%0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e69873 %T A Novel Just-in-Time Intervention for Promoting Safer Drinking Among College Students: App Testing Across 2 Independent Pre-Post Trials %A Chow,Philip I %A Smith,Jessica %A Saini,Ravjot %A Frederick,Christina %A Clark,Connie %A Ritterband,Maxwell %A Halbert,Jennifer P %A Cheney,Kathryn %A Daniel,Katharine E %A Ingersoll,Karen S %K alcohol %K college students %K smartphone intervention %K binge drinking %K safe drinking %D 2025 %7 10.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Binge drinking, which is linked to various immediate and long-term negative outcomes, is highly prevalent among US college students. Behavioral interventions delivered via mobile phones have a strong potential to help decrease the hazardous effects of binge drinking by promoting safer drinking behaviors. Objective: This study aims to evaluate the preliminary efficacy of bhoos, a novel smartphone app designed to promote safer drinking behaviors among US college students. The app offers on-demand educational content about safer alcohol use, provides dynamic feedback as users log their alcohol consumption, and includes an interactive drink tracker that estimates blood alcohol content in real time. Methods: The bhoos app was tested in 2 independent pre-post studies each lasting 4 weeks, among US college students aged 18‐35 years. The primary outcome in both trials was students’ self-reported confidence in using protective behavioral strategies related to drinking, with self-reported frequency of alcohol consumption over the past month examined as a secondary outcome. Results: In study 1, bhoos was associated with increased confidence in using protective behavioral strategies. Students also endorsed the high usability of the app and reported acceptable levels of engagement. Study 2 replicated findings of increased confidence in using protective behavioral strategies, and demonstrated a reduction in the self-reported frequency of alcohol consumption. Conclusions: Bhoos is a personalized, accessible, and highly scalable digital intervention with a strong potential to effectively address alcohol-related behaviors on college campuses. %R 10.2196/69873 %U https://humanfactors.jmir.org/2025/1/e69873 %U https://doi.org/10.2196/69873 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e59405 %T Development of Digital Strategies for Reducing Sedentary Behavior in a Hybrid Office Environment: Modified Delphi Study %A Parés-Salomón,Iris %A Vaqué-Crusellas,Cristina %A Coffey,Alan %A Loef,Bette %A Proper,Karin I %A Señé-Mir,Anna M %A Puig-Ribera,Anna %A Dowd,Kieran P %A Bort-Roig,Judit %+ Faculty of Health Sciences and Welfare, University of Vic – Central University of Catalonia (UVic-UCC), C Sagrada Família, 7, Vic, 08500, Spain, 34 938 815 50, iris.pares@uvic.cat %K sedentary behavior %K office work %K home office %K hybrid work %K technology %K Delphi %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hybrid work is the new modus operandi for many office workers, leading to more sedentary behavior than office-only working. Given the potential of digital interventions to reduce sedentary behavior and the current lack of studies evaluating these interventions for home office settings, it is crucial to develop digital interventions for such contexts involving all stakeholders. Objective: This study aimed to reach expert consensus on the most feasible work strategies and the most usable digital elements as a delivery method to reduce sedentary behavior in the home office context. Methods: A modified Delphi study including 3 survey rounds and focus groups was conducted to achieve consensus. The first Delphi round consisted of two 9-point Likert scales for assessing the feasibility of work strategies and the potential usefulness of digital elements to deliver the strategies. The work strategies were identified and selected from a scoping review, a systematic review, and 2 qualitative studies involving managers and employees. The median and mean absolute deviation from the median for each item are reported. The second round involved 2 ranking lists with the highly feasible strategies and highly useful digital elements based on round 1 responses to order the list according to experts’ preferences. The weighted average ranking for each item was calculated to determine the most highly ranked work strategies and digital elements. The third round encompassed work strategies with a weight above the median from round 2 to be matched with the most useful digital elements to implement each strategy. In total, 4 focus groups were additionally conducted to gain a greater understanding of the findings from the Delphi phase. Focus groups were analyzed using the principles of reflexive thematic analysis. Results: A total of 27 international experts in the field of occupational health participated in the first round, with response rates of 86% (25/29) and 66% (19/29) in rounds 2 and 3, respectively, and 52% (15/29) in the focus groups. Consensus was achieved on 18 work strategies and 16 digital elements. Feedback on activity progress and goal achievement; creating an action plan; and standing while reading, answering phone calls, or conducting videoconferences were the most feasible work strategies, whereas wrist-based activity trackers, a combination of media, and app interfaces in smartphones were the most useful digital elements. Moreover, experts highlighted the requirement of combining multiple levels of strategies, such as social support, physical environment, and individual strategies, to enhance their implementation and effectiveness in reducing sedentary behavior when working from home. Conclusions: This expert consensus provided a foundation for developing digital interventions for sedentary behavior in home office workers. Ongoing interventions should enable the evaluation of feasible strategies delivered via useful digital elements in home office or hybrid contexts. %M 40198908 %R 10.2196/59405 %U https://humanfactors.jmir.org/2025/1/e59405 %U https://doi.org/10.2196/59405 %U http://www.ncbi.nlm.nih.gov/pubmed/40198908 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65785 %T Comparison of an AI Chatbot With a Nurse Hotline in Reducing Anxiety and Depression Levels in the General Population: Pilot Randomized Controlled Trial %A Chen,Chen %A Lam,Kok Tai %A Yip,Ka Man %A So,Hung Kwan %A Lum,Terry Yat Sang %A Wong,Ian Chi Kei %A Yam,Jason C %A Chui,Celine Sze Ling %A Ip,Patrick %K AI chatbot %K anxiety %K depression %K effectiveness %K artificial intelligence %D 2025 %7 6.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI) chatbots have been customized to deliver on-demand support for people with mental health problems. However, the effectiveness of AI chatbots in tackling mental health problems among the general public in Hong Kong remains unclear. Objective: This study aimed to develop a local AI chatbot and compare the effectiveness of the AI chatbot with a conventional nurse hotline in reducing the level of anxiety and depression among individuals in Hong Kong. Methods: This study was a pilot randomized controlled trial conducted from October 2022 to March 2023, involving 124 participants allocated randomly (1:1 ratio) into the AI chatbot and nurse hotline groups. Among these, 62 participants in the AI chatbot group and 41 in the nurse hotline group completed both the pre- and postquestionnaires, including the GAD-7 (Generalized Anxiety Disorder Scale-7), PHQ-9 (Patient Health Questionnaire-9), and satisfaction questionnaire. Comparisons were conducted using independent and paired sample t tests (2-tailed) and the χ2 test to analyze changes in anxiety and depression levels. Results: Compared to the mean baseline score of 5.13 (SD 4.623), the mean postdepression score in the chatbot group was 3.68 (SD 4.397), which was significantly lower (P=.008). Similarly, a reduced anxiety score was also observed after the chatbot test (pre vs post: mean 4.74, SD 4.742 vs mean 3.4, SD 3.748; P=.005), respectively. No significant differences were found in the pre-post scores for either depression (P=.38) or anxiety (P=.19). No statistically significant difference was observed in service satisfaction between the two platforms (P=.32). Conclusions: The AI chatbot was comparable to the traditional nurse hotline in alleviating participants’ anxiety and depression after responding to inquiries. Moreover, the AI chatbot has shown potential in alleviating short-term anxiety and depression compared to the nurse hotline. While the AI chatbot presents a promising solution for offering accessible strategies to the public, more extensive randomized controlled studies are necessary to further validate its effectiveness. Trial Registration: ClinicalTrials.gov NCT06621134; https://clinicaltrials.gov/study/NCT06621134 %R 10.2196/65785 %U https://humanfactors.jmir.org/2025/1/e65785 %U https://doi.org/10.2196/65785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64303 %T Culturally Adapted Guided Internet-Based Cognitive Behavioral Therapy for Hong Kong People With Depressive Symptoms: Randomized Controlled Trial %A Pan,Jia-Yan %A Rafi,Jonas %+ Department of Social Work, Hong Kong Baptist University, AAB1026, 10/F, Academic and Administration Building, 15 Baptist University Road, Baptist University Road Campus, Hong Kong Baptist University, Kowloon Tong, KLN, Hong Kong, China (Hong Kong), 852 34116415, jiayan@hkbu.edu.hk %K Internet-based cognitive behavioral therapy %K depression %K Chinese %K Hong Kong, culturally adapted internet intervention %D 2025 %7 25.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: A significant number of individuals with depression in Hong Kong remain undiagnosed and untreated through traditional face-to-face psychotherapy. Internet-based cognitive behavioral therapy (iCBT) has emerged as a tool to improve access to mental health services. However, iCBT remains underdeveloped in Chinese communities, particularly in Hong Kong. Objective: This study aims to (1) develop and evaluate the effectiveness of a culturally and linguistically appropriate guided iCBT program for Hong Kong Chinese with depressive symptoms, and (2) explore their treatment adherence. Methods: An 11-week guided iCBT program, “Confront and Navigate Depression Online” (CANDO), consisting of 8 online modules, was developed and implemented for Hong Kong residents. The program was accessible via either an online platform (web-based iCBT) or a smartphone app (app-based iCBT). A 3-arm randomized controlled trial was conducted, with participants recruited through open recruitment and referrals from 2 local non-governmental organizations. A total of 402 eligible participants with mild to moderate depressive symptoms were randomly allocated into 3 groups: (1) web-based iCBT (n=139); (2) app-based iCBT (n=131); and (3) waitlist control (WLC) group (n=132), who transitioned to the web-based iCBT group after waiting for 11 weeks. Therapist support was provided by a clinical psychologist through 3 counseling sessions and weekly assignment feedback. The primary outcomes were the Beck Depression Inventory-II (BDI-II) and the 9-item Patient Health Questionnaire (PHQ-9), while the secondary outcome measures included the 12-item General Health Questionnaire (GHQ-12), the Chinese Automatic Thoughts Questionnaire (CATQ), and the Chinese Affect Scale (CAS). These scales were administered at preintervention, postintervention, and at 3-month and 6-month follow-up assessments. Data analysis was conducted using linear mixed effects modeling, adhering to the intent-to-treat principle. Results: Participants in both the web- and app-based iCBT groups reported significant improvements compared with the WLC group on all primary (P<.001) and secondary measures (P<.001 and P=.009) at posttreatment. Large between-group effect sizes were observed in the reduction of depressive symptoms, with Cohen's d value of 1.07 (95% CI 0.81-1.34) for the web-based group and 1.15 (95% CI 0.88-1.43) for the app-based group on the BDI-II. Additionally, the web- and app-based groups showed effect sizes of 0.78 (95% CI 0.52-1.04) and 0.95 (95% CI 0.63-1.27) on PHQ-9, respectively. Medium to large effect sizes were observed for secondary outcomes at posttreatment. These positive effects were maintained at both the 3- and 6-month follow-ups, with medium to large within-group effect sizes. The adherence rate in the 2 iCBT groups was 154 out of 270 (57.0%) for completing all 8 online modules and 152 out of 270 (56.3%) for attending all 4 counseling sessions (including an intake interview). The recovery rate, as measured by the BDI-II at posttreatment, was 35 out of 90 (39%) for the web-based group and 36 out of 91 (40%) for the app-based group, compared with 3 out of 112 (3%) in the WLC group. Conclusions: Culturally and linguistically adapted iCBT is an effective and feasible treatment for Hong Kong Chinese with mild to moderate depressive symptoms, demonstrating a satisfactory recovery rate and treatment adherence. ICBT offers an accessible and viable alternative to face-to-face interventions in Hong Kong. The Hong Kong government should allocate more resources and support the use of iCBT as a tool to treat people with depressive symptoms. Trial Registration: ClinicalTrials.gov (NCT04388800); https://clinicaltrials.gov/study/NCT04388800 %M 39998865 %R 10.2196/64303 %U https://www.jmir.org/2025/1/e64303 %U https://doi.org/10.2196/64303 %U http://www.ncbi.nlm.nih.gov/pubmed/39998865 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59656 %T Interventions for Digital Addiction: Umbrella Review of Meta-Analyses %A Lu,Peng %A Qiu,Jiamin %A Huang,Shiqi %A Wang,Xinman %A Han,Shasha %A Zhu,Sui %A Ning,Youjing %A Zeng,Fang-fang %A Yuan,Yuan %+ Department of Chinese International Education, Chinese Language and Culture College, Huaqiao University, No 8 Jiageng Road, Xiamen, 361021, China, 86 6068002, yuanyuan361021@163.com %K digital addiction %K interventions %K umbrella reviews %K systematic review %K internet addiction %K loneliness %K quality of life %K well-being %K internet %K psychological %K pharmacological treatment %K cognitive behavioral therapy %D 2025 %7 11.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to become familiar with all available literature and find appropriate interventions. Objective: This study aims to summarize and assess the certainty of evidence of interventions proposed to decrease digital addiction from published meta-analyses. Methods: An umbrella review of published meta-analyses was performed. We searched PubMed, Cochrane Library, Web of Science, and Embase for meta-analyses published up to February 2024. Eligible studies evaluated interventions using randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies and were assessed for methodological quality using Assessment of Multiple Systematic Reviews version 2. A random effects model was used to analyze data, considering heterogeneity and publication bias. Grading of Recommendations, Assessment, Development, and Evaluations was applied to assess evidence with certainty. Results: A total of 5 studies assessing 21 associations were included in the umbrella review, of which 4 (80%) were high-quality meta-analyses. Weak evidence was observed in 19 associations, whereas null associations appeared in the remaining 2 associations. These associations pertained to 8 interventions (group counseling, integrated internet addiction [IA] prevention programs, psychosocial interventions, reality therapy, self-control training programs, cognitive behavioral therapy, interventions to reduce screen time in children, and exercise) and 9 outcomes (self-control, self-esteem, internet gaming disorder symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety, and depression). Cognitive behavioral therapy reduces anxiety (standardized mean difference [SMD] 0.939, 95% CI 0.311 to 1.586), internet gaming disorder symptoms (SMD 1.394, 95% CI 0.664 to 2.214), time spent gaming (SMD 1.259, 95% CI, 0.311 to 2.206), and IA scores (SMD –2.097, 95% CI –2.814 to –1.381). Group counseling had a large effect on improving self-control (SMD 1.296, 95% CI 0.269 to 2.322) and reducing IA levels (SMD –1.417, 95% CI –1.836 to –0.997). Exercise intervention reduced IA scores (SMD –2.322, 95% CI –3.212 to –1.431), depression scores (SMD –1.421, 95% CI –2.046 to –797), and interpersonal sensitivity scores (SMD –1.433, 95% CI –2.239 to –0.627). Conclusions: The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence. Trial Registration: PROSPERO CRD42024528173; crd.york.ac.uk/PROSPERO/display_record.php?RecordID=528173 %M 39933164 %R 10.2196/59656 %U https://www.jmir.org/2025/1/e59656 %U https://doi.org/10.2196/59656 %U http://www.ncbi.nlm.nih.gov/pubmed/39933164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53566 %T Adapting a Mobile Health App for Smoking Cessation in Black Adults With Anxiety Through an Analysis of the Mobile Anxiety Sensitivity Program Proof-of-Concept Trial: Qualitative Study %A Cheney,Marshall K %A Alexander,Adam C %A Garey,Lorra %A Gallagher,Matthew W %A Hébert,Emily T %A Vujanovic,Anka A %A Kezbers,Krista M %A Matoska,Cameron T %A Zvolensky,Michael J %A Businelle,Michael S %+ Department of Health and Exercise Science, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States, 1 4053255211, marshall@ou.edu %K cultural tailoring %K tailoring %K African American %K black %K smoking cessation %K mHealth %K smartphone application %K just in time adaptive intervention %K qualitative %K formative evaluation %K app %K application %K anxiety %K adult %K qualitative analysis %K smoking %K mobile phone %K tobacco %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: At least half of smokers make a serious quit attempt each year, but Black adults who smoke are less likely than White adults who smoke to quit smoking successfully. Black adults who smoke and