Patrick Stefan Höhener, Robert Tobias, James Martin Allen, Pascal Küng, Urte Scholz
Background: Social exchange processes, such as social support and social control, can promote health behavior change. However, these processes are often neglected when studying health behavior change and designing interventions. Intervening on these social exchange processes using dyadic interventions may provide a promising approach to promote health behaviors.
Objective: This study aimed to investigate the effects of dyadic interventions to increase moderate-to-vigorous physical activity (MVPA) in romantic couples. Furthermore, we explored how the target, type, and timing of the interventions affect their effectiveness.
Methods: In total, 38 romantic couples (mean age 34.01, SD 11.03 y) were recruited through online advertisements and participated in a smartphone-based microrandomized trial over 55 days consisting of control and intervention phases. The fully automated dyadic interventions included a one-time psychoeducation intervention, weekly dyadic and collaborative planning, and dyadic just-in-time adaptive interventions (JITAIs). MVPA was measured through daily diaries and wrist-worn accelerometers. We used multilevel modeling to estimate the effect of the intervention phase and weighted and centered estimation for microrandomized trials to estimate the treatment effects of dyadic and collaborative planning, as well as the dyadic JITAIs.
Results: Participants indicated higher device-based (b=5.88, SE=3.04, t3665=1.93; P=.03) and self-reported (b=8.26, SE=3.88, t3904=2.13; P=.01) MVPA during the intervention phase compared with the control phase. Dyadic and collaborative planning did not increase device-based (b=6.31, SE=5.18; P=.12) but only self-reported (b=14.25, SE=5.16; P=.005) MVPA. However, the effects of the 2 kinds of planning on self-reported MVPA disappeared when additional covariates were included (b=0.14, SE=3.32; P=.48). Furthermore, the dyadic JITAIs targeting both the actor and the partner increased device-based (actor: b=11.17, SE=3.18; P<.001; partner: b=7.23, SE=3.60; P=.03) and self-reported (actor: b=17.34, SE=3.65; P<.001; partner: b=11.82, SE=4.10; P<.001) MVPA. However, the effects of the dyadic JITAIs targeting the actor disappeared for self-reported MVPA (b=2.20, SE=3.22; P=0.25) when additional covariates were included. Exploratory analyses revealed that different types and timings of dyadic JITAIs were differentially effective.
Conclusions: This study demonstrated the promising effects of dyadic interventions to promote MVPA and highlighted the importance of the target, type, and timing of the interventions. Further research should investigate the mechanisms underlying the effects of dyadic interventions on health behaviors.
{"title":"Effectiveness of Smartphone-Based Dyadic Interventions to Increase Physical Activity in Romantic Couples: Microrandomized Trial.","authors":"Patrick Stefan Höhener, Robert Tobias, James Martin Allen, Pascal Küng, Urte Scholz","doi":"10.2196/67136","DOIUrl":"https://doi.org/10.2196/67136","url":null,"abstract":"<p><strong>Background: </strong>Social exchange processes, such as social support and social control, can promote health behavior change. However, these processes are often neglected when studying health behavior change and designing interventions. Intervening on these social exchange processes using dyadic interventions may provide a promising approach to promote health behaviors.</p><p><strong>Objective: </strong>This study aimed to investigate the effects of dyadic interventions to increase moderate-to-vigorous physical activity (MVPA) in romantic couples. Furthermore, we explored how the target, type, and timing of the interventions affect their effectiveness.</p><p><strong>Methods: </strong>In total, 38 romantic couples (mean age 34.01, SD 11.03 y) were recruited through online advertisements and participated in a smartphone-based microrandomized trial over 55 days consisting of control and intervention phases. The fully automated dyadic interventions included a one-time psychoeducation intervention, weekly dyadic and collaborative planning, and dyadic just-in-time adaptive interventions (JITAIs). MVPA was measured through daily diaries and wrist-worn accelerometers. We used multilevel modeling to estimate the effect of the intervention phase and weighted and centered estimation for microrandomized trials to estimate the treatment effects of dyadic and collaborative planning, as well as the dyadic JITAIs.</p><p><strong>Results: </strong>Participants indicated higher device-based (b=5.88, SE=3.04, t<sub>3665</sub>=1.93; P=.03) and self-reported (b=8.26, SE=3.88, t<sub>3904</sub>=2.13; P=.01) MVPA during the intervention phase compared with the control phase. Dyadic and collaborative planning did not increase device-based (b=6.31, SE=5.18; P=.12) but only self-reported (b=14.25, SE=5.16; P=.005) MVPA. However, the effects of the 2 kinds of planning on self-reported MVPA disappeared when additional covariates were included (b=0.14, SE=3.32; P=.48). Furthermore, the dyadic JITAIs targeting both the actor and the partner increased device-based (actor: b=11.17, SE=3.18; P<.001; partner: b=7.23, SE=3.60; P=.03) and self-reported (actor: b=17.34, SE=3.65; P<.001; partner: b=11.82, SE=4.10; P<.001) MVPA. However, the effects of the dyadic JITAIs targeting the actor disappeared for self-reported MVPA (b=2.20, SE=3.22; P=0.25) when additional covariates were included. Exploratory analyses revealed that different types and timings of dyadic JITAIs were differentially effective.</p><p><strong>Conclusions: </strong>This study demonstrated the promising effects of dyadic interventions to promote MVPA and highlighted the importance of the target, type, and timing of the interventions. Further research should investigate the mechanisms underlying the effects of dyadic interventions on health behaviors.</p><p><strong>Trial registration: </strong>ISRCTN registry ISRCTN15673058; https://www.isrctn.com/ISRCTN15673058.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e67136"},"PeriodicalIF":6.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Psychological stress during pregnancy is common and has been associated with adverse maternal and neonatal outcomes. Digital health interventions (DHIs) have emerged as a scalable approach to support stress management during pregnancy, yet evidence remains fragmented, and prior reviews have largely focused on broad perinatal mental health outcomes or delivery platforms rather than stress-specific effects and targeted intervention components.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the effectiveness of DHIs specifically designed to reduce stress during pregnancy and to examine how intervention strategies and delivery methods are associated with stress outcomes.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Randomized controlled trials and quasi-experimental studies involving pregnant women were eligible if they evaluated any digitally delivered intervention-such as mobile apps, web-based programs, or telemedicine-intended to reduce stress, and reported validated stress outcomes. We searched CINAHL, the Cochrane Library, Embase, and PubMed from database inception through November 2025. Risk of bias was assessed using the Cochrane risk of bias 2 tool for randomized trials and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. Where appropriate, effect sizes were pooled using random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method and reported as standardized mean differences.</p><p><strong>Results: </strong>A total of 19 studies were included. Overall, DHIs were associated with a significant reduction in stress compared with control conditions (standardized mean difference -0.45, 95% CI -0.59 to -0.32; 95% prediction interval -0.78 to -0.13), with low to moderate heterogeneity. Strategy-based subgroup analyses indicated that mindfulness- and education-focused interventions showed favorable effects, but formal tests for between-subgroup differences were not statistically significant. Evidence certainty was rated as moderate, primarily due to risk-of-bias concerns in some trials.</p><p><strong>Conclusions: </strong>This review provides stress-focused evidence that DHIs can support stress reduction during pregnancy and extends existing literature by systematically disaggregating interventions according to delivery methods, functional features, and content strategies. This study offers a component-oriented synthesis that informs the design and selection of digital stress-management interventions for pregnant women. In real-world antenatal care, these tools may complement clinician-delivered services by expanding access to low-intensity, scalable support, particularly when interventions integrate skills-based content with supportive digital functions. Future research should dir
