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(Re-)designing health care and making health care interventions and technologies usable, safe, and effective.

Latest Submissions Open for Peer Review

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JMIR Submissions under Open Peer Review

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Titles/Abstracts of Articles Currently Open for Review:

  • Background: The COVID-19 pandemic accelerated the adoption of technology-mediated mental health services, yet questions remain about whether immersive digital platforms can match the therapeutic effectiveness of traditional face-to-face therapy. Virtual Reality (VR) offers unique affordances beyond conventional telehealth by providing embodied presence and shared virtual spaces, potentially addressing limitations of video-based teletherapy. However, empirical evidence directly comparing VR-mediated therapy with in-person sessions using both subjective and objective measures remains scarce. Objective: This study aimed to compare therapeutic engagement, self-disclosure, and emotional arousal between VR-mediated and face-to-face initial counselling sessions using a multi-methods approach combining self-report measures, qualitative participant feedback, and continuous physiological monitoring. Methods: We conducted a within-subjects experimental study with 30 adult participants (19 male, 11 female; mean age 32.5 years, SD 12.1) who each completed one VR-based and one face-to-face counselling session with licensed clinical psychologists. Sessions were counterbalanced and followed a semi-structured protocol. The VR condition used Oculus Quest 2 headsets with avatar-mediated interaction in a virtual counselling environment. We collected subjective data via validated instruments including the Session Evaluation Questionnaire (SEQ), Working Alliance Inventory-Short Form (WAI-SF), and custom engagement scales. Qualitative data were collected through open-ended written feedback and analysed using thematic analysis. Physiological data included continuous heart rate measured via photoplethysmography and electrodermal activity (EDA) recorded throughout each session. Statistical analyses employed paired t-tests and Wilcoxon signed-rank tests for within-subject comparisons. Results: While participants initially rated face-to-face sessions as more appropriate (mean 7.63, SD 1.42 vs mean 6.80, SD 1.98; Z=2.541, P<.05) and reported feeling better immediately after in-person sessions (mean 7.00, SD 1.83 vs mean 6.03, SD 2.31; Z=2.585, P<.05), there were no significant differences in willingness to continue therapy (P>.05) or recommendation likelihood (P>.05) between modalities. Qualitative analysis revealed that 73% of participants reported greater self-disclosure in VR sessions, with thematic analysis identifying that avatar-mediated interaction reduced social anxiety and facilitated openness, particularly through the psychological distance and reduced self-consciousness afforded by virtual representation. Physiological measures showed no significant differences in heart rate (mean 85.67, SD 12.85 vs mean 83.12, SD 12.45; P>.05) or skin conductance levels (mean 9.47, SD 3.67 vs mean 9.18, SD 3.54; P>.05) between conditions, indicating comparable emotional arousal during initial therapeutic encounters. Therapist-rated alliance scores were equivalent across modalities (P>.05). Conclusions: VR-mediated therapy achieved therapeutic engagement levels comparable to face-to-face sessions during initial encounters, with unique advantages for facilitating self-disclosure among certain clients. While traditional therapy remains preferred for immediate comfort, VR demonstrates viability as a complementary digital mental health intervention. These findings support the integration of immersive technologies in mental healthcare delivery, particularly for populations who may benefit from the psychological distance afforded by avatar-mediated interaction. Future research should explore optimal client-technology matching and long-term therapeutic outcomes in VR-delivered interventions.

