 %9 Corrigenda and Addenda %J JMIR Form Res %G English %X %R 10.2196/65416 %U https://formative.jmir.org/2024/1/e65416 %U https://doi.org/10.2196/65416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60033 %T Quality of Pancreatic Neuroendocrine Tumor Videos Available on TikTok and Bilibili: Content Analysis %A Niu,Zheyu %A Hao,Yijie %A Yang,Faji %A Jiang,Qirong %A Jiang,Yupeng %A Zhang,Shizhe %A Song,Xie %A Chang,Hong %A Zhou,Xu %A Zhu,Huaqiang %A Gao,Hengjun %A Lu,Jun %K pancreatic neuroendocrine tumors %K short videos %K quality analysis %K TikTok %K Bilibili %K social media %D 2024 %7 11.12.2024 %9 %J JMIR Form Res %G English %X Background: Disseminating disease knowledge through concise videos on various platforms is an innovative and efficient approach. However, it remains uncertain whether pancreatic neuroendocrine tumor (pNET)-related videos available on current short video platforms can effectively convey accurate and impactful information to the general public. Objective: Our study aims to extensively analyze the quality of pNET-related videos on TikTok and Bilibili, intending to enhance the development of pNET-related social media content to provide the general public with more comprehensive and suitable avenues for accessing pNET-related information. Methods: A total of 168 qualifying videos pertaining to pNETs were evaluated from the video-sharing platforms Bilibili and TikTok. Initially, the fundamental information conveyed in the videos was documented. Subsequently, we discerned the source and content type of each video. Following that, the Global Quality Scale (GQS) and modified DISCERN (mDISCERN) scale were employed to appraise the educational value and quality of each video. A comparative evaluation was conducted on the videos obtained from these two platforms. Results: The number of pNET-related videos saw a significant increase since 2020, with 9 videos in 2020, 19 videos in 2021, 29 videos in 2022, and 106 videos in 2023. There were no significant improvements in the mean GQS or mDISCERN scores from 2020 to 2023, which were 3.22 and 3.00 in 2020, 3.33 and 2.94 in 2021, 2.83 and 2.79 in 2022, and 2.78 and 2.94 in 2023, respectively. The average quality scores of the videos on Bilibili and Tiktok were comparable, with GQS and mDISCERN scores of 2.98 on Bilibili versus 2.77 on TikTok and 2.82 on Bilibili versus 3.05 on TikTok, respectively. The source and format of the videos remained independent factors affecting the two quality scores. Videos that were uploaded by professionals (hazard ratio=7.02, P=.002) and recorded in specialized popular science formats (hazard ratio=12.45, P<.001) tended to exhibit superior quality. Conclusions: This study demonstrates that the number of short videos on pNETs has increased in recent years, but video quality has not improved significantly. This comprehensive analysis shows that the source and format of videos are independent factors affecting video quality, which provides potential measures for improving the quality of short videos. %R 10.2196/60033 %U https://formative.jmir.org/2024/1/e60033 %U https://doi.org/10.2196/60033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52306 %T Web-Based Search Volume for HIV Tests and HIV-Testing Preferences During the COVID-19 Pandemic in Japan: Infodemiology Study %A Kanamori,Rie %A Umemura,Futaba %A Uemura,Kosuke %A Miyagami,Taiju %A Valenti,Simon %A Fukui,Nobuyuki %A Yuda,Mayumi %A Saita,Mizue %A Mori,Hirotake %A Naito,Toshio %+ Department of General Medicine, Faculty of Medicine, Juntendo University, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan, 81 3 5802 1190, naito@juntendo.ac.jp %K HIV test %K infodemiology %K self-test %K COVID-19 %K search engine %K Japan %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research has found a COVID-19 pandemic–related impact on HIV medical services, including clinic visits, testing, and antiviral therapy initiation in countries including Japan. However, the change in trend for HIV/AIDS testing during the COVID-19 pandemic has not been explored extensively in the Japanese population. Objective: This infodemiology study examines the web-based search interest for two types of HIV tests, self-test kits and facility-based tests, before and during the COVID-19 pandemic in Japan. Methods: The monthly search volume of queried search terms was obtained from Yahoo! JAPAN. Search volumes for the following terms were collected from November 2017 to October 2018: “HIV test,” “HIV test kit,” and “HIV test health center.” The search term “Corona PCR” and the number of new COVID-19 cases by month were used as a control for the search trends. The number of new HIV cases in the corresponding study period was obtained from the AIDS Trend Committee Quarterly Report from the AIDS Prevention Foundation. Results: Compared to the search volume of “corona-PCR,” which roughly fluctuated corresponding to the number of new COVID-19 cases in Japan, the search volume of “HIV test” was relatively stable from 2019 to 2022. When we further stratified by the type of HIV test, the respective web-based search interest in HIV self-testing and facility-based testing showed distinct patterns from 2018 to 2022. While the search volume of “HIV test kit” remained stable, that of “HIV test health center” displayed a decreasing trend starting in 2018 and has remained low since the beginning of the COVID-19 pandemic. Around 66%-71% of the search volume of “HIV test kits” was attributable to searches made by male internet users from 2018 to 2022, and the top three contributing age groups were those aged 30-39 (27%-32%), 20-29 (19%-32%), and 40-49 (19%-25%) years. On the other hand, the search volume of “HIV test health centers” by male users decreased from more than 500 from 2018 to 2019 to fewer than 300 from 2020 to 2022. Conclusions: Our study found a notable decrease in the search volume of “HIV test health center” during the pandemic, while the search volume for HIV self-testing kits remained stable before and during the COVID-19 crisis in Japan. This suggests that the previously reported COVID-19–related decrease in the number of HIV tests mostly likely referred to facility-based testing. This sheds light on the change in HIV-testing preferences in Japan, calling for a more comprehensive application and regulatory acceptance of HIV self-instructed tests. %M 38236622 %R 10.2196/52306 %U https://formative.jmir.org/2024/1/e52306 %U https://doi.org/10.2196/52306 %U http://www.ncbi.nlm.nih.gov/pubmed/38236622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46087 %T A Novel Approach for the Early Detection of Medical Resource Demand Surges During Health Care Emergencies: Infodemiology Study of Tweets %A Kaur,Mahakprit %A Cargill,Taylor %A Hui,Kevin %A Vu,Minh %A Bragazzi,Nicola Luigi %A Kong,Jude Dzevela %+ Dalla Lana School of Public Health, University of Toronto, 155 College St, Room 500, Toronto, ON, M5T 3M7, Canada, 1 416 978 0901, jdkong@yorku.ca %K COVID-19 %K Twitter %K social media %K medical supply shortage %K pandemic %K global health %K Granger %K convergent cross-mapping %K causal analysis %K intensive care unit bed %K ICU bed %D 2024 %7 29.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has highlighted gaps in the current handling of medical resource demand surges and the need for prioritizing scarce medical resources to mitigate the risk of health care facilities becoming overwhelmed. Objective: During a health care emergency, such as the COVID-19 pandemic, the public often uses social media to express negative sentiment (eg, urgency, fear, and frustration) as a real-time response to the evolving crisis. The sentiment expressed in COVID-19 posts may provide valuable real-time information about the relative severity of medical resource demand in different regions of a country. In this study, Twitter (subsequently rebranded as X) sentiment analysis was used to investigate whether an increase in negative sentiment COVID-19 tweets corresponded to a greater demand for hospital intensive care unit (ICU) beds in specific regions of the United States, Brazil, and India. Methods: Tweets were collected from a publicly available data set containing COVID-19 tweets with sentiment labels and geolocation information posted between February 1, 2020, and March 31, 2021. Regional medical resource shortage data were gathered from publicly available data sets reporting a time series of ICU bed demand across each country. Negative sentiment tweets were analyzed using the Granger causality test and convergent cross-mapping (CCM) analysis to assess the utility of the time series of negative sentiment tweets in forecasting ICU bed shortages. Results: For the United States (30,742,934 negative sentiment tweets), the results of the Granger causality test (for whether negative sentiment COVID-19 tweets forecast ICU bed shortage, assuming a stochastic system) were significant (P<.05) for 14 (28%) of the 50 states that passed the augmented Dickey-Fuller test at lag 2, and the results of the CCM analysis (for whether negative sentiment COVID-19 tweets forecast ICU bed shortage, assuming a dynamic system) were significant (P<.05) for 46 (92%) of the 50 states. For Brazil (3,004,039 negative sentiment tweets), the results of the Granger causality test were significant (P<.05) for 6 (22%) of the 27 federative units, and the results of the CCM analysis were significant (P<.05) for 26 (96%) of the 27 federative units. For India (4,199,151 negative sentiment tweets), the results of the Granger causality test were significant (P<.05) for 6 (23%) of the 26 included regions (25 states and the national capital region of Delhi), and the results of the CCM analysis were significant (P<.05) for 26 (100%) of the 26 included regions. Conclusions: This study provides a novel approach for identifying the regions of high hospital bed demand during a health care emergency scenario by analyzing Twitter sentiment data. Leveraging analyses that take advantage of natural language processing–driven tweet extraction systems has the potential to be an effective method for the early detection of medical resource demand surges. %M 38285495 %R 10.2196/46087 %U https://formative.jmir.org/2024/1/e46087 %U https://doi.org/10.2196/46087 %U http://www.ncbi.nlm.nih.gov/pubmed/38285495 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52768 %T Exploring the Perspectives of Patients Living With Lupus: Retrospective Social Listening Study %A Spies,Erica %A Andreu,Thomas %A Hartung,Matthias %A Park,Josephine %A Kamudoni,Paul %+ The Healthcare Business of Merck KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany, 49 15114543257, paul.kamudoni@emdgroup.com %K systemic lupus erythematosus %K SLE %K cutaneous lupus erythematosus %K CLE %K quality of life %K health-related quality of life %K HRQoL %K social media listening %K lupus %K rare %K cutaneous %K social media %K infodemiology %K infoveillance %K social listening %K natural language processing %K machine learning %K experience %K experiences %K tagged %K tagging %K visualization %K visualizations %K knowledge graph %K chronic %K autoimmune %K inflammation %K inflammatory %K skin %K dermatology %K dermatological %K forum %K forums %K blog %K blogs %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease affecting various organs with a wide range of clinical manifestations. Cutaneous lupus erythematosus (CLE) can manifest as a feature of SLE or an independent skin ailment. Health-related quality of life (HRQoL) is frequently compromised in individuals living with lupus. Understanding patients’ perspectives when living with a disease is crucial for effectively meeting their unmet needs. Social listening is a promising new method that can provide insights into the experiences of patients living with their disease (lupus) and leverage these insights to inform drug development strategies for addressing their unmet needs. Objective: The objective of this study is to explore the experience of patients living with SLE and CLE, including their disease and treatment experiences, HRQoL, and unmet needs, as discussed in web-based social media platforms such as blogs and forums. Methods: A retrospective exploratory social listening study was conducted across 13 publicly available English-language social media platforms from October 2019 to January 2022. Data were processed using natural language processing and knowledge graph tagging technology to clean, format, anonymize, and annotate them algorithmically before feeding them to Pharos, a Semalytix proprietary data visualization and analysis platform, for further analysis. Pharos was used to generate descriptive data statistics, providing insights into the magnitude of individual patient experience variables, their differences in the magnitude of variables, and the associations between algorithmically tagged variables. Results: A total of 45,554 posts from 3834 individuals who were algorithmically identified as patients with lupus were included in this study. Among them, 1925 (authoring 5636 posts) and 106 (authoring 243 posts) patients were identified as having SLE and CLE, respectively. Patients frequently mentioned various symptoms in relation to SLE and CLE including pain, fatigue, and rashes; pain and fatigue were identified as the main drivers of HRQoL impairment. The most affected aspects of HRQoL included “mobility,” “cognitive capabilities,” “recreation and leisure,” and “sleep and rest.” Existing pharmacological interventions poorly managed the most burdensome symptoms of lupus. Conversely, nonpharmacological treatments, such as exercise and meditation, were frequently associated with HRQoL improvement. Conclusions: Patients with lupus reported a complex interplay of symptoms and HRQoL aspects that negatively influenced one another. This study demonstrates that social listening is an effective method to gather insights into patients’ experiences, preferences, and unmet needs, which can be considered during the drug development process to develop effective therapies and improve disease management. %M 38306157 %R 10.2196/52768 %U https://formative.jmir.org/2024/1/e52768 %U https://doi.org/10.2196/52768 %U http://www.ncbi.nlm.nih.gov/pubmed/38306157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47245 %T Patient Experiences and Insights on Chronic Ocular Pain: Social Media Listening Study %A Sloesen,Brigitte %A O'Brien,Paul %A Verma,Himanshu %A Asaithambi,Sathyaraj %A Parashar,Nikita %A Mothe,Raj Kumar %A Shaikh,Javed %A Syntosi,Annie %+ Novartis Pharma NV, Medialaan 40, B-1800, Vilvoorde, Belgium, 32 478881453, brigitte.sloesen@novartis.com %K chronic ocular surface pain, patients' experiences %K quality of life %K social media %K Twitter %K unmet needs %K ocular pain %K ophthalmology %K ocular %K listening %K experience %K experiences %K tweet %K eye pain %K eye condition %K social media platforms %K social media use %K patient experience %K chronic pain %K pain %K internet %K eye %K retina %K online health %K digital health %K web %K vision %K optical %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Ocular pain has multifactorial etiologies that affect activities of daily life, psychological well-being, and health-related quality of life (QoL). Chronic ocular surface pain (COSP) is a persistent eye pain symptom lasting for a period longer than 3 months. Objective: The objective of this social media listening study was to better understand COSP and related symptoms and identify its perceived causes, comorbidities, and impact on QoL from social media posts. Methods: A search from February 2020 to February 2021 was performed on social media platforms (Twitter, Facebook, blogs, and forums) for English-language content posted on the web. Social media platforms that did not provide public access to information or posts were excluded. Social media posts from Australia, Canada, the United Kingdom, and the United States were retrieved using the Social Studio platform—a web-based aggregator tool. Results: Of the 25,590 posts identified initially, 464 posts about COSP were considered relevant; the majority of conversations (98.3%, n=456) were posted by adults (aged >18 years). Work status was mentioned in 52 conversations. Patients’ or caregivers’ discussions across social media platforms were centered around the symptoms (61.9%, n=287) and causes (58%, n=269) of ocular pain. Patients mentioned having symptoms associated with COSP, including headache or head pressure, dry or gritty eyes, light sensitivity, etc. Patients posted that their COSP impacts day-to-day activities such as reading, driving, sleeping, and their social, mental, and functional well-being. Conclusions: Insights from this study reported patients’ experiences, concerns, and the adverse impact on overall QoL. COSP imposes a significant burden on patients, which spans multiple aspects of daily life. %M 38358786 %R 10.2196/47245 %U https://formative.jmir.org/2024/1/e47245 %U https://doi.org/10.2196/47245 %U http://www.ncbi.nlm.nih.gov/pubmed/38358786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44726 %T Identification of Myths and Misinformation About Treatment for Opioid Use Disorder on Social Media: Infodemiology Study %A ElSherief,Mai %A Sumner,Steven %A Krishnasamy,Vikram %A Jones,Christopher %A Law,Royal %A Kacha-Ochana,Akadia %A Schieber,Lyna %A De Choudhury,Munmun %+ Khoury College of Computer Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 (617) 373 2462, m.elsherif@northeastern.edu %K addiction treatment %K machine learning %K misinformation %K natural language processing %K opioid use disorder %K social media %K substance use %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation and myths about treatment for opioid use disorder (OUD) are present on social media and contribute to challenges in preventing drug overdose deaths. However, no systematic, quantitative methodology exists to identify what types of misinformation are being shared and discussed. Objective: We developed a multistage analytic pipeline to assess social media posts from Twitter (subsequently rebranded as X), YouTube, Reddit, and Drugs-Forum for the presence of health misinformation about treatment for OUD. Methods: Our approach first used document embeddings to identify potential new statements of misinformation from known myths. These