{"title":"Evaluating the Effectiveness of Digital Interventions for Stress Management in Pregnant Women: Systematic Review and Meta-Analysis.","authors":"Jeung-Im Kim, Joo Yun Lee, So-Hee Park","doi":"10.2196/66267","DOIUrl":"10.2196/66267","url":null,"abstract":"<p><strong>Background: </strong>Psychological stress during pregnancy is common and has been associated with adverse maternal and neonatal outcomes. Digital health interventions (DHIs) have emerged as a scalable approach to support stress management during pregnancy, yet evidence remains fragmented, and prior reviews have largely focused on broad perinatal mental health outcomes or delivery platforms rather than stress-specific effects and targeted intervention components.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the effectiveness of DHIs specifically designed to reduce stress during pregnancy and to examine how intervention strategies and delivery methods are associated with stress outcomes.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Randomized controlled trials and quasi-experimental studies involving pregnant women were eligible if they evaluated any digitally delivered intervention-such as mobile apps, web-based programs, or telemedicine-intended to reduce stress, and reported validated stress outcomes. We searched CINAHL, the Cochrane Library, Embase, and PubMed from database inception through November 2025. Risk of bias was assessed using the Cochrane risk of bias 2 tool for randomized trials and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. Where appropriate, effect sizes were pooled using random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method and reported as standardized mean differences.</p><p><strong>Results: </strong>A total of 19 studies were included. Overall, DHIs were associated with a significant reduction in stress compared with control conditions (standardized mean difference -0.45, 95% CI -0.59 to -0.32; 95% prediction interval -0.78 to -0.13), with low to moderate heterogeneity. Strategy-based subgroup analyses indicated that mindfulness- and education-focused interventions showed favorable effects, but formal tests for between-subgroup differences were not statistically significant. Evidence certainty was rated as moderate, primarily due to risk-of-bias concerns in some trials.</p><p><strong>Conclusions: </strong>This review provides stress-focused evidence that DHIs can support stress reduction during pregnancy and extends existing literature by systematically disaggregating interventions according to delivery methods, functional features, and content strategies. This study offers a component-oriented synthesis that informs the design and selection of digital stress-management interventions for pregnant women. In real-world antenatal care, these tools may complement clinician-delivered services by expanding access to low-intensity, scalable support, particularly when interventions integrate skills-based content with supportive digital functions. Future research should dir","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e66267"},"PeriodicalIF":6.2,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Intermittent fasting emerges as a promising dietary approach against obesity, offering a cost-effective strategy for implementation via web-based platforms. We developed a Brief Online Intermittent Fasting Program (OIF), featuring a self-administered, weekly 1-day fasting regimen with replacement meals delivery, online guidance, and app messaging to support adherence.</p><p><strong>Objective: </strong>This pilot study aimed to assess the preliminary effectiveness, feasibility, and safety of the OIF on weight loss in adults with overweight and obesity in Japan. Secondary objectives were to assess its effects on body composition and metabolic markers.</p><p><strong>Methods: </strong>This 12-week, 1:1 randomized controlled trial recruited adults with overweight and obesity (BMI from 23 to <35) in 1 university, 1 hospital, and 2 company offices. Participants were randomized into 2 groups stratified by sex and age (<40 or ≥40 years). The intervention group received very low-calorie (407 kcal) meal replacements for weekly intermittent fasting, online guidance via Zoom (Zoom Video Communications, Inc), and app messages encouraging fasting and healthy lifestyles. The control group received app messages promoting healthy lifestyles only. Interventions were administered by a nonblinded researcher. The primary outcome was the change in body weight after 12 weeks, analyzed using intention-to-treat principles and adjusted for sex, age, and baseline weight. Secondary outcomes encompassed body composition, blood pressure, biomarkers (eg, hemoglobin A<sub>1c</sub>, triglycerides, and cholesterol), quality of life, physical activity, intervention adherence, and adverse events.</p><p><strong>Results: </strong>A total of 57 individuals were enrolled (28 in the intervention group and 29 in the control group). At 12 weeks, 25 participants in the intervention group and 27 participants in the control group completed follow-up. The baseline median weight was 75.8 (IQR 68.3-80.6) kg for the intervention group and 74.8 (IQR 69.8-81.8) kg for the control group. The mean weight change was -0.9 (SD 1.9) kg in the intervention group and +0.6 (SD 1.4) kg in the control group. The adjusted between-group difference in weight change was statistically significant at -1.6 (95% CI -2.5 to -0.8) kg. Fat mass change was not statistically significant (-0.1, 95% CI -1.3 to 1.4 kg), but muscle mass reduction was implied (-1.3, 95% CI -2.5 to -0.2 kg). Intervention adherence was 79% (22/28) in the intervention group. No serious adverse events were reported, and there were no significant changes in key biomarkers, such as hemoglobin A<sub>1c</sub> or quality of life.</p><p><strong>Conclusions: </strong>The OIF demonstrated effectiveness in promoting modest weight loss among adults with overweight and obesity over 12 weeks, with high feasibility and safety indicated by low dropout rates and absence of serious adverse events. However, the observed reduction in
背景：间歇性禁食作为一种很有前景的对抗肥胖的饮食方法，为通过网络平台实施提供了一种具有成本效益的策略。我们开发了一个简短的在线间歇性禁食计划（OIF），其特点是自我管理，每周1天的禁食方案，并提供替代膳食，在线指导和应用程序消息来支持坚持。目的：本试点研究旨在评估OIF对日本超重和肥胖成人减肥的初步有效性、可行性和安全性。次要目的是评估其对身体成分和代谢指标的影响。方法：这项为期12周的1:1随机对照试验招募了超重和肥胖（BMI从23到1c，甘油三酯和胆固醇），生活质量，身体活动，干预依从性和不良事件的成年人。结果：共入组57例（干预组28例，对照组29例）。12周时，干预组25名参与者和对照组27名参与者完成随访。干预组的基线中位体重为75.8 (IQR 68.3-80.6) kg，对照组为74.8 (IQR 69.8-81.8) kg。干预组平均体重变化为-0.9 (SD 1.9) kg，对照组平均体重变化为+0.6 (SD 1.4) kg。调整后的组间体重变化差异具有统计学意义，为-1.6 kg (95% CI -2.5至-0.8)kg。脂肪质量变化无统计学意义（-0.1,95% CI -1.3至1.4 kg），但肌肉质量减少（-1.3,95% CI -2.5至-0.2 kg）。干预组的干预依从性为79%（22/28）。没有严重不良事件的报道，关键生物标志物，如血红蛋白A1c或生活质量没有显著变化。结论：OIF在12周内有效促进超重和肥胖成人适度减肥，具有高可行性和安全性，退学率低，无严重不良事件。然而，观察到的肌肉量减少表明需要改进计划，例如纳入运动指导，以优化健康结果。试验注册：UMIN-CTR UMIN000050437；https://tinyurl.com/4x5h2t2x。