  • Background: Digital health platforms have the potential to expand access to HIV care by reducing geographic, social, and institutional barriers. However, among key populations such as men who have sex with men and transgender people living with HIV/AIDS in Nigeria, technology adoption is shaped by more than system functionality alone. Structural stigma, criminalisation, fear of disclosure, and limited health system access continue to constrain engagement with formal healthcare services. While teleconsultation and medication-delivery platforms offer alternative pathways to care, their acceptance and intended use within marginalised populations cannot be assumed and require empirical investigation. Objective: This study aimed to examine the factors influencing behavioural intention to adopt TechAids, a confidentiality-oriented digital health platform designed to support HIV consultation and service access among men who have sex with men and transgender individuals in Nigeria, using an extended Unified Theory of Acceptance and Use of Technology framework. Methods: A cross-sectional survey was conducted among 141 platform users and 27 healthcare providers, yielding a total sample of 168 participants. The study employed an extended UTAUT model incorporating Performance Expectancy, Effort Expectancy, Social Influence, and Facilitating Conditions, alongside Trust and Perceived Stigma. Data were analysed using correlation analysis and ordinary least squares regression. Age and educational attainment were examined as potential moderating variables. Qualitative feedback was also collected to contextualise quantitative findings. Results: Facilitating Conditions emerged as the strongest predictor of behavioural intention to use the platform (β=0.813, p<0.001), explaining a substantial proportion of variance in adoption intention (R²=0.652). Age demonstrated a modest but statistically significant positive effect on behavioural intention (β=0.105, p=0.026). Contrary to theoretical expectations, Performance Expectancy, Effort Expectancy, Social Influence, Trust, and Perceived Stigma did not significantly predict intention to adopt the platform. Qualitative feedback highlighted practical infrastructure-related concerns, including reliable internet access, offline functionality, and availability of technical support, as more salient than psychological or feature-based considerations. Conclusions: In resource-constrained and highly stigmatised contexts, enabling infrastructure and practical support conditions may outweigh cognitive, social, and attitudinal determinants of technology acceptance. These findings suggest that successful digital health interventions for marginalised populations require not only privacy-conscious and user-centred design but also sustained investment in facilitating conditions that support real-world use. Designing technology for HIV care in such settings must therefore address structural and infrastructural barriers alongside behavioural and psychosocial factors.

  • Background: Enhancing telemedicine requires a clear understanding of how avatars influence medical collaboration. The ArtekMed study group developed a MR teleconsultation system that enables a remote expert (VR user) to interact in real-time with a local augmented reality (AR) user within a shared working space. The system was compared to a standard video call system in five randomized cross-over trials in a healthcare simulation center. Objective: This post-hoc study investigates user’s perceptions of a virtual character representing a remote expert across four real-time mixed-reality (MR) teleconsultation scenarios. Methods: A total of 56 medical professionals participated as AR users collaborating with a remote expert represented by a virtual character. A post-hoc qualitative analysis of structured post-session interviews was performed to explore participants’s perceptions of the avatar, focusing on perceived helpfulness, visual design and user engagement. Results: Overall, most participants did not perceive the avatar as helpful for task execution in procedural scenarios and frequently described it as unnecessary or even distracting. In contrast, in more complex and demanding scenarios, such as emergency craniotomy planning or intensive care treatment of patients with acute respiratory distress syndrome, some participants perceived the avatar as providing mentorship, guidance and psychological support. These findings suggests that while avatars may offer limited perceived value in task-focused medical collaboration, they may support user engagement in scenarios requiring sustained interaction and social presence. Conclusions: The results align with existing literature indicating that the impact of avatars is context dependent. In mixed-reality environments, where virtual character coexists with real-world reconstructions, avoiding behavioral incongruence and uncanny effects may be more critical than achieving high visual fidelity. Future research should prospectively explore how different levels of avatar abstraction and fidelity influence collaboration in MR telemedicine.