have high anxiety sensitivity (an individual difference factor implicated in smoking relapse and culturally relevant to Black adults) are even less successful. The Mobile Anxiety Sensitivity Program for Smoking (MASP) is a smoking cessation smartphone app culturally tailored to Black adults who smoke to increase smoking cessation rates by targeting anxiety sensitivity. Objective: This study examined the acceptability and feasibility of the MASP smartphone app following a 6-week pilot test through postintervention qualitative interviews. Methods: The MASP smoking cessation app was adapted from an evidence-based app by adding culturally tailored narration and images specific to the Black community, educational content on tobacco use in the Black community and the role of menthol, culturally tailored messages, and addressing tobacco use and racial discrimination. The MASP app was piloted with 24 adults with high anxiety sensitivity who identified as Black, smoked daily, and were not currently using medications or psychotherapy for smoking cessation. At the end of the 6-week pilot test, 21/24 participants (67% female; 95.2% non-Hispanic; mean age=47.3 years; 43% college educated; 86% single or separated) completed an audio-recorded semistructured interview assessing the acceptability and utility of the app, individual experiences, barriers to use, the cultural fit for Black adults who wanted to quit smoking, and identified areas for improvement. Transcribed interviews were coded using NVivo (Lumivero), and then analyzed for themes using an inductive, use-focused process. Results: Most participants (17/21, 81%) had smoked for more than 20 years and 29% (6/21) of them smoked more than 20 cigarettes daily. Participants felt the MASP app was helpful in quitting smoking (20/21, 95%) and made them more aware of smoking thoughts, feelings, and behaviors (16/19, 84%). Half of the participants (11/21, 52%) thought the combination of medication and smartphone app gave them the best chance of quitting smoking. Themes related to participant experiences using the app included establishing trust and credibility through the recruitment experience, providing personally tailored content linked to evidence-based stress reduction techniques, and self-reflection through daily surveys. The culturally tailored material increased app relevance, engagement, and acceptability. Suggested improvements included opportunities to engage with other participants, more control over app functions, and additional self-monitoring functions. Conclusions: Adding culturally tailored material to an evidence-based mobile health (mHealth) intervention could increase the use of smoking cessation interventions among Black adults who want to quit smoking. Qualitative interviews provide mHealth app developers important insights into how apps can be improved before full study implementation and emphasize the importance of getting feedback from the target population throughout the development process of mHealth interventions. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 %M 39918847 %R 10.2196/53566 %U https://formative.jmir.org/2025/1/e53566 %U https://doi.org/10.2196/53566 %U http://www.ncbi.nlm.nih.gov/pubmed/39918847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66769 %T The Development of an Instagram Reel-Based Bystander Intervention Message Among College Students: Formative Survey and Mixed Methods Pilot Study %A Couto,Leticia %K bystander intervention %K message development %K sexual health %K college %K student %K sexual violence %K bystander %K reel-based %K Instagram %K social media %K short message %K formative research %K mixed methods %K social norms %K perceived behavior %K qualitative %K behavioral health %K digital health %D 2025 %7 27.1.2025 %9 %J JMIR Form Res %G English %X Background: Bystander intervention is a common method to address the ubiquitous issue that is sexual violence across college campuses. Short messages that incentivize bystander intervention behavior can be another tool to fight sexual violence. Objective: This study aimed to conduct formative research surrounding social norms and bystander barriers to pilot and develop Instagram (Meta) reel-based messages addressing bystander intervention among college students. Methods: The first step was to conduct a formative survey to identify peer norms and actual behavior of the intended population. Once that data were collected, a mixed methods message pilot was conducted by a survey where participants randomly saw 5 of the 12 messages developed, assessing them for credibility, perceived message effect, and intended audience. Results: The formative survey was conducted among 195 college students from the same institution, and the pilot test was conducted among 107 college students. The formative survey indicated a discrepancy between perceived peer behavior and actual behavior of the participants in all 3 measures, allowing for the development of normative messaging. The pilot testing indicated the credibility was acceptable (eg, mean 3.94, SD 1.15 on a 5-point scale) as well as the perceived message effect (eg, mean 4.26, SD 0.94 on a 5-point scale). Intended audiences were also identified and reached. Qualitative results indicated that the messages may have lacked credibility, although the quantitative results suggest otherwise. Conclusions: Participants understood the messages concerned bystander intervention, and perceived message effects results indicated the messages to be effective in assisting bystander intervention engagement by normative messaging. Messages were considered credible and reached the intended audience. The qualitative results provided further insights on how the messages can be adapted before being tested for effects. Future research should focus on further adapting the messages and testing their effects among the studied population. %R 10.2196/66769 %U https://formative.jmir.org/2025/1/e66769 %U https://doi.org/10.2196/66769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64244 %T The Association of Psychological Factors With Willingness to Share Health-Related Data From Technological Devices: Cross-Sectional Questionnaire Study %A Eversdijk,Marijn %A Douma,Emma Rixt %A Habibovic,Mirela %A Kop,Willem Johan %K health data sharing %K privacy concerns %K wearable health technology %K personality %K psychological flexibility %K optimism %K social inhibition %K psychological factors %K willingness %K health-related data %K mobile phone %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Background: Health-related data from technological devices are increasingly obtained through smartphone apps and wearable devices. These data could enable physicians and other care providers to monitor patients outside the clinic or assist individuals in improving lifestyle factors. However, the use of health technology data might be hampered by the reluctance of patients to share personal health technology data because of the privacy sensitivity of this information. Objective: This study investigates to what extent psychological factors play a role in people’s willingness to share personal health technology data. Methods: Data for this cross-sectional study were obtained by quota sampling based on age and sex in a community-based sample (N=1013; mean age 48.6, SD 16.6 years; 522/1013, 51.5% women). Willingness to share personal health technology data and related privacy concerns were assessed using an 8-item questionnaire with good psychometric properties (Cronbach’s α=0.82). Psychological variables were assessed using validated questionnaires for optimism (Life Orientation Test—Revised), psychological flexibility (Psychological Flexibility Questionnaire), negative affectivity (Type D Scale-14—Negative Affectivity), social inhibition (Type D Scale-14—Social Inhibition), generalized anxiety (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9). Data were analyzed using multiple linear regression analyses, and network analysis was used to visualize the associations between the item scores. Results: Higher levels of optimism (β=.093; P=.004) and psychological flexibility (β=.127; P<.001) and lower levels of social inhibition (β=−.096; P=.002) were significantly associated with higher levels of willingness to share health technology data when adjusting for age, sex, and education level in separate regression models. Other associations with psychological variables were not statistically significant. Network analysis revealed that psychological flexibility clustered more with items that focused on the benefits of sharing data, while optimism was negatively associated with privacy concerns. Conclusions: The current results suggest that people with higher levels of optimism and psychological flexibility and those with lower social inhibition levels are more likely to share health technology data. The magnitude of the effect sizes was low, and future studies with additional psychological measures are needed to establish which factors identify people who are reluctant to share their data such that optimal use of devices in health care can be facilitated. %R 10.2196/64244 %U https://formative.jmir.org/2025/1/e64244 %U https://doi.org/10.2196/64244 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55736 %T Biomarkers of Response to Internet-Based Psychological Interventions: Systematic Review %A Gotti,Giulia %A Gabelli,Chiara %A Russotto,Sophia %A Madeddu,Fabio %A Courtet,Philippe %A Lopez-Castroman,Jorge %A Zeppegno,Patrizia %A Gramaglia,Carla Maria %A Calati,Raffaella %+ Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, U6 Building, Room 3129, Milan, 20126, Italy, 39 3477752087, raffaella.calati@unimib.it %K biomarker %K cognitive behavioral therapy %K internet-based intervention %K systematic review %K psychological intervention %K mental health intervention %K meta analysis %K psychiatric %K blood glucose %K mindfulness %K stress management %K immune response %K smoking %K cortisol %D 2024 %7 29.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Internet-based psychological interventions provide accessible care to a wide range of users, overcoming some obstacles—such as distance, costs, and safety—that might discourage seeking help for mental issues. It is well known that psychological treatments and programs affect the body, as well as the mind, producing physiological changes that ought to be considered when assessing the efficacy of the intervention. However, the literature investigating changes in biomarkers specifically after internet-based psychological and mental health interventions has not yet extensively inquired into this topic. Objective: This systematic review aims to provide a synthesis of literature examining the effects of internet-based psychological interventions—targeting both clinical (mental and physical) and nonclinical conditions—on biomarkers. A secondary aim was to evaluate whether the biomarkers’ variations were related to a complementary modification of the psychological or physical symptoms or to a general improvement of the participants’ well-being. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. A literature search was performed through 3 databases (PubMed, PsycINFO, and Scopus). Studies examining changes in biomarkers before and after internet-based psychological interventions or programs targeting both clinical and nonclinical samples were included, with no exclusion criteria concerning mental or physical conditions. Results: A total of 24 studies fulfilled the inclusion criteria. These studies involved individuals with psychiatric or psychological problems (n=6, 25%), those with organic or medical diseases (n=10, 42%), and nonclinical populations (n=8, 33%). Concerning psychiatric or psychological problems, cognitive behavioral therapy (CBT) and CBT-informed interventions showed partial effectiveness in decreasing glycated hemoglobin blood glucose level (n=1) and chemokines (n=1) and in increasing connectivity between the default-mode network and the premotor or dorsolateral prefrontal cortex (n=1). Among individuals with organic or medical diseases, studies reported a significant change in cardiac or cardiovascular (n=3), inflammatory (n=2), cortisol (n=2), glycated hemoglobin (n=2), and immune response (n=1) biomarkers after CBT and CBT-informed interventions, and mindfulness and stress management interventions. Lastly, mindfulness, CBT and CBT-informed interventions, and music therapy succeeded in modifying immune response (n=2), cortisol (n=1), α amylase (n=1), posterior cingulate cortex reactivity to smoking cues (n=1), and carbon monoxide (n=1) levels in nonclinical populations. In some of the included studies (n=5), the psychological intervention or program also produced an improvement of the mental or physical condition of the participants or of their general well-being, alongside significant variations in biomarkers; CBT and CBT-informed interventions proved effective in reducing both psychological (n=2) and physical symptoms (n=2), while a mindfulness program successfully lowered cigarette consumption in a nonclinical sample (n=1). Conclusions: Although further evidence is required, we hope to raise awareness on the potential impact of internet-based interventions on biomarkers related to mental and physical health. %M 39612489 %R 10.2196/55736 %U https://www.jmir.org/2024/1/e55736 %U https://doi.org/10.2196/55736 %U http://www.ncbi.nlm.nih.gov/pubmed/39612489 %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 %@ 1929-073X %I JMIR Publications %V 13 %N %P e66626 %T Supporting the Mind in Space: Psychological Tools for Long-Duration Missions %A Pagnini,Francesco %+ Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, Milan, 20123, Italy, Francesco.Pagnini@unicatt.it %K space psychology %K astronauts %K psychotherapy %K isolated and confined environment %K mindfulness %K relaxation %K mind-body %D 2024 %7 9.10.2024 %9 Commentary %J Interact J Med Res %G English %X The psychological well-being of astronauts is becoming just as vital as their physical and technical readiness as space missions extend into deep space. Long-duration missions pose unique challenges, such as isolation, confinement, communication delays, and microgravity, which can significantly affect mental health and cognitive performance. This commentary discusses the need for innovative mental health support systems, including automated psychotherapy, as well as Earth-based training methods like mindfulness and relaxation techniques, to address the psychological demands of space travel. By integrating these approaches into pre-mission preparation and in-flight routines, astronauts can develop self-regulation strategies to manage stress, improve focus, and enhance emotional resilience. Automated psychotherapy available 24-7 provides real-time confidential support when communication with Earth is delayed. As space exploration moves forward, the success of missions will depend not only on technological advancements but also on the development of psychological countermeasures that prioritize mental health alongside physical well-being. This paper emphasizes the importance of continued research and collaboration to refine and test these tools in analog environments, ensuring astronauts are mentally and emotionally prepared for the challenges of space. %M 39382951 %R 10.2196/66626 %U https://www.i-jmr.org/2024/1/e66626 %U https://doi.org/10.2196/66626 %U http://www.ncbi.nlm.nih.gov/pubmed/39382951 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58803 %T Automated Psychotherapy in a Spaceflight Environment: Advantages, Drawbacks, and Unknowns %A Smith,Logan %+ Oklahoma State University, 306 Psychology Building, Stillwater, OK, 74078, United States, 1 772 242 5012, logan.smith12@okstate.edu %K mental health %K deep space %K astronauts %K aerospace medicine %K spaceflight %K flight %K psychotherapy %K privacy %K communication %D 2024 %7 9.10.2024 %9 Viewpoint %J Interact J Med Res %G English %X Various behavioral and mental health issues have been reported by space crews for decades, with the overall number of mental health complications expected to be higher than is publicly known. The broad range of mental health complications encountered in space is expected to grow as people venture deeper into space. Issues with privacy, dual relationships, and delayed communications make rendering effective psychological therapy difficult in a spaceflight environment and nearly impossible in deep space. Automated psychotherapy offers a way to provide psychotherapy to astronauts both in deep space and low Earth orbit. Although automated psychotherapy is growing in popularity on Earth, little is known about its efficacy in space. This viewpoint serves to highlight the knowns and unknowns regarding this treatment modality for future deep space missions, and places an emphasis on the need for further research into the applicability and practicality of automated psychotherapy for the spaceflight environment, especially as it relates to long-duration, deep space missions. %M 39382952 %R 10.2196/58803 %U https://www.i-jmr.org/2024/1/e58803 %U https://doi.org/10.2196/58803 %U http://www.ncbi.nlm.nih.gov/pubmed/39382952 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e47141 %T Using Games to Simulate Medication Adherence and Nonadherence: Laboratory Experiment in Gamified Behavioral Simulation %A Taj,Umar %A Grimani,Aikaterini %A Read,Daniel %A Vlaev,Ivo %K behavior change %K experimental modeling %K gamification %K medication adherence %K antibiotics %K games %K medication %K testing behavior %K clinical outcome %K simulate %K diagnosis %K devices %K symptoms %K tool %D 2024 %7 24.9.2024 %9 %J JMIR Serious Games %G English %X Background: Medical nonadherence is a significant problem associated with worse clinical outcomes, higher downstream rehospitalization rates, and a higher use of resources. To improve medication