{"title":"A Brief Web-Based and Mobile Intervention of Intermittent Fasting With Meal Support for Weight Loss Among Adults With Overweight and Obesity in Japan: Pilot Randomized Controlled Trial.","authors":"Takashi Noda, Tomonari Shimamoto, Kosuke Kiyohara, Mie Imanaka, Norihiro Nishioka, Yukiko Tateyama, Taku Iwami","doi":"10.2196/58930","DOIUrl":"10.2196/58930","url":null,"abstract":"<p><strong>Background: </strong>Intermittent fasting emerges as a promising dietary approach against obesity, offering a cost-effective strategy for implementation via web-based platforms. We developed a Brief Online Intermittent Fasting Program (OIF), featuring a self-administered, weekly 1-day fasting regimen with replacement meals delivery, online guidance, and app messaging to support adherence.</p><p><strong>Objective: </strong>This pilot study aimed to assess the preliminary effectiveness, feasibility, and safety of the OIF on weight loss in adults with overweight and obesity in Japan. Secondary objectives were to assess its effects on body composition and metabolic markers.</p><p><strong>Methods: </strong>This 12-week, 1:1 randomized controlled trial recruited adults with overweight and obesity (BMI from 23 to <35) in 1 university, 1 hospital, and 2 company offices. Participants were randomized into 2 groups stratified by sex and age (<40 or ≥40 years). The intervention group received very low-calorie (407 kcal) meal replacements for weekly intermittent fasting, online guidance via Zoom (Zoom Video Communications, Inc), and app messages encouraging fasting and healthy lifestyles. The control group received app messages promoting healthy lifestyles only. Interventions were administered by a nonblinded researcher. The primary outcome was the change in body weight after 12 weeks, analyzed using intention-to-treat principles and adjusted for sex, age, and baseline weight. Secondary outcomes encompassed body composition, blood pressure, biomarkers (eg, hemoglobin A<sub>1c</sub>, triglycerides, and cholesterol), quality of life, physical activity, intervention adherence, and adverse events.</p><p><strong>Results: </strong>A total of 57 individuals were enrolled (28 in the intervention group and 29 in the control group). At 12 weeks, 25 participants in the intervention group and 27 participants in the control group completed follow-up. The baseline median weight was 75.8 (IQR 68.3-80.6) kg for the intervention group and 74.8 (IQR 69.8-81.8) kg for the control group. The mean weight change was -0.9 (SD 1.9) kg in the intervention group and +0.6 (SD 1.4) kg in the control group. The adjusted between-group difference in weight change was statistically significant at -1.6 (95% CI -2.5 to -0.8) kg. Fat mass change was not statistically significant (-0.1, 95% CI -1.3 to 1.4 kg), but muscle mass reduction was implied (-1.3, 95% CI -2.5 to -0.2 kg). Intervention adherence was 79% (22/28) in the intervention group. No serious adverse events were reported, and there were no significant changes in key biomarkers, such as hemoglobin A<sub>1c</sub> or quality of life.</p><p><strong>Conclusions: </strong>The OIF demonstrated effectiveness in promoting modest weight loss among adults with overweight and obesity over 12 weeks, with high feasibility and safety indicated by low dropout rates and absence of serious adverse events. However, the observed reduction in","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e58930"},"PeriodicalIF":6.2,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lovisa Jäderlund Hagstedt, Helena Hvitfeldt, Maria Hägglund
Background: Digitalization and mobile health (mHealth) technologies hold promise for improving home care delivery. However, many mHealth initiatives fail to achieve their goals. Understanding the reasons behind these failures is critical for informing the successful implementation of mHealth in primary and home care settings.
Objective: This study aimed to explore the implementation process of a tablet computer with an mHealth app providing mobile access to the electronic health record (EHR) in home care, identifying barriers and facilitators to its uptake.
Methods: A tablet with EHR access was introduced at 4 primary care centers and 1 municipal home care organization in Sweden. Participants were nurses and physicians working at the study sites. Focus group discussions and interviews were conducted to obtain a rich understanding of implementation-related issues experienced by the health care professionals. Qualitative content analysis was conducted using the Consolidated Framework for Implementation Research to guide interpretation.
Results: Eighteen health care professionals (16 nurses and 2 physicians) participated in the study. The implementation of the mHealth app was largely unsuccessful. Key barriers included limited functionality of the app, technological immaturity, and unstable infrastructure. Organizational context influenced uptake, especially due to differing EHR systems and varying levels of user engagement. Users who were involved in the development process were more positive, despite the absence of certain functionalities, while those excluded struggled with adoption. Long development and implementation timelines and limited training reduced enthusiasm and negatively affected user engagement. Additional challenges included insufficient implementation planning, lack of leadership engagement, and inadequate resources for support and training.
Conclusions: For mHealth implementations to succeed, tools must meet users' needs and integrate seamlessly with existing eHealth ecosystems and infrastructures. Premature implementations can lead to change fatigue and diminish future engagement. Investments in user-centered design, thorough testing, organizational readiness, and sustained support are essential to realize the potential of mHealth in home care.
{"title":"Failed Implementation of Mobile Access to Electronic Health Records in Home Care: Qualitative Study in Sweden.","authors":"Lovisa Jäderlund Hagstedt, Helena Hvitfeldt, Maria Hägglund","doi":"10.2196/69590","DOIUrl":"10.2196/69590","url":null,"abstract":"<p><strong>Background: </strong>Digitalization and mobile health (mHealth) technologies hold promise for improving home care delivery. However, many mHealth initiatives fail to achieve their goals. Understanding the reasons behind these failures is critical for informing the successful implementation of mHealth in primary and home care settings.</p><p><strong>Objective: </strong>This study aimed to explore the implementation process of a tablet computer with an mHealth app providing mobile access to the electronic health record (EHR) in home care, identifying barriers and facilitators to its uptake.</p><p><strong>Methods: </strong>A tablet with EHR access was introduced at 4 primary care centers and 1 municipal home care organization in Sweden. Participants were nurses and physicians working at the study sites. Focus group discussions and interviews were conducted to obtain a rich understanding of implementation-related issues experienced by the health care professionals. Qualitative content analysis was conducted using the Consolidated Framework for Implementation Research to guide interpretation.</p><p><strong>Results: </strong>Eighteen health care professionals (16 nurses and 2 physicians) participated in the study. The implementation of the mHealth app was largely unsuccessful. Key barriers included limited functionality of the app, technological immaturity, and unstable infrastructure. Organizational context influenced uptake, especially due to differing EHR systems and varying levels of user engagement. Users who were involved in the development process were more positive, despite the absence of certain functionalities, while those excluded struggled with adoption. Long development and implementation timelines and limited training reduced enthusiasm and negatively affected user engagement. Additional challenges included insufficient implementation planning, lack of leadership engagement, and inadequate resources for support and training.</p><p><strong>Conclusions: </strong>For mHealth implementations to succeed, tools must meet users' needs and integrate seamlessly with existing eHealth ecosystems and infrastructures. Premature implementations can lead to change fatigue and diminish future engagement. Investments in user-centered design, thorough testing, organizational readiness, and sustained support are essential to realize the potential of mHealth in home care.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e69590"},"PeriodicalIF":6.2,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sintieh Nchinda Ngek Ekongefeyin, Paola Daniore, Vasileios Nittas, Stefania Iaquinto, Enriqueta Vallejo-Yagüe, Christian P Kamm, Pasquale Calabrese, Claudia Baum, Claudio Gobbi, Chiara Zecca, Andrew Chan, Milo Puhan, Viktor von Wyl