  • Background: Anxiety and depressive disorders remain highly prevalent and insufficiently treated, with many individuals experiencing persistent or untreated symptoms, limited access to evidence-based care, or insufficient support between clinical encounters. Adults with disabilities represent a particularly underserved sub-population, often facing compounded barriers to mental health care and higher rates of anxiety and depression. Digital therapeutics offer a scalable opportunity to address these gaps by extending structured, evidence-based interventions beyond traditional care settings. Objective: The current pilot study evaluated Rauha™, a novel digital therapeutic that integrates cognitive behavioral therapy (CBT)-based modules with live weekly sessions led by a National Board-Certified Health and Wellness Coach (NBC-HWC), delivering structured, smartphone-based psychoeducation and interactive therapeutic exercises combined with personalized mental health coaching supporting behavior change. Methods: Thirteen adults with mobility and/or hearing disabilities and clinically elevated anxiety and/or depression were enrolled in a single-arm, within-subjects design. Participants completed eight weeks of CBT modules delivered via smartphone, accompanied by synchronous virtual mental health coaching. Anxiety and depression were assessed using the Hamilton Anxiety (HAM-A) and Hamilton Depression (HAM-D) Rating Scales, respectively, at baseline, post-treatment, and at four-week follow-up. Results: Mean reductions were significant for both anxiety (-13.05 ± 2.51, P < .001) and depression (-12.83 ± 1.55, P < .001), exceeding thresholds for clinical significance and sustained through follow-up. At post-treatment, 84.6% of participants showed clinically significant improvement in both anxiety and depression. At follow-up, 76.9% and 92.3% of participants showed clinically significant improvement in anxiety and depression, respectively. Between baseline and follow-up timepoints, these reductions corresponded to mean shifts from moderate to mild anxiety on the HAM-A and moderate to mild/non-depressed on the HAM-D. Participants reported strongly favorable acceptability, experience, and usability ratings for the Rauha™ treatment program, demonstrating 100% treatment retention and an average 5.5 replay rate of personalized smartphone content. Conclusions: Findings demonstrate that a combined digital CBT and NBC-HWC approach can yield clinically meaningful and durable symptom reductions in depression and anxiety, coupled with high user acceptability and engagement, for adults with disabilities. These findings provide preliminary evidence supporting Rauha™ as a scalable, evidence-informed mental health intervention with strong potential to improve access and address key barriers to care.

  • Determinants of Adoption of a Mechanical Ventilation Dashboard in Intensive Care: A MIDI-Based Evaluation

    Date Submitted: Jan 28, 2026
    Open Peer Review Period: Feb 2, 2026 - Mar 30, 2026

    Background: Lung-protective ventilation (LPV) reduces complications of mechanical ventilation, yet adherence in intensive care (ICUs) remains inconsistent. Digital dashboards may support LPV by improving situational awareness and supporting protocol adherence. However, adoption of such tools in high-acuity clinical environments depends on a range of cognitive, professional and contextual determinants. The Measurement Instrument for Determinants of Innovations (MIDI) provides a validated framework to systematically assess these factors. Objective: To identify determinants influencing adoption of a newly piloted mechanical ventilation dashboard in the ICU using the MIDI framework. Methods: We conducted a single-center, cross-sectional evaluation among ICU healthcare professionals during a dedicated survey period within a pilot introduction of a mechanical ventilation dashboard at Amsterdam UMC. Participants completed a structured questionnaire consisting of 24 MIDI items adapted to the ICU context rated on a 5-point Likert scale (completely disagree to completely agree), supplemented by open-ended questions on perceived barriers and facilitators to its use. Determinants were classified as facilitators when ≥80% of respondents selected “agree” or “completely agree” and as barriers when ≥20% selected “disagree” or “completely disagree”. Open-ended responses were analyzed using a general inductive thematic approach. Results: A total of seventy-one completed questionnaires were analyzed, including responses from nurses, physicians, intensivists, ventilation specialists, and researchers in mechanical ventilation. Six determinants met criteria for facilitators: outcome expectations; self-efficacy; procedural clarity; low complexity; correctness; and observability. Two determinants met criteria for barriers: relevance for client; and professional obligation. Analysis of open-ended responses highlighted perceived barriers such as additional workload, the need for an extra device, overlap with existing systems, and limited role-specific relevance. Facilitators included improved situational overview, educational value, easier trend monitoring, and increased efficiency. Conclusions: This evaluation identified key determinants influencing adoption of a mechanical ventilation dashboard in ICU. While the dashboard was generally perceived as useful and easy to understand, adoption was shaped by determinants related to workflow integration, role-specific relevance, and professional responsibility. These findings suggest that successful introduction of digital clinical support tools in intensive care requires attention not only to technical design, but also to how such tools align with users’ roles, daily work processes, and shared clinical responsibilities. Systematic assessment of determinants provides actionable insight into adoption of digital decision-support tools in high-acuity care settings. Clinical Trial: Not applicable; this study was not a registered clinical trial.