statements were grouped into themes using hierarchical agglomerative clustering, and public health experts then reviewed the results for misinformation. Results: We collected a total of 19,953,599 posts discussing opioid-related content across the aforementioned platforms. Our multistage analytic pipeline identified 7 main clusters or discussion themes. Among a high-yield data set of posts (n=303) for further public health expert review, these included discussion about potential treatments for OUD (90/303, 29.8%), the nature of addiction (68/303, 22.5%), pharmacologic properties of substances (52/303, 16.9%), injection drug use (36/303, 11.9%), pain and opioids (28/303, 9.3%), physical dependence of medications (22/303, 7.2%), and tramadol use (7/303, 2.3%). A public health expert review of the content within each cluster identified the presence of misinformation and myths beyond those used as seed myths to initialize the algorithm. Conclusions: Identifying and addressing misinformation through appropriate communication strategies could be an increasingly important component of preventing overdose deaths. To further this goal, we developed and tested an approach to aid in the identification of myths and misinformation about OUD from large-scale social media content. %M 38393772 %R 10.2196/44726 %U https://formative.jmir.org/2024/1/e44726 %U https://doi.org/10.2196/44726 %U http://www.ncbi.nlm.nih.gov/pubmed/38393772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49198 %T Arabic Web-Based Information on Oral Lichen Planus: Content Analysis %A AlMeshrafi,Azzam %A AlHamad,Arwa F %A AlKuraidees,Hamoud %A AlNasser,Lubna A %+ Dental Services, Ministry of National Gaurd Health Affairs, Prince Mutib bin Abdullah bin Abdulaziz Rd, Riyadh, 11426, Saudi Arabia, 966 118011111, hamadar@mngha.med.sa %K oral lichen planus %K health information %K Arabic %K medical information %K information seeking %K quality %K online information %K Arab %K oral %K inflammatory %K inflammation %K chronic %K mouth %K mucous membrane %K mucous membranes %K reliable %K reliability %K credible %K credibility %K periodontology %K dental %K dentist %K dentistry %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of web-based health information (WBHI) is on the rise, serving as a valuable tool for educating the public about health concerns and enhancing treatment adherence. Consequently, evaluating the availability and quality of context-specific WBHI is crucial to tackle disparities in health literacy and advance population health outcomes. Objective: This study aims to explore and assess the quality of the WBHI available and accessible to the public on oral lichen planus (OLP) in Arabic. Methods: The Arabic translation of the term OLP and its derivatives were searched in three general search platforms, and each platform’s first few hundred results were reviewed for inclusion. We excluded content related to cutaneous LP, content not readily accessible to the public (eg, requiring subscription fees or directed to health care providers), and content not created by health care providers or organizations (ie, community forums, blogs, and social media). We assessed the quality of the Arabic WBHI with three standardized and validated tools: DISCERN, Journal of the American Medical Association (JAMA) benchmarks, and Health On the Net (HON). Results: Of the 911 resources of WBHI reviewed for eligibility, 49 were included in this study. Most WBHI resources were provided by commercial affiliations (n=28, 57.1%), with the remainder from academic or not-for-profit affiliations. WBHI were often presented with visual aids (ie, images; n=33, 67.4%). DISCERN scores were highest for WBHI resources that explicitly stated their aim, while the lowest scores were for providing the effect of OLP (or OLP treatment) on the quality of life. One-quarter of the resources (n=11, 22.4%) met all 4 JAMA benchmarks, indicating the high quality of the WBHI, while the remainder of the WBHI failed to meet one or more of the JAMA benchmarks. HON scores showed that one-third of WBHI sources had scores above 75%, indicating higher reliability and credibility of the WBHI source, while one-fifth of the sources scored below 50%. Only 1 in 7 WBHI resources scored simultaneously high on all three quality instruments. Generally, WBHI from academic affiliations had higher quality scores than content provided by commercial affiliations. Conclusions: There are considerable variations in the quality of WBHI on OLP in Arabic. Most WBHI resources were deemed to be of moderate quality at best. Providers of WBHI could benefit from increasing collaboration between commercial and academic institutions in creating WBHI and integrating guidance from international quality assessment tools to improve the quality and, hopefully, the utility of these valuable WBHI resources. %M 38502161 %R 10.2196/49198 %U https://formative.jmir.org/2024/1/e49198 %U https://doi.org/10.2196/49198 %U http://www.ncbi.nlm.nih.gov/pubmed/38502161 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53666 %T Social Network Analysis of e-Cigarette–Related Social Media Influencers on Twitter/X: Observational Study %A Zhou,Runtao %A Xie,Zidian %A Tang,Qihang %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K social network %K social media %K influencer %K electronic cigarettes %K e-cigarette %K vaping %K vape %K Twitter %K observational study %K aerosol %K consumer %K influencers %K social network analysis %K antivaping %K campaigns %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An e-cigarette uses a battery to heat a liquid that generates an aerosol for consumers to inhale. e-Cigarette use (vaping) has been associated with respiratory disease, cardiovascular disease, and cognitive functions. Recently, vaping has become increasingly popular, especially among youth and young adults. Objective: The aim of this study was to understand the social networks of Twitter (now rebranded as X) influencers related to e-cigarettes through social network analysis. Methods: Through the Twitter streaming application programming interface, we identified 3,617,766 unique Twitter accounts posting e-cigarette–related tweets from May 3, 2021, to June 10, 2022. Among these, we identified 33 e-cigarette influencers. The followers of these influencers were grouped according to whether or not they post about e-cigarettes themselves; specifically, the former group was defined as having posted at least five e-cigarette–related tweets in the past year, whereas the latter group was defined as followers that had not posted any e-cigarette–related tweets in the past 3 years. We randomly sampled 100 user accounts among each group of e-cigarette influencer followers and created corresponding social networks for each e-cigarette influencer. We compared various network measures (eg, clustering coefficient) between the networks of the two follower groups. Results: Major topics from e-cigarette–related tweets posted by the 33 e-cigarette influencers included advocating against vaping policy (48.0%), vaping as a method to quit smoking (28.0%), and vaping product promotion (24.0%). The follower networks of these 33 influencers showed more connections for those who also post about e-cigarettes than for followers who do not post about e-cigarettes, with significantly higher clustering coefficients for the former group (0.398 vs 0.098; P=.005). Further, networks of followers who post about e-cigarettes exhibited substantially more incoming and outgoing connections than those of followers who do not post about e-cigarettes, with significantly higher in-degree (0.273 vs 0.084; P=.02), closeness (0.452 vs 0.137; P=.04), betweenness (0.036 vs 0.008; P=.001), and out-of-degree (0.097 vs 0.014; P=.02) centrality values. The followers who post about e-cigarettes also had a significantly (P<.001) higher number of followers (n=322) than that of followers who do not post about e-cigarettes (n=201). The number of tweets in the networks of followers who post about e-cigarettes was significantly higher than that in the networks of followers who do not post about e-cigarettes (93 vs 43; P<.001). Two major topics discussed in the networks of followers who post about e-cigarettes included promoting e-cigarette products or vaping activity (55.7%) and vaping being a help for smoking cessation and harm reduction (44.3%). Conclusions: Followers of e-cigarette influencers who also post about e-cigarettes have more closely connected networks than those of followers who do not themselves post about e-cigarettes. These findings provide a potentially practical intervention approach for future antivaping campaigns. %M 38557555 %R 10.2196/53666 %U https://formative.jmir.org/2024/1/e53666 %U https://doi.org/10.2196/53666 %U http://www.ncbi.nlm.nih.gov/pubmed/38557555 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50368 %T Preferences on Governance Models for Mental Health Data: Qualitative Study With Young People %A Carey,Emma Grace %A Adeyemi,Faith Oluwasemilore %A Neelakantan,Lakshmi %A Fernandes,Blossom %A Fazel,Mina %A Ford,Tamsin %A , %A Burn,Anne-Marie %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 01223 336961, amb278@cam.ac.uk %K young people %K mental health %K data %K governance %K deliberative democracy %K mobile phone %D 2024 %7 23.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving access to mental health data to accelerate research and improve mental health outcomes is a potentially achievable goal given the substantial data that can now be collected from mobile devices. Smartphones can provide a useful mechanism for collecting mental health data from young people, especially as their use is relatively ubiquitous in high-resource settings such as the United Kingdom and they have a high capacity to collect active and passive data. This raises the interesting opportunity to establish a large bank of mental health data from young people that could be accessed by researchers worldwide, but it is important to clarify how to ensure that this is done in an appropriate manner aligned with the values of young people. Objective: In this study, we discussed the preferences of young people in the United Kingdom regarding the governance, sharing, and use of their mental health data with the establishment of a global data bank in mind. We aimed to determine whether young people want and feel safe to share their mental health data; if so, with whom; and their preferences in doing so. Methods: Young people (N=46) were provided with 2 modules of educational material about data governance models and background in scientific research. We then conducted 2-hour web-based group sessions using a deliberative democracy methodology to reach a consensus where possible. Findings were analyzed using the framework method. Results: Young people were generally enthusiastic about contributing data to mental health research. They believed that broader availability of mental health data could be used to discover what improves or worsens mental health and develop new services to support young people. However, this enthusiasm came with many concerns and caveats, including distributed control of access to ensure appropriate use, distributed power, and data management that included diverse representation and sufficient ethical training for applicants and data managers. Conclusions: Although it is feasible to use smartphones to collect mental health data from young people in the United Kingdom, it is essential to carefully consider the parameters of such a data bank. Addressing and embedding young people’s preferences, including the need for robust procedures regarding how their data are managed, stored, and accessed, will set a solid foundation for establishing any global data bank. %M 38652525 %R 10.2196/50368 %U https://formative.jmir.org/2024/1/e50368 %U https://doi.org/10.2196/50368 %U http://www.ncbi.nlm.nih.gov/pubmed/38652525 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38761 %T Media Discourse Regarding COVID-19 Vaccinations for Children Aged 5 to 11 Years in Australia, Canada, the United Kingdom, and the United States: Comparative Analysis Using the Narrative Policy Framework %A Chadwick,Verity L %A Saich,Freya %A Freeman,Joseph %A Martiniuk,Alexandra %+ Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27 Fisher Road, Camperdown, 2006, Australia, 61 (02) 9351 2222, alexandra.martiniuk@sydney.edu.au %K COVID-19 %K SARS-CoV-2 %K vaccine %K mRNA %K Pfizer-BioNTech %K pediatric %K children %K media %K news %K web-based %K infodemic %K disinformation %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Media narratives can shape public opinion and actions, influencing the uptake of pediatric COVID-19 vaccines. The COVID-19 pandemic has occurred at a time where infodemics, misinformation, and disinformation are present, impacting the COVID-19 response. Objective: This study aims to investigate how narratives about pediatric COVID-19 vaccines in the media of 4 English-speaking countries: the United States, Australia, Canada, and the United Kingdom. Methods: The Narrative Policy Framework was used to guide the comparative analyses of the major print and web-based news agencies’ media regarding COVID-19 vaccines for children aged 5 to 11 years. Data were sought using systematic searching on Factiva (Dow Jones) of 4 key phases of pediatric vaccine approval and rollout. Results: A total of 400 articles (n=287, 71.8% in the United States, n=40, 10% in Australia, n=60, 15% in Canada, and n=13, 3% in the United Kingdom) met the search criteria and were included. Using the Narrative Policy Framework, the following were identified in each article: hero, villain, survivor, and plot. The United States was the earliest country to vaccinate children, and other countries’ media often lauded the United States for this. Australian and Canadian media narratives about vaccines for children aged 5 to 11 years were commonly about protecting susceptible people in society, whereas the US and the UK narratives focused more on the vaccine helping children return to school. All 4 countries focused on the vaccines for children aged 5 to 11 years as being key to “ending” the pandemic. Australian and Canadian narratives frequently compared vaccine rollouts across states or provinces and bemoaned local progress in vaccine delivery compared with other countries globally. Canadian and US narratives highlighted the “infodemic” about the COVID-19 pandemic and disinformation regarding child vaccines as impeding uptake. All 4 countries—the United States, Australia, the United Kingdom, and Canada—used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by the COVID-19 pandemic, and the media reporting increasingly blamed the unvaccinated. The UK media narrative was unique in describing vaccinating children as a distraction from adult COVID-19 vaccination efforts. The United States and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners were labelled as heroes. Finally, the Canadian narrative suggested altruistic forgoing of COVID-19 vaccine “boosters” as well as pediatric COVID-19 vaccines to benefit those in poorer nations. Conclusions: Public health emergencies require clear; compelling and accurate communication. The stories told during this pandemic are compelling because they contain the classic elements of a narrative; however, they can be reductive and inaccurate. %M 36383344 %R 10.2196/38761 %U https://formative.jmir.org/2024/1/e38761 %U https://doi.org/10.2196/38761 %U http://www.ncbi.nlm.nih.gov/pubmed/36383344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54433 %T Examining the Gateway Hypothesis and Mapping Substance Use Pathways on Social Media: Machine Learning Approach %A Yuan,Yunhao %A Kasson,Erin %A Taylor,Jordan %A Cavazos-Rehg,Patricia %A De Choudhury,Munmun %A Aledavood,Talayeh %+ Department of Computer Science, Aalto University, P.O. Box 11000 (Otakaari 1B), FI-00076 AALTO, Espoo, FI-00076, Finland, 358 509113635, Yunhao.Yuan@aalto.fi %K gateway hypothesis %K substance use %K social media %K deep learning %K natural language processing %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance misuse presents significant global public health challenges. Understanding transitions between substance types and the timing of shifts to polysubstance use is vital to developing effective prevention and recovery strategies. The gateway hypothesis suggests that high-risk substance use is preceded by lower-risk substance use. However, the source of this correlation is hotly contested. While some claim that low-risk substance use causes subsequent, riskier substance use, most people using low-risk substances also do not escalate to higher-risk substances. Social media data hold the potential to shed light on the factors contributing to substance use transitions. Objective: By leveraging social media data, our study aimed to gain a better understanding of substance use pathways. By identifying and analyzing the transitions of individuals between different risk levels of substance use, our goal was to find specific linguistic cues in individuals’ social media posts that could indicate escalating or de-escalating patterns in substance use. Methods: We conducted a large-scale analysis using data from Reddit, collected between 2015 and 2019, consisting of over 2.29 million posts and approximately 29.37 million comments by around 1.4 million users from subreddits. These data, derived from substance use subreddits, facilitated the creation of a risk transition data set reflecting the substance use behaviors of over 1.4 million users. We deployed deep learning and machine learning techniques to predict the escalation or de-escalation transitions in risk levels, based on initial transition phases documented in posts and comments. We conducted a linguistic analysis to analyze the language patterns associated with transitions in substance use, emphasizing the role of n-gram features in predicting future risk trajectories. Results: Our results showed promise in predicting the escalation or de-escalation transition in risk levels, based on the historical data of Reddit users created on initial transition phases among drug-related subreddits, with an accuracy of 78.48% and an F1-score of 79.20%. We highlighted the vital predictive features, such as specific substance