adherence, it is vital for researchers and practitioners to have a solid theoretical understanding of what interventions are likely to work. To achieve this understanding, we propose that researchers should focus on creating small-scale laboratory analogs to the larger real-world setting and determine what interventions, such as nudges or incentives, work to change behavior in the laboratory. To do this, we took inspiration from the literature on serious games and gamification and experimental economics. We call our approach “gamified behavioral simulation.” In this paper, we modeled everyday life as the state of being engaged in a simple but addictive game, illness as being interruptions to the functionality of that game, treatment as being a series of actions that can be taken to prevent or mitigate those interruptions, and adherence as sticking to a prescribed rule for the application of those actions. Objective: This study carries out a behavioral diagnosis of the medication adherence problem through a theoretically informed framework and then develops the gamified behavioral modeling approach to simulate medication nonadherence. Methods: A laboratory experiment was conducted using a modified popular and addictive open-source video game called “2048,” which created an abstract model for the medication adherence behavior observed in real life. In total, 509 participants were assigned to the control and 4 intervention groups (“incentive” group, “reminder” group, “commitment device” group, and “elongated duration for symptoms” group). Results: The results of the modeling experiment showed that having theoretically informed interventions can increase the likelihood for them to be successful. In particular, there is evidence that the use of reminders improves the medication adherence rates for patients, and the same result was found in the modeling experiment, as they improved adherence significantly by 23% (95% CI −33.97% to −11.72%; P<.001). However, providing an incentive did not improve the adherence rate. We also tested the use of commitment devices, which, in line with real-world evidence, did not improve adherence rates. The fourth treatment tested elongated duration for symptoms, which attempted to show the power of modeling experiments where we test a what-if scenario that is extremely difficult to test in a real setting. The results indicated that if symptoms last longer, people did not adhere more to their medication regimen. Conclusions: Gamified behavioral simulation is a useful tool to explain real health behaviors and help in identifying which interventions are most likely to work in a randomized trial. %R 10.2196/47141 %U https://games.jmir.org/2024/1/e47141 %U https://doi.org/10.2196/47141 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e44662 %T Design and Implementation of an Opioid Scorecard for Hospital System–Wide Peer Comparison of Opioid Prescribing Habits: Observational Study %A Slovis,Benjamin Heritier %A Huang,Soonyip %A McArthur,Melanie %A Martino,Cara %A Beers,Tasia %A Labella,Meghan %A Riggio,Jeffrey M %A Pribitkin,Edmund deAzevedo %K opioids %K peer comparison %K quality %K scorecard %K prescribing %K design %K implementation %K opioid %K morbidity %K mortality %K opioid usage %K opioid dependence %K drug habits %D 2024 %7 9.9.2024 %9 %J JMIR Hum Factors %G English %X Background: Reductions in opioid prescribing by health care providers can lead to a decreased risk of opioid dependence in patients. Peer comparison has been demonstrated to impact providers’ prescribing habits, though its effect on opioid prescribing has predominantly been studied in the emergency department setting. Objective: The purpose of this study is to describe the development of an enterprise-wide opioid scorecard, the architecture of its implementation, and plans for future research on its effects. Methods: Using data generated by the author’s enterprise vendor–based electronic health record, the enterprise analytics software, and expertise from a dedicated group of informaticists, physicians, and analysts, the authors developed an opioid scorecard that was released on a quarterly basis via email to all opioid prescribers at our institution. These scorecards compare providers’ opioid prescribing habits on the basis of established metrics to those of their peers within their specialty throughout the enterprise. Results: At the time of this study’s completion, 2034 providers have received at least 1 scorecard over a 5-quarter period ending in September 2021. Poisson regression demonstrated a 1.6% quarterly reduction in opioid prescribing, and chi-square analysis demonstrated pre-post reductions in the proportion of prescriptions longer than 5 days’ duration and a morphine equivalent daily dose of >50. Conclusions: To our knowledge, this is the first peer comparison effort with high-quality evidence-based metrics of this scale published in the literature. By sharing this process for designing the metrics and the process of distribution, the authors hope to influence other health systems to attempt to curb the opioid pandemic through peer comparison. Future research examining the effects of this intervention could demonstrate significant reductions in opioid prescribing, thus potentially reducing the progression of individual patients to opioid use disorder and the associated increased risk of morbidity and mortality. %R 10.2196/44662 %U https://humanfactors.jmir.org/2024/1/e44662 %U https://doi.org/10.2196/44662 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58371 %T Influence of TikTok on Body Satisfaction Among Generation Z in Indonesia: Mixed Methods Approach %A Ariana,Hanifa %A Almuhtadi,Ikmal %A Natania,Nikita Jacey %A Handayani,Putu Wuri %A Bressan,Stéphane %A Larasati,Pramitha Dwi %+ Faculty of Computer Science Universitas Indonesia, Kampus UI Street, Depok, 16424, Indonesia, 62 217863410, Putu.wuri@cs.ui.ac.id %K body satisfaction %K social media %K TikTok %K Indonesia %K cyber-bullying %K cyberbullying %K cyberbully %K cyber-harassment %K bullying %K harassment %K body shaming %K objectify %K objectifying %K social media %K social media use %K social media usage %K socials %K social network %K social networks %K social networking %K Tik Tok %K GenZ %K Gen-Z %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K young-adult %K young-adults %D 2024 %7 6.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As social media platforms gain popularity, their usage is increasingly associated with cyberbullying and body shaming, causing devastating effects. Objective: This study aims to investigate the impact of social media on Generation Z users’ body image satisfaction. More specifically, it examines the impact of TikTok on body image satisfaction among TikTok users aged between 17 years and 26 years in Indonesia. Methods: The methodology used mixed-method approaches. Quantitative data were obtained from 507 responses to a questionnaire and analyzed using covariance-based structural equation modeling. Qualitative data were obtained from the interviews of 32 respondents and analyzed through content analysis. Results: This study reveals that upward appearance comparison is influenced by video-based activity and appearance motivation. Conversely, thin-ideal internalization is influenced by appearance motivation and social media literacy. Upward appearance comparisons and thin-ideal internalization comparisons detrimentally impact users’ body image satisfaction. Conclusions: The results of this study are expected to provide valuable insights for social media providers, regulators, and educators in their endeavors to establish a positive and healthy social media environment for users. %R 10.2196/58371 %U https://humanfactors.jmir.org/2024/1/e58371 %U https://doi.org/10.2196/58371 %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 %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50944 %T Identifying Effective Components of a Social Marketing Campaign to Improve Engagement With Express Sexual Health Services Among Gay, Bisexual, and Other Men Who Have Sex With Men: Case Study %A Chambers,Laura C %A Malyuta,Yelena %A Goedel,William C %A Chan,Philip A %A Sutten Coats,Cassandra %A Allen,Ken %A Nunn,Amy S %K social marketing %K sexually transmitted infection %K HIV %K sexual and gender minorities %K sexual health %K gay %K MSM %K men who have sex with men %K STI %K testing %K digital marketing %K digital %K campaign %K promote %K treatment %K prevention %K bisexual %K advertisement %K Google display %K Grindr %K Facebook %D 2024 %7 23.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Little is known about how best to reach people with social marketing messages promoting use of clinical HIV and sexually transmitted infection (STI) services. Objective: We evaluated a multiplatform, digital social marketing campaign intended to increase use of HIV/STI testing, treatment, and prevention services among gay, bisexual, and other men who have sex with men (MSM) at an LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and/or questioning) community health center. Methods: We evaluated engagement with a social marketing campaign launched by Open Door Health, the only LGBTQ+ community health center in Rhode Island, during the first 8 months of implementation (April to November 2021). Three types of advertisements encouraging use of HIV/STI services were developed and implemented on Google Search, Google Display, Grindr, and Facebook. Platforms tracked the number of times that an advertisement was displayed to a user (impressions), that a user clicked through to a landing page that facilitated scheduling (clicks), and that a user requested a call to schedule an appointment from the landing page (conversions). We calculated the click-through rate (clicks per impression), conversion rate (conversions per click), and the dollar amount spent per 1000 impressions and per click and conversion. Results: Overall, Google Search yielded the highest click-through rate (7.1%) and conversion rate (7.0%) compared to Google Display, Grindr, and Facebook (click-through rates=0.4%‐3.3%; conversion rates=0%‐0.03%). Although the spend per 1000 impressions and per click was higher for Google Search compared to other platforms, the spend per conversion—which measures the number of people intending to attend the clinic for services—was substantially lower for Google Search (US $48.19 vs US $3120.42-US $3436.03). Conclusions: Campaigns using the Google Search platform may yield the greatest return on investment for engaging MSM in HIV/STI services at community health clinics. Future studies are needed to measure clinical outcomes among those who present to the clinic for services after viewing campaign advertisements and to compare the return on investment with use of social marketing campaigns relative to other approaches. %R 10.2196/50944 %U https://publichealth.jmir.org/2024/1/e50944 %U https://doi.org/10.2196/50944 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56315 %T Effectiveness and Acceptability of Cognitive Behavioral Therapy and Family Therapy for Gaming Disorder: Protocol for a Nonrandomized Intervention Study of a Novel Psychological Treatment %A Bore,Per %A Nilsson,Sara %A Andersson,Mitchell %A Oehm,Kajsa %A Attvall,Joel %A Håkansson,Anders %A Claesdotter-Knutsson,Emma %+ Section for Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Sölvegatan 19 - BMC I12, Lund, 221 84, Sweden, 46 0702184963, per.bore@med.lu.se %K gaming disorder %K psychological treatment %K CBT %K cognitive behavioral therapy %K family therapy %K effectiveness %K acceptability %K gaming %K addiction %K mixed method design %K video games %K leisure activity %K Sweden %K young adult %K teenager %K internet gaming disorder %D 2024 %7 16.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients. Objective: This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy. Methods: This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients’ and relatives’ experiences of the treatment. Results: This study started in March 2022 and the recruitment is expected to close in August 2024. Conclusions: This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity. Trial Registration: ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922 International Registered Report Identifier (IRRID): DERR1-10.2196/56315 %M 39151165 %R 10.2196/56315 %U https://www.researchprotocols.org/2024/1/e56315 %U https://doi.org/10.2196/56315 %U http://www.ncbi.nlm.nih.gov/pubmed/39151165 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52643 %T The Association Between Physical Distancing Behaviors to Avoid COVID-19 and Health-Related Quality of Life in Immunocompromised and Nonimmunocompromised Individuals: Patient-Informed Protocol for the Observational, Cross-Sectional EAGLE Study %A Williams,Paul %A Herring,Timothy A %A Yokota,Renata T C %A Maia,Tiago %A Venkatesan,Sudhir %A Marcus,James C %A Settergren,Gabriella %A Arnetorp,Sofie %A Lloyd,Andrew %A Severens,Johan L %A Varni,James W %A Dixon,Sharon %A Hamusankwa,Lweendo %A Powell,Philip A %A Taylor,Sylvia %A Ware Jr,John E %A Krol,Marieke %+ Global Evidence, BioPharmaceuticals Medical, AstraZeneca, Pepparedsleden 1, Gothenburg, SE-431 83, Sweden, 46 722198256, paul.williams8@astrazeneca.com %K SARS-CoV-2 %K social isolation %K patient participation %K patient-reported outcome measures %K quality of life %K immunosuppression %K respiratory tract infection %K cost of illness %K surveys and questionnaires %K protocol %D 2024 %7 13.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Immunocompromised individuals are known to respond inadequately to SARS-CoV-2 vaccines, placing them at high risk of severe or fatal COVID-19. Thus, immunocompromised individuals and their caregivers may still practice varying degrees of social or physical distancing to avoid COVID-19. However, the association between physical distancing to avoid COVID-19 and quality of life has not been comprehensively evaluated in any study. Objective: We aim to measure physical distancing behaviors among immunocompromised individuals and the association between those behaviors and person-centric outcomes, including health-related quality of life (HRQoL) measures, health state utilities, anxiety and depression, and work and school productivity impairment. Methods: A patient-informed protocol was developed to conduct the EAGLE Study, a large cross-sectional, observational study, and this paper describes that protocol. EAGLE is designed to measure distancing behaviors and outcomes in immunocompromised individuals, including children (aged ≥6 mo) and their caregivers, and nonimmunocompromised adults in the United States and United Kingdom who report no receipt of passive immunization against COVID-19. We previously developed a novel self- and observer-reported instrument, the Physical Distancing Scale for COVID-19 Avoidance (PDS-C19), to measure physical distancing behavior levels cross-sectionally and retrospectively. Using an interim or a randomly selected subset of the study population, the PDS-C19 psychometric properties will be assessed, including structural validity, internal consistency, known-group validity, and convergent validity. Associations (correlations) will be assessed between the PDS-C19 and validated HRQoL-related measures and utilities. Structural equation modeling and regression will be used to assess these associations, adjusting for potential confounders. Participant recruitment and data collection took place from December 2022 to June 2023 using direct-to-patient channels, including panels, clinician referral, patient advocacy groups, and social media, with immunocompromising diagnosis confirmation collected and assessed for a randomly selected 25% of immunocompromised participants. The planned total sample size is 3718 participants and participant-caregiver pairs. Results will be reported by immunocompromised status, immunocompromising condition category, country, age group, and other subgroups. Results: All data analyses and reporting were planned to be completed by December 2023. Results are planned to be submitted for publication in peer-reviewed journals in 2024-2025. Conclusions: This study will quantify immunocompromised individuals’ physical distancing behaviors to avoid COVID-19 and their association with HRQoL as well as health state utilities. International Registered Report Identifier (IRRID): RR1-10.2196/52643 %M 39137022 %R 10.2196/52643 %U https://www.researchprotocols.org/2024/1/e52643 %U https://doi.org/10.2196/52643 %U http://www.ncbi.nlm.nih.gov/pubmed/39137022 %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 %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57577 %T Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis %A Thomas,Pamela Carien %A Curtis,Kristina %A Potts,Henry W W %A Bark,Pippa %A Perowne,Rachel %A Rookes,Tasmin %A Rowe,Sarah %+ Department of Epidemiology & Applied Clinical Research, Division of Psychiatry, University College London, 6th Floor, Wings A and B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 0207 679 9000, s.rowe@ucl.ac.uk %K digital health %K eHealth %K mobile health %K mHealth %K mobile apps %K smartphone %K behavior change %K behavior change technique %K systematic review %K eating disorders %K disordered eating %K binge eating %K bulimia nervosa %K mobile phone %D 2024 %7 1.