  • Background: FDA-cleared artificial intelligence (AI) triage tools for intracranial hemorrhage (ICH) are increasingly deployed in clinical radiology. In real-world practice, perceived utility may depend not only on diagnostic performance but also on workflow friction, false-alarm burden, and calibrated trust when AI outputs conflict with radiologist interpretation. Objective: To characterize radiologists’ perceptions, trust calibration, and self-reported vigilance behaviors when using an FDA-cleared ICH AI triage tool in a national teleradiology network and to evaluate differences by neuroradiology subspecialty training. Methods: We conducted an anonymous cross-sectional survey of radiologists in a national teleradiology practice who had access to an FDA-cleared ICH detection AI overlay during routine noncontrast head CT interpretation. Survey domains included perceived reliability and usefulness, false-alarm burden, workflow integration, medicolegal concerns, and items designed to probe self-reported vigilance behaviors consistent with automation complacency. Responses used a 5-point Likert scale (Strongly agree, Agree, Neutral, Disagree, Strongly disagree). Results are summarized as agreement proportions (“agree”/“strongly agree”). We evaluated subgroup differences between neuroradiologists and non-neuroradiologists using Fisher exact tests. To reduce risk of spurious findings from multiple comparisons, we prespecified a primary endpoint and treated other items as exploratory with false discovery rate (FDR) control using the Benjamini–Hochberg procedure. Optional free-text responses were analyzed qualitatively to identify recurring themes. Results: Sixty-five radiologists responded (23 neuroradiologists; 42 non-neuroradiologists). Only 18.5% (12/65) agreed that false-positive alerts were infrequent enough to be acceptable. Trust was highly conditional: 50.8% (33/65) trusted the AI when it agreed with their interpretation, whereas only 3.1% (2/65) trusted it when it conflicted. The primary endpoint—agreement that false-positive workload outweighed benefits—was endorsed by 33.9% (22/65) overall and was more common among neuroradiologists than non-neuroradiologists (52.2% vs 23.8%; unadjusted P=.029). However, after FDR correction across exploratory items, no subgroup differences remained statistically significant. Self-reported vigilance reduction on AI-negative outputs was uncommon (6.2% overall; 0% neuroradiologists; 9.5% non-neuroradiologists). Free-text feedback emphasized artifact-driven false positives, delayed or inconsistent AI availability, consult burden, and medicolegal concerns. Conclusions: In a national teleradiology environment, radiologists reported substantial false-alarm burden and highly conditional trust when using an FDA-cleared ICH AI triage tool. Self-reported vigilance reduction was uncommon but present in a minority of users. Human factors–oriented optimization—including specificity improvements, earlier availability, better localization, and workflow-aware triage routing—may improve acceptance and perceived utility.

  • Evaluation of the Black Medical Students Association of Canada Website: A Cross-Sectional Usability Study

    Date Submitted: Jan 29, 2026
    Open Peer Review Period: Feb 2, 2026 - Mar 30, 2026

    Background: In Canada, Black students continue to be underrepresented in medical schools and face institutional barriers, including limited access to the information necessary for their admission and their academic path. The Black Medical Students Association of Canada (BMSAC) has developed a bilingual website for these students. Objective: The purpose of this research is to evaluate the quality, accessibility and usefulness of the site and make recommendations for its improvement. Methods: A cross-sectional survey was conducted through an online system using the System Usability Scale (SUS), a validated website user experience evaluation tool. Three open-ended questions were added to the survey to identify areas for improvement. The data from the SUS were analyzed using descriptive statistics and the answers to the questions underwent thematic analysis. Results: 50 participants responded to the survey (24 in English and 26 in French). The overall SUS score was 75.8. The SUS scores for the English and French versions were 77.0 and 74.7, respectively. More than three quarters of respondents lived in Quebec. Respondents learned more about the available resources and recommended including more images illustrating organized events on the site. Conclusions: The overall SUS score and that of English and French respondents were considered satisfactory. The lack of visual support, updated information and some technical problems seemingly explain these results. Strong Quebec representation also indicates the need to promote the site elsewhere in Canada.

