Background: Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults.
Objective: This study aimed to assess the impact of a Facebook-based intervention (#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years.
Methods: A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (#HPVVaxTalks). #HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants' satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis.
Results: Overall, 32 of the 43 (74%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants' satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness.
Conclusions: The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities.
{"title":"The Impact of a Human Papillomavirus Facebook-Based Intervention (#HPVVaxTalks) Among Young Black (African American and Sub-Saharan African Immigrants) Adults: Pilot Pre- and Poststudy.","authors":"Adebola Adegboyega, Amanda Wiggins, Abubakari Wuni, Melinda Ickes","doi":"10.2196/69609","DOIUrl":"https://doi.org/10.2196/69609","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults.</p><p><strong>Objective: </strong>This study aimed to assess the impact of a Facebook-based intervention (#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years.</p><p><strong>Methods: </strong>A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (#HPVVaxTalks). #HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants' satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis.</p><p><strong>Results: </strong>Overall, 32 of the 43 (74%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants' satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness.</p><p><strong>Conclusions: </strong>The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e69609"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shivesh Shourya, Jianfang Liu, Sophia McInerney, Trinity Casimir, James Kenniff, Trace Kershaw, David Batey, Rebecca Schnall
<p><strong>Background: </strong>Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the United States achieve viral suppression, largely due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence rates, which must be maintained at ≥95% to prevent viral load rebound. Combination interventions leveraging community health worker (CHW) support and mobile health (mHealth) technologies have the potential to overcome previously identified barriers and provide cost-effective support for improving adherence and viral suppression outcomes in people with HIV.</p><p><strong>Objective: </strong>This pilot study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of remote delivery of the Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, combining the WiseApp, CHW support, and the CleverCap smart pill bottle. A secondary aim was to gather participants' feedback on the usability of the app and pill bottle as well as to better understand their experiences with remote study procedures.</p><p><strong>Methods: </strong>This mixed methods pilot study involved 40 participants with HIV, who were randomly assigned to a control group (n=20, 50%) or the CHAMPS intervention (n=20, 50%) over 3 months. The intervention group participated in up to 12 sessions with CHWs and used the WiseApp, paired with a CleverCap smart pill bottle, to support ART adherence. Remote baseline and follow-up visits were conducted via Zoom and included surveys measuring adherence, self-efficacy, and usability (measured by Health Information Technology Usability Evaluation Scale [Health-ITUES] and Poststudy System Usability Questionnaire [PSSUQ]). Semistructured interviews explored participants' experiences with the intervention. Thematic analysis was used to identify key facilitators and barriers based on the Mobile Health Technology Acceptance Model.</p><p><strong>Results: </strong>Remote delivery of the CHAMPS intervention was feasible, with high usability ratings for both the WiseApp and CleverCap (overall scores on Health-ITUES: mean 4.35, SD 0.58 and PSSUQ: mean 2.04, SD 1.03). In the intervention group, there were nonsignificant improvements in self-reported adherence scores (P=.29) and in self-efficacy scores (P=.07). The adjusted odds ratio for achieving undetectable viral load in the intervention group compared to the control group was 3.01 (95% CI -1.59 to 4.12), indicating a medium effect size in favor of the intervention. Overall study retention was 75% (30/40), with higher retention in the control group. Participants valued the flexibility of remote study procedures, particularly Zoom-based study visits and mailed blood sample kits. Qualitative feedback highlighted the intervention's acceptability and ability to overcome logistical barriers.</p><p><strong>Conclusions: </strong>The remote CHAMPS pilot study demonstrated the feasibility and