<p><strong>Background: </strong>Telehealth can improve access to care for people living with multiple sclerosis (MS), but information on its acceptance is limited in Switzerland.</p><p><strong>Objective: </strong>This study aimed to determine the proportion of people living with MS willing to accept telehealth as a new default and the factors associated with their acceptance.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using survey data from the Swiss Multiple Sclerosis Registry. We defined "telehealth as a default" as a health care model where remote consultations (telephone and/or video calls) are the primary mode of interaction between patients and their physicians, with in-person visits based on clinical necessity. Multivariable logistic regression was performed to evaluate the association between telehealth acceptance and sociodemographic and health-related factors. Telehealth acceptance was described in relation to 3 survey variables that mirrored key constructs from the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. The variables were digital communication preferences, internet use for health provider searches, and experience with telemedicine.</p><p><strong>Results: </strong>Among 427 respondents, 15.5% (66/427) reported a willingness to accept telehealth as their default. In this group, only 21.2% (14/66) had experience using telemedicine. A descriptive analysis of our 3 NASSS-derived key constructs showed that among the 78.5% (335/427) respondents who generally agreed to digital access to health data, only 17.0% (57/335) accepted telehealth as a default. Notably, 30.7% (129/427) of participants stated a wish for support for using devices or the internet. Among those 129 individuals, 17.1% (22/129) were willing to accept telehealth as a default. Of the 89 people with prior telehealth experience, 15.7% (14/89) were willing to accept telehealth. In multivariable analysis, digital communication with health care providers (adjusted odds ratio [aOR] 14.56, 95% CI 6.18-39.04; P<.001), current internet use for health care provider search (aOR 7.78, 95% CI 1.34-45.32; P=.021), and a secondary progressive MS diagnosis (aOR 0.22, 95% CI 0.05-0.72; P=.021) were independently associated with accepting telehealth as a default.</p><p><strong>Conclusions: </strong>Our findings suggest a low acceptance of telehealth as a default among people living with MS in Switzerland. While our 3 postulated NASSS-derived key constructs were not associated with telehealth acceptance, we noted additional behavioral factors, including previous digital communication with health care providers and using the internet to search for health care provider information, which were associated with telehealth acceptance. Moreover, advanced disease states like secondary progressive MS were negatively associated with telehealth acceptance. Thus, telehealth as a default will be most acceptable in people living with MS w
背景：远程医疗可以改善多发性硬化症（MS）患者获得护理的机会，但瑞士对其接受程度的信息有限。目的：本研究旨在确定多发性硬化症患者愿意接受远程医疗作为一种新的默认方式的比例及其接受程度的相关因素。方法：我们使用瑞士多发性硬化症登记处的调查数据进行了横断面分析。我们将“远程医疗作为默认”定义为一种医疗保健模式，其中远程咨询（电话和/或视频通话）是患者和医生之间互动的主要模式，并根据临床需要进行亲自访问。采用多变量逻辑回归来评估远程医疗接受程度与社会人口统计学和健康相关因素之间的关系。远程医疗接受程度与3个调查变量有关，这些变量反映了不采用、放弃、扩大规模、传播和可持续性（NASSS）框架的关键结构。这些变量包括数字通信偏好、医疗服务提供者搜索的互联网使用和远程医疗经验。结果：在427名受访者中，15.5%（66/427）表示愿意接受远程医疗。在该组中，只有21.2%（14/66）有使用远程医疗的经验。对我们的3个nasss衍生的关键结构的描述性分析表明，在78.5%（335/427）的受访者中，他们普遍同意数字化访问健康数据，只有17.0%（57/335）的受访者接受远程医疗作为默认值。值得注意的是，30.7%（129/427）的参与者表示希望支持使用电子设备或互联网。在这129人中，17.1%（22/129）的人愿意接受远程医疗作为默认选项。在89名有远程医疗经验的人中，15.7%（14/89）的人愿意接受远程医疗。在多变量分析中，与医疗保健提供者的数字通信(调整优势比[aOR] 14.56, 95% CI 6.18-39.04；结论：我们的研究结果表明，瑞士多发性硬化症患者对远程医疗的接受程度较低。虽然我们假设的3个nasss衍生的关键结构与远程医疗接受度无关，但我们注意到其他行为因素，包括以前与医疗保健提供者的数字通信以及使用互联网搜索医疗保健提供者信息，这些因素与远程医疗接受度有关。此外，像继发性进展性MS这样的晚期疾病状态与远程医疗接受度呈负相关。因此，远程医疗作为一种默认方式，对于那些已经使用互联网来获取健康的MS患者和那些病情较轻的人来说是最容易接受的。未来的研究应探索提供者的观点和评估长期战略接受远程医疗在多发性硬化症护理。
{"title":"Acceptability of Telehealth as the Default Modality for Multiple Sclerosis Care in Switzerland: Cross-Sectional Study.","authors":"Sintieh Nchinda Ngek Ekongefeyin, Paola Daniore, Vasileios Nittas, Stefania Iaquinto, Enriqueta Vallejo-Yagüe, Christian P Kamm, Pasquale Calabrese, Claudia Baum, Claudio Gobbi, Chiara Zecca, Andrew Chan, Milo Puhan, Viktor von Wyl","doi":"10.2196/84447","DOIUrl":"10.2196/84447","url":null,"abstract":"<p><strong>Background: </strong>Telehealth can improve access to care for people living with multiple sclerosis (MS), but information on its acceptance is limited in Switzerland.</p><p><strong>Objective: </strong>This study aimed to determine the proportion of people living with MS willing to accept telehealth as a new default and the factors associated with their acceptance.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using survey data from the Swiss Multiple Sclerosis Registry. We defined \"telehealth as a default\" as a health care model where remote consultations (telephone and/or video calls) are the primary mode of interaction between patients and their physicians, with in-person visits based on clinical necessity. Multivariable logistic regression was performed to evaluate the association between telehealth acceptance and sociodemographic and health-related factors. Telehealth acceptance was described in relation to 3 survey variables that mirrored key constructs from the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. The variables were digital communication preferences, internet use for health provider searches, and experience with telemedicine.</p><p><strong>Results: </strong>Among 427 respondents, 15.5% (66/427) reported a willingness to accept telehealth as their default. In this group, only 21.2% (14/66) had experience using telemedicine. A descriptive analysis of our 3 NASSS-derived key constructs showed that among the 78.5% (335/427) respondents who generally agreed to digital access to health data, only 17.0% (57/335) accepted telehealth as a default. Notably, 30.7% (129/427) of participants stated a wish for support for using devices or the internet. Among those 129 individuals, 17.1% (22/129) were willing to accept telehealth as a default. Of the 89 people with prior telehealth experience, 15.7% (14/89) were willing to accept telehealth. In multivariable analysis, digital communication with health care providers (adjusted odds ratio [aOR] 14.56, 95% CI 6.18-39.04; P<.001), current internet use for health care provider search (aOR 7.78, 95% CI 1.34-45.32; P=.021), and a secondary progressive MS diagnosis (aOR 0.22, 95% CI 0.05-0.72; P=.021) were independently associated with accepting telehealth as a default.