  • Exploring the Requirements of Clinicians for Transparent and Trustworthy Decision Support Systems in Intensive Care: Semistructured Interview Study

    Date Submitted: Jan 20, 2026
    Open Peer Review Period: Jan 27, 2026 - Mar 24, 2026

    Background: Understanding how digital systems can support clinical decision-making is crucial, especially with the growing deployment of increasingly complex artificial intelligence (AI) models. This complexity raises concerns about trustworthiness, impacting the safe and effective adoption of such technologies. In intensive care units (ICUs), where clinicians make high-stakes, time-sensitive decisions, decision-support tools must be designed to align with clinical needs and cognitive workflows. Improved understanding of decision-making processes and requirements for decision support tools is vital for providing effective solutions. Objective: This study aimed to investigate ICU clinicians’ decision-making processes, the challenges posed by patient complexity, and the requirements for decision-support systems to ensure transparent and trustworthy recommendations. Methods: We conducted group interviews with seven ICU clinicians, representing diverse roles and experience levels, to explore perspectives on decision-support tools. Reflexive thematic analysis was used to identify key themes and thereafter design recommendations. Results: Three core themes emerged from the analysis: (T1) ICU decision-making relies on a wide range of factors; (T2) patient complexity challenges shared decision-making, and (T3) acceptability and usability of decision support systems. Design recommendations derived from clinical input provide insights to inform future decision support systems for intensive care. Conclusions: Decision-support tools have the potential to enhance ICU decision-making, but their adoption depends on alignment with clinicians' needs and workflows. To improve trust and usability, future systems must be transparent in their recommendations, adapt to varying patient complexities, and facilitate, rather than replace, human expertise. Our findings inform the development of digital systems that are both transparent and trustworthy, aiding clinically acceptance in ICU settings. Clinical Trial: Not applicable.

  • Background: Intensive care clinicians rely on timely access to large volumes of electronic data to make complex decisions. The Central Adelaide Local Health Network (CALHN) implemented an electronic medical record (EMR) across its hospitals in South Australia, but the generic user interface is not optimised for critical care workflows. The CALHN Critical Care Informatics System (CCCIS) was developed as a prototype user interface (UI) to present ICU-relevant information in a more intuitive, task-focused format. Objective: This study aimed to evaluate the usability of CCCIS from the perspective of senior intensivists, and to identify key design principles for effective critical care informatics systems. Methods: We undertook a usability study with eight intensivists from CALHN. Participants interacted with a prototype version of CCCIS during a structured video-based session incorporating a Cognitive Walkthrough and Think Aloud approach. Sessions were screen-recorded and transcribed. Qualitative data were coded as positive, negative or neutral feedback and grouped into three domains: content, layout and visibility. Emergent themes were mapped across CCCIS components. Following the usability test, participants completed a System Usability Scale, NASA Task Load Index and a bespoke questionnaire assessing perceived usability, cognitive demand and clinical relevance. Reporting is aligned with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for interview-based research. Results: Participants reported that CCCIS supported rapid comprehension of patient information and facilitated integration between physiological data, interventions and clinical trajectory. The ability to customise views and to navigate between ward-level and bed-level information was highlighted as a strength. Areas for improvement included refinement of the ward board, ribbon and vital signs displays, particularly where duplicated information or visual clutter reduced clarity. Across the content, layout and visibility domains, recurrent themes included the importance of structured tabular displays, consistent visual hierarchies and explicit highlighting of clinically salient values. Survey responses suggested that CCCIS was easy to learn and use, exerted low cognitive demand, and was perceived as clinically relevant to everyday critical care practice. Conclusions: In this qualitative usability evaluation, intensivists perceived CCCIS as a usable and clinically meaningful critical care informatics system. The study identified design principles—such as structured presentation of data, alignment with mental models of ICU workflow and support for rapid synthesis of information—that may inform further development of CCCIS and other electronic medical record-integrated ICU interfaces.

  • The CAPABLE mHealth intervention: a qualitative study on patients’ perspectives.

    Date Submitted: Jan 14, 2026
    Open Peer Review Period: Jan 21, 2026 - Mar 18, 2026