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. Objective: This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. Methods: A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. Results: Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: χ21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results. Conclusions: There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. Trial Registration: PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060 %M 39088817 %R 10.2196/57577 %U https://mental.jmir.org/2024/1/e57577 %U https://doi.org/10.2196/57577 %U http://www.ncbi.nlm.nih.gov/pubmed/39088817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55366 %T eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review %A De Lucia,Annalisa %A Perlini,Cinzia %A Chiarotto,Alessandro %A Pachera,Sara %A Pasini,Ilenia %A Del Piccolo,Lidia %A Donisi,Valeria %+ Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Ludovico Antonio Scuro 10, Verona, 37134, Italy, 39 0458124038, cinzia.perlini@univr.it %K chronic pain %K older adults %K eHealth %K scoping review %K psychological intervention %K physical intervention %K multimodal intervention %K biopsychosocial model for chronic pain %K self-management %K mobile phone %D 2024 %7 29.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. Objective: The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. Methods: This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. Results: A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality–based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants’ engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. Conclusions: Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293235 %M 39073865 %R 10.2196/55366 %U https://www.jmir.org/2024/1/e55366 %U https://doi.org/10.2196/55366 %U http://www.ncbi.nlm.nih.gov/pubmed/39073865 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e48355 %T The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis %A Xu,Zijun %A Zheng,Xiaoxiang %A Ding,Hanyue %A Zhang,Dexing %A Cheung,Peter Man-Hin %A Yang,Zuyao %A Tam,King Wa %A Zhou,Weiju %A Chan,Dicken Cheong-Chun %A Wang,Wenyue %A Wong,Samuel Yeung-Shan %K walking %K depression %K anxiety %K systematic review %K meta-analysis %D 2024 %7 23.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Previous literature lacks summative information on the mental health benefits achieved from different forms of walking. Objective: The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety. Methods: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool. Results: This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD −0.591, 95% CI −0.778 to −0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD −0.446, 95% CI −0.628 to −0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD −1.863, 95% CI −2.764 to −0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD −0.442, 95% CI −0.604 to −0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD −0.126, 95% CI −0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD −0.053, 95% CI −0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69). Conclusions: Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021247983; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=247983 %R 10.2196/48355 %U https://publichealth.jmir.org/2024/1/e48355 %U https://doi.org/10.2196/48355 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53869 %T Effects of Background Music on Attentional Networks of Children With and Without Attention Deficit/Hyperactivity Disorder: Case Control Experimental Study %A Mendes,Camila Guimarães %A de Paula,Jonas Jardim %A Miranda,Débora Marques %+ Department of Pediatrics, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190 sl85, Belo Horizonte, 30130100, Brazil, 55 3134099663, camilagmbh@gmail.com %K attention %K background music %K ADHD %K children %K adolescents %K music %K attention network %K effects %K preliminary study %K attention deficit/hyperactivity disorder %D 2024 %7 18.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: To sustain performance during a task that requires attention may be a challenge for children with attention deficit/hyperactivity disorder (ADHD), which strongly influences motivation for tasks and has been connected to the level of arousal. Objective: This study aimed to analyze the effect of musical stimulus on attentional performance in children with ADHD and typically developing children. Methods: A total of 76 boys (34 with ADHD and 42 typically developing) performed the Attention Network Test (ANT) for children under 2 experimental conditions (with and without music). Four attentional measures were extracted from the ANT. We tested the effect of the experimental condition and its interaction with the group using repeated measures ANOVA. Results: We found no significant main effects or interactions for the reaction times of the alerting, orienting, and conflict attentional networks of the ANT (all P>.05). Regarding ANT errors, we found a significant main effect for music, with a moderate effect size (F1,72=9.83; P=.03; ηp2=0.06) but the condition×group interaction was not significant (F1,72=1.79; P=.18). Participants made fewer errors when listening to music compared to the control condition. Conclusions: Music seems not to interfere in the attentional network in children and adolescents. Perhaps background music affects motivation. Future studies will be needed to validate this. Trial Registration: ReBEC.gov U1111-12589039; https://ensaiosclinicos.gov.br/rg/RBR-8s22sh8 %M 39024557 %R 10.2196/53869 %U https://www.i-jmr.org/2024/1/e53869 %U https://doi.org/10.2196/53869 %U http://www.ncbi.nlm.nih.gov/pubmed/39024557 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50186 %T mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan %A Ali,Suad %A Alizai,Hira %A Hagos,Delal Jemal %A Rubio,Sindy Ramos %A Calabia,Dale %A Serrano Jimenez,Penelope %A Senthil,Vinuu Aarif %A Appel,Lora %+ Faculty of Health, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, lora.appel@yorku.ca %K dementia %K Alzheimer disease %K mHealth %K mobile health %K apps %K lifestyle behaviors %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. Objective: This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. Methods: A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. Results: Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices. Conclusions: There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully. %M 38959029 %R 10.2196/50186 %U https://mhealth.jmir.org/2024/1/e50186 %U https://doi.org/10.2196/50186 %U http://www.ncbi.nlm.nih.gov/pubmed/38959029 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55831 %T Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial %A Heckman,Carolyn J %A Mitarotondo,Anna %A Lin,Yong %A Khavjou,Olga %A Riley,Mary %A Manne,Sharon L %A Yaroch,Amy L %A Niu,Zhaomeng %A Glanz,Karen %+ Rutgers Cancer Institute, 120 Albany St, New Brunswick, NJ, 08901, United States, 1 732 235 8830, ch842@rutgers.edu %K skin cancer prevention %K sun protection %K sun exposure %K digital intervention %K social media %K young adults %K sun %K skin cancer %K prevention %K cancer %K randomized controlled trial %K Facebook %K Instagram %K engagement %K behavior %K protection %K skin %K sunscreen %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations. Objective: This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer. Methods: This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn. Results: The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant. Conclusions: The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed). Trial Registration: ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492 %M 38954433 %R 10.2196/55831 %U https://www.jmir.org/2024/1/e55831 %U https://doi.org/10.2196/55831 %U http://www.ncbi.nlm.nih.gov/pubmed/38954433 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54030 %T Effects of Sound Interventions on the Mental Stress Response in Adults: Protocol for a Scoping Review %A Saskovets,Marina %A Liang,Zilu %A Piumarta,Ian %A Saponkova,Irina %+ Faculty of Engineering, Kyoto University of Advanced Science, 18 Yamanouchi Gotanda-cho, Ukyo-ku, Kyoto, 615-8577, Japan, 81 9049473689, vetryvody@gmail.com %K mental stress %K anxiety %K sound therapy %K music therapy %K voice-guided relaxation %K voice-guided meditation %K prosody %K paralanguage %K expressive sounds %K psychoacoustics %D 2024 %7 27.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sound therapy methods have seen a surge in popularity, with a predominant focus on music among all types of sound stimulation. There is substantial evidence documenting the integrative impact of music therapy on psycho-emotional and physiological outcomes, rendering it beneficial for addressing stress-related conditions such as pain syndromes, depression, and anxiety. Despite these advancements, the therapeutic aspects of sound, as well as the mechanisms underlying its efficacy, remain incompletely understood. Existing research on music as a holistic cultural phenomenon often overlooks crucial aspects of sound therapy mechanisms, particularly those related to speech acoustics or the so-called “music of speech.” Objective: This study aims to provide an overview of empirical research on sound interventions to elucidate the mechanism underlying their positive effects. Specifically, we will focus on identifying therapeutic factors and mechanisms of change associated with sound interventions. Our analysis will compare the most prevalent types of sound interventions reported in clinical studies and experiments. Moreover, we will explore the therapeutic effects of sound beyond music, encompassing natural human speech and intermediate forms such as traditional poetry performances. Methods: This review adheres to the methodological guidance of the Joanna Briggs Institute and follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for reporting review studies, which is adapted from the Arksey and O’Malley framework. Our search strategy encompasses PubMed, Web of Science, Scopus, and PsycINFO or EBSCOhost, covering literature from 1990 to the present. Among the different study types, randomized controlled trials, clinical trials, laboratory experiments, and field experiments were included. Results: Data collection began in October 2022. We found a total of 2027 items. Our initial search uncovered an asymmetry in the distribution of studies, with a larger number focused on music therapy compared with those exploring prosody in spoken interventions such as guided meditation or hypnosis. We extracted and selected papers using Rayyan software (Rayyan) and identified 41 eligible papers after title and abstract screening. The completion of the scoping review is anticipated by October 2024, with key steps comprising the analysis of findings by May 2024, drafting and revising the study by July 2024, and submitting the paper for publication in October 2024. Conclusions: In the next step, we will conduct a quality evaluation of the papers and then chart and group the therapeutic factors extracted from them. This process aims to unveil conceptual gaps in existing studies. Gray literature sources, such as Google Scholar, ClinicalTrials.gov, nonindexed conferences, and reference list searches of retrieved studies, will be added to our search strategy to increase the number of relevant papers that we cover. International Registered Report Identifier (IRRID): DERR1-10.2196/54030 %M 38935945 %R 10.2196/54030 %U https://www.researchprotocols.org/2024/1/e54030 %U https://doi.org/10.2196/54030 %U http://www.ncbi.nlm.nih.gov/pubmed/38935945 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55747 %T Insights Derived From Text-Based Digital Media, in Relation to Mental Health and Suicide Prevention, Using Data Analysis and Machine Learning: Systematic Review %A Sweeney,Colm %A Ennis,Edel %A Mulvenna,Maurice D %A Bond,Raymond %A O'Neill,Siobhan %+ Department of Psychlogy, Ulster University, Cromore Rd, Coleraine, BT52 1SA, United Kingdom, 44 02870 123 456, Sweeney-C23@ulster.ac.uk %K mental health %K machine learning %K text analysis %K digital intervention %D 2024 %7 27.6.2024 %9 Review %J JMIR Ment Health %G English %X Background: Text-based digital media platforms have revolutionized communication and information sharing, providing valuable access to knowledge and understanding in the fields of mental health and suicide prevention. Objective: This systematic review aimed to determine how machine learning and data analysis can be applied to text-based digital media data to understand mental health and aid suicide prevention. Methods: A systematic review of research papers from the following major electronic databases was conducted: Web of Science, MEDLINE, Embase (via MEDLINE), and PsycINFO (via MEDLINE). The database search was supplemented by a hand search using Google Scholar. Results: Overall, 19 studies were included, with five major themes as to how data analysis and machine learning techniques could be applied: (1) as predictors of personal mental health, (2) to understand how personal mental health and suicidal behavior are communicated, (3) to detect mental disorders and suicidal risk, (4) to identify help seeking for mental health difficulties, and (5) to determine the efficacy of interventions to support mental well-being. Conclusions: Our findings show that data analysis and machine learning can be used to gain valuable insights, such as the following: web-based conversations relating to depression vary among different ethnic groups, teenagers engage in a web-based conversation about suicide more often than adults, and people seeking support in web-based mental health communities feel better after receiving online support. Digital tools and mental health apps are being used successfully to manage mental health, particularly through the COVID-19 epidemic, during which analysis has revealed that there was increased anxiety and depression, and web-based communities played a part in reducing isolation during the pandemic. Predictive analytics were also shown to have potential, and virtual reality shows promising results in the delivery of preventive or curative care. Future research efforts could center on optimizing algorithms to enhance the potential of text-based digital media analysis in mental health and suicide prevention. In addressing depression, a crucial step involves identifying the factors that contribute to happiness and using machine learning to forecast these sources of happiness. This could extend to understanding how various activities result in improved happiness across different socioeconomic groups. Using insights gathered from such data analysis and machine learning, there is an opportunity to craft digital interventions, such as chatbots, designed to provide support and address mental health challenges and suicide prevention. %M 38935419 %R 10.2196/55747 %U https://mental.jmir.org/2024/1/e55747 %U https://doi.org/10.2196/55747 %U http://www.ncbi.nlm.nih.gov/pubmed/38935419 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53517 %T Effects of Lifestyle Interventions on Cardiovascular Disease Risk and Risk Factors Among Individuals at High Risk for Type 2 Diabetes: Protocol for a Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Demissie,Getu Debalkie %A Birungi,Josephine %A Haregu,Tilahun %A Thirunavukkarasu,Sathish %A Oldenburg,Brian %+ School of Psychology and Public Health, La Trobe University, Plenty Road & Kingsbury Drive, Bundoora VIC, Melbourne, 3086, Australia, 61 0410 689 847, 21377861@students.latrobe.edu.au %K diabetes %K prediabetes %K cardiovascular disease %K CVD %K CVD risk %K CVD risk factors %K lifestyle interventions %K systematic review %K meta-analysis %D 2024 %7 27.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals at high risk for type 2 diabetes are also at an increased risk for developing cardiovascular disease (CVD). Although there are separate trials examining the effects of lifestyle interventions on absolute CVD risk among people at high risk for type 2 diabetes, a comprehensive evidence synthesis of these trials is lacking. Objective: We will systematically synthesize the evidence on the effects of lifestyle interventions in reducing absolute CVD risk and CVD risk factors among people at high risk for type 2 diabetes. Methods: We adhered to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) statement in reporting the details of this protocol. Randomized controlled trials of diabetes prevention that examined the effects of lifestyle interventions for at least 6 months on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes will be eligible. We will systematically search the MEDLINE, Embase, PsycINFO, CENTRAL, and Scopus databases and ClinicalTrials.gov using a mix of Medical Subject Headings and text words. Two authors will independently screen the abstract and title of the articles retrieved from the search, followed by full-text reviews using the inclusion and exclusion criteria and data extraction from the eligible studies. Article screening and data extraction will be performed in the Covidence software. The primary outcome will be the changes in absolute 10-year CVD risk, as estimated by risk prediction models. The secondary outcomes are the changes in CVD risk factors, including behavioral, clinical, biochemical, and psychosocial risk factors, and incidence of type 2 diabetes. Results: An initial database search was conducted in July 2023. After screening 1935 articles identified through the database search, 42 articles were considered eligible for inclusion. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of 2024. Conclusions: This study will provide up-to-date, systematically synthesized evidence on the effects of lifestyle interventions on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes. Trial Registration: PROSPERO CRD42023429869; https://tinyurl.com/59ajy7rw International Registered Report Identifier (IRRID): DERR1-10.2196/53517 %M 38935416 %R 10.2196/53517 %U https://www.researchprotocols.org/2024/1/e53517 %U https://doi.org/10.2196/53517 %U http://www.ncbi.nlm.nih.gov/pubmed/38935416 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56714 %T Social Factors Associated With Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review %A Mills,Christine Marie %A Boyar,Liza %A O’Flaherty,Jessica A %A Keller,Heather H %+ Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567, chris.mills@uwaterloo.ca %K community %K malnutrition risk %K nutrition risk %K older adults %K social factors %K geriatric %K geriatrics %K malnutrition %K community-dwelling %K older adult %K elderly %K HIC %K high-income countries %K diet %K dietary intake %K nutritional status %K Canada %K nutritional risk %K social %K intervention %K public health %K community-based intervention %K health promotion %D 2024 %7 25.