</p><p><strong>Conclusions: </strong>Our findings suggest a low acceptance of telehealth as a default among people living with MS in Switzerland. While our 3 postulated NASSS-derived key constructs were not associated with telehealth acceptance, we noted additional behavioral factors, including previous digital communication with health care providers and using the internet to search for health care provider information, which were associated with telehealth acceptance. Moreover, advanced disease states like secondary progressive MS were negatively associated with telehealth acceptance. Thus, telehealth as a default will be most acceptable in people living with MS w","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e84447"},"PeriodicalIF":6.2,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Sedentary employees face increased chronic health risks due to physical inactivity, immobility, and unhealthy eating behavior. Although mobile health (mHealth) interventions have shown promise in improving lifestyle behaviors, their effectiveness in occupational settings remains underexplored. Building on our previous workplace interventions, this study developed and evaluated a mobile-enabled web app-SIMPLE HEALTH-integrating activity tracking, healthy eating, and behavioral support for sedentary employees.</p><p><strong>Objective: </strong>This study evaluated the short-term effects of a 12-week mHealth intervention on physical activity, sedentary behavior, dietary habits, and cardiometabolic health indicators among sedentary employees in Taiwan.</p><p><strong>Methods: </strong>A 2-arm quasi-experimental study was conducted at two aerospace industrial workplaces. A total of 101 sedentary employees (mean age 46.9, SD 12.2 years; 51.5% female) were allocated by coin toss to either the intervention group (n=50) or control group (n=51). The intervention group participated in the SIMPLE HEALTH program, an mHealth intervention grounded in Social Cognitive Theory and the Ecological Model, consisting of eight components: activity tracking, goal setting, behavior logging, reminders, personalized advice, educational and motivational e-booklets, and individual and team challenges. The control group received six print educational booklets. Cardiometabolic biomarkers, objectively measured physical activity (Fitbit Charge 3), occupational sitting (occupational sitting and physical activity questionnaire), and dietary behavior (3-day photographic food records and the healthy eating behavior inventory) were assessed at baseline and 12 weeks. Data were analyzed using generalized estimating equations following the intention-to-treat principle.</p><p><strong>Results: </strong>At 12 weeks, the intervention group showed significant improvements in step counts (B 1227.13, 95% CI 2.90 to 2451.36; P=.049), moderate physical activity (B 0.17, 95% CI 0.01 to 0.33; P=.04), and dietary behaviors-reduced intake of calories (B -144.59, 95% CI -276.57 to -12.60), carbohydrates (B -19.88, 95% CI -37.99 to -1.78), fats (B -6.99, 95% CI -13.69 to -0.29), and grains (B -1.46, 95% CI -2.43 to -0.50), and increased vegetable intake (B 0.47, 95% CI 0.06 to 0.88), compared to the control group (all P<.05). Favorable trends were noted in diastolic blood pressure (B -2.38, 95% CI -4.99 to 0.22; P=.07) and soft lean mass (B 0.34, 95% CI -0.06 to 0.75; P=.097). Both groups showed significant within-group improvements in low-density lipoprotein cholesterol, body fat percentage, waist circumference, and occupational sitting and walking (all P<.05), but between-group differences were nonsignificant.</p><p><strong>Conclusions: </strong>The 12-week mHealth intervention effectively improved physical activity and dietary behaviors and showed favorable trends in
背景：久坐的员工由于缺乏身体活动、不动和不健康的饮食行为而面临越来越多的慢性健康风险。尽管移动医疗（mHealth）干预措施已显示出改善生活方式行为的希望，但其在职业环境中的有效性仍未得到充分探索。在我们之前的工作场所干预的基础上，本研究开发并评估了一款支持移动设备的web应用程序——simple健康整合活动跟踪、健康饮食和久坐员工行为支持。目的：本研究评估为期12周的移动健康干预对台湾久坐员工身体活动、久坐行为、饮食习惯和心脏代谢健康指标的短期影响。方法：在两个航空航天工业工作场所进行双臂准实验研究。通过抛硬币将101名久坐员工（平均年龄46.9岁，SD 12.2岁，其中51.5%为女性）分为干预组（n=50）和对照组（n=51）。干预组参加了SIMPLE HEALTH项目，这是一个基于社会认知理论和生态模型的移动健康干预项目，由八个部分组成：活动跟踪、目标设定、行为记录、提醒、个性化建议、教育和激励电子小册子，以及个人和团队挑战。对照组收到6本印刷的教育小册子。在基线和12周时评估心脏代谢生物标志物、客观测量的身体活动（Fitbit Charge 3）、职业性坐着（职业性坐着和身体活动问卷）和饮食行为（3天照片食物记录和健康饮食行为清单）。数据分析使用广义估计方程遵循意向治疗原则。结果：在12周时，干预组在步数（b1227.13, 95% CI 2.90 ~ 2451.36； P= 0.049）、中度体力活动(b0.17, 95% CI 0.01 ~ 0.33；P= 0.04)，以及饮食行为——与对照组相比，减少了卡路里（B -144.59, 95% CI -276.57至-12.60）、碳水化合物（B -19.88, 95% CI -37.99至-1.78）、脂肪（B -6.99, 95% CI -13.69至-0.29）和谷物（B -1.46, 95% CI -2.43至-0.50）的摄入量（B 0.47, 95% CI 0.06至0.88）。为期12周的移动健康干预有效地改善了久坐员工的身体活动和饮食行为，并显示出心脏代谢指标的有利趋势。这些发现支持将移动健康项目整合到员工健康计划中，以促进健康行为，减轻生产力损失，并减轻慢性疾病负担。进一步的研究应评估在不同职业环境中的长期可持续性、可扩展性和成本效益。临床试验：ClinicalTrials.gov NCT04347096；https://clinicaltrials.gov/study/NCT04347096。
{"title":"Short-Term Effects of a Mobile Health Intervention on Healthy Behaviors and Cardiometabolic Health in Sedentary Employees: A Quasi-Experimental Study.","authors":"Yun-Ping Lin, Shu-Hua Lu, Kwo-Chen Lee, Wei-Fen Ma, Ya-Fang Ho, Wen-Chun Liao, Hui-Ting Yang, OiSaeng Hong","doi":"10.2196/70074","DOIUrl":"https://doi.org/10.2196/70074","url":null,"abstract":"<p><strong>Background: </strong>Sedentary employees face increased chronic health risks due to physical inactivity, immobility, and unhealthy eating behavior. Although mobile health (mHealth) interventions have shown promise in improving lifestyle behaviors, their effectiveness in occupational settings remains underexplored. Building on our previous workplace interventions, this study developed and evaluated a mobile-enabled web app-SIMPLE HEALTH-integrating activity tracking, healthy eating, and behavioral support for sedentary employees.</p><p><strong>Objective: </strong>This study evaluated the short-term effects of a 12-week mHealth intervention on physical activity, sedentary behavior, dietary habits, and cardiometabolic health indicators among sedentary employees in Taiwan.</p><p><strong>Methods: </strong>A 2-arm quasi-experimental study was conducted at two aerospace industrial workplaces. A total of 101 sedentary employees (mean age 46.9, SD 12.2 years; 51.5% female) were allocated by coin toss to either the intervention group (n=50) or control group (n=51). The intervention group participated in the SIMPLE HEALTH program, an mHealth intervention grounded in Social Cognitive Theory and the Ecological Model, consisting of eight components: activity tracking, goal setting, behavior logging, reminders, personalized advice, educational and motivational e-booklets, and individual and team challenges. The control group received six print educational booklets. Cardiometabolic biomarkers, objectively measured physical activity (Fitbit Charge 3), occupational sitting (occupational sitting and physical activity questionnaire), and dietary behavior (3-day photographic food records and the healthy eating behavior inventory) were assessed at baseline and 12 weeks. Data were analyzed using generalized estimating equations following the intention-to-treat principle.</p><p><strong>Results: </strong>At 12 weeks, the intervention group showed significant improvements in step counts (B 1227.13, 95% CI 2.90 to 2451.36; P=.049), moderate physical activity (B 0.17, 95% CI 0.01 to 0.33; P=.04), and dietary behaviors-reduced intake of calories (B -144.59, 95% CI -276.57 to -12.60), carbohydrates (B -19.88, 95% CI -37.99 to -1.78), fats (B -6.99, 95% CI -13.69 to -0.29), and grains (B -1.46, 95% CI -2.43 to -0.50), and increased vegetable intake (B 0.47, 95% CI 0.06 to 0.88), compared to the control group (all P<.05). Favorable trends were noted in diastolic blood pressure (B -2.38, 95% CI -4.99 to 0.22; P=.07) and soft lean mass (B 0.34, 95% CI -0.06 to 0.75; P=.097). Both groups showed significant within-group improvements in low-density lipoprotein cholesterol, body fat percentage, waist circumference, and occupational sitting and walking (all P<.05), but between-group differences were nonsignificant.</p><p><strong>Conclusions: </strong>The 12-week mHealth intervention effectively improved physical activity and dietary behaviors and showed favorable trends in ","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Approximately one-third of university students are overweight or obese, and a similar proportion experience anxiety or depression. Despite the interrelated nature of weight and mental health, interventions rarely address these issues simultaneously in young adults. Digital peer support interventions have the potential to promote healthy lifestyle and mental well-being. However, evidence is limited on whether a digital peer-driven approach can concurrently improve weight management and mental health in university populations with preobesity.