    Background: The CAPABLE (Cancer Patients Better Life Experience) project developed an application for remote monitoring and management of treatment-related symptoms, as well as for delivering a set of supplementary nonpharmacological interventions, with the aim of improving patients’ quality of life. Clinical studies were conducted to evaluate the effectiveness of CAPABLE, yielding encouraging results. However, these studies did not explore individual patients’ perspectives. Objective: Following the evaluation of the CAPABLE intervention’s efficacy, this study aims at exploring end users’ overall experience with the telemonitoring system, identifying strengths and weaknesses in relation to users’ needs and expectations, in order to inform future developments. Methods: Toward the end of the clinical study, a focus group was conducted with a subset of enrolled patients. The discussion was led by a psycho-oncologist using a predefined framework of topic-related questions, which served as prompts to encourage open discussion. Patients freely shared their experiences, and a thematic analysis was performed on the collected statements. Results: The findings showed that the tool primarily served a dual function of support and reassurance. Patients reported psychological relief and a sense of security, driven by the perception of being closely monitored and supported by a multidisciplinary hospital team. CAPABLE was perceived as easy to use, effective, and useful. Nevertheless, several weaknesses also emerged. Suggestions for improvement focused on a closer alignment between CAPABLE functionalities and patients’ individual treatments and preferences, as well as concerns regarding application maintenance after the end of the project. Conclusions: The focus group provided valuable insights to inform the future development of telemonitoring applications for cancer patients.

  • Background: The Ready-Made Garments (RMG) industry is a vital part of Bangladesh's economy and employing over 4 million workers from low-income backgrounds that generally neglects their healthcare aspects. Historically, the sector is criticized for labor exploitation, unsafe working conditions, and rights violations since there has been massive loss of lives over accidents. While compliant factories adhere to better labor standards, many non-compliant factories expose workers to poor conditions, increasing their health risks. The COVID-19 pandemic exacerbated vulnerabilities within this workforce, resulting in widespread factory closures and massive job losses, heightened health risks, and leaving millions of workers without wages. Although the government provided some relief, it lacked policies for job security, social protection, health services, and emergency relief. Although technology has played a critical role in crisis response and healthcare, access to these technologies remains limited for them due to digital literacy gaps. Many RMG workers primarily use basic mobile phones for communication, not for accessing health or emergency services. Therefore, there is a need to develop a sustainable system that leverages their existing technological familiarity to ensure their voices are heard. Objective: Our aim was to gain a deeper understanding of RMG workers' experiences based on their existing work environments and interactions with technology, healthcare management, and the impact of COVID-19 on their circumstances. By understanding these aspects, we can recommend a technology-based framework design that serves as a sustainable and contextual model. Methods: We conducted in-person interviews with 55 RMG workers, comprising 32 female and 23 male participants from urban and suburban areas of Dhaka and suburban Gazipur, in Phase 1, before the pandemic. The participants were aged between 18-40. We reconnected with 12 participants from Phase 1 during the pandemic in Phase 2, in addition to three stakeholders from RMG factories via one-on-one phone conversations. Each interview was conducted in Bengali, and we obtained consent to record the audio. Overall, 846 minutes of discussion were translated and transcribed. The results were analyzed using thematic analysis. Results: We found insights into the working conditions, personal experiences, perceptions of healthcare, lifestyle choices, and technology use, all of which differed based on the type of factory which is yet not discussed together. Those employed at compliant factories enjoyed better healthcare support and utilized technology more effectively compared to their counterparts in non-compliant factories. Due to the pandemic, the situation for all workers changed dramatically, regardless of factory compliance, leading to major impacts on their daily lives, heightened health and safety worries, and a lack of emergency assistance. The RMG sector encountered a lot of challenges, underscoring the pressing need for targeted emergency relief and healthcare services for these workers. Conclusions: This research examined the workplace and daily lives of RMG workers, focusing on their challenges, healthcare perspectives, and technology use during the pandemic. Based on the findings, we proposed a technology-based framework design called VOICE, which connects workers to service providers through a straightforward interface. This would help reach marginalized communities during emergencies and provide essential support to improve their well-being.