{"title":"A Remote Intervention Based on mHealth and Community Health Workers for Antiretroviral Therapy Adherence in People With HIV: Pilot Randomized Controlled Trial.","authors":"Shivesh Shourya, Jianfang Liu, Sophia McInerney, Trinity Casimir, James Kenniff, Trace Kershaw, David Batey, Rebecca Schnall","doi":"10.2196/67997","DOIUrl":"https://doi.org/10.2196/67997","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the United States achieve viral suppression, largely due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence rates, which must be maintained at ≥95% to prevent viral load rebound. Combination interventions leveraging community health worker (CHW) support and mobile health (mHealth) technologies have the potential to overcome previously identified barriers and provide cost-effective support for improving adherence and viral suppression outcomes in people with HIV.</p><p><strong>Objective: </strong>This pilot study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of remote delivery of the Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, combining the WiseApp, CHW support, and the CleverCap smart pill bottle. A secondary aim was to gather participants' feedback on the usability of the app and pill bottle as well as to better understand their experiences with remote study procedures.</p><p><strong>Methods: </strong>This mixed methods pilot study involved 40 participants with HIV, who were randomly assigned to a control group (n=20, 50%) or the CHAMPS intervention (n=20, 50%) over 3 months. The intervention group participated in up to 12 sessions with CHWs and used the WiseApp, paired with a CleverCap smart pill bottle, to support ART adherence. Remote baseline and follow-up visits were conducted via Zoom and included surveys measuring adherence, self-efficacy, and usability (measured by Health Information Technology Usability Evaluation Scale [Health-ITUES] and Poststudy System Usability Questionnaire [PSSUQ]). Semistructured interviews explored participants' experiences with the intervention. Thematic analysis was used to identify key facilitators and barriers based on the Mobile Health Technology Acceptance Model.</p><p><strong>Results: </strong>Remote delivery of the CHAMPS intervention was feasible, with high usability ratings for both the WiseApp and CleverCap (overall scores on Health-ITUES: mean 4.35, SD 0.58 and PSSUQ: mean 2.04, SD 1.03). In the intervention group, there were nonsignificant improvements in self-reported adherence scores (P=.29) and in self-efficacy scores (P=.07). The adjusted odds ratio for achieving undetectable viral load in the intervention group compared to the control group was 3.01 (95% CI -1.59 to 4.12), indicating a medium effect size in favor of the intervention. Overall study retention was 75% (30/40), with higher retention in the control group. Participants valued the flexibility of remote study procedures, particularly Zoom-based study visits and mailed blood sample kits. Qualitative feedback highlighted the intervention's acceptability and ability to overcome logistical barriers.</p><p><strong>Conclusions: </strong>The remote CHAMPS pilot study demonstrated the feasibility and ","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e67997"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Moreah Zisquit, Alon Shoa, Ramon Oliva, Stav Perry, Bernhard Spanlang, Anat Brunstein Klomek, Mel Slater, Doron Friedman
<p><strong>Background: </strong>Access to mental health services continues to pose a global challenge, with current services often unable to meet the growing demand. This has sparked interest in conversational artificial intelligence (AI) agents as potential solutions. Despite this, the development of a reliable virtual therapist remains challenging, and the feasibility of AI fulfilling this sensitive role is still uncertain. One promising approach involves using AI agents for psychological self-talk, particularly within virtual reality (VR) environments. Self-talk in VR allows externalizing self-conversation by enabling individuals to embody avatars representing themselves as both patient and counselor, thus enhancing cognitive flexibility and problem-solving abilities. However, participants sometimes experience difficulties progressing in sessions, which is where AI could offer guidance and support.</p><p><strong>Objective: </strong>This formative study aims to assess the challenges and advantages of integrating an AI agent into self-talk in VR for psychological counseling, focusing on user experience and the potential role of AI in supporting self-reflection, problem-solving, and positive behavioral change.</p><p><strong>Methods: </strong>We carried out an iterative design and development of a system and protocol integrating large language models (LLMs) within VR self-talk during the first two and a half years. The design process addressed user interface, speech-to-text functionalities, fine-tuning the LLMs, and prompt engineering. Upon completion of the design process, we conducted a 3-month long exploratory qualitative study in which 11 healthy participants completed a session that included identifying a problem they wanted to address, attempting to address this problem using self-talk in VR, and then continuing self-talk in VR but this time with the assistance of an LLM-based virtual human. The sessions were carried out with a trained clinical psychologist and followed by semistructured interviews. We used applied thematic analysis after the interviews to code and develop key themes for the participants that addressed our research objective.</p><p><strong>Results: </strong>In total, 4 themes were identified regarding the quality of advice, the potential advantages of human-AI collaboration in self-help, the believability of the virtual human, and user preferences for avatars in the scenario. The participants rated their desire to engage in additional such sessions at 8.3 out of 10, and more than half of the respondents indicated that they preferred using VR self-talk with AI rather than without it. On average, the usefulness of the session was rated 6.9 (SD 0.54), and the degree to which it helped solve their problem was rated 6.1 (SD 1.58). Participants specifically noted that human-AI collaboration led to improved outcomes and facilitated more positive thought processes, thereby enhancing self-reflection and problem-solving abilities.</p>