</p><p><strong>Objective: </strong>This randomized controlled trial (RCT) evaluated the efficacy of a digital peer support program in concurrently improving weight management and mental health outcomes among university students with preobesity.</p><p><strong>Methods: </strong>In a single-blind parallel group RCT, 216 students with preobesity were allocated equally among three 6-month arms, which were a peer support intervention, an active wellness control, and a waitlist control. The peer support arm began with an interactive online workshop followed by moderated WeChat (Tencent) group discussions, daily micro tasks, biweekly group challenges, and digital badges to reinforce engagement. The active control group received the same schedule and formats but focused on general wellness topics. The waitlist group completed the same assessments without any intervention during the study period. The primary outcome measured the change in BMI from baseline to 6 months. Secondary outcomes included weekly physical activity measured in metabolic equivalent of task minutes, self-esteem, loneliness, anxiety, and depression assessed at 0, 2, 4, and 6 months. Analyses used linear mixed effects models.</p><p><strong>Results: </strong>Retention exceeded 90%. At 6 months, the peer-support group achieved a greater BMI reduction than the active control by 0.47 (95% CI -0.89 to -0.04) kg/m² and waitlist by 0.54 (95% CI -0.85 to -0.01) kg/m². Weekly metabolic equivalent of task-minutes was 129.5 higher than active control (95% CI 53.3-205.6) and 152.9 higher than waitlist (95% CI 68.4-237.4). Self-esteem increased by 1.81 points versus active control (95% CI 0.22-3.39) and 1.99 points versus waitlist (95% CI 0.21-3.76). Loneliness scores fell by 3.79 points relative to active control (95% CI -7.03 to -0.56) and by 5.02 points relative to waitlist (95% CI -8.38 to -1.66). No significant differences emerged for anxiety or depression.</p><p><strong>Conclusions: </strong>A comprehensive digital peer-support program delivered via WeChat produced modest but clinically meaningful improvements in weight management, physical activity, self-esteem, and social connectedness among undergraduates with preobesity compared with wellness control and no intervention. These findings suggest that integrating peer support into scalable digital platforms can simultaneously address physical and psychosocial health in at-risk
背景：大约三分之一的大学生超重或肥胖，同样比例的大学生有焦虑或抑郁。尽管体重和心理健康具有相互关联的性质，但干预措施很少同时解决年轻人的这些问题。数字同伴支持干预措施有可能促进健康的生活方式和心理健康。然而，关于数字同伴驱动方法是否可以同时改善大学肥胖前期人群的体重管理和心理健康的证据有限。目的：本随机对照试验（RCT）评估数字同伴支持计划同时改善肥胖前期大学生体重管理和心理健康结果的有效性。方法：采用单盲平行组随机对照试验，将216名肥胖前期学生平均分为同伴支持干预组、积极健康对照组和候补组。同伴支持部门以互动在线研讨会开始，随后是微信（腾讯）小组讨论、每日微任务、两周一次的小组挑战和数字徽章，以加强参与度。积极控制组接受相同的时间表和形式，但侧重于一般健康主题。在研究期间，候选名单组在没有任何干预的情况下完成了相同的评估。主要结果测量了从基线到6个月的BMI变化。次要结果包括每周身体活动（代谢当量），在第0、2、4和6个月时评估自尊、孤独、焦虑和抑郁。分析采用线性混合效应模型。结果：保留率达90%以上。在6个月时，同伴支持组的BMI比积极对照组降低了0.47 (95% CI -0.89至-0.04)kg/m²，等待组的BMI降低了0.54 (95% CI -0.85至-0.01)kg/m²。每周任务分钟代谢当量比主动对照组高129.5 (95% CI 53.3-205.6)，比候补组高152.9 （95% CI 68.4-237.4）。与主动控制组相比，自尊增加了1.81分（95% CI 0.22-3.39），与候补组相比增加了1.99分（95% CI 0.21-3.76）。孤独感得分相对于主动控制组下降了3.79分（95% CI -7.03至-0.56），相对于等候组下降了5.02分（95% CI -8.38至-1.66）。焦虑和抑郁方面没有显著差异。结论：与健康控制和不干预相比，通过微信提供的全面数字同伴支持计划在肥胖前期大学生的体重管理、身体活动、自尊和社会联系方面产生了适度但有临床意义的改善。这些发现表明，将同伴支持整合到可扩展的数字平台中，可以同时解决高危大学人群的身体和心理健康问题。
{"title":"Efficacy of a Digital Peer Support Program on Weight Management and Mental Health in University Students With Preobesity: Randomized Controlled Trial.","authors":"Xingyu Liu, Ting Liu, Tao Chen, Ruisi Ma","doi":"10.2196/78960","DOIUrl":"10.2196/78960","url":null,"abstract":"<p><strong>Background: </strong>Approximately one-third of university students are overweight or obese, and a similar proportion experience anxiety or depression. Despite the interrelated nature of weight and mental health, interventions rarely address these issues simultaneously in young adults. Digital peer support interventions have the potential to promote healthy lifestyle and mental well-being. However, evidence is limited on whether a digital peer-driven approach can concurrently improve weight management and mental health in university populations with preobesity.</p><p><strong>Objective: </strong>This randomized controlled trial (RCT) evaluated the efficacy of a digital peer support program in concurrently improving weight management and mental health outcomes among university students with preobesity.</p><p><strong>Methods: </strong>In a single-blind parallel group RCT, 216 students with preobesity were allocated equally among three 6-month arms, which were a peer support intervention, an active wellness control, and a waitlist control. The peer support arm began with an interactive online workshop followed by moderated WeChat (Tencent) group discussions, daily micro tasks, biweekly group challenges, and digital badges to reinforce engagement. The active control group received the same schedule and formats but focused on general wellness topics. The waitlist group completed the same assessments without any intervention during the study period. The primary outcome measured the change in BMI from baseline to 6 months. Secondary outcomes included weekly physical activity measured in metabolic equivalent of task minutes, self-esteem, loneliness, anxiety, and depression assessed at 0, 2, 4, and 6 months. Analyses used linear mixed effects models.</p><p><strong>Results: </strong>Retention exceeded 90%. At 6 months, the peer-support group achieved a greater BMI reduction than the active control by 0.47 (95% CI -0.89 to -0.04) kg/m² and waitlist by 0.54 (95% CI -0.85 to -0.01) kg/m². Weekly metabolic equivalent of task-minutes was 129.5 higher than active control (95% CI 53.3-205.6) and 152.9 higher than waitlist (95% CI 68.4-237.4). Self-esteem increased by 1.81 points versus active control (95% CI 0.22-3.39) and 1.99 points versus waitlist (95% CI 0.21-3.76). Loneliness scores fell by 3.79 points relative to active control (95% CI -7.03 to -0.56) and by 5.02 points relative to waitlist (95% CI -8.38 to -1.66). No significant differences emerged for anxiety or depression.</p><p><strong>Conclusions: </strong>A comprehensive digital peer-support program delivered via WeChat produced modest but clinically meaningful improvements in weight management, physical activity, self-esteem, and social connectedness among undergraduates with preobesity compared with wellness control and no intervention. These findings suggest that integrating peer support into scalable digital platforms can simultaneously address physical and psychosocial health in at-risk","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e78960"},"PeriodicalIF":6.2,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12823021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jung Hyun Kim, Minjeong Sohn, Jimin Woo, Jaeyong Shin, Euna Han