names and tools indicative of future risk escalations. Our linguistic analysis showed that terms linked with harm reduction strategies were instrumental in signaling de-escalation, whereas descriptors of frequent substance use were characteristic of escalating transitions. Conclusions: This study sheds light on the complexities surrounding the gateway hypothesis of substance use through an examination of web-based behavior on Reddit. While certain findings validate the hypothesis, indicating a progression from lower-risk substances such as marijuana to higher-risk ones, a significant number of individuals did not show this transition. The research underscores the potential of using machine learning with social media analysis to predict substance use transitions. Our results point toward future directions for leveraging social media data in substance use research, underlining the importance of continued exploration before suggesting direct implications for interventions. %M 38713904 %R 10.2196/54433 %U https://formative.jmir.org/2024/1/e54433 %U https://doi.org/10.2196/54433 %U http://www.ncbi.nlm.nih.gov/pubmed/38713904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54023 %T Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study %A Hakariya,Hayase %A Yokoyama,Natsuki %A Lee,Jeonse %A Hakariya,Arisa %A Ikejiri,Tatsuki %+ Interfaculty Institute of Biochemistry, University of Tuebingen, Auf der Morgenstelle 15, Tuebingen, 72076, Germany, 49 7071 29 75377, hayase.hakariya@uni-tuebingen.de %K illegal trading %K pharmacovigilance %K social networking service %K SNS %K overdose %K social support %K antipsychotics %K Japan %K prescription medication %K cross-sectional study %K prescription drug %K social networking %K medication %K pharmaceutical %K pharmaceutical drugs %K Japanese %K psychiatric %K support %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nonmedical use of prescription drugs can cause overdose; this represents a serious public health crisis globally. In this digital era, social networking services serve as viable platforms for illegal acquisition of excessive amounts of medications, including prescription medications. In Japan, such illegal drug transactions have been conducted through popular flea market applications, social media, and auction websites, with most of the trades being over-the-counter (OTC) medications. Recently, an emerging unique black market, where individuals trade prescription medications—predominantly nervous system drugs—using a specific keyword (“Okusuri Mogu Mogu”), has emerged on X (formerly Twitter). Hence, these dynamic methods of illicit trading should routinely be monitored to encourage the appropriate use of medications. Objective: This study aimed to specify the characteristics of medications traded on X using the search term “Okusuri Mogu Mogu” and analyze individual behaviors associated with X posts, including the types of medications traded and hashtag usage. Methods: We conducted a cross-sectional study with publicly available posts on X between September 18 and October 1, 2022. Posts that included the term “Okusuri Mogu Mogu” during this period were scrutinized. Posts were categorized on the basis of their contents: buying, selling, self-administration, heads-up, and others. Among posts categorized as buying, selling, and self-administration, medication names were systematically enumerated and categorized using the Anatomical Therapeutic Chemical (ATC) classification. Additionally, hashtags in all the analyzed posts were counted and classified into 6 categories: medication name, mental disorder, self-harm, buying and selling, community formation, and others. Results: Out of 961 identified posts, 549 were included for analysis. Of these posts, 119 (21.7%) referenced self-administration, and 237 (43.2%; buying: n=67, 12.2%; selling: n=170, 31.0%) referenced transactions. Among these 237 posts, 1041 medication names were mentioned, exhibiting a >5-fold increase from the study in March 2021. Categorization based on the ATC classification predominantly revealed nervous system drugs, representing 82.1% (n=855) of the mentioned medications, consistent with the previous survey. Of note, the diversity of medications has expanded to include medications that have not been approved by the Japanese government. Interestingly, OTC medications were frequently mentioned in self-administration posts (odds ratio 23.6, 95% CI 6.93-80.15). Analysis of hashtags (n=866) revealed efforts to foster community connections among users. Conclusions: This study highlighted the escalating complexity of trading of illegal prescription medication facilitated by X posts. Regulatory measures to enhance public awareness should be considered to prevent illegal transactions, which may ultimately lead to misuse or abuse such as overdose. Along with such pharmacovigilance measures, social approaches that could direct individuals to appropriate medical or psychiatric resources would also be beneficial as our hashtag analysis shed light on the formation of a cohesive or closed community among users. %M 38805262 %R 10.2196/54023 %U https://formative.jmir.org/2024/1/e54023 %U https://doi.org/10.2196/54023 %U http://www.ncbi.nlm.nih.gov/pubmed/38805262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51094 %T Mediterranean Diet Information on TikTok and Implications for Digital Health Promotion Research: Social Media Content Analysis %A Raber,Margaret %A Allen,Haley %A Huang,Sophia %A Vazquez,Maria %A Warner,Echo %A Thompson,Debbe %+ Department of Health Disparities Research, MD Anderson Cancer Center, 1400 Pressler Street Dr., Houston, TX, 77030, United States, 1 713 702 4801, mpraber@mdanderson.org %K misinformation %K social media %K Mediterranean Diet %K content analysis %K health communication %K communication %K TikTok %K diet %K cardiometabolic disease %K cardiometabolic %K consumer %K eating %K social media %K quality %K mHealth %K mobile health %K digital health %K promotion research %K nutrition therapy %K healthy diet %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Mediterranean diet has been linked to reduced risk for several cardiometabolic diseases. The lack of a clear definition of the Mediterranean diet in the scientific literature and the documented proliferation of nutrition misinformation on the internet suggest the potential for confusion among consumers seeking web-based Mediterranean diet information. Objective: We conducted a social media content analysis of information about the Mediterranean diet on the influential social media platform, TikTok, to examine public discourse about the diet and identify potential areas of misinformation. We then analyzed these findings in the context of health promotion to identify potential challenges and opportunities for the use of TikTok in promoting the Mediterranean diet for healthy living. Methods: The first-appearing 202 TikTok posts that resulted from a search of the hashtag #mediterraneandiet were downloaded and qualitatively examined. Post features and characteristics, poster information, and engagement metrics were extracted and synthesized across posts. Posts were categorized as those created by health professionals and those created by nonhealth professionals based on poster-reported credentials. In addition to descriptive statistics of the entire sample, we compared posts created by professionals and nonprofessionals for content using chi-square tests. Results: TikTok posts varied in content, but posts that were developed by health professionals versus nonprofessionals were more likely to offer a definition of the Mediterranean diet (16/106, 15.1% vs 2/96, 2.1%; P=.001), use scientific citations to support claims (26/106, 24.5% vs 0/96, 0%; P<.001), and discuss specific nutrients (33/106, 31.1% vs 6/96, 6.3%; P<.001) and diseases related to the diet (27/106, 25.5% vs 5/96, 5.2%; P<.001) compared to posts created by nonhealth professionals. Conclusions: Social media holds promise as a venue to promote the Mediterranean diet, but the variability in information found in this study highlights the need to create clear definitions about the diet and its components when developing Mediterranean diet interventions that use new media structures. %M 38896841 %R 10.2196/51094 %U https://formative.jmir.org/2024/1/e51094 %U https://doi.org/10.2196/51094 %U http://www.ncbi.nlm.nih.gov/pubmed/38896841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56755 %T Barriers to, and Facilitators of, Checking Drugs for Adulterants in the Era of Fentanyl and Xylazine: Qualitative Study %A Aronson,Ian David %A Ardouin-Guerrier,Mary-Andrée %A Baus,Juan Esteban %A Bennett,Alex S %+ Center for Technology-based Education and Community Health, NDRI-USA, 31 W 34th St Suite 8006, New York, NY, 10001, United States, 1 212 845 4444, aronson@ndri-usa.org %K overdose %K overdoses %K fentanyl %K xylazine %K benzodiazepines %K adulterants %K drug %K drugs %K substance %K substances %K illicit drug %K illicit drugs %K drug test %K drug testing %K drug checking %K qualitative %K interview %K interviews %K digital health %K digital technology %K digital intervention %K digital interventions %K technological intervention %K technological interventions %K technology-based intervention %K technology-based interventions %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants and are exposed to a combination of drugs they did not intend to take. Although test strips and more sophisticated devices enable people to check drugs for adulterants including fentanyl and xylazine prior to consumption and are often available free of charge, many people who use drugs decline to use them. Objective: We sought to better understand why people in the New York City area do or do not check drugs before use. We plan to use study findings to inform the development of technology-based interventions to encourage consistent drug checking. Methods: In summer 2023, team members who have experience working with people who use drugs conducted 22 semistructured qualitative interviews with a convenience sample of people who reported illicit drug use within the past 90 days. An interview guide examined participants’ knowledge of and experience with adulterants including fentanyl, xylazine, and benzodiazepines; using drug testing strips; and whether they had ever received harm reduction services. All interviews were audio recorded, transcribed, and analyzed for emerging themes. Results: Most participants lacked knowledge of adulterants, and only a few reported regularly checking drugs. Reasons for not checking included lacking convenient access to test supplies, or a place to check samples out of the public’s view, as well as time considerations. Some participants also reported a strong belief that they were not at risk from fentanyl, xylazine, or other adulterants because they exclusively used cocaine or crack, or that they were confident the people they bought drugs from would not sell them adulterated substances. Those who did report testing their drugs described positive interactions with harm reduction agency staff. Conclusions: New forms of outreach are needed not only to increase people’s knowledge of adulterated substances and awareness of the increasing risks they pose but also to encourage people who use drugs to regularly check their substances prior to use. This includes new intervention messages that highlight the importance of drug checking in the context of a rapidly changing and volatile drug supply. This messaging can potentially help normalize drug checking as an easily enacted behavior that benefits public health. To increase effectiveness, messages can be developed with, and outreach can be conducted by, trusted community members including people who use drugs and, potentially, people who sell drugs. Pairing this messaging with access to no-cost drug-checking supplies and equipment may help address the ongoing spiral of increased overdose deaths nationwide. %M 38959505 %R 10.2196/56755 %U https://formative.jmir.org/2024/1/e56755 %U https://doi.org/10.2196/56755 %U http://www.ncbi.nlm.nih.gov/pubmed/38959505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51327 %T Public Perceptions and Discussions of the US Food and Drug Administration's JUUL Ban Policy on Twitter: Observational Study %A Liu,Pinxin %A Lou,Xubin %A Xie,Zidian %A Shang,Ce %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K e-cigarettes %K JUUL %K Twitter %K deep learning %K FDA %K Food and Drug Administration %K vape %K vaping %K smoking %K social media %K regulation %D 2024 %7 11.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: On June 23, 2022, the US Food and Drug Administration announced a JUUL ban policy, to ban all vaping and electronic cigarette products sold by Juul Labs. Objective: This study aims to understand public perceptions and discussions of this policy using Twitter (subsequently rebranded as X) data. Methods: Using the Twitter streaming application programming interface, 17,007 tweets potentially related to the JUUL ban policy were collected between June 22, 2022, and July 25, 2022. Based on 2600 hand-coded tweets, a deep learning model (RoBERTa) was trained to classify all tweets into propolicy, antipolicy, neutral, and irrelevant categories. A deep learning model (M3 model) was used to estimate basic demographics (such as age and gender) of Twitter users. Furthermore, major topics were identified using latent Dirichlet allocation modeling. A logistic regression model was used to examine the association of different Twitter users with their attitudes toward the policy. Results: Among 10,480 tweets related to the JUUL ban policy, there were similar proportions of propolicy and antipolicy tweets (n=2777, 26.5% vs n=2666, 25.44%). Major propolicy topics included “JUUL causes youth addition,” “market surge of JUUL,” and “health effects of JUUL.” In contrast, major antipolicy topics included “cigarette should be banned instead of JUUL,” “against the irrational policy,” and “emotional catharsis.” Twitter users older than 29 years were more likely to be propolicy (have a positive attitude toward the JUUL ban policy) than those younger than 29 years. Conclusions: Our study showed that the public showed different responses to the JUUL ban policy, which varies depending on the demographic characteristics of Twitter users. Our findings could provide valuable information to the Food and Drug Administration for future electronic cigarette and other tobacco product regulations. %M 38990633 %R 10.2196/51327 %U https://formative.jmir.org/2024/1/e51327 %U https://doi.org/10.2196/51327 %U http://www.ncbi.nlm.nih.gov/pubmed/38990633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48284 %T Effects of Intervention Timing on Health-Related Fake News: Simulation Study %A Gwon,Nahyun %A Jeong,Wonjeong %A Kim,Jee Hyun %A Oh,Kyoung Hee %A Jun,Jae Kwan %+ Cancer Knowledge and Information Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea, 82 31 920 2184, jkjun@ncc.re.kr %K disinformation %K fenbendazole %K cancer information %K simulation %K fake news %K online social networking %K misinformation %K lung cancer %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Fake health-related news has spread rapidly through the internet, causing harm to individuals and society. Despite interventions, a fenbendazole scandal recently spread among patients with lung cancer in South Korea. It is crucial to intervene appropriately to prevent the spread of fake news. Objective: This study investigated the appropriate timing of interventions to minimize the side effects of fake news. Methods: A simulation was conducted using the susceptible-infected-recovered (SIR) model, which is a representative model of the virus spread mechanism. We applied this model to the fake news spread mechanism. The parameters were set similarly to those in the digital environment, where the fenbendazole scandal occurred. NetLogo, an agent-based model, was used as the analytical tool. Results: Fake news lasted 278 days in the absence of interventions. As a result of adjusting and analyzing the timing of the intervention in response to the fenbendazole scandal, we found that faster intervention leads to a shorter duration of fake news (intervention at 54 days = fake news that lasted for 210 days; intervention at 16 days = fake news that lasted for 187 days; and intervention at 10 days = fake news that lasted for 157 days). However, no significant differences were observed when the intervention was performed within 10 days. Conclusions: Interventions implemented within 10 days were effective in reducing the duration of the spread of fake news. Our findings suggest that timely intervention is critical for preventing the spread of fake news in the digital environment. Additionally, a monitoring system that can detect fake news should be developed for a rapid response %M 39109788 %R 10.2196/48284 %U https://formative.jmir.org/2024/1/e48284 %U https://doi.org/10.2196/48284 %U http://www.ncbi.nlm.nih.gov/pubmed/39109788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55535 %T Evaluation of the Quality and Readability of Web-Based Information Regarding Foreign Bodies of the Ear, Nose, and Throat: Qualitative Content Analysis %A Ko,Tsz Ki %A Tan,Denise Jia Yun %A Fan,Ka Siu %+ Department of Surgery, Royal Stoke Hospital, Newcastle Road, Stoke, United Kingdom, 44 7378977812, tszkiko95@gmail.com %K foreign body %K quality of internet information %K readability of internet information %K EQIP %K Ensuring Quality Information for Patients %K medical informatics %K readability %K readable %K health information %K online information %K information resource %K information resources %K website %K websites %K quality %K evaluation %K evaluations %K reading level %K grade level %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Foreign body (FB) inhalation, ingestion, and insertion account for 11% of emergency admissions for ear, nose, and throat conditions. Children are disproportionately affected, and urgent intervention may be needed to maintain airway patency and prevent blood vessel occlusion. High-quality, readable online information could help reduce poor outcomes from FBs. Objective: We aim to evaluate the quality and readability of available online health information relating to FBs. Methods: In total, 6 search phrases were queried using the Google search engine. For each search term, the first 30 results were captured. Websites in the English language and displaying health information were included. The provider and country of origin were recorded. The modified 36-item Ensuring Quality Information for Patients tool was used to assess information quality. Readability was assessed using a combination of tools: Flesch Reading Ease score, Flesch-Kincaid Grade Level, Gunning-Fog Index, and Simple Measure of Gobbledygook. Results: After the removal of duplicates, 73 websites were assessed, with the majority originating from the United States (n=46, 63%). Overall, the quality of the content was of moderate quality, with a median Ensuring Quality Information for Patients score of 21 (IQR 18-25, maximum 29) out of a maximum possible score of 36. Precautionary measures were not mentioned on 41% (n=30) of websites and 30% (n=22) did not identify disk batteries as a risky FB. Red flags necessitating urgent care were identified on 95% (n=69) of websites, with 89% (n=65) advising patients to seek medical attention and 38% (n=28) advising on safe FB removal. Readability scores (Flesch Reading Ease score=12.4, Flesch-Kincaid Grade Level=6.2, Gunning-Fog Index=6.5, and Simple Measure of Gobbledygook=5.9 years) showed most websites (56%) were below the recommended sixth-grade level. Conclusions: The current quality and readability of information regarding FBs is inadequate. More than half of the websites were above the recommended sixth-grade reading level, and important information regarding high-risk FBs such as disk batteries and magnets was frequently excluded. Strategies should be developed to improve access to high-quality information that informs patients and parents about risks and when to seek medical help. Strategies to promote high-quality websites in search results also have the potential to improve outcomes. %M 39145998 %R 10.2196/55535 %U https://formative.jmir.org/2024/1/e55535 %U https://doi.org/10.2196/55535 %U http://www.ncbi.nlm.nih.gov/pubmed/39145998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48389 %T Investigating Topical Steroid Withdrawal Videos on TikTok: Cross-Sectional Analysis of the Top 100 Videos %A Haddad,Firas %A Abou Shahla,William %A Saade,Dana %+ Department of Dermatology, American University of Beirut Medical Center, Bliss Street, Beirut, 1107 2020, Lebanon, 961 1350000 ext 5333, ds45@aub.edu.lb %K steroid withdrawal %K medical dermatology %K drug response %K social media %K videos %K TikTok %K steroids %K content analysis %K information quality %K skin %K topical %K dermatology %K misinformation %D 2024 %7 29.