  • Background: Inclusive physical education (PE) plays an important role in promoting participation and development among students with different abilities. However, many teachers do not have adequate tools to modify PE activities to meet these diverse needs. In addition, parents are essential partners, as their involvement helps to reinforce strategies and provide useful information about their children. While online platforms provide a practical way to deliver such solutions, only a few are intentionally created to support both teachers and parents in implementing inclusive PE learning. Objective: This study aimed to develop an online platform that provides inclusion strategies for PE teachers and to examine how teachers and parents perceived its usability, acceptability, and overall usefulness using a mixed methods approach. Methods: A mixed methods research design was adopted in two phases. Phase 1 involved the development of the platform through expert consultation and literature review with feedback from educators. Phase 2 focused on user evaluation and involved usability testing using the System Usability Scale (SUS) and the Questionnaire for User Interaction Satisfaction (QUIS), alongside task performance metrics. Semi-structured interviews were also conducted with PE teachers (n=8) and parents (n = 8). Quantitative data were analyzed descriptively and with inferential statistics, while qualitative responses were coded thematically and the results were integrated using joint display. Results: All participants successfully completed the assigned tasks except few instances of minor difficulty during task completion (14 total errors across 136 task attempts). The Platform satisfaction scores were good as reported by PE teachers (8.03±1.59) and parents (8.13±1.06). QUIS scores were high among PE teachers (overall reaction: 8.03 ± 1.59; learning: 9.69 ± 0.40) and parents (overall reaction: 8.13 ± 1.06; learning: 8.63 ± 1.57). Mixed-methods integration showed strong convergence between high satisfaction scores and positive professional value quotes. However, divergence was noted in the learning domain, as high scores contrasted with reported uncertainty among new users. Lower system capability scores from parents (6.69 ± 2.25) were consistent with qualitative concerns about navigation inefficiencies and slow platform response. Desktop design was praised, while the mobile view was considered visually dense. Conclusions: The online platform provides strong usability and satisfaction among PE teachers and parents. Future work will involve improved implementation and evaluation of its impact on students’ participation outcomes.

  • Digital Mental Health Promotion Services for Youth: A Qualitative Study of Help-Seeking Through Mindhelper.dk

    Date Submitted: Jan 7, 2026
    Open Peer Review Period: Jan 15, 2026 - Mar 12, 2026

    Background: Young people increasingly experience mental health challenges and often turn to the internet for support. Self-guided digital mental health promotion services have become widely used resources for youth seeking help and guidance. These platforms offer accessible, anonymous support, yet little is known about the concerns young people articulate when engaging with them. Objective: This study examines inquiries submitted to a digital letterbox on one of Denmark’s most widely used digital mental health promotion services, Mindhelper.dk, to identify recurring themes in young people's inquiries about mental health and well-being. In addition, it explores how gender influences these experiences in the context of engagement with a self-guided digital platform. Methods: Employing an inductive analysis strategy and a grounded theory–inspired coding framework, this study analyzes a dataset of 2,523 inquiries submitted to the Mindhelper letterbox between March 2016 and August 2023. The archive provides rare, unsolicited first-person accounts from young people in moments of emotional vulnerability, providing immediate and authentic insights into their mental health concerns. Results: The analysis identifies 17 recurring themes that reflect the mental health challenges young people seek help for. These themes are grouped into three overarching analytical categories: Social Relations and Social Contexts, Emotional Life, and Body and Illness, with the first two dominating the material. The most prominent themes include Sociality, Love Life, Unease, Self-Criticism and Insecurity, and Communication and Reaching Out for Support. The intersection of themes underscores the central role of social relationships in young people's mental health and well-being, with frequent co-occurrence of inquiries addressing both Love Life and Sociality. Regardless of gender, users frequently inquire about Sociality and Love Life, indicating shared concerns related to social relationships. However, girls were markedly overrepresented among inquirers, highlighting potential gender differences in help-seeking behavior. Conclusions: Social relationships play a central role in young people's lives, yet many also face emotional struggles, particularly related to anxiety, self-esteem, and despair. The letterbox serves as an important help-seeking channel for youth who may lack access to support elsewhere, with a marked overrepresentation of girls, indicating gender patterns in help-seeking behavior. This study provides novel insights into the mental health challenges Danish youth face and their engagement with digital support services, informing the design of targeted, gender-sensitive self-help content and guiding future efforts to promote well-being and reduce barriers to help-seeking.