{"title":"AI-Enhanced Virtual Reality Self-Talk for Psychological Counseling: Formative Qualitative Study.","authors":"Moreah Zisquit, Alon Shoa, Ramon Oliva, Stav Perry, Bernhard Spanlang, Anat Brunstein Klomek, Mel Slater, Doron Friedman","doi":"10.2196/67782","DOIUrl":"https://doi.org/10.2196/67782","url":null,"abstract":"<p><strong>Background: </strong>Access to mental health services continues to pose a global challenge, with current services often unable to meet the growing demand. This has sparked interest in conversational artificial intelligence (AI) agents as potential solutions. Despite this, the development of a reliable virtual therapist remains challenging, and the feasibility of AI fulfilling this sensitive role is still uncertain. One promising approach involves using AI agents for psychological self-talk, particularly within virtual reality (VR) environments. Self-talk in VR allows externalizing self-conversation by enabling individuals to embody avatars representing themselves as both patient and counselor, thus enhancing cognitive flexibility and problem-solving abilities. However, participants sometimes experience difficulties progressing in sessions, which is where AI could offer guidance and support.</p><p><strong>Objective: </strong>This formative study aims to assess the challenges and advantages of integrating an AI agent into self-talk in VR for psychological counseling, focusing on user experience and the potential role of AI in supporting self-reflection, problem-solving, and positive behavioral change.</p><p><strong>Methods: </strong>We carried out an iterative design and development of a system and protocol integrating large language models (LLMs) within VR self-talk during the first two and a half years. The design process addressed user interface, speech-to-text functionalities, fine-tuning the LLMs, and prompt engineering. Upon completion of the design process, we conducted a 3-month long exploratory qualitative study in which 11 healthy participants completed a session that included identifying a problem they wanted to address, attempting to address this problem using self-talk in VR, and then continuing self-talk in VR but this time with the assistance of an LLM-based virtual human. The sessions were carried out with a trained clinical psychologist and followed by semistructured interviews. We used applied thematic analysis after the interviews to code and develop key themes for the participants that addressed our research objective.</p><p><strong>Results: </strong>In total, 4 themes were identified regarding the quality of advice, the potential advantages of human-AI collaboration in self-help, the believability of the virtual human, and user preferences for avatars in the scenario. The participants rated their desire to engage in additional such sessions at 8.3 out of 10, and more than half of the respondents indicated that they preferred using VR self-talk with AI rather than without it. On average, the usefulness of the session was rated 6.9 (SD 0.54), and the degree to which it helped solve their problem was rated 6.1 (SD 1.58). Participants specifically noted that human-AI collaboration led to improved outcomes and facilitated more positive thought processes, thereby enhancing self-reflection and problem-solving abilities.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e67782"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily G Lattie, Miranda Beltzer, Alethea Varra, Connie E Chen, Anita Lungu
Background: Lyra Health's short-term blended care therapy model, Lyra Care Therapy (LCT), has demonstrated effectiveness at scale. In LCT, clients participate in synchronous telehealth sessions and asynchronous guided practice sessions, in which they are provided with digital tools to reinforce key concepts and skills. These digital tools include animated video lessons that use storytelling to show characters learning and implementing new skills from therapy, written psychoeducational materials, interactive exercises that prompt reflection and skills practice, symptom assessments, and messaging with therapists. Past research on LCT found that time spent in therapy sessions and viewing digital video lessons predicts improvements in depression and anxiety symptoms.
Objective: This study aims to explore the client experience of LCT digital tools and to understand clients' perceived benefits and challenges of using digital tools while in LCT.
Methods: In total, 12 ethnically and racially diverse adults (5 male, 6 female, and 1 pangender) who had graduated from LCT in the previous 4 months participated in semistructured interviews. Interviews focused on experiences with the digital components of LCT (ie, video lessons, symptom assessments, and written exercises). Transcripts were analyzed using thematic analytic methods to determine the benefits and challenges associated with components of the LCT model.