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms like TikTok are a very popular source of information, especially for skin diseases. Topical steroid withdrawal (TSW) is a condition that is yet to be fully defined and understood. This did not stop the hashtag #topicalsteroidwithdrawal from amassing more than 600 million views on TikTok. It is of utmost importance to assess the quality and content of TikTok videos on TSW to prevent the spread of misinformation. Objective: This study aims to assess the quality and content of the top 100 videos dedicated to the topic of TSW on TikTok. Methods: This observational study assesses the content and quality of the top 100 videos about TSW on TikTok. A total of 3 independent scoring systems: DISCERN, Journal of the American Medical Association, and Global Quality Scale were used to assess the video quality. The content of the videos was coded by 2 reviewers and analyzed for recurrent themes and topics. Results: This study found that only 10.0% (n=10) of the videos clearly defined what TSW is. Videos were predominantly posted by White, middle-aged, and female creators. Neither cause nor mechanism of the disease were described in the videos. The symptoms suggested itching, peeling, and dryness which resembled the symptoms of atopic dermatitis. The videos fail to mention important information regarding the use of steroids such as the reason it was initially prescribed, the name of the drug, concentration, mechanism of usage, and method of discontinuation. Management techniques varied from hydration methods approved for treatment of atopic dermatitis to treatment options without scientific evidence. Overall, the videos had immense reach with over 200 million views, 45 million likes, 90,000 comments, and 100,000 shares. Video quality was poor with an average DISCERN score of 1.63 (SD 0.56)/5. Video length, total view count, and views/day were all associated with increased quality, indicating that patients were interacting more with higher quality videos. However, videos were created exclusively by personal accounts, highlighting the absence of dermatologists on the platform to discuss this topic. Conclusions: The videos posted on TikTok are of low quality and lack pertinent information. The content is varied and not consistent. Health care professionals, including dermatologists and residents in the field, need to be more active on the topic, to spread proper information and prevent an increase in steroid phobia. Health care professionals are encouraged to ride the wave and produce high-quality videos discussing what is known about TSW to avoid the spread of misinformation. %M 39208411 %R 10.2196/48389 %U https://formative.jmir.org/2024/1/e48389 %U https://doi.org/10.2196/48389 %U http://www.ncbi.nlm.nih.gov/pubmed/39208411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51513 %T The Quality of Short Videos as a Source of Coronary Heart Disease Information on TikTok: Cross-Sectional Study %A Gong,Xun %A Chen,Meijuan %A Ning,Lihong %A Zeng,Lingzhong %A Dong,Bo %+ Department of Cardiology and Cardiac Rehabilitation Center, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61 West Jiefang Road, Furong District, Changsha, China, 86 18874832298, dt2008bj@sina.com %K coronary heart disease %K content quality %K social media %K short-video platform %K TikTok %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Coronary heart disease (CHD) is a leading cause of death worldwide and imposes a significant economic burden. TikTok has risen as a favored platform within the social media sphere for disseminating CHD-related information and stands as a pivotal resource for patients seeking knowledge about CHD. However, the quality of such content on TikTok remains largely unexplored. Objective: This study aims to assess the quality of information conveyed in TikTok CHD-related videos. Methods: A comprehensive cross-sectional study was undertaken on TikTok videos related to CHD. The sources of the videos were identified and analyzed. The comprehensiveness of content was assessed through 6 questions addressing the definition, signs and symptoms, risk factors, evaluation, management, and outcomes. The quality of the videos was assessed using 3 standardized evaluative instruments: DISCERN, the Journal of the American Medical Association (JAMA) benchmarks, and the Global Quality Scale (GQS). Furthermore, correlative analyses between video quality and characteristics of the uploaders and the videos themselves were conducted. Results: The search yielded 145 CHD-related videos from TikTok, predominantly uploaded by health professionals (n=128, 88.3%), followed by news agencies (n=6, 4.1%), nonprofit organizations (n=10, 6.9%), and for-profit organizations (n=1, 0.7%). Content comprehensiveness achieved a median score of 3 (IQR 2-4). Median values for the DISCERN, JAMA, and GQS evaluations across all videos stood at 27 (IQR 24-32), 2 (IQR 2-2), and 2 (IQR 2-3), respectively. Videos from health professionals and nonprofit organizations attained significantly superior JAMA scores in comparison to those of news agencies (P<.001 and P=.02, respectively), whereas GQS scores for videos from health professionals were also notably higher than those from news agencies (P=.048). Within health professionals, cardiologists demonstrated discernibly enhanced performance over noncardiologists in both DISCERN and GQS assessments (P=.02). Correlative analyses unveiled positive correlations between video quality and uploader metrics, encompassing the positive correlations between the number of followers; total likes; average likes per video; and established quality indices such as DISCERN, JAMA, or GQS scores. Similar investigations relating to video attributes showed correlations between user engagement factors—likes, comments, collections, shares—and the aforementioned quality indicators. In contrast, a negative correlation emerged between the number of days since upload and quality indices, while a longer video duration corresponded positively with higher DISCERN and GQS scores. Conclusions: The quality of the videos was generally poor, with significant disparities based on source category. The content comprehensiveness coverage proved insufficient, casting doubts on the reliability and quality of the information relayed through these videos. Among health professionals, video contributions from cardiologists exhibited superior quality compared to noncardiologists. As TikTok’s role in health information dissemination expands, ensuring accurate and reliable content is crucial to better meet patients’ needs for CHD information that conventional health education fails to fulfill. %M 39226540 %R 10.2196/51513 %U https://formative.jmir.org/2024/1/e51513 %U https://doi.org/10.2196/51513 %U http://www.ncbi.nlm.nih.gov/pubmed/39226540 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46531 %T The Portrayal of Cesarean Section on Instagram: Mixed Methods Social Media Analysis %A Zahroh,Rana Islamiah %A Cheong,Marc %A Hazfiarini,Alya %A Vazquez Corona,Martha %A Ekawati,Fitriana Murriya %A Emilia,Ova %A Homer,Caroline SE %A Betrán,Ana Pilar %A Bohren,Meghan A %+ Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia, 61 481386220, r.zahroh@unimelb.edu.au %K cesarean section %K social media analysis %K maternal health %K childbirth %K mode of birth %K instagram %D 2024 %7 6.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cesarean section (CS) rates in Indonesia are rapidly increasing for both sociocultural and medical reasons. However, there is limited understanding of the role that social media plays in influencing preferences regarding mode of birth (vaginal or CS). Social media provides a platform for users to seek and exchange information, including information on the mode of birth, which may help unpack social influences on health behavior. Objective: This study aims to explore how CS is portrayed on Instagram in Indonesia. Methods: We downloaded public Instagram posts from Indonesia containing CS hashtags and extracted their attributes (image, caption, hashtags, and objects and texts within images). Posts were divided into 2 periods—before COVID-19 and during COVID-19—to examine changes in CS portrayal during the pandemic. We used a mixed methods approach to analysis using text mining, descriptive statistics, and qualitative content analysis. Results: A total of 9978 posts were analyzed quantitatively, and 720 (7.22%) posts were sampled and analyzed qualitatively. The use of text (527/5913, 8.91% vs 242/4065, 5.95%; P<.001) and advertisement materials (411/5913, 6.95% vs 83/4065, 2.04%; P<.001) increased during the COVID-19 pandemic compared to before the pandemic, indicating growth of information sharing on CS over time. Posts with CS hashtags primarily promoted herbal medicine for faster recovery and services for choosing auspicious childbirth dates, encouraging elective CS. Some private health facilities offered discounts on CS for special events such as Mother’s Day and promoted techniques such as enhanced recovery after CS for comfortable, painless birth, and faster recovery after CS. Hashtags related to comfortable or painless birth (2358/5913, 39.88% vs 278/4065, 6.84%; P<.001), enhanced recovery after CS (124/5913, 2.1% vs 0%; P<.001), feng shui services (110/5913, 1.86% vs 56/4065, 1.38%; P=.03), names of health care providers (2974/5913, 50.3% vs 304/4065, 7.48%; P<.001), and names of hospitals (1460/5913, 24.69% vs 917/4065, 22.56%; P=.007) were more prominent during compared to before the pandemic. Conclusions: This study highlights the necessity of enforcing advertisement regulations regarding birth-related medical services in the commercial and private sectors. Enhanced health promotion efforts are crucial to ensure that women receive accurate, balanced, and appropriate information about birth options. Continuous and proactive health information dissemination from government organizations is essential to counteract biases favoring CS over vaginal birth. %M 39241228 %R 10.2196/46531 %U https://formative.jmir.org/2024/1/e46531 %U https://doi.org/10.2196/46531 %U http://www.ncbi.nlm.nih.gov/pubmed/39241228 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54025 %T Japanese Perception of Brain Death and Implications for New Medical Technologies: Quantitative and Qualitative Social Media Analysis %A Vargas Meza,Xanat %A Oikawa,Masanori %+ Institute for the Advanced Study of Human Biology, Faculty of Medicine, Kyoto University, Building B, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan, 81 75 753 9882, vargasmeza.xanat.8z@kyoto-u.ac.jp %K brain death %K Japan %K social media %K multidimensional analysis %K Twitter %K YouTube %D 2024 %7 18.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Brain death has been used to decide whether to keep sustained care and treatment. It can facilitate tissue, organ, and body donation for several purposes, such as transplantation and medical education and research. In Japan, brain death has strict diagnostic criteria and family consent is crucial, but it has been a challenging concept for the public since its introduction, including knowledge and communication issues. Objective: We analyzed data across YouTube and Twitter in Japan to uncover actors and assess the quality of brain death communication, providing recommendations to communicate new medical technologies. Methods: Using the keyword “脳死” (brain death), we collected recent data from YouTube and Twitter, classifying the data into 5 dimensions: time, individuality (type of users), place, activity, and relations (hyperlinks). We employed a scale to evaluate brain death information quality. We divided YouTube videos into 3 groups and assessed their differences through statistical analysis. We also provided a text-based analysis of brain death–related narratives. Results: Most videos (20/61, 33%) were uploaded in 2019, while 10,892 tweets peaked between July 3 and 9, 2023, and June 12 and 18, 2023. Videos about brain death were mostly uploaded by citizens (18/61, 27%), followed by media (13/61, 20%) and unknown actors (10/61, 15%). On the other hand, most identified users in a random sample of 100 tweets were citizens (73/100, 73%), and the top 10 retweeted and liked tweets were also mostly authored by citizens (75/100, 75%). No specific information on location was uncovered. Information videos contained guides for accreditation of the National Nursing Exam and religious points of view, while misinformation videos mostly contained promotions by spirituality actors and webtoon artists. Some tweets involved heart transplantation and patient narratives. Most hyperlinks pointed to YouTube and Twitter. Conclusions: Brain death has become a common topic in everyday life, with some actors disseminating high-quality information, others disseminating no medical information, and others disseminating misinformation. Recommendations include partnering with interested actors, discussing medical information in detail, and teaching people to recognize pseudoscience. %M 39291895 %R 10.2196/54025 %U https://formative.jmir.org/2024/1/e54025 %U https://doi.org/10.2196/54025 %U http://www.ncbi.nlm.nih.gov/pubmed/39291895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56371 %T Public Perceptions of the Food and Drug Administration's Regulatory Authority Over Synthetic Nicotine on Twitter: Observational Study %A Zou,Jonathan %A Feliciano,Juan Ramon %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K FDA %K synthetic nicotine %K omnibus %K Twitter %K Food and Drug Administration %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Omnibus Budget Bill, known as H. R. 2471, passed through Congress on March 10, 2022, and was eventually signed by President Biden on March 15, 2022. This bill amended the Federal Food, Drug, and Cosmetic Act granting the Food and Drug Administration (FDA) regulatory authority over synthetic nicotine. Objective: This study aims to examine the public perceptions of the Omnibus Bill that regulates synthetic nicotine products as tobacco products on Twitter (rebranded as X). Methods: Through the X streaming application programming interface, we collected and identified 964 tweets related to the Omnibus Bill on synthetic nicotine between March 8, 2022, and April 13, 2022. The longitudinal trend was used to examine the discussions related to the bill over time. An inductive method was used for the content analysis of related tweets. By hand-coding 200 randomly selected tweets by 2 human coders respectively with high interrater reliability, the codebook was developed for relevance, major topics, and attitude to the bill, which was used to single-code the rest of the tweets. Results: Between March 8, 2022, and April 13, 2022, we identified 964 tweets related to the Omnibus Bill regulating synthetic nicotine. Our longitudinal trend analysis showed a spike in the number of tweets related to the bill during the immediate period following the bill’s introduction, with roughly half of the tweets identified being posted between March 8 and 11, 2022. A majority of the tweets (497/964, 51.56%) had a negative sentiment toward the bill, while a much smaller percentage of tweets (164/964, 17.01%) had a positive sentiment toward the bill. Around 31.43% (303/964) of all tweets were categorized as objective news or questions about the bill. The most popular topic for opposing the bill was users believing that this bill would lead users back to smoking (145/497, 29.18%), followed by negative implications for small vape businesses (122/497, 24.55%) and government or FDA mistrust (94/497, 18.91%). The most popular topic for supporting