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In high-income countries (HICs), between 65% and 70% of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors’ knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically. Objective: The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in HICs and to identify social interventions that address nutrition risk in community-dwelling older adults in HICs. Methods: This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE (Ovid), CINAHL, PsycINFO, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote (Clarivate Analytics) and Covidence (Veritas Health Innovation Ltd) will be used for reference management and removal of duplicate studies. Articles will be screened, and data will be extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, and dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, and demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and the details of social interventions designed to address nutrition risk. Results: The scoping review was started in October 2023 and will be finalized by August 2024. The findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables. Conclusions: Given the high prevalence of nutrition risk in community-dwelling older adults in HICs and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk. International Registered Report Identifier (IRRID): DERR1-10.2196/56714 %M 38696645 %R 10.2196/56714 %U https://www.researchprotocols.org/2024/1/e56714 %U https://doi.org/10.2196/56714 %U http://www.ncbi.nlm.nih.gov/pubmed/38696645 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56565 %T Effect of Flavored on! Nicotine Pouch Products on Smoking Behaviors: Protocol for a Sequential, Multiple Assignment, Randomized Controlled Trial %A Cheng,Hui G %A Rose,Jed E %A Karelitz,Joshua L %A Botts,David R %A Botts,Tanaia L %A Willette,Perry N %A Cohen,Gal %+ Altria Client Services, LLC, 601 E Jackson St, Richmond, VA, 23219, United States, 1 5175998785, hui.cheng@altria.com %K nicotine pouches %K flavored products %K smoking reduction %K tobacco harm reduction %K randomized controlled trial %D 2024 %7 21.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cigarette smoking is a leading cause of morbidity and mortality. For adults who smoke cigarettes and cannot or will not quit smoking, smoke-free products, such as nicotine pouches, have been recognized as a potential alternative to smoking combusted cigarettes to reduce harm due to cigarette smoking. The role of flavors in these smoke-free products in tobacco harm reduction has not been fully understood. Objective: This study evaluates the effect of flavors in on! nicotine pouch products (research products) in the reduction of cigarette smoking among adults who smoke cigarettes in their natural environment. Methods: This study uses a sequential, multiple assignment, randomized trial design. Approximately 400 eligible adults who smoke cigarettes will be enrolled and randomized to have access to either the Original (unflavored) on! nicotine pouch product only or a complete flavor profile (ie, Berry, Cinnamon, Citrus, Coffee, Mint, Original, and Wintergreen) of on! nicotine pouch products. After 3 weeks, participants in the Original-only arm will be randomized again, with half remaining in the Original-only arm and half having access to the complete flavor profile for another 3 weeks. Primary outcomes are expired-air carbon monoxide (CO) levels. Secondary outcomes are self-reported cigarette consumption and CO-verified cigarette abstinence. Results: Recruitment and data collection started in September 2023 and is projected to last until March 2025. We anticipate completing the data analysis in 2025. As of May 2024, we have enrolled 314 participants. Conclusions: This study will provide empirical evidence about the effect that flavor availability in smoke-free products may have in reducing cigarette smoking. Trial Registration: ClinicalTrials.gov NCT06072547; https://clinicaltrials.gov/study/NCT06072547 International Registered Report Identifier (IRRID): DERR1-10.2196/56565 %M 38905632 %R 10.2196/56565 %U https://www.researchprotocols.org/2024/1/e56565 %U https://doi.org/10.2196/56565 %U http://www.ncbi.nlm.nih.gov/pubmed/38905632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45469 %T App Engagement as a Predictor of Weight Loss in Blended-Care Interventions: Retrospective Observational Study Using Large-Scale Real-World Data %A Lehmann,Marco %A Jones,Lucy %A Schirmann,Felix %+ Oviva AG, Dortustraße 48, Potsdam, 14467, Germany, 49 3055572034, marco.lehmann@oviva.com %K obesity %K weight loss %K blended-care %K digital health %K real-world data %K app engagement %K mHealth %K mobile health %K technology engagement %K weight management %K mobile phone %D 2024 %7 7.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. Objective: Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. Methods: Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. Results: For the entire sample (N=19,211), mean weight loss was –3.24% (SD 4.58%) at 3 months and –5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months<.001 and P6 months=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (PSwitzerland<.001, PUnited Kingdom=.12, and PGermany=.005). Higher age was associated with stronger weight loss in the 3-month period (PSwitzerland=.001, PUnited Kingdom=.002, and PGermany<.001) and, for Germany, also in the 6-month period (PSwitzerland=.09, PUnited Kingdom=.46, and PGermany=.03). In Switzerland, higher numbers of patients’ messages to coaches were associated with higher weight loss (P3 months<.001 and P6 months<.001). Messages from coaches were not significantly associated with weight loss (all P>.05). Conclusions: Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design. %M 38848556 %R 10.2196/45469 %U https://www.jmir.org/2024/1/e45469 %U https://doi.org/10.2196/45469 %U http://www.ncbi.nlm.nih.gov/pubmed/38848556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51708 %T Six-Month Outcomes of a Theory- and Technology-Enhanced Physical Activity Intervention for Latina Women (Pasos Hacia La Salud II): Randomized Controlled Trial %A Connell Bohlen,Lauren %A Dunsiger,Shira I %A von Ash,Tayla %A Larsen,Britta A %A Pekmezi,Dori %A Marquez,Becky %A Benitez,Tanya J %A Mendoza-Vasconez,Andrea %A Hartman,Sheri J %A Williams,David M %A Marcus,Bess H %+ Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, United States, 1 4018636559, lauren_bohlen@brown.edu %K digital health %K web-based intervention %K exercise %K social support %K behavior change intervention %K support %K Latina women %K women %K Latina %K physical activity %K barrier %K aerobic %K remote intervention %K text message %K behavior change %K behavior %D 2024 %7 6.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: More than half (55%) of Latina women do not meet aerobic physical activity (PA) guidelines, and frequently cite time, childcare, and transportation as barriers to PA. In addition to linguistic adaptations for this population, successful PA interventions for Latina women addressed these barriers through remote intervention delivery approaches (eg, mail, phone, or web delivery). Objective: We aimed to evaluate 6-month outcomes of a randomized trial comparing a Spanish-language, individually tailored, web-delivered PA intervention (original) to an enhanced version with text messages and additional features (enhanced). Further, we evaluated if increases in PA at 6 months were moderated by baseline activity status. Methods: In total, 195 Latina women aged 18-65 years participated in a trial comparing the efficacy of the enhanced versus original interventions at initiating PA behavior change. We examined minutes per week of accelerometer-measured PA in the enhanced versus original arms, and the proportion of each arm meeting aerobic PA guidelines (150 min/wk at 6 mo). For moderator analyses, participants were classified as inactive (0 min/wk) or low active (1-90 min/wk) at baseline, measured via the 7 Day Physical Activity Recall interview. Results: PA increased from 19.7 (SD 47.9) minutes per week at baseline to 46.9 (SD 66.2) minutes per week at 6 months in the enhanced arm versus 20.6 (SD 42.7) minutes per week to 42.9 (SD 78.2) minutes per week in the original arm (P=.78). Overall, 30% (31/103) of the enhanced group met aerobic PA guidelines at 6 months, compared to 21% (19/92) of the original group (odds ratio [OR] 1.75, 95% CI 0.87-3.55). Baseline PA (inactive vs low active) moderated treatment effects on PA. For inactive participants, there were no group differences at 6 months (b=7.1; SE 22.8; P=.75), while low-active participants increased more in enhanced than original (b=72.5; SE 27.9; P=.01). For low-active participants, 45% (46/103) of the enhanced group met PA guidelines at 6 months, versus 20% (18/92) of the original arm (OR 3.29, 95% CI 1.05-11.31). For inactive participants, there were no group differences (25/103, 24% vs n=19/92, 21% for enhanced vs original, respectively; OR 1.28, 95% CI 0.54-3.06). Conclusions: Intervention effects were conditional on baseline PA. For low-active Latina women, the enhanced intervention was more effective at increasing PA. Additional tailored intervention enhancements may be necessary to increase PA for inactive Latina women. Trial Registration: ClinicalTrials.gov NCT03491592; https://www.clinicaltrials.gov/study/NCT03491592 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06575-4 %M 38842930 %R 10.2196/51708 %U https://www.jmir.org/2024/1/e51708 %U https://doi.org/10.2196/51708 %U http://www.ncbi.nlm.nih.gov/pubmed/38842930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47515 %T Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial %A Doukani,Asmae %A Quartagno,Matteo %A Sera,Francesco %A Free,Caroline %A Kakuma,Ritsuko %A Riper,Heleen %A Kleiboer,Annet %A Cerga-Pashoja,Arlinda %A van Schaik,Anneke %A Botella,Cristina %A Berger,Thomas %A Chevreul,Karine %A Matynia,Maria %A Krieger,Tobias %A Hazo,Jean-Baptiste %A Draisma,Stasja %A Titzler,Ingrid %A Topooco,Naira %A Mathiasen,Kim %A Vernmark,Kristofer %A Urech,Antoine %A Maj,Anna %A Andersson,Gerhard %A Berking,Matthias %A Baños,Rosa María %A Araya,Ricardo %+ Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 020 7636 8636 ext 2463, asmae.doukani@lshtm.ac.uk %K blended psychotherapy %K cognitive behavioral therapy %K depression %K digital mental health interventions %K psychotherapy %K mental health %K program usability %K therapeutic alliance %K usability heuristics %K working alliance %D 2024 %7 31.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. Objective: This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. Methods: We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised–Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Results: Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=−0.12, 95% CI −0.17 to −0.06) and TAU (B=−0.06, 95% CI −0.11 to −0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=−0.030, 95% CI −0.05 to −0.01; P=.005). Conclusions: To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. Trial Registration: ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1511-1 %M 38819882 %R 10.2196/47515 %U https://www.jmir.org/2024/1/e47515 %U https://doi.org/10.2196/47515 %U http://www.ncbi.nlm.nih.gov/pubmed/38819882 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54486 %T Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial %A Hogue,Aaron %A Porter,Nicole P %A Ozechowski,Timothy J %A Becker,Sara J %A O'Grady,Megan A %A Bobek,Molly %A Cerniglia,Monica %A Ambrose,Kevin %A MacLean,Alexandra %A Hadland,Scott E %A Cunningham,Hetty %A Bagley,Sarah M %A Sherritt,Lon %A O'Connell,Maddie %A Shrier,Lydia A %A Harris,Sion Kim %+ Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, 711 Third Avenue, Suite 500, New York, NY, 10017, United States, 1 2126559566, nporter@toendaddiction.org %K adolescent substance use %K pediatric primary care %K screening %K brief intervention %K referral to treatment %K family-based %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite the recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures. Objective: This randomized effectiveness trial will advance research and scope on SBIRT-A in primary care by conducting a head-to-head test of 2 conceptually grounded, evidence-informed approaches: a standard adolescent-only approach (SBIRT-A-Standard) versus a more expansive family-based approach (SBIRT-A-Family). The SBIRT-A-Family approach enhances the procedures of the SBIRT-A-Standard approach by screening for AOD risk with both adolescents and caregivers; leveraging multidomain, multireporter AOD risk and protection data to inform case identification and risk categorization; and directly involving caregivers in brief intervention and referral to treatment activities. Methods: The study will include 2300 adolescents (aged 12-17 y) and their caregivers attending 1 of 3 hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities will occur during a single pediatric visit. SBIRT-A procedures will be delivered digitally on handheld tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, and parent-adolescent communication about AOD use) and secondary outcomes (adolescent quality of life, adolescent risk factors, and therapy attendance) will be assessed at screening and initial assessment and 3-, 6-, 9-, and 12-month follow-ups. The study is well powered to conduct all planned main and moderator (age, sex, race, ethnicity, and youth AOD risk status) analyses. Results: This study will be conducted over a 5-year period. Provider training was initiated in year 1 (December 2023). Participant recruitment and follow-up data collection began in year 2 (March 2024). We expect the results from this study to be published in early 2027. Conclusions: SBIRT-A is widely endorsed but currently underused in pediatric primary care settings, and questions remain about optimal approaches and overall effectiveness. In particular, referral to treatment procedures in primary care remains virtually untested among youth. In addition, whereas research strongly supports involving families in interventions for adolescent AOD, SBIRT-A effectiveness trial testing approaches that actively engage family members in primary care are absent. This trial is designed to help fill these research gaps to inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care. Trial Registration: ClinicalTrials.gov NCT05964010; https://www.clinicaltrials.gov/study/NCT05964010 International Registered Report Identifier (IRRID): PRR1-10.2196/54486 %M 38819923 %R 10.2196/54486 %U https://www.researchprotocols.org/2024/1/e54486 %U https://doi.org/10.2196/54486 %U http://www.ncbi.nlm.nih.gov/pubmed/38819923 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e54496 %T Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review %A Fernandes,Sofia %A von Gunten,Armin %A Verloo,Henk %+ School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Chemin de l’Agasse 5, Sion, 1950, Switzerland, 41 00415860861, sofia.fernandes@hevs.ch %K artificial intelligence %K behavioral and psychological symptoms of dementia %K neuropsychiatric symptoms %K early detection %K management %K narrative literature review %D 2024 %7 28.5.2024 %9 Review %J JMIR Nursing %G English %X Background: The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence–based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. Objective: The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. Methods: A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. Results: A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. Conclusions: Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions. %M 38805252 %R 10.2196/54496 %U https://nursing.jmir.org/2024/1/e54496 %U https://doi.org/10.2196/54496 %U http://www.ncbi.nlm.nih.gov/pubmed/38805252 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54375 %T Digital Behavior Change Intervention Designs for Habit Formation: Systematic Review %A Zhu,Yujie %A Long,Yonghao %A Wang,Hailiang %A Lee,Kun Pyo %A Zhang,Lie %A Wang,Stephen Jia %+ School of Design, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China (Hong Kong), 852 2766 5478, stephen.j.wang@polyu.edu.hk %K habit formation %K digital health %K digital behavior change interventions design %K behavior change techniques %K physical activity %K mobile phone %D 2024 %7 24.5.2024 %9 Review %J J Med Internet Res %G English %X Background: With the development of emerging technologies, digital behavior change interventions (DBCIs) help to maintain regular physical activity in daily life. Objective: To comprehensively understand the design implementations of habit formation techniques in current DBCIs, a systematic review was conducted to investigate the implementations of behavior change techniques, types of habit formation techniques, and design strategies in current DBCIs. Methods: The process of this review followed the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases were systematically searched from 2012 to 2022, which included Web of Science, Scopus, ACM Digital Library, and PubMed. The inclusion criteria encompassed studies that used digital tools for physical activity, examined behavior change intervention techniques, and were written in English. Results: A total of 41 identified research articles were included in this review. The results show that the most applied behavior change techniques were the self-monitoring of behavior, goal setting, and prompts and cues. Moreover, habit formation techniques were identified and developed based on intentions, cues, and positive reinforcement. Commonly used methods included automatic monitoring, descriptive feedback, general guidelines, self-set goals, time-based cues, and virtual rewards. Conclusions: A total of 32 commonly design strategies of habit formation techniques were summarized and mapped to the proposed conceptual framework, which was categorized into target-mediated (generalization and personalization) and technology-mediated interactions (explicitness and implicitness). Most of the existing studies use the explicit interaction, aligning with the personalized habit formation techniques in the design strategies of DBCIs. However, implicit interaction design strategies are lacking in the reviewed studies. The proposed conceptual framework and potential solutions can serve as guidelines for designing strategies aimed at habit formation within DBCIs. %M 38787601 %R 10.2196/54375 %U https://www.jmir.org/2024/1/e54375 %U https://doi.org/10.2196/54375 %U http://www.ncbi.nlm.nih.gov/pubmed/38787601 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e51429 %T Effects of Food Depictions in Entertainment Media on Children’s Unhealthy Food Preferences: Content Analysis Linked With Panel Data %A Matthes,Jörg %A Binder,Alice %A Naderer,Brigitte %A Forrai,Michaela %A Spielvogel,Ines %A Knupfer,Helena %A Saumer,Melanie %K children %K health %K unhealthy food preferences %K food depictions %K centrality %K coviewing %K longitudinal linkage study %K child %K food %K eating %K diet %K dietary %K preference %K preferences %K nutrition %K nutritional %K diet %K media %K entertainment %K panel %K foods %K pediatric %K pediatrics %K food preference %K food preferences %D 2024 %7 22.5.