<p><strong>Background: </strong>Insomnia is a prevalent sleep disorder characterized by difficulty initiating or maintaining sleep and is associated with substantial health and economic burdens. Although cognitive behavioral therapy (CBT) is recommended as the first-line treatment, pharmacotherapy remains widely used despite adverse effects and significant indirect costs related to impaired productivity and workplace safety. Digital therapeutics delivering CBT through mobile platforms have emerged as scalable alternatives to improve access and outcomes. Somzz is a commercially available, domestically developed digital therapeutic that delivers CBT-based interventions for insomnia via a mobile app.</p><p><strong>Objective: </strong>This study evaluated the cost-effectiveness of Somzz compared with conventional insomnia treatment combining CBT and pharmacotherapy from both health care system and societal perspectives in South Korea.</p><p><strong>Methods: </strong>A decision-analytic model integrating a short-term decision tree with a Markov model was developed to compare costs and outcomes of digital CBT via Somzz versus conventional care in 2023. The model simulated a 27-week time horizon (three treatment cycles) and applied an annual discount rate of 4.5%. Clinical inputs, including remission probabilities and health utility values, were derived from a published randomized clinical trial comparing digital CBT delivered via Somzz with sleep hygiene education. Additional inputs, including health care resource use and unit costs, were obtained from published literature and national sources. Health outcomes were measured in quality-adjusted life years (QALYs). The cost analysis included direct medical costs and indirect costs related to absenteeism, productivity loss, and workplace accidents attributable to insomnia. Incremental cost-effectiveness ratios (ICERs) were estimated in 2023 South Korean Won (KRW). Deterministic one-way and probabilistic sensitivity analyses were conducted to assess uncertainty.</p><p><strong>Results: </strong>From a health care system perspective, digital CBT via Somzz resulted in modestly higher costs and improved health outcomes compared with standard care. Over approximately 6.5 months, Somzz generated an additional 0.0092 QALYs per patient at an incremental cost of KRW 79,691 (US $61.87), yielding an ICER of KRW 8,719,727 (US $990,883) per QALY gained. This estimate was well below the Korean willingness-to-pay threshold of KRW 30,000,000 (US $23,192.91) per QALY. From a societal perspective, digital CBT was cost-saving, producing a negative ICER due to reductions in health care utilization, workplace accidents, and productivity losses associated with higher remission rates. Sensitivity analyses identified intervention costs and remission probabilities as key drivers; however, digital CBT remained cost-effective across all scenarios under willingness-to-pay thresholds of KRW 30,000,000 and KRW 15,000,000 per QALY.</p><
{"title":"Digital Cognitive Behavioral Therapy for Chronic Insomnia in South Korea: Cost-Effectiveness Analysis Using Decision Tree and Markov Modeling Based on a Secondary Analysis of a Randomized Clinical Trial.","authors":"Jung Hyun Kim, Minjeong Sohn, Jimin Woo, Jaeyong Shin, Euna Han","doi":"10.2196/71750","DOIUrl":"10.2196/71750","url":null,"abstract":"<p><strong>Background: </strong>Insomnia is a prevalent sleep disorder characterized by difficulty initiating or maintaining sleep and is associated with substantial health and economic burdens. Although cognitive behavioral therapy (CBT) is recommended as the first-line treatment, pharmacotherapy remains widely used despite adverse effects and significant indirect costs related to impaired productivity and workplace safety. Digital therapeutics delivering CBT through mobile platforms have emerged as scalable alternatives to improve access and outcomes. Somzz is a commercially available, domestically developed digital therapeutic that delivers CBT-based interventions for insomnia via a mobile app.</p><p><strong>Objective: </strong>This study evaluated the cost-effectiveness of Somzz compared with conventional insomnia treatment combining CBT and pharmacotherapy from both health care system and societal perspectives in South Korea.</p><p><strong>Methods: </strong>A decision-analytic model integrating a short-term decision tree with a Markov model was developed to compare costs and outcomes of digital CBT via Somzz versus conventional care in 2023. The model simulated a 27-week time horizon (three treatment cycles) and applied an annual discount rate of 4.5%. Clinical inputs, including remission probabilities and health utility values, were derived from a published randomized clinical trial comparing digital CBT delivered via Somzz with sleep hygiene education. Additional inputs, including health care resource use and unit costs, were obtained from published literature and national sources. Health outcomes were measured in quality-adjusted life years (QALYs). The cost analysis included direct medical costs and indirect costs related to absenteeism, productivity loss, and workplace accidents attributable to insomnia. Incremental cost-effectiveness ratios (ICERs) were estimated in 2023 South Korean Won (KRW). Deterministic one-way and probabilistic sensitivity analyses were conducted to assess uncertainty.</p><p><strong>Results: </strong>From a health care system perspective, digital CBT via Somzz resulted in modestly higher costs and improved health outcomes compared with standard care. Over approximately 6.5 months, Somzz generated an additional 0.0092 QALYs per patient at an incremental cost of KRW 79,691 (US $61.87), yielding an ICER of KRW 8,719,727 (US $990,883) per QALY gained. This estimate was well below the Korean willingness-to-pay threshold of KRW 30,000,000 (US $23,192.91) per QALY. From a societal perspective, digital CBT was cost-saving, producing a negative ICER due to reductions in health care utilization, workplace accidents, and productivity losses associated with higher remission rates. Sensitivity analyses identified intervention costs and remission probabilities as key drivers; however, digital CBT remained cost-effective across all scenarios under willingness-to-pay thresholds of KRW 30,000,000 and KRW 15,000,000 per QALY.</p><","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e71750"},"PeriodicalIF":6.2,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sunyoung Kang, Jung-In Lim, Lukas Stenzel, Keun You Kim, Eosu Kim, Hong Jun Jeon, Doo-Heum Park, Hyun Kook Lim, YongSoo Shim, Jae-Won Jang, Yeshin Kim, Sanghoon Lee, Kee Hyung Park
Background: Metamemory training (MMT) offers a potential nonpharmacological approach to enhance cognitive function in individuals with mild cognitive impairment (MCI). While digital cognitive training improves accessibility, the effectiveness of mobile app-based MMT has not been evaluated in a randomized clinical trial.
Objective: We aimed to evaluate the efficacy and safety of a mobile app-based MMT program, ET-101 (Cogthera), compared to a sham device control group in individuals with MCI.
Methods: This multicenter, randomized controlled trial enrolled participants with MCI, recruited from 7 medical centers, and randomly assigned them to the ET-101 or control group (1:1 ratio). The intervention lasted 12 weeks, with a 12-week follow-up. The ET-101 group received metamemory-based multimemory strategy training and real-time feedback. Assessments of cognition, the daily activities of living, and the quality of life were conducted at baseline, week 12, and week 24. The primary outcome was the proportion of participants who showed cognitive improvement as assessed by the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog)-14 at weeks 12 and 24. Secondary outcomes included changes in the scores of scales assessing cognition, daily activities, and quality of life. Safety analysis assessed adverse events and their relation to digital therapeutics.
Results: In the full analysis set, 49 participants were included in the ET-101 group and 50 in the control group. At week 24, the proportion of responders who maintained or improved their ADAS-Cog-14 scores was significantly higher in the ET-101 group than in the control group (P=.002). Additionally, the ET-101 group showed a significant improvement in ADAS-Cog-14 scores at week 24 compared to baseline levels (estimates=-2.53; t265=-3.05; Bonferroni-adjusted P=.003). A subdomain analysis revealed significant improvements in the memory (estimates=-2.50; t264=-4.03; Bonferroni-adjusted P<.001) and language (estimates=-0.807; t290=-3.68; Bonferroni-adjusted P<.001) domains at week 24 in the ET-101 group compared to the control group. In the safety analysis, 6 adverse events occurred in the ET-101 group and 4 in the control group, but none were related to the interventions. The attrition rate in the ET-101 group was 22.4% (11/49).