Results: In total, 3 primary themes were generated through thematic analysis. These themes centered around supporting knowledge and skill development, the benefits and challenges associated with the range of digital tools, and the combination of flexibility and accountability promoting positive change. First, we summarize the ways in which guided practice sessions allow clients to develop additional knowledge and learn skills related to their mental health and well-being. Then, we describe how the range of digital tools included in LCT presents different benefits and challenges for clients. Finally, we discuss how flexibility inherent in having both synchronous and asynchronous sessions, along with the accountability from a provider, encourages clients to continue to practice skills related to their mental health and well-being.
Conclusions: Results provide insights into the unique contributions of different components of the LCT model on therapeutic gains. While perceived time constraints and content preferences can impact engagement with digital tools, overall the digital tools were perceived as carrying significant value for participants in the LCT program.
{"title":"Examining the Client Experience of Digital Tools in Blended Care Therapy: Qualitative Interview Study.","authors":"Emily G Lattie, Miranda Beltzer, Alethea Varra, Connie E Chen, Anita Lungu","doi":"10.2196/68249","DOIUrl":"https://doi.org/10.2196/68249","url":null,"abstract":"<p><strong>Background: </strong>Lyra Health's short-term blended care therapy model, Lyra Care Therapy (LCT), has demonstrated effectiveness at scale. In LCT, clients participate in synchronous telehealth sessions and asynchronous guided practice sessions, in which they are provided with digital tools to reinforce key concepts and skills. These digital tools include animated video lessons that use storytelling to show characters learning and implementing new skills from therapy, written psychoeducational materials, interactive exercises that prompt reflection and skills practice, symptom assessments, and messaging with therapists. Past research on LCT found that time spent in therapy sessions and viewing digital video lessons predicts improvements in depression and anxiety symptoms.</p><p><strong>Objective: </strong>This study aims to explore the client experience of LCT digital tools and to understand clients' perceived benefits and challenges of using digital tools while in LCT.</p><p><strong>Methods: </strong>In total, 12 ethnically and racially diverse adults (5 male, 6 female, and 1 pangender) who had graduated from LCT in the previous 4 months participated in semistructured interviews. Interviews focused on experiences with the digital components of LCT (ie, video lessons, symptom assessments, and written exercises). Transcripts were analyzed using thematic analytic methods to determine the benefits and challenges associated with components of the LCT model.</p><p><strong>Results: </strong>In total, 3 primary themes were generated through thematic analysis. These themes centered around supporting knowledge and skill development, the benefits and challenges associated with the range of digital tools, and the combination of flexibility and accountability promoting positive change. First, we summarize the ways in which guided practice sessions allow clients to develop additional knowledge and learn skills related to their mental health and well-being. Then, we describe how the range of digital tools included in LCT presents different benefits and challenges for clients. Finally, we discuss how flexibility inherent in having both synchronous and asynchronous sessions, along with the accountability from a provider, encourages clients to continue to practice skills related to their mental health and well-being.</p><p><strong>Conclusions: </strong>Results provide insights into the unique contributions of different components of the LCT model on therapeutic gains. While perceived time constraints and content preferences can impact engagement with digital tools, overall the digital tools were perceived as carrying significant value for participants in the LCT program.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e68249"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>In the modern economy, shift work is prevalent in numerous occupations. However, it often disrupts workers' circadian rhythms and can result in shift work sleep disorder. Proper management of shift work sleep disorder involves comprehensive and patient-specific strategies, some of which are similar to cognitive behavioral therapy for insomnia.</p><p><strong>Objective: </strong>Our goal was to develop and evaluate machine learning algorithms that predict physicians' sleep advice using wearable and survey data. We developed a web- and app-based system to provide individualized sleep and behavior advice based on cognitive behavioral therapy for insomnia for shift workers.