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Entertainment media content is often mentioned as one of the roots of children’s unhealthy food consumption. This might be due to the high quantity of unhealthy foods presented in children’s media environments. However, less is known about the role of the centrality of food placement, that is, whether foods are interacted with, consumed, verbally mentioned, or appear unobtrusively. We also lack longitudinal research measuring both children’s unhealthy and healthy food consumption behaviors as outcomes. Objective: The aim is to connect content analytical data based on children’s actual media diet with panel data in order to explain children’s food preferences. Moreover, this study not only focuses on the amount of healthy and unhealthy foods children are exposed to, but also on how these foods are presented (ie, centrally or not). Furthermore, we looked at the question of how parental coviewing can diminish (or enhance) the effects of unhealthy (or healthy) food depictions, and we measured healthy and unhealthy consumption as dependent variables. Methods: We conducted a 2-wave panel study with children and one of their parents (of 2250 parents contacted, 829 responded, for a response rate of 36.84%; 648 valid cases, ie, parent-child pairs, were used for analysis), with 6 months between the 2 panel waves. We linked the 2-wave panel data for the children and their parents to content analytical data for movies (n=113) and TV series (n=134; 3 randomly chosen episodes per TV series were used) that children were exposed to over the course of 6 months. Results: There was no significant relationship between exposure to unhealthy food presentation and unhealthy (b=0.008; P=.07) or healthy (b=−0.003; P=.57) food consumption over time. Also, healthy food presentation was unrelated to unhealthy (b=0.009; P=.18) or healthy (b=0.000; P=.99) food consumption over time. However, there was a significant, positive interaction between unhealthy food presentation and presentation centrality on unhealthy food consumption (b=0.000; P=.03), suggesting that the effects of unhealthy food presentation rise with increasing levels of centrality. There was no interaction between unhealthy food presentation and presentation centrality on the consumption of healthy foods (b=0.000; P=.10). Also, exposure to healthy food presentation interacted with centrality (b=−0.001; P=.003). That is, when a healthy product was presented at maximum centrality, it led to less unhealthy food consumption in children. Coviewing did not interact with exposure to unhealthy foods when explaining unhealthy (b=0.003; P=.08) or healthy (b=−0.001; P=.70) food consumption. Conclusions: We conclude that simply presenting more healthy foods is not sufficient to combat children’s unhealthy food preferences. Further regulations may be necessary with respect to representations of unhealthy foods in children’s media. %R 10.2196/51429 %U https://pediatrics.jmir.org/2024/1/e51429 %U https://doi.org/10.2196/51429 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50982 %T Predicting the Effectiveness of a Mindfulness Virtual Community Intervention for University Students: Machine Learning Model %A El Morr,Christo %A Tavangar,Farideh %A Ahmad,Farah %A Ritvo,Paul %A , %+ School of Health Policy and Management, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 426 736 2100 ext 22053, elmorr@yorku.ca %K machine learning %K virtual community %K virtual care %K mindfulness %K depression %K anxiety %K stress %K students %K online %K randomized controlled trial %K Canada %K virtual %K artificial intelligence %K symptoms %K behavioral therapy %K sociodemographic %K mindfulness video %K online video %D 2024 %7 13.5.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Students’ mental health crisis was recognized before the COVID-19 pandemic. Mindfulness virtual community (MVC), an 8-week web-based mindfulness and cognitive behavioral therapy program, has proven to be an effective web-based program to reduce symptoms of depression, anxiety, and stress. Predicting the success of MVC before a student enrolls in the program is essential to advise students accordingly. Objective: The objectives of this study were to investigate (1) whether we can predict MVC’s effectiveness using sociodemographic and self-reported features and (2) whether exposure to mindfulness videos is highly predictive of the intervention’s success. Methods: Machine learning models were developed to predict MVC’s effectiveness, defined as success in reducing symptoms of depression, anxiety, and stress as measured using the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS), to at least the minimal clinically important difference. A data set representing a sample of undergraduate students (N=209) who took the MVC intervention between fall 2017 and fall 2018 was used for this secondary analysis. Random forest was used to measure the features’ importance. Results: Gradient boosting achieved the best performance both in terms of area under the curve (AUC) and accuracy for predicting PHQ-9 (AUC=0.85 and accuracy=0.83) and PSS (AUC=1 and accuracy=1), and random forest had the best performance for predicting BAI (AUC=0.93 and accuracy=0.93). Exposure to online mindfulness videos was the most important predictor for the intervention’s effectiveness for PHQ-9, BAI, and PSS, followed by the number of working hours per week. Conclusions: The performance of the models to predict MVC intervention effectiveness for depression, anxiety, and stress is high. These models might be helpful for professionals to advise students early enough on taking the intervention or choosing other alternatives. The students’ exposure to online mindfulness videos is the most important predictor for the effectiveness of the MVC intervention. Trial Registration: ISRCTN Registry ISRCTN12249616; https://www.isrctn.com/ISRCTN12249616 %M 38578872 %R 10.2196/50982 %U https://www.i-jmr.org/2024/1/e50982 %U https://doi.org/10.2196/50982 %U http://www.ncbi.nlm.nih.gov/pubmed/38578872 %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 %@ 2561-1011 %I JMIR Publications %V 8 %N %P e53815 %T Cognitive Behavioral Therapy for Symptom Preoccupation Among Patients With Premature Ventricular Contractions: Nonrandomized Pretest-Posttest Study %A Liliequist,Björn E %A Särnholm,Josefin %A Skúladóttir,Helga %A Ólafsdóttir,Eva %A Ljótsson,Brjánn %A Braunschweig,Frieder %+ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, Stockholm, 171 65, Sweden, 46 08 524 800 00, bjorn.liliequist@ki.se %K premature ventricular contractions %K quality of life %K symptom preoccupation %K cognitive behavioral therapy: CBT %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Premature ventricular contractions (PVCs) are a common cardiac condition often associated with disabling symptoms and impaired quality of life (QoL). Current treatment strategies have limited effectiveness in reducing symptoms and restoring QoL for patients with PVCs. Symptom preoccupation, involving cardiac-related fear, hypervigilance, and avoidance behavior, is associated with disability in other cardiac conditions and can be effectively targeted by cognitive behavioral therapy (CBT). Objective: The aim of this study was to evaluate the effect of a PVC-specific CBT protocol targeting symptom preoccupation in patients with symptomatic idiopathic PVCs. Methods: Nineteen patients diagnosed with symptomatic idiopathic PVCs and symptom preoccupation underwent PVC-specific CBT over 10 weeks. The treatment was delivered by a licensed psychologist via videoconference in conjunction with online text-based information and homework assignments. The main components of the treatment were exposure to cardiac-related symptoms and reducing cardiac-related avoidance and control behavior. Self-rated measures were collected at baseline, post treatment, and at 3- and 6-month follow-ups. The primary outcome was PVC-specific QoL at posttreatment assessment measured with a PVC-adapted version of the Atrial Fibrillation Effects on Quality of Life questionnaire. Secondary measures included symptom preoccupation measured with the Cardiac Anxiety Questionnaire. PVC burden was evaluated with 5-day continuous electrocardiogram recordings at baseline, post treatment, and 6-month follow-up. Results: We observed large improvements in PVC-specific QoL (Cohen d=1.62, P<.001) and symptom preoccupation (Cohen d=1.73, P<.001) post treatment. These results were sustained at the 3- and 6-month follow-ups. PVC burden, as measured with 5-day continuous electrocardiogram, remained unchanged throughout follow-up. However, self-reported PVC symptoms were significantly lower at posttreatment assessment and at both the 3- and 6-month follow-ups. Reduction in symptom preoccupation had a statistically significant mediating effect of the intervention on PVC-specific QoL in an explorative mediation analysis. Conclusions: This uncontrolled pilot study shows preliminary promising results for PVC-specific CBT as a potentially effective treatment approach for patients with symptomatic idiopathic PVCs and symptom preoccupation. The substantial improvements in PVC-specific QoL and symptom preoccupation, along with the decreased self-reported PVC-related symptoms warrant further investigation in a larger randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT05087238; https://clinicaltrials.gov/study/NCT05087238 %M 38713500 %R 10.2196/53815 %U https://cardio.jmir.org/2024/1/e53815 %U https://doi.org/10.2196/53815 %U http://www.ncbi.nlm.nih.gov/pubmed/38713500 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55364 %T Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives %A Theopilus,Yansen %A Al Mahmud,Abdullah %A Davis,Hilary %A Octavia,Johanna Renny %+ Centre for Design Innovation, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 39214383, aalmahmud@swin.edu.au %K addiction therapist %K children %K digital intervention %K internet addiction %K digital devices %K parents %K parental control %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. Objective: This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. Methods: This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Results: Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps’ functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. Conclusions: The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children’s competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children’s internet use, providing tailored or personalized content to suit users’ characteristics, and considering the provision of training and information about the use of interventions and privacy agreements. %M 38669672 %R 10.2196/55364 %U https://pediatrics.jmir.org/2024/1/e55364 %U https://doi.org/10.2196/55364 %U http://www.ncbi.nlm.nih.gov/pubmed/38669672 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53022 %T Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology–Supported Intervention %A Foster,Marva %A Fix,Gemmae M %A Hyde,Justeen %A Dunlap,Shawn %A Byrne,Thomas H %A Sugie,Naomi F %A Kuhn,Randall %A Gabrielian,Sonya %A Roncarati,Jill S %A Zhao,Shibei %A McInnes,D Keith %+ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, United States, 1 857 203 6671, marva.foster@va.gov %K ethnography %K homelessness %K housing transitions %K longitudinal data %K military %K mobile technology %K smartphone %K social support %K veterans %D 2024 %7 22.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population’s health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support. Objective: The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless. Methods: This study’s design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3. Results: The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress. Conclusions: This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions. International Registered Report Identifier (IRRID): DERR1-10.2196/53022 %M 38648101 %R 10.2196/53022 %U https://www.researchprotocols.org/2024/1/e53022 %U https://doi.org/10.2196/53022 %U http://www.ncbi.nlm.nih.gov/pubmed/38648101 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54406 %T Psychotherapy for Ketamine’s Enhanced Durability in Chronic Neuropathic Pain: Protocol for a Pilot Randomized Controlled Trial %A Goel,Akash %A Kapoor,Bhavya %A Chan,Hillary %A Ladha,Karim %A Katz,Joel %A Clarke,Hance %A Pazmino-Canizares,Janneth %A Thomas,Zaaria %A Philip,Kaylyssa %A Mattina,Gabriella %A Ritvo,Paul %+ Department of Anesthesia and Pain Medicine, St Michael’s Hospital, 30 Bond Street, 65-501 Donnelly South, Toronto, ON, M5B1W8, Canada, 1 4168645071, akash.goel@unityhealth.to %K 3-arm parallel group %K cognitive behavior therapy %K ketamine hydrochloride %K pain intensity %K pain interference %K psychotherapy %K randomized controlled trial %D 2024 %7 17.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain affects approximately 8 million Canadians (~20%), impacting their physical and mental health while burdening the health care system with costs of upwards of US $60 billion a year. Indeed, patients are often trialed on numerous medications over several years without reductions to their symptoms. Therefore, there is an urgent need to identify new therapies for chronic pain to improve patients’ quality of life, increase the availability of treatment options, and reduce the burden on the health care system. Objective: The primary objective of this study is to examine the feasibility of a parallel 3-arm pilot randomized controlled trial whereby patients are randomized to either intravenous ketamine alone, cognitive behavioral therapy (CBT) and mindfulness meditation (MM) training (CBT/MM), or the combination of intravenous ketamine and CBT/MM. The secondary outcome is to assess the durability and efficacy of combination intravenous ketamine and CBT/MM for treatment of chronic pain as compared to CBT/MM or intravenous ketamine alone (assessed at week 20 of the study). Methods: This is a single-center, 16-week, 3-arm pilot study that will take place at the Chronic Pain Clinic at St. Michael’s Hospital, Toronto, Ontario, which receives 1000 referrals per year. Patients will be enrolled in the study for a total of 20 weeks. Participants who are allocated CBT/MM therapy will receive remote weekly psychotherapy from week 1 to week 16, inclusive of health coaching administered through the NexJ Health Inc (NexJ Health) platform. Patients who are allocated ketamine-infusion therapy will receive monthly ketamine infusion treatments on weeks 2, 7, and 12. Patients who are allocated ketamine+CBT/MM will receive weekly psychotherapy from weeks 1 to 16, inclusive, as well as ketamine infusion treatments on weeks 2, 7, and 12. We will be assessing recruitment rates, consent rates, withdrawal rates, adherence, missing data, and adverse events as pilot outcome measures. Secondary clinical outcomes include changes relative to baseline in pain intensity and pain interference. Results: As of November 1, 2023, the recruitment process has not been initiated. Given the recruitment, consent, and intervention target of 30 participants for this feasibility study, with each patient undergoing monitoring and treatments for a course of 20 weeks, we expect to complete the study by December 2025. Conclusions: This study assesses the feasibility of conducting a 3-arm randomized controlled trial to examine the effects of ketamine administration with the concurrent use of CBT/MM in a population with chronic neuropathic pain. The results of this pilot randomized controlled trial will inform the development of a larger-scale randomized controlled trial. Future studies will be aimed at including a sufficiently powered sample that will inform decisions about optimal treatment calibration and treatment effect duration. Trial Registration: ClinicalTrials.gov NCT05639322; https://classic.clinicaltrials.gov/ct2/show/NCT05639322 International Registered Report Identifier (IRRID): PRR1-10.2196/54406 %M 38630524 %R 10.2196/54406 %U https://www.researchprotocols.org/2024/1/e54406 %U https://doi.org/10.2196/54406 %U http://www.ncbi.nlm.nih.gov/pubmed/38630524 %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 %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55039 %T Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial %A Shrier,Lydia A %A O'Connell,Madison M %A Torres,Alessandra %A Shone,Laura P %A Fiks,Alexander G %A Plumb,Julia A %A Maturo,Jessica L %A McCaskill,Nicholas H %A Harris,Donna %A Burke,Pamela J %A Felt,Thatcher %A Murphy,Marie Lynd %A Sherritt,Lon %A Harris,Sion Kim %+ Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Mailstop 3189, Boston, MA, 02115, United States, 1 617 355 8306, lydia.shrier@childrens.harvard.edu %K alcohol %K substance use %K adolescent %K primary care %K prevention %K intervention %K screening %K brief intervention %K computer-facilitated screening and brief intervention %K cSBI %K mobile phone %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. Objective: This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. Methods: We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use–associated health risks. During the visit, intervention clinicians access a computerized summary of the patient’s screening results and a tailored counseling script to deliver a motivational interviewing–based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. Results: The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. Conclusions: Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. Trial Registration: ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966 International Registered Report Identifier (IRRID): DERR1-10.2196/55039 %M 38530346 %R 10.2196/55039 %U https://www.researchprotocols.org/2024/1/e55039 %U https://doi.org/10.2196/55039 %U http://www.ncbi.nlm.nih.gov/pubmed/38530346 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48677 %T An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing %A Huguet,Anna %A Rozario,Sharlene %A Wozney,Lori %A McGrath,Patrick J %+ Department of Psychology, Universitat Rovira i Virgili, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 977 55 80 96, anna.huguet@urv.cat %K adolescents %K cognitive-behavioral intervention %K design process %K end users %K headaches %K internet %K usability %K young adult %D 2023 %7 12.