the bill was that this bill would take a dangerous tobacco product targeted at teens off the market (94/164, 57.32%). Conclusions: We observed a more negative sentiment toward the bill on X, largely due to users believing it would lead users back to smoking and negatively impact small vape businesses. This study provides insight into public perceptions and discussions of this bill on X and adds valuable information for future regulations on alternative nicotine products. %M 39298747 %R 10.2196/56371 %U https://formative.jmir.org/2024/1/e56371 %U https://doi.org/10.2196/56371 %U http://www.ncbi.nlm.nih.gov/pubmed/39298747 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52977 %T Seasonal and Weekly Patterns of Korean Adolescents’ Web Search Activity on Insomnia: Retrospective Study %A Baek,Kwangyeol %A Jeong,Jake %A Kim,Hyun-Woo %A Shin,Dong-Hyeon %A Kim,Jiyoung %A Lee,Gha-Hyun %A Cho,Jae Wook %+ Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Mulgeum up, 20 Geumo-ro, Yangsan, 50612, Republic of Korea, 82 553602122, sleepcho@pusan.ac.kr %K insomnia %K sleep %K internet search %K adolescents %K school %K seasonal %K weekly %K NAVER %K infodemiology %K inforveillance %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep deprivation in adolescents is a common but serious public health issue. Adolescents often have a progressive circadian delay and suffer from insufficient sleep during weekdays due to the school schedule. Temporal patterns in internet search activity data can provide relevant information for understanding the characteristic sleep problems of the adolescent population. Objective: We aimed to reveal whether adolescents exhibit distinct temporal seasonal and weekly patterns in internet search activity on insomnia compared to adults. Methods: We hypothesized that adolescents exhibit larger variations in the internet search volume for insomnia, particularly in association with the school schedule (e.g., academic vacations and weekends). We extracted the daily search volume for insomnia in South Korean adolescents (13-18 years old), adults (19-59 years old), and young adults (19-24 years old) during the years 2016-2019 using NAVER DataLab, the most popular search engine in South Korea. The daily search volume data for each group were normalized with the annual median of each group. The time series of the search volume was decomposed into slow fluctuation (over a year) and fast fluctuation (within a week) using fast Fourier transform. Next, we compared the normalized search volume across months in a year (slow fluctuation) and days in a week (fast fluctuation). Results: In the annual trend, 2-way ANOVA revealed a significant (group) × (month) interaction (P<.001). Adolescents exhibited much greater seasonal variations across a year than the adult population (coefficient of variation=0.483 for adolescents vs 0.131 for adults). The search volume for insomnia in adolescents was notably higher in January, February, and August, which are academic vacation periods in South Korea (P<.001). In the weekly pattern, 2-way ANOVA revealed a significant (group) × (day) interaction (P<.001). Adolescents showed a considerably increased search volume on Sunday and Monday (P<.001) compared to adults. In contrast, young adults demonstrated seasonal and weekly patterns similar to adults. Conclusions: Adolescents demonstrate distinctive seasonal and weekly patterns in internet searches on insomnia (ie, increased search in vacation months and weekend–weekday transitions), which are closely associated with the school schedule. Adolescents’ sleep concerns might be potentially affected by the disrupted daily routine and the delayed sleep phase during vacations and weekends. As we demonstrated, comparing various age groups in infodemiology and infoveillance data might be helpful in identifying distinctive features in vulnerable age groups. %M 39311496 %R 10.2196/52977 %U https://formative.jmir.org/2024/1/e52977 %U https://doi.org/10.2196/52977 %U http://www.ncbi.nlm.nih.gov/pubmed/39311496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57720 %T Oral Diabetes Medication Videos on Douyin: Analysis of Information Quality and User Comment Attitudes %A Zhang,Baolu %A Kalampakorn,Surintorn %A Powwattana,Arpaporn %A Sillabutra,Jutatip %A Liu,Gang %+ Department of Public Health Nursing, Faculty of Public Health, Mahidol University, 420/1 Rajavithi Rd, Bangkok, 10400, Thailand, 66 96 646 2696, surintorn.kal@mahidol.ac.th %K diabetes %K oral diabetes medication %K information quality %K user comment attitude %K video analysis %K Douyin %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Oral diabetes medications are important for glucose management in people with diabetes. Although there are many health-related videos on Douyin (the Chinese version of TikTok), the quality of information and the effects on user comment attitudes are unclear. Objective: The purpose of this study was to analyze the quality of information and user comment attitudes related to oral diabetes medication videos on Douyin. Methods: The key phrase “oral diabetes medications” was used to search Douyin on July 24, 2023, and the final samples included 138 videos. The basic information in the videos and the content of user comments were captured using Python. Each video was assigned a sentiment category based on the predominant positive, neutral, or negative attitude, as analyzed using the Weiciyun website. Two independent raters assessed the video content and information quality using the DISCERN (a tool for assessing health information quality) and PEMAT-A/V (Patient Education Materials Assessment Tool for Audiovisual Materials) instruments. Results: Doctors were the main source of the videos (136/138, 98.6%). The overall information quality of the videos was acceptable (median 3, IQR 1). Videos on Douyin showed relatively high understandability (median 75%, IQR 16.6%) but poor actionability (median 66.7%, IQR 48%). Most content on oral diabetes medications on Douyin related to the mechanism of action (75/138, 54.3%), precautions (70/138, 50.7%), and advantages (68/138, 49.3%), with limited content on indications (19/138, 13.8%) and contraindications (14/138, 10.1%). It was found that 10.1% (14/138) of the videos contained misinformation, of which 50% (7/14) were about the method of administration. Regarding user comment attitudes, the majority of videos garnered positive comments (81/138, 58.7%), followed by neutral comments (46/138, 33.3%) and negative comments (11/138, 8%). Multinomial logistic regression revealed 2 factors influencing a positive attitude: user comment count (adjusted odds ratio [OR] 1.00, 95% CI 1.00-1.00; P=.02) and information quality of treatment choices (adjusted OR 1.49, 95% CI 1.09-2.04; P=.01). Conclusions: Despite most videos on Douyin being posted by doctors, with generally acceptable information quality and positive user comment attitudes, some content inaccuracies and poor actionability remain. Users show more positive attitudes toward videos with high-quality information about treatment choices. This study suggests that health care providers should ensure the accuracy and actionability of video content, enhance the information quality of treatment choices of oral diabetes medications to foster positive user attitudes, help users access accurate health information, and promote medication adherence. %M 39423367 %R 10.2196/57720 %U https://formative.jmir.org/2024/1/e57720 %U https://doi.org/10.2196/57720 %U http://www.ncbi.nlm.nih.gov/pubmed/39423367 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60541 %T Body Positivity, Physical Health, and Emotional Well-Being Discourse on Social Media: Content Analysis of Lizzo’s Instagram %A Albert,Stephanie L %A Massar,Rachel E %A Cassidy,Omni %A Fennelly,Kayla %A Jay,Melanie %A Massey,Philip M %A Bragg,Marie A %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 917 689 1163, stephanie.albert@nyulangone.org %K weight stigma %K body positivity %K health at every size %K emotional well-being %K social media %K qualitative content analysis %K well-being %K social media %K influencers %K mental health outcomes %K psychological health %K body shaming %K bullying %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Weight stigma is a fundamental cause of health inequality. Body positivity may be a counterbalance to weight stigma. Social media is replete with weight-stigmatizing content and is a driver of poor mental health outcomes; however, there remains a gap in understanding its potential to mitigate the prevalence and impact of harmful messaging and to promote positive effects on a large scale. Objective: We selected musical artist Lizzo, whose brand emphasizes body positivity and empowerment, for an instrumental case study on the discourse on social media and specifically Instagram. We focused on 3 domains, including body positivity, physical health, and emotional well-being. These domains challenge social norms around weight and body size and have the potential to positively affect the physical and psychological health of people with diverse body sizes. Methods: We evaluated posts by Lizzo, comments from Instagram users, and replies to comments over a 2-month period (October 11 to December 12, 2019). Two coders rated Lizzo’s posts and Instagram users’ comments for their sentiments on the 3 domains. Replies to Instagram users’ comments were assessed for their reactions to comments (ie, did they oppose or argue against the comment or did they support or bolster the comment). Engagement metrics, including the number of “likes,” were also collected. Results: The final sample included 50 original posts by Lizzo, 250 comments from Instagram users, and 1099 replies to comments. A proportion of Lizzo’s content included body positive sentiments (34%) and emotional well-being (18%); no posts dealt explicitly with physical health. A substantial amount Instagram users’ comments and replies contained stigmatizing content including the use of nauseated and vomiting emojis, implications that Lizzo’s body was shameful and should be hidden away, accusations that she was promoting obesity, and impeachments of Lizzo’s health. In spite of the stigmatizing content, we also discovered content highlighting the beneficial nature of having positive representation of a Black woman living in a larger body who is thriving. Moreover, analysis of the discourse between users illustrated that stigmatizing expressions are being combated online, at least to some degree. Conclusions: This study demonstrates that Lizzo has exposed millions of social media users to messages about body positivity and provided more visibility for conversations about weight and shape. Future research should examine the extent to which body positive messages can lead to greater acceptance of individuals living in larger bodies. Instagram and other social media platforms should consider ways to reduce body-shaming content while finding ways to promote content that features diverse bodies. Shifting the landscape of social media could decrease stereotypes about weight and shape while increasing dialog about the need for greater acceptance and inclusion of people with diverse bodies. %M 39496156 %R 10.2196/60541 %U https://formative.jmir.org/2024/1/e60541 %U https://doi.org/10.2196/60541 %U http://www.ncbi.nlm.nih.gov/pubmed/39496156 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56006 %T Association of Drugs for Sale on the Internet and Official Health Indicators: Darknet Parsing and Correlational Study %A Soshnikov,Sergey %A Bekker,Svetlana %A Idrisov,Bulat %A Vlassov,Vasiliy %+ Public Health Division, School of Health Scienses, Central Michigan University, Health Professions Building, CMU, Mount Pleasant, MI, 48859, United States, 1 9897742744, soshn1s@cmich.edu %K darknet %K Internet black market %K illicit drugs %K Hydra %K marketplace %K cannabis %K opiates %K zakladka %K Bitcoin %K crypto %K public health %K overdose %K harmful drug use %K drug availability %K drug use %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Studying illicit drug circulation and its effects on population health is complicated due to the criminalization of trade and consumption. Illicit drug markets have evolved with IT, moving digital to the “darknet.” Previous research has analyzed darknet market listings and customer reviews. Research tools include public health surveys and medical reports but lack neutral data on drugs' spread and impact. This study fills this gap with an analysis of the volume of drugs traded on the darknet market. Objective: We aimed to use the dark web data and officially published indicators to identify the most vulnerable regions of Russia and the correlations between the pairs of variables to measure how illicit drug trade can affect population well-being. Methods: We web-parsed the Hydra darknet drug marketplace using Python code. The dataset encompassed 3045 individual sellers marketing 6721 unique products via 58,563 distinct postings, each representing specific quantities sold in different Russian regions during 2019. In the second stage, we collected 31 variables from official sources to compare officially collected data with darknet data about amounts and types of selling drugs in every 85 regions of Russia. The health-related data were obtained from official published sources—statistical yearbooks. Maps, diagrams, correlation matrixes, and applied observational statistical methods were used. Results: In 2019, a minimum of 124 kilograms of drugs circulated daily in small batches on the Russian darknet. Cannabis dominated the market, being 10 times more prevalent than opiates, and cannabis products' higher availability in the region is correlated with a lower incidence of opiate overdoses. The “grams of opiates in the region” variable is significantly correlated with drug overdose deaths (r=.41; P=.003), HIV-positive cases due to drug use (r=.51; P=.002), and drug court convictions in Russia (r=.39; P=.004). The study identified significant correlations between opiate sales on the darknet and higher rates of HIV among injection drug users (r=.47; P=.003). Conversely, regions with higher cannabis sales exhibited significant negative correlations with indicators of harmful drug use (r=–.52; P=.002) and its prevalence (r=–.49; P=.001). These findings suggest regional variations in drug sales on the darknet may be associated with differing public health outcomes. These indicators accurately reflect regional drug issues, though some official statistics may be incomplete or biased. Conclusions: Our findings point to varying levels of risk associated with different types of drugs sold on the darknet, but further research is needed to explore these relationships in greater depth. The study's findings highlight the importance of considering regional variations in darknet drug sales when developing public health strategies. The significant correlations between drug sales data and public health indicators suggest that region-specific interventions could be more effective in addressing the diverse challenges posed by illicit drug use. %M 39546792 %R 10.2196/56006 %U https://formative.jmir.org/2024/1/e56006 %U https://doi.org/10.2196/56006 %U http://www.ncbi.nlm.nih.gov/pubmed/39546792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63035 %T Public Perceptions of Very Low Nicotine Content on Twitter: Observational Study %A Xie,Zidian %A Liu,Xinyi %A Lou,Xubin %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K very low nicotine %K Twitter %K public perception %K observational study %K content analysis %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nicotine is a highly addictive agent in tobacco products. On June 21, 2022, the US Food and Drug Administration (FDA) announced a plan to propose a rule to establish a maximum nicotine level in cigarettes and other combusted tobacco products. Objective: This study aimed to understand public perception and discussion of very low nicotine content (VLNC) on Twitter (rebranded as X in July 2023). Methods: From December 12, 2021, to January 1, 2023, we collected Twitter data using relevant keywords such as “vln,” “low nicotine,” and “reduced nicotine.” After a series of preprocessing steps (such as removing duplicates, retweets, and commercial tweets), we identified 3270 unique noncommercial tweets related to VLNC. We used an inductive method to assess the public perception and discussion of VLNC on Twitter. To establish a codebook, we randomly selected 300 tweets for hand-coding, including the attitudes (positive, neutral, and negative) toward VLNC (including its proposed rule) and major topics (13 topics). The Cohen κ statistic between the 2 human coders reached over 70%, indicating a substantial interrater agreement. The rest of the tweets were single-coded according to the codebook. Results: We observed a significant peak in the discussion of VLNC on Twitter within 4 days of the FDA’s announcement of the proposed rule on June 21, 2022. The proportion of tweets with a negative attitude toward VLNC was significantly lower than those with a positive attitude, 24.5% (801/3270) versus 37.09% (1213/3270) with P<.001 from the 2-proportion z test. Among tweets with a positive attitude, the topic “Reduce cigarette consumption or help smoking cessation” was dominant (1097/1213, 90.44%). Among tweets with a negative attitude, the topic “VLNC leads to more smoking” was the most popular topic (227/801, 28.34%), followed by “Similar toxicity of VLNC as a regular cigarette” (223/801, 27.84%), and “VLNC is not a good method for quitting smoking” (211/801, 26.34%). Conclusions: There is a more positive attitude toward VLNC than a negative attitude on Twitter, resulting from different opinions about VLNC. Discussions around VLNC mainly focused on whether VLNC could help people quit smoking. %M 39631065 %R 10.2196/63035 %U https://formative.jmir.org/2024/1/e63035 %U https://doi.org/10.2196/63035 %U http://www.ncbi.nlm.nih.gov/pubmed/39631065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52871 %T The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation %A Béchard,Benoît %A Gramaccia,Julie A %A Gagnon,Dominique %A Laouan-Sidi,Elhadji Anassour %A Dubé,Ève %A Ouimet,Mathieu %A de Hemptinne,Delphine %A Tremblay,Sébastien %+ School of Psychology, Université Laval, 2325 Allée des Bibliothèques, Pavillon Félix-Antoine-Savard, Québec, QC, G1V 0A6, Canada, 1 4186565383, benoit.bechard.1@ulaval.ca %K attitude toward vaccination %K misinformation %K reinformation %K confidence %K perceived tentativeness %K vaccine hesitancy %K COVID-19 %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation. Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination. Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general. Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article (χ21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style (χ21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups. Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual’s level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals’ perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one’s opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness. International Registered Report Identifier (IRRID): RR2-10.2196/41012 %M 39413215 %R 10.2196/52871 %U https://formative.jmir.org/2024/1/e52871 %U https://doi.org/10.2196/52871 %U http://www.ncbi.nlm.nih.gov/pubmed/39413215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63281 %T Health-Related Messages About Herbs, Spices, and Other Botanicals Appearing in Print Issues and Websites of Legacy Media: Content Analysis and Evaluation %A Gaba,Ann %A Bennett,Richard %+ Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, United States, 1 (646) 364 9512, Ann.Gaba@sph.cuny.edu %K legacy media %K health applications %K health communication %K botanical products %K content analysis %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Legacy media are publications that existed before the internet. Many of these have migrated to a web format, either replacing or in parallel to their print issues. Readers place an economic value on access to the information presented as they pay for subscriptions and place a higher degree of trust in their content. Much has been written about inaccurate and misleading health information in social media; however, the content and accuracy of information contained in legacy media has not been examined in detail. Discussion of herbs, spices, and other botanicals has been absent from this context. Objective: The objectives of this study were to (1) identify the health associations of botanical products mentioned in legacy media targeted to a range of demographic groups and (2) evaluate these health associations for accuracy against published scientific studies. Methods: In total, 10 popular magazines targeting a range of gender, race/ethnicity, and sexual orientation demographic groups were selected for analysis. Relevant content was extracted and coded over 1 year. Associations between specific botanical products and health factors were identified. For the most frequent botanical–health application associations, a PubMed search was conducted to identify reviews corresponding to each item’s indicated applications. Where no systematic reviews were available, single research studies were sought. Results: A total of 237 unique botanical products were identified. There were 128 mentions of these in the print issues and 1215 on the websites. In total, 18 health applications were identified and used to categorize the indicated uses for the various products individually and as general categories. The most frequently mentioned applications were skin care, with 913 mentions, immunity enhancement, with 705 mentions, gastrointestinal health and probiotics, with 184 mentions, and cognitive function (stress and mental health), with 106 mentions. Comparison to published literature evaluating the efficacy of these functions identified positive support for aloe vera, argan oil, chamomile, jojoba oil, lavender, rosemary, and tea tree oil in skin care. Berries, ginger, turmeric, and green tea had the strongest evidence for a role in immunity enhancement. Ginger and oats were supported as having a role in gastrointestinal health. Finally, berries, lavender, ashwagandha, and cannabidiol were supported as having a role in managing stress. Other frequently mentioned items such as aloe vera, ashwagandha, or mushrooms for immunity were less strongly supported. Conclusions: Comparison of the most prevalent associations between botanical products and health applications to published literature indicates that, overall, these associations were consistent with current scientific reports about the health applications of botanical products. While some products had a greater degree of research support than others, truly egregious falsehoods were absent. Therefore, legacy media may be considered a credible source of information to readers about these topics. %M 39631062 %R 10.2196/63281 %U https://formative.jmir.org/2024/1/e63281 %U https://doi.org/10.2196/63281 %U http://www.ncbi.nlm.nih.gov/pubmed/39631062 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54092 %T Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey %A Na,Kilhoe %A Zimdars,Melissa %A Cullinan,Megan E %+ Department of Communication and Media, Merrimack College, Cushing Hall 306B, 315 Turnpike St., North Andover, MA, 01845, United States, 1 9788375765, nak@merrimack.edu %K alternative health %K social media %K misinformation %K vaccination %K COVID-19 %K Coronavirus %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms have become home to numerous alternative health groups where people share health information and scientifically unproven treatments. Individuals share not only health information but also health misinformation in alternative health groups on social media. Yet, little research has been carried out to understand members of these groups. This study aims to better understand various characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and COVID-19 and influenza vaccination–related behaviors. Objective: This study aims to test hypotheses about different potential characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and vaccine-related behaviors. Methods: A web-based cross-sectional survey (N=1050) was conducted. Participants were recruited from 19 alternative health social media groups and Amazon’s Mechanical Turk. A total of 596 participants were members of alternative health groups and 454 were nonmembers of alternative health groups. Logistic regressions were performed to test the hypotheses about the relationship between membership and the variables of interest. Results: Logistic regression revealed that there is a positive association between alternative health social media group membership and 3 personal characteristics: sharing trait (B=.83, SE=.11; P<.01; odds ratio [OR] 2.30, 95% CI 1.85-2.86), fear of negative evaluations (B=.19, SE=.06; P<.001, OR 1.21, 95% CI 1.06-1.37), and conspiratorial mentality (B=.33, SE=.08; P<.01; OR 1.40, 95% CI 1.18-1.65). Also, the results indicate that there is a negative association between membership and 2 characteristics: health literacy (B=–1.09, SE=.17; P<.001; OR .33, 95% CI 0.23-0.47) and attitudes toward vaccination (B=– 2.33, SE=.09; P=.02; OR 0.79, 95% CI 0.65-0.95). However, there is no association between membership and health consciousness (B=.12, SE=.10; P=.24; OR 1.13, 95% CI 0.92-1.38). Finally, membership is negatively associated with COVID-19 vaccination status (B=–.84, SE=.17; P<.001; OR 48, 95% CI 0.32-0.62), and influenza vaccination practice (B=–1.14, SE=.17; P<.001; OR .31, 95% CI 0.22-0.45). Conclusions: Our findings indicate that people joining alternative health social media groups differ from nonmembers in different aspects, such as sharing, fear of negative evaluations, conspiratorial mentality, and health literacy. They also suggest that there is a significant relationship between membership and vaccination. By more thoroughly exploring the demographic, or by better understanding the people for whom interventions are designed, this study is expected to help researchers to more strategically and effectively develop and implement interventions. %M 39636665 %R 10.2196/54092 %U https://formative.jmir.org/2024/1/e54092 %U https://doi.org/10.2196/54092 %U http://www.ncbi.nlm.nih.gov/pubmed/39636665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49567 %T An Analysis of the Prevalence and Trends in Drug-Related Lyrics on Twitter (X): Quantitative Approach %A Luo,Waylon %A Jin,Ruoming %A Kenne,Deric %A Phan,NhatHai %A Tang,Tang %+ Department of Computer Science, Kent State University, 1300 Lester A Lefton Esplanade, Kent, OH, 44241, United States, 1 330 672 9063, rjin1@kent.edu %K Twitter (X) %K popular music %K big data analysis %K music %K lyrics %K big data %K substance abuse %K tweet %K social media %K drug %K alcohol %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The pervasiveness of drug culture has become evident in popular music and social media. Previous research has examined drug abuse content in both social media and popular music; however, to our knowledge, the intersection of drug abuse content in these 2 domains has not been explored. To address the ongoing drug epidemic, we analyzed drug-related content on Twitter (subsequently rebranded X), with a specific focus on lyrics. Our study provides a novel finding on the prevalence of drug abuse by defining a new subcategory of X content: “tweets that reference established drug lyrics.” Objective: We aim to investigate drug trends in popular music on X, identify and classify popular drugs, and analyze related artists’ gender, genre, and popularity. Based on the collected data, our goal is to create a prediction model for future drug trends and gain a deeper understanding of the characteristics of users who cite drug lyrics on X. Methods: X data were collected from 2015 to 2017 through the X streaming application programming interface (API). Drug lyrics were obtained from the Genius lyrics database using the Genius API based on drug keywords. The Smith-Waterman text-matching algorithm is used to detect the drug lyrics in posts. We identified famous drugs in lyrics that were posted. Consequently, the analysis was extended to related artists, songs, genres, and popularity on X. The frequency of drug-related lyrics on X was aggregated into a time-series, which was then used to create prediction models using linear regression, Facebook Prophet, and NIXTLA TimeGPT-1. In addition, we analyzed the number of followers of users posting drug-related lyrics to explore user characteristics. Results: We analyzed over 1.97 billion publicly available posts from 2015 to 2017, identifying more than 157 million that matched drug-related keywords. Of these, 150,746 posts referenced drug-related lyrics. Cannabinoids, opioids, stimulants, and hallucinogens were the most cited drugs in lyrics on X. Rap and hip-hop dominated, with 91.98% of drug-related lyrics from these genres and 84.21% performed by male artists. Predictions from all 3 models, linear regression, Facebook Prophet, and NIXTLA TimeGPT-1, indicate a slight decline in the prevalence of drug-related lyrics on X over time. Conclusions: Our study revealed 2 significant findings. First, we identified a previously unexamined subset of drug-related content on X: drug lyrics, which could play a critical role in models predicting the surge in drug-related incidents. Second, we demonstrated the use of cutting-edge time-series forecasting tools, including Facebook Prophet and NIXTLA TimeGPT-1, in accurately predicting these trends. These insights contribute to our understanding of how social media shapes public behavior and sentiment toward drug use. %M 39753225 %R 10.2196/49567 %U https://formative.jmir.org/2024/1/e49567 %U https://doi.org/10.2196/49567 %U http://www.ncbi.nlm.nih.gov/pubmed/39753225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51013 %T Using a Semiautomated Procedure (CleanADHdata.R Script) to Clean Electronic Adherence Monitoring Data: Tutorial %A Bandiera,Carole %A Pasquier,Jérôme %A Locatelli,Isabella %A Schneider,Marie P %+ School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, Geneva, 1205, Switzerland, 41 223795316, marie.schneider@unige.ch %K medication adherence %K digital technology %K digital pharmacy %K electronic adherence monitoring %K data management %K data cleaning %K research methodology %K algorithms %K R %K semiautomated %K code %K coding %K computer science %K computer programming %K medications %K computer script %D 2024 %7 22.5.2024 %9 Tutorial %J JMIR Form Res %G English %X Background: Patient adherence to medications can be assessed using interactive digital health technologies such as electronic monitors (EMs). Changes in treatment regimens and deviations from EM use over time must be characterized to establish the actual level of medication adherence. Objective: We developed the computer script CleanADHdata.R to clean raw EM adherence data, and this tutorial is a guide for users. Methods: In addition to raw EM data, we collected adherence start and stop monitoring dates and identified the prescribed regimens, the expected number of EM openings per day based on the prescribed regimen, EM use deviations, and patients’ demographic data. The script formats the data longitudinally and calculates each day’s medication implementation. Results: We provided a simulated data set for 10 patients, for which 15 EMs were used over a median period of 187 (IQR 135-342) days. The median patient implementation before and after EM raw data cleaning was 83.3% (IQR 71.5%-93.9%) and 97.3% (IQR 95.8%-97.6%), respectively (Δ+14%). This difference is substantial enough to consider EM data cleaning to be capable of avoiding data misinterpretation and providing a cleaned data set for the adherence analysis in terms of implementation and persistence. Conclusions: The CleanADHdata.R script is a semiautomated procedure that increases standardization and reproducibility. This script has broader applicability within the realm of digital health, as it can be used to clean adherence data collected with diverse digital technologies. %M 38776539 %R 10.2196/51013 %U https://formative.jmir.org/2024/1/e51013 %U https://doi.org/10.2196/51013 %U http://www.ncbi.nlm.nih.gov/pubmed/38776539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54407 %T A Simple and Systematic Approach to Qualitative Data Extraction From Social Media for Novice Health Care Researchers: Tutorial %A Pretorius,Kelly %+ School of Health Sciences, St. Edward's University, 3001 South Congress Avenue, Austin, TX, 78704, United States, 1 (512) 448 8500, kpretori@stedwards.edu %K social media analysis %K data extraction %K health care research %K extraction tutorial %K Facebook extraction %K Facebook analysis %K safe sleep %K sudden unexpected infant death %K social media %K analysis %K systematic approach %K qualitative data %K data extraction %K Facebook %K health-related %K maternal perspective %K maternal perspectives %K sudden infant death syndrome %K mother %K mothers %K women %K United States %K SIDS %K SUID %K post %K posts %D 2024 %7 9.7.2024 %9 Tutorial %J JMIR Form Res %G English %X Social media analyses have become increasingly popular among health care researchers. Social media continues to grow its user base and, when analyzed, offers unique insight into health problems. The process of obtaining data for social media analyses varies greatly and involves ethical considerations. Data extraction is often facilitated by software tools, some of which are open source, while others are costly and therefore not accessible to all researchers. The use of software for data extraction is accompanied by additional challenges related to the uniqueness of social media data. Thus, this paper serves as a tutorial for a simple method of extracting social media data that is accessible to novice health care researchers and public health professionals who are interested in pursuing social media research. The discussed methods were used to extract data from Facebook for a study of maternal perspectives on sudden unexpected infant death. %M 38980712 %R 10.2196/54407 %U https://formative.jmir.org/2024/1/e54407 %U https://doi.org/10.2196/54407 %U http://www.ncbi.nlm.nih.gov/pubmed/38980712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58627 %T Best Practices for Designing and Testing Behavioral and Health Communication Interventions for Delivery in Private Facebook Groups: Tutorial %A Pagoto,Sherry %A Lueders,Natalie %A Palmer,Lindsay %A Idiong,Christie %A Bannor,Richard %A Xu,Ran %A Ingels,Spencer %+ Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States, 1 860 486 5917, sherry.pagoto@uconn.edu %K social media %K Facebook %K behavioral intervention %K health communication %K Facebook groups %D 2024 %7 4.9.2024 %9 Tutorial %J JMIR Form Res %G English %X Facebook, the most popular social media platform in the United States, is used by 239 million US adults, which represents 71% of the population. Not only do most US adults use Facebook but they also spend an average of 40 minutes per day on the platform. Due to Facebook’s reach and ease of use, it is increasingly being used as a modality for delivering behavioral and health communication interventions. Typically, a Facebook-delivered intervention involves creating a private group to deliver intervention content for participants to engage with asynchronously. In many interventions, a counselor is present to facilitate discussions and provide feedback and support. Studies of Facebook-delivered interventions have been conducted on a variety of topics, and they vary widely in terms of the intervention content used in the group, use of human counselors, group size, engagement, and other characteristics. In addition, results vary widely and may depend on how well the intervention was executed and the degree to which it elicited engagement among participants. Best practices for designing and delivering behavioral intervention content for asynchronous delivery in Facebook groups are lacking, as are best practices for engaging participants via this modality. In this tutorial, we propose best practices for the use of private Facebook groups for delivery and testing the efficacy of behavioral or health communication interventions, including converting traditional intervention content into Facebook posts; creating protocols for onboarding, counseling, engagement, and data management; designing and branding intervention