  • Computer Backlight Setting Effect on Concentration

    Date Submitted: Dec 30, 2025
    Open Peer Review Period: Jan 13, 2026 - Mar 10, 2026

    Background: Prolonged exposure to computer screens has been associated with visual fatigue and reduced visual comfort, which may in turn affect cognitive performance and concentration. While blue-enriched screen light and display settings are known to influence visual strain, their impact on short-term task performance under different backlight configurations remains insufficiently quantified from a human factors perspective. Objective: This study aimed to evaluate the effects of different computer screen backlight settings on user concentration, using typing speed as a quantitative proxy for task performance. Methods: A total of 22 adult participants performed standardized reading and typing tasks under different screen backlight conditions, including black text on a white background and white or orange text on a dark background. Screen illuminance and spectral characteristics were measured using a calibrated spectrometer. Typing speed was recorded after controlled reading periods, and statistical analyses were conducted to assess changes in performance across conditions. Results: Typing speed decreased significantly after 30 minutes of reading under a traditional black text on white background. In contrast, switching to a dark background with white text resulted in a significant increase in typing speed. Further improvement was observed when orange text was used on a dark background. Myopic diopter showed no significant correlation with changes in typing performance. Conclusions: Lower screen illuminance achieved through dark background display settings was associated with improved short-term task performance. These findings suggest that display configurations emphasizing reduced luminance may help maintain concentration during computer-based tasks and have implications for visual ergonomics and human-centered display design. Clinical Trial: Not applicable.

  • Background: Drug information apps are widely used clinical decision support tools that improve prescribing accuracy, yet in low- and middle-income countries such as Cameroon they remain unregulated, raising safety concerns. Despite high smartphone penetration among doctors, no studies have assessed whether available apps meet local needs or regulatory standards. Objective: This study aimed to evaluate whether drug information apps available in Cameroon met doctors’ clinical information needs by assessing content completeness and usability, using criteria that combine national regulatory standards with breadth of clinically relevant information. Methods: We systematically evaluated drug information apps from the Apple App Store and Google Play Store in Cameroon (March–June 2025). Of 193 eligible apps, 100 were selected through stratified sampling. A framework of 33 drug characteristics grouped into six macro-types was developed and applied based on the Ministry of Public Health standards and clinical needs. Completeness was measured through breadth coverage and Ministry of Public Health compliance; usability was assessed by two independent clinical assessors using the Mobile App Rating Scale (MARS). Results: Nineteen percent of the apps were developed in Africa, with only one from Cameroon. Just three offered bilingual content, while 39% required paid subscription averaging USD $37 annually. Most apps had low completeness with major gaps in safety (contraindications, drug interactions), and quality assurance information (references and author credentials). Usability was limited, with only 15% rated as good quality. Conclusions: Since most drug information apps did not meet Ministry of Public Health standards or core clinical decision-making requirements, there is an urgent need for regulatory oversight and the development of safer, locally adapted prescribing tools. The framework introduced in this study offers a scalable, evidence-based approach that can be adopted across low- and middle-income countries to guide regulation, strengthen quality assurance, and establish globally relevant benchmarks for evaluating drug information apps.

  • Background: The incidence of type 2 diabetes (T2D) continues to increase, and the lack of individualized therapy strategies hinders patient engagement with and commitment to a healthy lifestyle. The PROTEIN project aimed to facilitate users to choose healthy living, thereby improving their metabolism and T2D management. Objective: To assess the efficacy of a personalized mobile application to achieve a 5% time in range (TIR) improvement over a 12-week intervention in adults with prediabetes or T2DM. Methods: We conducted a randomized controlled trial (RCT) with 21 individuals with T2D or prediabetes who used a continuous glucose monitoring (CGM) system and the PROTEIN mobile application (PROTEIN app) for personalized meals and exercise recommendations based on their glucose levels and physical activity. Results: The TIR of the participants increased (p<0.05; from 71.8% ± 27.3% to 76.0% ± 28.1%) with individual use of the PROTEIN app but did not achieve a 5% improvement overall. Glycated hemoglobin, fasting blood glucose, and body weight did not fluctuate throughout the 12-week intervention. The dropout rate was high and the average duration of use of the PROTEIN app was 42 days (range 5 to 84). Conclusions: Our results showed an improvement in TIR with the use of the PROTEIN-app. Integrating wearables and automated personalization for wellbeing is an innovative approach that must keep pace with the accelerated development of ever-evolving technologies. Clinical Trial: ClinicalTrials.gov: registration no. NCT05951140 https://clinicaltrials.gov/study/NCT05951140