Conclusions: ET-101 significantly improved cognitive function compared to the sham device, with effects observed not only in the memory domain but also in the language domain, indicating a transfer effect. Therefore, ET-101 has the potential to provide effective MMT to a broader population with MCI by overcoming location and personnel limitations through a mobile app-based platform.
{"title":"Efficacy and Safety of Mobile App-Based Metamemory Cognitive Training for Mild Cognitive Impairment: Multicenter Randomized Clinical Trial.","authors":"Sunyoung Kang, Jung-In Lim, Lukas Stenzel, Keun You Kim, Eosu Kim, Hong Jun Jeon, Doo-Heum Park, Hyun Kook Lim, YongSoo Shim, Jae-Won Jang, Yeshin Kim, Sanghoon Lee, Kee Hyung Park","doi":"10.2196/73464","DOIUrl":"10.2196/73464","url":null,"abstract":"<p><strong>Background: </strong>Metamemory training (MMT) offers a potential nonpharmacological approach to enhance cognitive function in individuals with mild cognitive impairment (MCI). While digital cognitive training improves accessibility, the effectiveness of mobile app-based MMT has not been evaluated in a randomized clinical trial.</p><p><strong>Objective: </strong>We aimed to evaluate the efficacy and safety of a mobile app-based MMT program, ET-101 (Cogthera), compared to a sham device control group in individuals with MCI.</p><p><strong>Methods: </strong>This multicenter, randomized controlled trial enrolled participants with MCI, recruited from 7 medical centers, and randomly assigned them to the ET-101 or control group (1:1 ratio). The intervention lasted 12 weeks, with a 12-week follow-up. The ET-101 group received metamemory-based multimemory strategy training and real-time feedback. Assessments of cognition, the daily activities of living, and the quality of life were conducted at baseline, week 12, and week 24. The primary outcome was the proportion of participants who showed cognitive improvement as assessed by the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog)-14 at weeks 12 and 24. Secondary outcomes included changes in the scores of scales assessing cognition, daily activities, and quality of life. Safety analysis assessed adverse events and their relation to digital therapeutics.</p><p><strong>Results: </strong>In the full analysis set, 49 participants were included in the ET-101 group and 50 in the control group. At week 24, the proportion of responders who maintained or improved their ADAS-Cog-14 scores was significantly higher in the ET-101 group than in the control group (P=.002). Additionally, the ET-101 group showed a significant improvement in ADAS-Cog-14 scores at week 24 compared to baseline levels (estimates=-2.53; t<sub>265</sub>=-3.05; Bonferroni-adjusted P=.003). A subdomain analysis revealed significant improvements in the memory (estimates=-2.50; t<sub>264</sub>=-4.03; Bonferroni-adjusted P<.001) and language (estimates=-0.807; t<sub>290</sub>=-3.68; Bonferroni-adjusted P<.001) domains at week 24 in the ET-101 group compared to the control group. In the safety analysis, 6 adverse events occurred in the ET-101 group and 4 in the control group, but none were related to the interventions. The attrition rate in the ET-101 group was 22.4% (11/49).</p><p><strong>Conclusions: </strong>ET-101 significantly improved cognitive function compared to the sham device, with effects observed not only in the memory domain but also in the language domain, indicating a transfer effect. Therefore, ET-101 has the potential to provide effective MMT to a broader population with MCI by overcoming location and personnel limitations through a mobile app-based platform.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05938426; https://clinicaltrials.gov/study/NCT05938426.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e73464"},"PeriodicalIF":6.2,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Recently, mobile health and mobile apps have been proposed as a potential tool to improve different outcomes (eg, daily steps, blood glucose) in both people with and without chronic conditions. In particular, healthy people could benefit from these tools by improving health variables and for prevention. Previous evidence investigated different types of health interventions adopting apps in various settings and populations, but evidence of their effectiveness is still unclear.
Objective: The aim was to assess the effectiveness of mobile apps in improving health variables (eg, daily steps, maximal aerobic capacity) in healthy adults, involving an intervention regarding physical activity, diet, or their combination thereof. Evidence would suggest if apps could be effectively adopted in health interventions aiming toward prevention.
Methods: A systematic review was performed using Medline via PubMed, Cochrane Library-CENTRAL, and Embase. Only randomized controlled trials comparing the same intervention provided with and without a mobile app or a treatment and a mobile app compared with the treatment only were included in this systematic review. The Risk of Bias tool 2.0 was used to assess the risk of bias, and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was adopted for rating the certainty of evidence.
Results: Considering studies up to June 2025, only 2 studies were included in the review of mobile apps for physical activity, and none were included for mobile apps for diet and none for mobile apps for physical activity and diet combined. The quality of evidence of the 2 studies included was low due to a high risk of bias, several missing data, and deviation from the original interventions, suggesting a scarce rigor in the methodology adopted. Therefore, mobile apps' effectiveness in improving diet, physical activity, or their combination cannot be assessed.
Conclusions: Despite the widespread use of mobile apps for health and the large number of relative publications, the results of this systematic review did not allow us to ascertain the effectiveness of mobile apps for health, but they provided fundamental insights for future research. Hence, it is not possible to state if apps for health might be used as supporting tools for health interventions aiming toward prevention and health improvements in healthy people. There is an urgent need to develop stronger evidence of apps' effectiveness in addressing different populations and types of interventions for different health domains.
{"title":"Mobile Apps to Improve Health Parameters in Healthy Adults: Systematic Review.","authors":"Gaia Leuzzi, Mirko Job, Carola Cosentino, Riccardo Testa, Aldo Scafoglieri, Marco Testa","doi":"10.2196/66881","DOIUrl":"10.2196/66881","url":null,"abstract":"<p><strong>Background: </strong>Recently, mobile health and mobile apps have been proposed as a potential tool to improve different outcomes (eg, daily steps, blood glucose) in both people with and without chronic conditions. In particular, healthy people could benefit from these tools by improving health variables and for prevention. Previous evidence investigated different types of health interventions adopting apps in various settings and populations, but evidence of their effectiveness is still unclear.</p><p><strong>Objective: </strong>The aim was to assess the effectiveness of mobile apps in improving health variables (eg, daily steps, maximal aerobic capacity) in healthy adults, involving an intervention regarding physical activity, diet, or their combination thereof. Evidence would suggest if apps could be effectively adopted in health interventions aiming toward prevention.</p><p><strong>Methods: </strong>A systematic review was performed using Medline via PubMed, Cochrane Library-CENTRAL, and Embase. Only randomized controlled trials comparing the same intervention provided with and without a mobile app or a treatment and a mobile app compared with the treatment only were included in this systematic review. The Risk of Bias tool 2.0 was used to assess the risk of bias, and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was adopted for rating the certainty of evidence.</p><p><strong>Results: </strong>Considering studies up to June 2025, only 2 studies were included in the review of mobile apps for physical activity, and none were included for mobile apps for diet and none for mobile apps for physical activity and diet combined. The quality of evidence of the 2 studies included was low due to a high risk of bias, several missing data, and deviation from the original interventions, suggesting a scarce rigor in the methodology adopted. Therefore, mobile apps' effectiveness in improving diet, physical activity, or their combination cannot be assessed.</p><p><strong>Conclusions: </strong>Despite the widespread use of mobile apps for health and the large number of relative publications, the results of this systematic review did not allow us to ascertain the effectiveness of mobile apps for health, but they provided fundamental insights for future research. Hence, it is not possible to state if apps for health might be used as supporting tools for health interventions aiming toward prevention and health improvements in healthy people. There is an urgent need to develop stronger evidence of apps' effectiveness in addressing different populations and types of interventions for different health domains.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e66881"},"PeriodicalIF":6.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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