content; and using engagement data to optimize engagement and outcomes. %M 39231426 %R 10.2196/58627 %U https://formative.jmir.org/2024/1/e58627 %U https://doi.org/10.2196/58627 %U http://www.ncbi.nlm.nih.gov/pubmed/39231426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62963 %T Describing the Framework for AI Tool Assessment in Mental Health and Applying It to a Generative AI Obsessive-Compulsive Disorder Platform: Tutorial %A Golden,Ashleigh %A Aboujaoude,Elias %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, United States, 1 650 498 9111, eaboujaoude@stanford.edu %K artificial intelligence %K ChatGPT %K generative artificial intelligence %K generative AI %K large language model %K chatbots %K machine learning %K digital health %K telemedicine %K psychotherapy %K obsessive-compulsive disorder %D 2024 %7 18.10.2024 %9 Tutorial %J JMIR Form Res %G English %X As artificial intelligence (AI) technologies occupy a bigger role in psychiatric and psychological care and become the object of increased research attention, industry investment, and public scrutiny, tools for evaluating their clinical, ethical, and user-centricity standards have become essential. In this paper, we first review the history of rating systems used to evaluate AI mental health interventions. We then describe the recently introduced Framework for AI Tool Assessment in Mental Health (FAITA-Mental Health), whose scoring system allows users to grade AI mental health platforms on key domains, including credibility, user experience, crisis management, user agency, health equity, and transparency. Finally, we demonstrate the use of FAITA-Mental Health scale by systematically applying it to OCD Coach, a generative AI tool readily available on the ChatGPT store and designed to help manage the symptoms of obsessive-compulsive disorder. The results offer insights into the utility and limitations of FAITA-Mental Health when applied to “real-world” generative AI platforms in the mental health space, suggesting that the framework effectively identifies key strengths and gaps in AI-driven mental health tools, particularly in areas such as credibility, user experience, and acute crisis management. The results also highlight the need for stringent standards to guide AI integration into mental health care in a manner that is not only effective but also safe and protective of the users’ rights and welfare. %M 39423001 %R 10.2196/62963 %U https://formative.jmir.org/2024/1/e62963 %U https://doi.org/10.2196/62963 %U http://www.ncbi.nlm.nih.gov/pubmed/39423001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54632 %T The Relationship Between Changes in Mindfulness and Subsequent Changes in Well-Being Following Psychedelic Use: Prospective Cohort Study %A Jones,Grant %A Herrmann,Felipe %A Bear,Adam %A Carhart-Harris,Robin %A Kettner,Hannes %+ Harvard University, 32 Mill St Box 78, Cambridge, MA, 02138, United States, gmj005@g.harvard.edu %K psychedelics %K mindfulness %K observational %K web-based survey %K psychedelic %K meditation %K mental health %K anxiety %K depression %K survey %K surveys %K drug %K drugs %K substance use %K hallucinogen %K hallucinogens %D 2024 %7 4.3.2024 %9 Research Letter %J JMIR Form Res %G English %X This study demonstrates that changes in mindfulness predict subsequent changes in well-being in a data set including individuals who recently engaged in psychedelic use. %M 38437005 %R 10.2196/54632 %U https://formative.jmir.org/2024/1/e54632 %U https://doi.org/10.2196/54632 %U http://www.ncbi.nlm.nih.gov/pubmed/38437005 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51249 %T Smartwatch Versus Routine Tremor Documentation: Descriptive Comparison %A van Alen,Catharina Marie %A Brenner,Alexander %A Warnecke,Tobias %A Varghese,Julian %+ Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Bldg A11, Münster, 48149, Germany, 49 0251 8354 714, julian.varghese@uni-muenster.de %K Parkinson disease %K tremor %K smart wearables %K smartwatch %K mobile apps %K movement disorders %K tremor documentation %K tremor occurrence %K tremor score %D 2024 %7 20.3.2024 %9 Research Letter %J JMIR Form Res %G English %X We addressed the limitations of subjective clinical tremor assessment by comparing routine neurological evaluation with a Tremor Occurrence Score derived from smartwatch sensor data, among 142 participants with Parkinson disease and 77 healthy controls. Our findings highlight the potential of smartwatches for automated tremor detection as a valuable addition to conventional assessments, applicable in both clinical and home settings. %M 38506919 %R 10.2196/51249 %U https://formative.jmir.org/2024/1/e51249 %U https://doi.org/10.2196/51249 %U http://www.ncbi.nlm.nih.gov/pubmed/38506919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55202 %T A Health Information Technology Protocol to Enhance Colorectal Cancer Screening %A Baus,Adam %A Boatman,Dannell D %A Calkins,Andrea %A Pollard,Cecil %A Conn,Mary Ellen %A Subramanian,Sujha %A Kennedy-Rea,Stephenie %+ Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, 64 Medical Center Drive, PO Box 9190, Morgantown, WV, 26506, United States, 1 304 293 1083, abaus@hsc.wvu.edu %K electronic health record %K EHR %K colorectal cancer screening %K health information technology %K cancer %K colorectal cancer %D 2024 %7 19.4.2024 %9 Research Letter %J JMIR Form Res %G English %X This study addresses barriers to electronic health records–based colorectal cancer screening and follow-up in primary care through the development and implementation of a health information technology protocol. %M 38640474 %R 10.2196/55202 %U https://formative.jmir.org/2024/1/e55202 %U https://doi.org/10.2196/55202 %U http://www.ncbi.nlm.nih.gov/pubmed/38640474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56165 %T Clinical Accuracy, Relevance, Clarity, and Emotional Sensitivity of Large Language Models to Surgical Patient Questions: Cross-Sectional Study %A Dagli,Mert Marcel %A Oettl,Felix Conrad %A Gujral,Jaskeerat %A Malhotra,Kashish %A Ghenbot,Yohannes %A Yoon,Jang W %A Ozturk,Ali K %A Welch,William C %+ Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, 801 Spruce Street, Philadelphia, PA, 19106, United States, 1 2672306493, marcel.dagli@pennmedicine.upenn.edu %K artificial intelligence %K AI %K natural language processing %K NLP %K large language model %K LLM %K generative AI %K cross-sectional study %K health information %K patient education %K clinical accuracy %K emotional sensitivity %K surgical patient %K surgery %K surgical %D 2024 %7 7.6.2024 %9 Research Letter %J JMIR Form Res %G English %X This cross-sectional study evaluates the clinical accuracy, relevance, clarity, and emotional sensitivity of responses to inquiries from patients undergoing surgery provided by large language models (LLMs), highlighting their potential as adjunct tools in patient communication and education. Our findings demonstrated high performance of LLMs across accuracy, relevance, clarity, and emotional sensitivity, with Anthropic’s Claude 2 outperforming OpenAI’s ChatGPT and Google’s Bard, suggesting LLMs’ potential to serve as complementary tools for enhanced information delivery and patient-surgeon interaction. %M 38848553 %R 10.2196/56165 %U https://formative.jmir.org/2024/1/e56165 %U https://doi.org/10.2196/56165 %U http://www.ncbi.nlm.nih.gov/pubmed/38848553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58263 %T Digitally Enabled Peer Support and Social Health Platform for Vulnerable Adults With Loneliness and Symptomatic Mental Illness: Cohort Analysis %A Bravata,Dena %A Russell,Daniel %A Fellows,Annette %A Goldman,Ron %A Pace,Elizabeth %+ Center for Primary Care and Outcomes Research, Stanford University, 1840 Lexington Av, San Mateo, CA, 94402, United States, 1 4157065829, dbravata@gmail.com %K peer support %K social isolation %K loneliness %K depression %K depressive %K mental health %K anxiety %K quality of life %K isolation %K isolated %K online support %K digital health %K vulnerable %K race %K racial ethnic %K ethnicity %K gender %K socioeconomic %K demographic %D 2024 %7 24.7.2024 %9 Research Letter %J JMIR Form Res %G English %X This study prospectively evaluated the effects of digitally enabled peer support on mental health outcomes and estimated medical cost reductions among vulnerable adults with symptomatic depression, anxiety, and significant loneliness to address the mental health crisis in the United States. %M 38941568 %R 10.2196/58263 %U https://formative.jmir.org/2024/1/e58263 %U https://doi.org/10.2196/58263 %U http://www.ncbi.nlm.nih.gov/pubmed/38941568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55577 %T Benchmarking Large Language Models for Cervical Spondylosis %A Zhang,Boyan %A Du,Yueqi %A Duan,Wanru %A Chen,Zan %+ Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100000, China, 86 13911712120, chenzan66@163.com %K cervical spondylosis %K large language model %K LLM %K patient %K ChatGPT %D 2024 %7 5.8.2024 %9 Research Letter %J JMIR Form Res %G English %X Cervical spondylosis is the most common degenerative spinal disorder in modern societies. Patients require a great deal of medical knowledge, and large language models (LLMs) offer patients a novel and convenient tool for accessing medical advice. In this study, we collected the most frequently asked questions by patients with cervical spondylosis in clinical work and internet consultations. The accuracy of the answers provided by LLMs was evaluated and graded by 3 experienced spinal surgeons. Comparative analysis of responses showed that all LLMs could provide satisfactory results, and that among them, GPT-4 had the highest accuracy rate. Variation across each section in all LLMs revealed their ability boundaries and the development direction of artificial intelligence. %M 39102674 %R 10.2196/55577 %U https://formative.jmir.org/2024/1/e55577 %U https://doi.org/10.2196/55577 %U http://www.ncbi.nlm.nih.gov/pubmed/39102674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63858 %T Supporting Weight Loss Among Parents of Children With a Disability: Lessons Learned From a Single-Arm Pilot Study %A Wisniewski,Payson %A Depuy,Julia %A Kim,Cassandra %A Garrison,Olivia %A Jerome,Gerald J %+ Department of Kinesiology, Towson University, 8000 York Road, Towson, MD, 21252, United States, 1 4107045283, gjerome@towson.edu %K weight loss %K obesity %K disability %K parent %K family %K child %K weight loss intervention %D 2024 %7 7.10.2024 %9 Research Letter %J JMIR Form Res %G English %X This study assessed weight change in the parents of children with disabilities following a 12-week, remotely delivered weight loss program focused on lifestyle modifications and found a significant median weight reduction of 3 kg from baseline to week 12. %M 39374058 %R 10.2196/63858 %U https://formative.jmir.org/2024/1/e63858 %U https://doi.org/10.2196/63858 %U http://www.ncbi.nlm.nih.gov/pubmed/39374058 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64085 %T Understanding Patient Portal Uses and Needs: Cross-Sectional Study in a State Fair Setting %A Rajamani,Sripriya %A Austin,Robin %A Richwine,Chelsea %A Britt-Lalich,Malin %A Thakur,Madhur %A Odowa,Yasmin %A Jantraporn,Ratchada %A Marquard,Jenna %+ University of Minnesota, 6-174 Weaver Densford 308 Harvard St SE, Minneapolis, MN, 55455, United States, 1 651 278 7426, sripriya@umn.edu %K patient portals %K patient engagement %K health information technology %K consumer health informatics %K health informatics %K use %K online access %K medical records %K data access %K functionality %D 2024 %7 11.10.2024 %9 Research Letter %J JMIR Form Res %G English %X This study identified 22 features that are used and the needs for desired features/data in patient portals that enable online access to medical records. Data collected at a Midwestern state fair indicates that while most participants used patient portals, use and desirability of specific features varied widely. Identified needs for enhanced data access, portal functionality, and usability can be used to inform effective patient portal design. %M 39393063 %R 10.2196/64085 %U https://formative.jmir.org/2024/1/e64085 %U https://doi.org/10.2196/64085 %U http://www.ncbi.nlm.nih.gov/pubmed/39393063 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55999 %T Examining Passively Collected Smartphone-Based Data in the Days Prior to Psychiatric Hospitalization for a Suicidal Crisis: Comparative Case Analysis %A Jacobucci,Ross %A Ammerman,Brooke %A Ram,Nilam %+ Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN, 46556, United States, 1 574 631 6650, rjacobuc@nd.edu %K screenomics %K digital phenotyping %K passive assessment %K intensive time sampling %K suicide risk %K suicidal behaviors %K risk detection %K Comparative Analysis %K suicide %K suicidal %K risk %K risks %K behavior %K behaviors %K detection %K prediction %K Smartphone-Based %K screenomic %K case review %K participant %K participants %K smartphone %K smartphones %K suicidal ideation %D 2024 %7 20.3.2024 %9 Case Report %J JMIR Form Res %G English %X Background: Digital phenotyping has seen a broad increase in application across clinical research; however, little research has implemented passive assessment approaches for suicide risk detection. There is a significant potential for a novel form of digital phenotyping, termed screenomics, which captures smartphone activity via screenshots. Objective: This paper focuses on a comprehensive case review of 2 participants who reported past 1-month active suicidal ideation, detailing their passive (ie, obtained via screenomics screenshot capture) and active (ie, obtained via ecological momentary assessment [EMA]) risk profiles that culminated in suicidal crises and subsequent psychiatric hospitalizations. Through this analysis, we shed light on the timescale of risk processes as they unfold before hospitalization, as well as introduce the novel application of screenomics within the field of suicide research. Methods: To underscore the potential benefits of screenomics in comprehending suicide risk, the analysis concentrates on a specific type of data gleaned from screenshots—text—captured prior to hospitalization, alongside self-reported EMA responses. Following a comprehensive baseline assessment, participants completed an intensive time sampling period. During this period, screenshots were collected every 5 seconds while one’s phone was in use for 35 days, and EMA data were collected 6 times a day for 28 days. In our analysis, we focus on the following: suicide-related content (obtained via screenshots and EMA), risk factors theoretically and empirically relevant to suicide risk (obtained via screenshots and EMA), and social content (obtained via screenshots). Results: Our analysis revealed several key findings. First, there was a notable decrease in EMA compliance during suicidal crises, with both participants completing fewer EMAs in the days prior to hospitalization. This contrasted with an overall increase in phone usage leading up to hospitalization, which was particularly marked by heightened social use. Screenomics also captured prominent precipitating factors in each instance of suicidal crisis that were not well detected via self-report, specifically physical pain and loneliness. Conclusions: Our preliminary findings underscore the potential of passively collected data in understanding and predicting suicidal crises. The vast number of screenshots from each participant offers a granular look into their daily digital interactions, shedding light on novel risks not captured via self-report alone. When combined with EMA assessments, screenomics provides a more comprehensive view of an individual’s psychological processes in the time leading up to a suicidal crisis. %M 38506916 %R 10.2196/55999 %U https://formative.jmir.org/2024/1/e55999 %U https://doi.org/10.2196/55999 %U http://www.ncbi.nlm.nih.gov/pubmed/38506916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55408 %T Assessing the Impact of the Mindfulness-Based Body Scan Technique on Sleep Quality in Multiple Sclerosis Using Objective and Subjective Assessment Tools: Single-Case Study %A Iliakis,Ioannis %A Anagnostouli,Maria %A Chrousos,George %+ Medical School, University of Athens, National and Kapodistrian University of Athens, Omiriou 22, Athens, 16122, Greece, 30 6948531978, kiko_sympa@hotmail.com %K multiple sclerosis %K MS %K sleep problems %K electronic portable device %K EPD %K mindfulness-based body scan technique %K sleep quality %K neurodegenerative disease %K quality of life %K anxiety %K pain %K nocturia %K assessment tools %K single-case study %K effectiveness %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system, often leading to poor sleep quality and diminished quality of life (QoL) for affected patients. Sleep disturbances in MS do not always correlate linearly with other symptoms such as anxiety, depression, fatigue, or pain. Various approaches, including stress reduction techniques such as mindfulness-based interventions, have been proposed to manage MS-related sleep issues. Objective: The aim of this study was to evaluate the effects of the mindfulness-based body scan technique on sleep quality and QoL in patients with MS using both subjective (questionnaires) and objective (electronic portable device) measures. Methods: A single-case study was performed involving a 31-year-old woman diagnosed with relapsing-remitting MS. The patient practiced the mindfulness-based body scan technique daily before bedtime and outcomes were compared to measures evaluated at baseline. Results: The mindfulness-based body scan intervention demonstrated positive effects on both sleep quality and overall QoL. Biometric data revealed a notable dissociation between daily stress levels and sleep quality during the intervention period. Although self-report instruments indicated significant improvement, potential biases were noted. Conclusions: While this study is limited to a single patient, the promising outcomes suggest the need for further investigation on a larger scale. These findings underscore the potential benefits of the mindfulness-based body scan technique in managing sleep disturbances and enhancing QoL among patients with MS. %M 39052996 %R 10.2196/55408 %U https://formative.jmir.org/2024/1/e55408 %U https://doi.org/10.2196/55408 %U