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Headache disorders are common, debilitating health problems. Cognitive-behavioral therapy (CBT) is recommended but rarely easily available. With the use of the internet and communication technologies among youth and young adults, these individuals could be self-trained in CBT skills. There is an increasing number of internet-based interventions for headaches, but there has been little research into the usability of these interventions because evaluating usability across the intervention development life cycle is costly. We developed an internet-based CBT program, the Specialized Program for Headache Reduction (SPHERE). While developing it, we aimed to improve SPHERE through rapid usability testing cycles. Objective: This study aims to presents a rapid and affordable usability testing approach that can be performed throughout the intervention development life cycle. This paper also provides evidence of the usability of SPHERE. Methods: We used the “think aloud” usability testing method based on Krug’s approach to test user interaction within a lab setting. This was followed by a short posttest interview. We planned to test SPHERE with 3-5 participants testing the same part of the program each cycle. Both the design and development team and the research team actively participated in the usability testing process. Observers independently identified the top 3 usability issues, rated their severity, and conducted debriefing sessions to come to consensus on major issues and generate potential solutions. Results: The testing process allowed major usability issues to be identified and rectified rapidly before piloting SPHERE in a real-world context. A total of 2 cycles of testing were conducted. Of the usability issues encountered in cycles 1 and 2, a total of 68% (17/25) and 32% (12/38), respectively, were rated as major, discussed, and fixed. Conclusions: This study shows that rapid usability testing is an essential part of the design process that improves program functionality and can be easy and inexpensive to undertake. %M 38085567 %R 10.2196/48677 %U https://humanfactors.jmir.org/2023/1/e48677 %U https://doi.org/10.2196/48677 %U http://www.ncbi.nlm.nih.gov/pubmed/38085567 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46928 %T Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach %A Shaker,Ali Abbas %A Austin,Stephen F %A Jørgensen,Mie Sedoc %A Sørensen,John Aasted %A Bechmann,Henrik %A Kinnerup,Henriette E %A Petersen,Charlotte Juul %A Olsen,Ragnar Klein %A Simonsen,Erik %+ Psychiatric Research Unit, Psychiatric Department, Region Zealand Psychiatry, Fælledvej 6, Bygning 3, 4. sal, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K software models %K in-house development %K psychiatric services %K borderline personality disorder %K mobile application %K development %K mental health %K user design %K design %K psychiatric %K implementation %K innovation %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. Objective: This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. Methods: The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. Results: For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house–developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. Conclusions: The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology. %M 38032709 %R 10.2196/46928 %U https://humanfactors.jmir.org/2023/1/e46928 %U https://doi.org/10.2196/46928 %U http://www.ncbi.nlm.nih.gov/pubmed/38032709 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44194 %T Incorporating Community Partner Perspectives on eHealth Technology Data Sharing Practices for the California Early Psychosis Intervention Network: Qualitative Focus Group Study With a User-Centered Design Approach %A Tully,Laura M %A Nye,Kathleen E %A Ereshefsky,Sabrina %A Tryon,Valerie L %A Hakusui,Christopher Komei %A Savill,Mark %A Niendam,Tara A %+ Department of Psychiatry and Behavioral Sciences, University of California, Davis, 4701 X St, Sacramento, CA, 95817, United States, 1 916 699 5193, knye@ucdavis.edu %K attitude %K content analysis %K data sharing %K eHealth %K ethic %K focus group %K health information exchange %K mental health %K perspective %K preference %K psychosis %K psychotic %K qualitative data %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Increased use of eHealth technology and user data to drive early identification and intervention algorithms in early psychosis (EP) necessitates the implementation of ethical data use practices to increase user acceptability and trust. Objective: First, the study explored EP community partner perspectives on data sharing best practices, including beliefs, attitudes, and preferences for ethical data sharing and how best to present end-user license agreements (EULAs). Second, we present a test case of adopting a user-centered design approach to develop a EULA protocol consistent with community partner perspectives and priorities. Methods: We conducted an exploratory, qualitative, and focus group–based study exploring mental health data sharing and privacy preferences among individuals involved in delivering or receiving EP care within the California Early Psychosis Intervention Network. Key themes were identified through a content analysis of focus group transcripts. Additionally, we conducted workshops using a user-centered design approach to develop a EULA that addresses participant priorities. Results: In total, 24 participants took part in the study (14 EP providers, 6 clients, and 4 family members). Participants reported being receptive to data sharing despite being acutely aware of widespread third-party sharing across digital domains, the risk of breaches, and motives hidden in the legal language of EULAs. Consequently, they reported feeling a loss of control and a lack of protection over their data. Participants indicated these concerns could be mitigated through user-level control for data sharing with third parties and an understandable, transparent EULA, including multiple presentation modalities, text at no more than an eighth-grade reading level, and a clear definition of key terms. These findings were successfully integrated into the development of a EULA and data opt-in process that resulted in 88.1% (421/478) of clients who reviewed the video agreeing to share data. Conclusions: Many of the factors considered pertinent to informing data sharing practices in a mental health setting are consistent among clients, family members, and providers delivering or receiving EP care. These community partners’ priorities can be successfully incorporated into developing EULA practices that can lead to high voluntary data sharing rates. %M 37962921 %R 10.2196/44194 %U https://humanfactors.jmir.org/2023/1/e44194 %U https://doi.org/10.2196/44194 %U http://www.ncbi.nlm.nih.gov/pubmed/37962921 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44145 %T Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study %A Tadros,Michelle %A Li,Sophie %A Upton,Emily %A Newby,Jill %A Werner-Seidler,Aliza %+ The Black Dog Institute, The University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 2 9382 4530, m.tadros@unsw.edu.au %K university students %K sleep difficulties %K intervention %K student needs %K insomnia %K treatment %K focus group %K intervention design %K sleep %K sleep medicine %K student %K university %K college %K post secondary %K psychological %K psychotherapy %K help-seeking %K polysomnography %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. Objective: This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. Methods: Focus groups were conducted over 3 stages to examine students’ views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. Results: In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep. Conclusions: Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties. %M 37616036 %R 10.2196/44145 %U https://humanfactors.jmir.org/2023/1/e44145 %U https://doi.org/10.2196/44145 %U http://www.ncbi.nlm.nih.gov/pubmed/37616036 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e34629 %T Mixed Reality Technology to Deliver Psychological Interventions to Adolescents With Asthma: Qualitative Study Using the Theoretical Framework of Acceptability %A Sharrad,Kelsey %A Martini,Caitlin %A Tai,Andrew %A Spurrier,Nicola %A Smith,Ross %A Esterman,Adrian %A Gwilt,Ian %A Sandford,Debra %A Carson-Chahhoud,Kristin %+ Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 08 8302 2734, Kelsey.hibberd@live.com.au %K asthma %K augmented reality %K virtual reality %K mixed reality %K psychological distress %K adolescent %K cognitive behavioral therapies %K mental health %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Interactive, mixed reality technologies such as augmented reality, virtual reality, and holographic technology may provide a novel solution to fast-track the translation of evidence into practice. They may also help overcome barriers to both mental health and asthma management service uptake, such as cost, availability of appointments, fear of judgment, and quality of care. Objective: This study aimed to investigate if mixed reality technology is an acceptable mechanism for the delivery of a component of cognitive and behavioral therapies for the management of elevated psychological distress among young people with asthma. Methods: To explore the perceived acceptability of these technologies, mixed reality tools were evaluated via qualitative, 1-on-1 interviews with young people with asthma and symptoms of psychological distress, parents/caregivers of young people with asthma and symptoms of psychological distress, and relevant health professionals. The Theoretical Framework of Acceptability was used for the deductive coding of the recorded interview transcripts. Results: This study enrolled the following participants: (1) 3 adolescents with asthma and symptoms of psychological distress with a mean age of 14 (SD 1.7) years; (2) 4 parents/caregivers of adolescents with asthma with a mean age of 55 (SD 14.6) years; and (3) 6 health professionals with a mean age of 40.8 (SD 4.3) years. A total of 4 constructs—experienced affective attitude, experienced effectiveness, self-efficacy, and intervention coherence—were coded in all participant transcripts. The most frequently coded constructs were experienced affective attitude and intervention coherence, which were reported a total of 96 times. The least frequently coded construct was anticipated opportunity cost, which was reported a total of 5 times. Participants were mostly positive about the mixed reality resources. However, some concerns were raised regarding ethicality, particularly regarding privacy, accessibility, and messaging. Participants noted the need for technology to be used in conjunction with face-to-face engagement with health professionals and that some patients would respond to this type of delivery mechanism better than others. Conclusions: These results suggest that mixed reality technology to deliver psychological interventions may be an acceptable addition to current health care practices for young people with asthma and symptoms of psychological distress. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12620001109998; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380427 %M 37494096 %R 10.2196/34629 %U https://humanfactors.jmir.org/2023/1/e34629 %U https://doi.org/10.2196/34629 %U http://www.ncbi.nlm.nih.gov/pubmed/37494096 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46859 %T Attitudes Toward the Adoption of 2 Artificial Intelligence–Enabled Mental Health Tools Among Prospective Psychotherapists: Cross-sectional Study %A Kleine,Anne-Kathrin %A Kokje,Eesha %A Lermer,Eva %A Gaube,Susanne %+ Department of Psychology, Ludwig Maximilian University of Munich, Geschwister-Scholl-Platz 1, Munich, 80539, Germany, 49 1709076034, Anne-Kathrin.Kleine@psy.lmu.de %K artificial intelligence %K mental health %K clinical decision support systems %K Unified Theory of Acceptance and Use of Technology %K technology acceptance model %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite growing efforts to develop user-friendly artificial intelligence (AI) applications for clinical care, their adoption remains limited because of the barriers at individual, organizational, and system levels. There is limited research on the intention to use AI systems in mental health care. Objective: This study aimed to address this gap by examining the predictors of psychology students’ and early practitioners’ intention to use 2 specific AI-enabled mental health tools based on the Unified Theory of Acceptance and Use of Technology. Methods: This cross-sectional study included 206 psychology students and psychotherapists in training to examine the predictors of their intention to use 2 AI-enabled mental health care tools. The first tool provides feedback to the psychotherapist on their adherence to motivational interviewing techniques. The second tool uses patient voice samples to derive mood scores that the therapists may use for treatment decisions. Participants were presented with graphic depictions of the tools’ functioning mechanisms before measuring the variables of the extended Unified Theory of Acceptance and Use of Technology. In total, 2 structural equation models (1 for each tool) were specified, which included direct and mediated paths for predicting tool use intentions. Results: Perceived usefulness and social influence had a positive effect on the intention to use the feedback tool (P<.001) and the treatment recommendation tool (perceived usefulness, P=.01 and social influence, P<.001). However, trust was unrelated to use intentions for both the tools. Moreover, perceived ease of use was unrelated (feedback tool) and even negatively related (treatment recommendation tool) to use intentions when considering all predictors (P=.004). In addition, a positive relationship between cognitive technology readiness (P=.02) and the intention to use the feedback tool and a negative relationship between AI anxiety and the intention to use the feedback tool (P=.001) and the treatment recommendation tool (P<.001) were observed. Conclusions: The results shed light on the general and tool-dependent drivers of AI technology adoption in mental health care. Future research may explore the technological and user group characteristics that influence the adoption of AI-enabled tools in mental health care. %M 37436801 %R 10.2196/46859 %U https://humanfactors.jmir.org/2023/1/e46859 %U https://doi.org/10.2196/46859 %U http://www.ncbi.nlm.nih.gov/pubmed/37436801 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e29725 %T Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis %A Hardy,Amy %A Ward,Thomas %A Emsley,Richard %A Greenwood,Kathryn %A Freeman,Daniel %A Fowler,David %A Kuipers,Elizabeth %A Bebbington,Paul %A Garety,Philippa %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Henry Wellcome Building, London, SE5 8AF, United Kingdom, 44 2078485178, amy.hardy@kcl.ac.uk %K paranoia %K psychosis %K digital health %K apps %K human-centered design %K user experience %K adherence %K engagement %K therapy %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 %M 35776506 %R 10.2196/29725 %U https://humanfactors.jmir.org/2022/3/e29725 %U https://doi.org/10.2196/29725 %U http://www.ncbi.nlm.nih.gov/pubmed/35776506 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e31029 %T A Reference Architecture for Data-Driven and Adaptive Internet-Delivered Psychological Treatment Systems: Software Architecture Development and Validation Study %A Mukhiya,Suresh Kumar %A Lamo,Yngve %A Rabbi,Fazle %+ Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Bergen, 5063, Norway, 47 55 58 58 00, itsmeskm99@gmail.com %K software architecture %K adaptive system %K IDPT system %K health care systems %K ICBT %K adaptive strategies %K personalized therapies %K reference architecture %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Internet-delivered psychological treatment (IDPT) systems are software applications that offer psychological treatments via the internet. Such IDPT systems have become one of the most commonly practiced and widely researched forms of psychotherapy. Evidence shows that psychological treatments delivered by IDPT systems can be an effective way of treating mental health morbidities. However, current IDPT systems have high dropout rates and low user adherence. The primary reason is that the current IDPT systems are not flexible, adaptable, and personalized as they follow a fixed tunnel-based treatment architecture. A fixed tunnel-based architecture follows predefined, sequential treatment content for every patient, irrespective of their context, preferences, and needs. Moreover, current IDPT systems have poor interoperability, making it difficult to reuse and share treatment materials. There is a lack of development and documentation standards, conceptual frameworks, and established (clinical) guidelines for such IDPT systems. As a result, several ad hoc forms of IDPT models exist. Consequently, developers and researchers have tended to reinvent new versions of IDPT systems, making them more complex and less interoperable. Objective: This study aimed to design, develop, and evaluate a reference architecture (RA) for adaptive systems that can facilitate the design and development of adaptive, interoperable, and reusable IDPT systems. Methods: This study was conducted in collaboration with a large interdisciplinary project entitled INTROMAT (Introducing Mental Health through Adaptive Technology), which brings together information and communications technology researchers, information and communications technology industries, health researchers, patients, clinicians, and patients’ next of kin to reach its vision. First, we investigated previous studies and state-of-the-art works based on the project’s problem domain and goals. On the basis of the findings from these investigations, we identified 2 primary gaps in current IDPT systems: lack of adaptiveness and limited interoperability. Second, we used model-driven engineering and Domain-Driven Design techniques to design, develop, and validate the RA for building adaptive, interoperable, and reusable IDPT systems to address these gaps. Third, based on the proposed RA, we implemented a prototype as the open-source software. Finally, we evaluated the RA and open-source implementation using empirical (case study) and nonempirical approaches (software architecture analysis method, expert evaluation, and software quality attributes). Results: This paper outlines an RA that supports flexible user modeling and the adaptive delivery of treatments. To evaluate the proposed RA, we developed an open-source software based on the proposed RA. The open-source framework aims to improve development productivity, facilitate interoperability, increase reusability, and expedite communication with domain experts. Conclusions: Our results showed that the proposed RA is flexible and capable of adapting interventions based on patients’ needs, preferences, and context. Furthermore, developers and researchers can extend the proposed RA to various health care interventions. %M 35723905 %R 10.2196/31029 %U https://humanfactors.jmir.org/2022/2/e31029 %U https://doi.org/10.2196/31029 %U http://www.ncbi.nlm.nih.gov/pubmed/35723905 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30829 %T The Use of Telehealth for Psychological Counselling of Vulnerable Adult Patients With Rheumatic Diseases or Diabetes: Explorative Study Inspired by Participatory Design %A Rothmann,Mette Juel %A Mouritsen,Julie Drotner %A Ladefoged,Nanna Skov %A Jeppesen,Marie Nedergaard %A Lillevang,Anna Sofie %A Laustrup,Helle %A Ellingsen,Torkell %+ Steno Diabetes Center Odense, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark, 45 22346388, mette.rothmann@rsyd.dk %K telehealth %K videoconferencing %K app %K co-production %K co-creation %K psychologist %K psychology %K rheumatic diseases %K diabetes %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Video consultation is increasingly used in different health care settings to reach patients. However, little is known about telehealth in psychological counselling for vulnerable patients with somatic and chronic conditions such as rheumatoid arthritis and diabetes. Objective: This study aimed to develop and pilot test a telepsychology module for inclusion in the app My Hospital (Mit Sygehus) to provide remote psychological counselling to vulnerable adults with either rheumatic diseases or diabetes. Methods: With inspiration from participatory design, the content of the telepsychology module was developed through user involvement and evaluated by individual interviews with patients and psychologists as well as questionnaires. Results: We developed a module with our patient partners that targeted patients with rheumatic diseases and diabetes in relation to the psychological challenges of living with chronic diseases. The module included information, tools, exercises, and videoconferencing. In total, 16 patients and 3 psychologists participated in the pilot test. Psychological counselling was described by 4 themes: “The good relation despite physical distance,” “The comfort of being at home,” “The pros of saving time on transport and energy,” and “A therapeutic alliance at a distance.” Conclusions: Psychological counselling in relation to somatic care can be provided by videoconferencing supported by web-based or mobile delivery of tailored information, tools, and exercises without compromising on the quality of care. To ensure a good alliance between the patient and psychologist, a first face-to-face meeting is important. The home location provided patients with a safe environment and increased accessibility and reduced travel time to the hospital. %M 35311690 %R 10.2196/30829 %U https://humanfactors.jmir.org/2022/1/e30829 %U https://doi.org/10.2196/30829 %U http://www.ncbi.nlm.nih.gov/pubmed/35311690 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30359 %T Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review %A Kane,Hélène %A Gourret Baumgart,Jade %A El-Hage,Wissam %A Deloyer,Jocelyn %A Maes,Christine %A Lebas,Marie-Clotilde %A Marazziti,Donatella %A Thome,Johannes %A Fond-Harmant,Laurence %A Denis,Frédéric %+ Laboratoire Éducation, Éthique, Santé, Université de Tours, Boulevard Tonnellé, Tours, 37032, France, 33 279060019, helene.kane@gmail.com %K COVID-19 %K e–mental health %K professional practices %K quality of care %K telepsychiatry %K videoconferencing %D 2022 %7 4.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. Objective: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. Results: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. Conclusions: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users. %M 34736224 %R 10.2196/30359 %U https://humanfactors.jmir.org/2022/1/e30359 %U https://doi.org/10.2196/30359 %U http://www.ncbi.nlm.nih.gov/pubmed/34736224 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e17604 %T Mapping the Psychosocialcultural Aspects of Healthcare Professionals’ Information Security Practices: Systematic Mapping Study %A Yeng,Prosper Kandabongee %A Szekeres,Adam %A Yang,Bian %A Snekkenes,Einar Arthur %+ Department of Information Security and Communication Technology, Norwegian University of Science and Technology, Teknologivegen 22, Gjøvik, Norway, 47 61135400, prosper.yeng@ntnu.no %K information security %K psychological %K sociocultural %K health care professionals %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Data breaches in health care are on the rise, emphasizing the need for a holistic approach to mitigation efforts. Objective: The purpose of this study was to develop a comprehensive framework for modeling and analyzing health care professionals’ information security practices related to their individual characteristics, such as their psychological, social, and cultural traits. Methods: The study area was a hospital setting under an ongoing project called the Healthcare Security Practice Analysis, Modeling, and Incentivization (HSPAMI) project. A literature review was conducted for relevant theories and information security practices. The theories and security practices were used to develop an ontology and a comprehensive framework consisting of psychological, social, cultural, and demographic variables. Results: In the review, a number of psychological, social, and cultural theories were identified, including the health belief model, protection motivation theory, theory of planned behavior, and social control theory, in addition to some social demographic variables, to form a comprehensive set of health care professionals’ characteristics. Furthermore, an ontology was developed from these theories to systematically organize the concepts. The framework, called the psychosociocultural (PSC) framework, was then developed from the various combined psychological and sociocultural attributes of the ontology. The Human Aspect of Information Security Questionnaire was adopted as a comprehensive tool for gathering staff security practices as mediating variables in the framework. Conclusions: Data breaches occur often in health care today. This frequency has been attributed to the lack of experience of health care professionals in information security, the lack of development of conscious care security practices, and the lack of motivation to incentivize health care professionals. The frequent data breaches in health care threaten the mutual trust between health care professionals and patients, which implicitly impacts the quality of the health care service. The modeling and analysis of health care professionals’ security practices can be conducted with the PSC framework by combining methods of statistical survey, observations, and interviews in relation to PSC variables, such as perceptions (perceived benefits, perceived threats, and perceived barriers) or psychological traits, social factors, cultural factors, and social demographics. %M 34106077 %R 10.2196/17604 %U https://humanfactors.jmir.org/2021/2/e17604 %U https://doi.org/10.2196/17604 %U http://www.ncbi.nlm.nih.gov/pubmed/34106077 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e26390 %T Impact of Individual, Organizational, and Technological Factors on the Implementation of an Online Portal to Support a Clinical Pathway Addressing Psycho-Oncology Care: Mixed Methods Study %A Masya,Lindy %A Shepherd,Heather L %A Butow,Phyllis %A Geerligs,Liesbeth %A Allison,Karen C %A Dolan,Colette %A Prest,Gabrielle %A , %A Shaw,Joanne %+ Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Griffith Taylor Building (A19), Sydney, NSW 2006, Australia, 61 2 86270828, heather.shepherd@sydney.edu.au %K decision support systems %K clinical decision making %K psycho-oncology %K health informatics %K clinical pathways %K health services research %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Clinical pathways (CPs) can improve patient outcomes but can be complex to implement. Technologies, such as clinical decision support (CDS) tools, can facilitate their use, but require end-user testing in clinical settings. Objective: This study applied the Technology Acceptance Model to evaluate the individual, organizational, and technological contexts impacting application of a portal to facilitate a CP for anxiety and depression (the ADAPT Portal) in a metropolitan cancer service. The ADAPT Portal triggers patient screening on patient reported outcomes, alerts staff to high scores, recommends evidence-based management, and triggers review and rescreening at set intervals. Methods: Quantitative and qualitative data on portal activity, data accuracy, and health service staff perspectives were collected. Quantitative data were analyzed descriptively, and thematic analysis was applied to qualitative data. Results: Overall, 15 (100% of those invited) health service staff agreed to be interviewed. During the pilot, 73 users (36 health service staff members and 37 patients) were registered on the ADAPT Portal. Of the 37 patients registered, 16 (43%) completed screening at least once, with seven screening positive and triaged appropriately. In total, 34 support requests were lodged, resulting in 17 portal enhancements (technical issues). Health service staff considered the ADAPT Portal easy to use and useful; however, some deemed it unnecessary or burdensome (individual issues), particularly in a busy cancer service (organizational issues). Conclusions: User testing of a CDS to facilitate screening and assessment of anxiety and depression in cancer patients highlighted some technological issues in implementing the ADAPT CDS, resulting in 17 enhancements. Our results highlight the importance of obtaining health service staff feedback when piloting specialized CDS tools and addressing contextual factors when implementing them. %M 33851926 %R 10.2196/26390 %U https://humanfactors.jmir.org/2021/2/e26390 %U https://doi.org/10.2196/26390 %U http://www.ncbi.nlm.nih.gov/pubmed/33851926 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e21145 %T Young People’s Attitude Toward Positive Psychology Interventions: Thematic Analysis %A Michel,Toni %A Tachtler,Franziska %A Slovak,Petr %A Fitzpatrick,Geraldine %+ Technical University Vienna, Wien, Argentinierstraße 8, Vienna, , Austria, 49 1773075023, toni.michel@tuwien.ac.at %K adolescent %K mental health %K health resources %D 2020 %7 9.11.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the current global youth mental health crisis; however, young people are largely not engaging with available resources. Objective: The aim of this study is to explore young people’s attitudes toward various PPI principles to find ways of making digital instantiations of them more engaging. Methods: We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29 common PPIs. Ratings and recorded discussions were analyzed using thematic analysis. Results: Some interventions were conflicting with young people’s values or perceived as too difficult. Participants responded positively to interventions that fit them personally and allowed them to use their strengths. Conclusions: Values, context, strengths, and other personal factors are entangled with young people’s attitudes toward digital instantiations of PPI principles. %M 33164908 %R 10.2196/21145 %U http://humanfactors.jmir.org/2020/4/e21145/ %U https://doi.org/10.2196/21145 %U http://www.ncbi.nlm.nih.gov/pubmed/33164908 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e17088 %T Development and Usability Testing of a Web-Based and Therapist-Assisted Coping Skills Program for Managing Psychosocial Problems in Individuals With Hand and Upper Limb Injuries: Mixed Methods Study %A Babatunde,Folarin Omoniyi %A MacDermid,Joy %A Grewal,Ruby %A Macedo,Luciana %A Szekeres,Mike %+ School of Rehabilitation Science, Institute of Applied Health Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON, L8S 1C7, Canada, 1 9055259140 ext 22867, babatufo@mcmaster.ca %K usability testing %K upper extremities %K psychosocial %K internet %K coping skills %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Ineffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. Objective: This study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. Methods: The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. Results: In total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. Conclusions: We describe the development and usability testing of HOCOS; a new web-based psychosocial intervention for individuals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants. %M 32374265 %R 10.2196/17088 %U http://humanfactors.jmir.org/2020/2/e17088/ %U https://doi.org/10.2196/17088 %U http://www.ncbi.nlm.nih.gov/pubmed/32374265 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e10255 %T The Service User Technology Acceptability Questionnaire: Psychometric Evaluation of the Norwegian Version %A Torbjørnsen,Astrid %A Småstuen,Milada C %A Jenum,Anne Karen %A Årsand,Eirik %A Ribu,Lis %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Postboks 4 St. Olavs plass, Oslo, 0130, Norway, 47 92633075, astridto@oslomet.no %K acceptability %K factor analysis %K health care %K mHealth %K telemedicine %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When developing a mobile health app, users’ perception of the technology should preferably be evaluated. However, few standardized and validated questionnaires measuring acceptability are available. Objective: The aim of this study was to assess the validity of the Norwegian version of the Service User Technology Acceptability Questionnaire (SUTAQ). Methods: Persons with type 2 diabetes randomized to the intervention groups of the RENEWING HEALTH study used a diabetes diary app. At the one-year follow-up, participants in the intervention groups (n=75) completed the self-reported instrument SUTAQ to measure the acceptability of the equipment. We conducted confirmatory factor analysis for evaluating the fit of the original five-factor structure of the SUTAQ. Results: We confirmed only 2 of the original 5 factors of the SUTAQ, perceived benefit and care personnel concerns. Conclusions: The original five-factor structure of the SUTAQ was not confirmed in the Norwegian study, indicating that more research is needed to tailor the questionnaire to better reflect the Norwegian setting. However, a small sample size prevented us from drawing firm conclusions about the translated questionnaire. %M 30578191 %R 10.2196/10255 %U http://humanfactors.jmir.org/2018/4/e10255/ %U https://doi.org/10.2196/10255 %U http://www.ncbi.nlm.nih.gov/pubmed/30578191