http://www.ncbi.nlm.nih.gov/pubmed/39052996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57588 %T Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study %A Gehringer,James E %A Woodruff Jameson,Anne %A Boyer,Hailey %A Konieczny,Jennifer %A Thomas,Ryan %A Pierce III,James %A Cunha,Andrea B %A Willett,Sandra %+ Virtual Reality Laboratory, Munroe-Meyer Insitute, University of Nebraska Medical Center, 985450 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025592562, james.gehringer@unmc.edu %K cerebral palsy %K HABIT %K home intervention %K virtual reality %K rehabilitation %K VR %K case study %K hand %K hands %K arm %K arms %K intensive training %K feasibility %K game %K games %K gaming %K hand arm bimanual intensive training %K motor %K movement %K home setting %K home-based %K child %K children %K male %K males %K men %K quasi-experimental %K parent %K parents %K intervention %K interventions %D 2024 %7 6.9.2024 %9 Case Report %J JMIR Form Res %G English %X This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting. %M 39241226 %R 10.2196/57588 %U https://formative.jmir.org/2024/1/e57588 %U https://doi.org/10.2196/57588 %U http://www.ncbi.nlm.nih.gov/pubmed/39241226 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56598 %T High-Frequency Cognitive Control Training for Depression: Case Report %A Vander Zwalmen,Yannick %A Hoorelbeke,Kristof %A Demeester,David %A Koster,Ernst H W %+ Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 92649107, y.vander.zwalmen@ugent.be %K cognitive control training %K CCT %K cognitive function %K depression %K recurrence %K relapse %K prevention %K case report %K working memory %K memory training %K task performance %K digital health %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive control training (CCT) has gained attention in recent years as a preventative intervention in the context of major depressive disorder. To date, uncertainty exists around the working mechanisms of CCT and how its effects unfold overtime. Objective: This study aimed to examine cognitive and affective transfer effects following an unusually high number of training sessions. Methods: This case report presents data of a participant completing a large amount of training sessions (n=55) over the course of 1 year in 2 training phases: 10 initial sessions, followed by 45 additional sessions. Reliable change indices were calculated for several self-report questionnaires, measuring cognitive and affective functioning. Results: Cognitive task performance suggests improved cognitive functioning after training (accuracy scores increased from 43/181, 24% at baseline to 110/181, 61% shortly after training), which was maintained at follow-up (accuracy scores around 50%). Reliable change indices suggest a decrease in depressive symptoms (Beck Depression Inventory-II score decreased from 23 at baseline to 3 following initial training). Similarly, burnout symptoms following CCT showed a similar decrease. Maladaptive emotion regulation strategies displayed high variability, decreasing after periods of training but increasing when no training was performed. However, no changes in repetitive negative thinking were observed. Thematic analysis from an in-depth interview focusing on CCT adherence and user experience pointed to the importance of independency and accessibility of CCT in perceived agency, as well as the need for clear feedback mechanisms following training. Conclusions: Training task performance indicates further increases in performance beyond typical amounts of training sessions (10-20 sessions), hinting that more sessions could be beneficial for continued improvement in cognitive functioning. In line with previous research, CCT decreased depressive symptomatology. However, its effects on emotion regulation remain unclear. Further mechanistic studies into the temporal unfolding of CCT effects are necessary to investigate potential working mechanisms. Trial Registration: ClinicalTrials.gov NCT05166798; https://clinicaltrials.gov/study/NCT05166798 %M 39612206 %R 10.2196/56598 %U https://formative.jmir.org/2024/1/e56598 %U https://doi.org/10.2196/56598 %U http://www.ncbi.nlm.nih.gov/pubmed/39612206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52583 %T Tailoring of Health-Promotion Video Messaging for Reproductive-Aged Women at Risk for Developing Cardiometabolic Disease: Qualitative Focus-Groups Study %A Kent-Marvick,Jacqueline %A Gibson,Bryan %A Bristol,Alycia A %A St Clair,Stephanie %A Simonsen,Sara E %+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, United States, 1 4356686932, jacqueline.kent-marvick@utah.edu %K cardiometabolic disease %K type 2 diabetes mellitus %K gestational diabetes mellitus %K hypertensive disorder of pregnancy %K prediabetes %K obesity %K women’s health %K lifestyle change %K health promotion technology %K qualitative research %D 2024 %7 5.3.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Targeting reproductive-aged women at high risk for type 2 diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman’s experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk of developing T2D by nearly 60%. However, only 0.4% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50% less likely to participate than older women. In prior work, our team developed a mobile 360° video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women. Objective: This study aims to obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360° video designed to promote enrollment in the DPP, and to gather suggestions about tailoring video messages to reproductive-aged women. Methods: Focus groups and a qualitative descriptive approach were used. Women with at least 1 previous pregnancy, aged 18 to 40 years, participated in one of three focus groups stratified by the following health risks: (1) a history of GDM or a hypertensive disorder of pregnancy, (2) a diagnosis of prediabetes, or (3) a BMI classified as obese. Focus-group questions addressed several topics; this report shared findings regarding video feedback. The 3 focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes. Results: The main themes identified were positive feedback, negative feedback, centering motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for health-behavior change, all participants agreed that design changes could improve the video’s motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women’s difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health behavior change. Women suggested using storytelling, both to describe how complications experienced during pregnancy impact long-term health and to motivate health behavior change. Conclusions: Reproductive-aged women require tailored lifestyle-change messaging that addresses barriers commonly encountered by this population (eg, parenting or work responsibilities). Moreover, messaging should prioritize a positive tone that harnesses storytelling and human connection while offering realistic solutions. %M 38441920 %R 10.2196/52583 %U https://formative.jmir.org/2024/1/e52583 %U https://doi.org/10.2196/52583 %U http://www.ncbi.nlm.nih.gov/pubmed/38441920 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43022 %T Using a Smartphone-Based Chatbot for Postoperative Care After Intravitreal Injection During the COVID-19 Pandemic: Retrospective Cohort Study %A Wu,Pei-Chang %A Chiang,Wei-Yu %A Lo,Jung %A Lee,Jong-Jer %A Chen,Yung-Jen %A Kuo,Hsi-Kung %A Chiau,Jie-Shin %A Hsu,Shu-Hui %A Chen,Yi-Hao %+ Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, 886 77317123 ext 2801, kaneyhc@gmail.com %K smartphone chatbot %K postoperative care %K intravitreal injection %K age-related macular degeneration %K self-report, endophthalmitis %K COVID-19 %D 2024 %7 2.8.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic period, it was difficult to carry out regular and scheduled follow-up of patients in the outpatient department, especially during lockdown periods. However, early detection of initial infection or other serious conditions is vital for patients after ocular surgery, such as intravitreal injection (IVI) for age-related macular degeneration (AMD). Objective: We evaluated the use of a smartphone-based postoperative care chatbot system (PCCS) with an instant bidirectional feedback system for patients to self-report postoperative symptoms and signs. Methods: During the COVID-19 level 3 epidemic alert in July 2021 in Taiwan, the PCCS alerted the patients to report and grade 6 ocular symptoms and signs associated with ocular inflammation or retinal detachment. Patients used the PCCS for 7 days post surgery to assess their symptoms and signs each day after receiving an alert. Data were automatically collected using a cloud computer system, including symptom grades and messages sent to medical staff for further medical assistance. A user satisfaction questionnaire was administered to the patients on the seventh day post surgery. Results: In total, 185 patients participated in this study. There were 26 (3.03%) reports of symptom grade deterioration (including increased blurred vision, eye swelling, nausea, and floaters or flashes) from 12 (6.5%) patients. We found no difference in the gender of patients who received an early medical consultation. One case of endophthalmitis was reported, wherein an improvement was observed after prompt administration of IVI antibiotics twice. Overall, 87% (n=185) of patients were satisfied or very satisfied with communicating their symptoms instantly through the app; they were willing to use it again and believed that it could improve the quality of care. Seven of the 185 (3.8%) patients had an earlier medical consultation and 1 (0.5%) had endophthalmitis. Conclusions: The chatbot system, designed for self-reporting postoperative symptoms and providing instant bidirectional feedback on smartphones, could be beneficial for enhancing the quality of care in early medical consultations without gender differences among patients with AMD receiving IVI, and achieved satisfactory responses from patients. %M 38643063 %R 10.2196/43022 %U https://formative.jmir.org/2024/1/e43022 %U https://doi.org/10.2196/43022 %U http://www.ncbi.nlm.nih.gov/pubmed/38643063 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56327 %T Impact of COVID-19 on Characteristics and Funding of U.S. Healthcare Startups: Retrospective Review %A Ganeshan,Smitha %A Goldstein,Joshua %A Sohn,Young-Jin %A Pollack,Amie %A Phillips,Russell S %A Rotenstein,Lisa %+ Division of Hospital Medicine, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94117, United States, 1 4155141000, smitha.ganeshan@ucsf.edu %K artificial intelligence %K venture capital %K COVID-19 %K health care startup %K health care %K AI %K retrospective study %K telehealth %K telemedicine %K pandemic %K patients %K digital health %K coronavirus %D 2024 %7 27.8.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: The rise of telehealth and telemedicine during the pandemic allowed patients and providers to develop a sense of comfort with telehealth, which may have increased the demand for virtual-first care solutions with spillover effects into venture capital funding. Objective: We aimed to understand the size and type of digital health investments occurring in the prepandemic and pandemic periods. Methods: We examined health care companies founded from March 14, 2019, to March 14, 2020 (prepandemic) versus those founded from March 15, 2020, to March 14, 2022, after pandemic onset. Data were obtained from Crunchbase, a publicly available database that catalogs information about venture capital investments for companies. We also compared companies founded prepandemic to those founded after the first year of the pandemic (pandemic steady-state). We performed a Wilcoxon rank sum test to compare median funding amounts. We compared the 2 groups of companies according to the type of funding round raised, geography, health care subcategory, total amount of funding per year since founding, and number of founders. Results: There were 2714 and 2218 companies founded prepandemic and during the pandemic, respectively. The companies were similarly distributed across geographies in the prepandemic and pandemic periods (P=.46) with no significant differences in the number of founders (P=.32). There was a significant difference in total funding per year since founding between prepandemic and pandemic companies (US $10.8 million vs US $20.9 million; P<.001). The distribution of funding rounds differed significantly for companies founded in prepandemic and pandemic periods (P<.001). On excluding data from the first year of the pandemic, there were 581 companies founded in the pandemic steady-state period from March 14, 2021, to March 14, 2022. Companies founded prepandemic had a significantly greater mean number of founders than those founded during the pandemic (P=.02). There was no significant difference in total funding per year since founding between prepandemic and steady-state pandemic companies (US $10.8 million vs US $14.4 million; P=.34). The most common types of health care companies included wellness, biotech/biopharma, and software companies. Distributions of companies across health care subcategories were not significantly different before and during the pandemic. However, significant differences were identified when data from the first year of the pandemic were excluded (P<.001). Companies founded during the steady-state pandemic period were significantly more likely to be classified as artificial intelligence (7.3% vs 4.7%; P=.005), software (17.3% vs 12.7%; P=.002), and insurance (3.3% vs 1.7%; P=.003), and were significantly less likely to be classified as health care diagnostics (2.4% vs 5.1%; P=.002). Conclusions: We demonstrate no significant changes in the types of health care companies founded before versus during the pandemic, although significant differences emerge when comparing prepandemic companies to those founded after the first year of the pandemic. %M 39190909 %R 10.2196/56327 %U https://formative.jmir.org/2024/1/e56327 %U https://doi.org/10.2196/56327 %U http://www.ncbi.nlm.nih.gov/pubmed/39190909 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53510 %T Occurrence of Stigmatizing Documentation Among Hospital Medicine Encounters With Opioid-Related Diagnosis Codes: Cohort Study %A Bradford,William S %A Bratches,Reed W R %A Porras,Hollie %A Chen,David R %A Gagnon,Kelly W %A Ascher,Simon B %+ Division of Infectious Diseases, University of Alabama Birmingham, Boshell Building 8th floor, 1808 7th Ave S, Birmingham, AL, 35233, United States, 1 205 934 8610, wsbradford@uabmc.edu %K stigmatizing language %K OUD %K opioid use disorder %K people with opioid use disorder (POUD) %K people who inject drugs (PWID) %K people who use drugs (PWUD) %K drug use %D 2024 %7 24.10.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Physician use of stigmatizing language in the clinical documentation of hospitalized adults with opioid use is common. However, patient factors associated with stigmatizing language in this setting remain poorly characterized. Objective: This study aimed to determine whether specific demographic factors and clinical outcomes are associated with the presence of stigmatizing language by physicians in the clinical documentation of encounters with opioid-related ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes. Methods: Hospital encounters with one or more associated opioid-related ICD-10 admission diagnoses on the hospital medicine service during the 2020 calendar year were analyzed for the presence of stigmatizing language in history and physical and discharge summaries. Multivariable adjusted logistic regression models were used to determine associations of age, race, gender, medication for addiction treatment use, against medical advice discharge, homelessness, comorbid polysubstance use, comorbid psychiatric disorder, comorbid chronic pain, cost, and 30-day readmission with the presence of stigmatizing language. Results: A total of 221 encounters were identified, of which 64 (29%) encounters had stigmatizing language present in physician documentation. Most stigmatizing language was due to use of “substance abuse” rather than the preferred term “substance use” (63/66 instances). Polysubstance use and homelessness were independently associated with the presence of stigmatizing language (adjusted odds ratio [aOR] 7.83; 95% CI 3.42-19.24 and aOR 2.44; 95% CI 1.03-5.90) when controlling for chronic pain and other covariates. Conclusions: Among hospital medicine encounters with an opioid-related diagnosis, stigmatizing language by physicians in clinical documentation was common and independently associated with comorbid polysubstance use and homelessness. %M 39447164 %R 10.2196/53510 %U https://formative.jmir.org/2024/1/e53510 %U https://doi.org/10.2196/53510 %U http://www.ncbi.nlm.nih.gov/pubmed/39447164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59794 %T Ethics of the Use of Social Media as Training Data for AI Models Used for Digital Phenotyping %A Jaiswal,Aditi %A Shah,Aekta %A Harjadi,Christopher %A Windgassen,Erik %A Washington,Peter %+ Department of Information and Computer Sciences, University of Hawaii at Manoa, 1680 East-West Road, Honolulu, HI, 96822, United States, 1 8088296359, pyw@hawaii.edu %K social media analytics %K machine learning %K ethics %K research ethics %K consent %K scientific integrity %D 2024 %7 17.7.2024 %9 Commentary %J JMIR Form Res %G English %X Digital phenotyping, or personal sensing, is a field of research that seeks to quantify traits and characteristics of people using digital technologies, usually for health care purposes. In this commentary, we discuss emerging ethical issues regarding the use of social media as training data for artificial intelligence (AI) models used for digital phenotyping. In particular, we describe the ethical need for explicit consent from social media users, particularly in cases where sensitive information such as labels related to neurodiversity are scraped. We also advocate for the use of community-based participatory design principles when developing health care AI models using social media data. %M 39018549 %R 10.2196/59794 %U https://formative.jmir.org/2024/1/e59794 %U https://doi.org/10.2196/59794 %U http://www.ncbi.nlm.nih.gov/pubmed/39018549