</p><p><strong>Methods: </strong>Data were collected for 5 weeks from shift workers (N=61) in the intensive care unit at 2 hospitals in Japan. The data comprised 3 modalities: Fitbit data, survey data, and sleep advice. After the first week of enrollment, physicians reviewed Fitbit and survey data to provide sleep advice and selected 1 to 5 messages from a list of 23 options. We handcrafted physiological and behavioral features from the raw data and identified clusters of participants with similar characteristics using hierarchical clustering. We explored 3 models (random forest, light gradient-boosting machine, and CatBoost) and 3 data-balancing approaches (no balancing, random oversampling, and synthetic minority oversampling technique) to predict selections for the 7 most frequent advice messages related to bedroom brightness, smartphone use, and nap and sleep duration. We tested our predictions under participant-dependent and participant-independent settings and analyzed the most important features for prediction using permutation importance and Shapley additive explanations.</p><p><strong>Results: </strong>We found that the clusters were distinguished by work shifts and behavioral patterns. For example, one cluster had days with low sleep duration and the lowest sleep quality when there was a day shift on the day before and a midnight shift on the current day. Our advice prediction models achieved a higher area under the precision-recall curve than the baseline in all settings. The performance differences were statistically significant (P<.001 for 13 tests and P=.003 for 1 test). Sensitivity ranged from 0.50 to 1.00, and specificity varied between 0.44 and 0.93 across all advice messages and dataset split settings. Feature importance analysis of our models found several important features that matched the corresponding advice messages sent. For instance, for message 7 (darken the bedroom when you go to bed), the models primarily examined the average brightness of the sleep environment to make predictions.</p><p><strong>Conclusions: </strong>Although our current system requires physician input, an accurate machine learning algorithm shows promise for automatic advice without compromising the trustworthiness of the selected recommendations. Despite
{"title":"Personalized Physician-Assisted Sleep Advice for Shift Workers: Algorithm Development and Validation Study.","authors":"Yufei Shen, Alicia Choto Olivier, Han Yu, Asami Ito-Masui, Ryota Sakamoto, Motomu Shimaoka, Akane Sano","doi":"10.2196/65000","DOIUrl":"https://doi.org/10.2196/65000","url":null,"abstract":"<p><strong>Background: </strong>In the modern economy, shift work is prevalent in numerous occupations. However, it often disrupts workers' circadian rhythms and can result in shift work sleep disorder. Proper management of shift work sleep disorder involves comprehensive and patient-specific strategies, some of which are similar to cognitive behavioral therapy for insomnia.</p><p><strong>Objective: </strong>Our goal was to develop and evaluate machine learning algorithms that predict physicians' sleep advice using wearable and survey data. We developed a web- and app-based system to provide individualized sleep and behavior advice based on cognitive behavioral therapy for insomnia for shift workers.</p><p><strong>Methods: </strong>Data were collected for 5 weeks from shift workers (N=61) in the intensive care unit at 2 hospitals in Japan. The data comprised 3 modalities: Fitbit data, survey data, and sleep advice. After the first week of enrollment, physicians reviewed Fitbit and survey data to provide sleep advice and selected 1 to 5 messages from a list of 23 options. We handcrafted physiological and behavioral features from the raw data and identified clusters of participants with similar characteristics using hierarchical clustering. We explored 3 models (random forest, light gradient-boosting machine, and CatBoost) and 3 data-balancing approaches (no balancing, random oversampling, and synthetic minority oversampling technique) to predict selections for the 7 most frequent advice messages related to bedroom brightness, smartphone use, and nap and sleep duration. We tested our predictions under participant-dependent and participant-independent settings and analyzed the most important features for prediction using permutation importance and Shapley additive explanations.</p><p><strong>Results: </strong>We found that the clusters were distinguished by work shifts and behavioral patterns. For example, one cluster had days with low sleep duration and the lowest sleep quality when there was a day shift on the day before and a midnight shift on the current day. Our advice prediction models achieved a higher area under the precision-recall curve than the baseline in all settings. The performance differences were statistically significant (P<.001 for 13 tests and P=.003 for 1 test). Sensitivity ranged from 0.50 to 1.00, and specificity varied between 0.44 and 0.93 across all advice messages and dataset split settings. Feature importance analysis of our models found several important features that matched the corresponding advice messages sent. For instance, for message 7 (darken the bedroom when you go to bed), the models primarily examined the average brightness of the sleep environment to make predictions.</p><p><strong>Conclusions: </strong>Although our current system requires physician input, an accurate machine learning algorithm shows promise for automatic advice without compromising the trustworthiness of the selected recommendations. Despite","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e65000"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The use of virtual reality (VR) technology in rehabilitation therapy has been growing, leading to the development of VR-based upper-limb rehabilitation softwares. To ensure the effective use of such software, usability evaluations are critical to enhance user satisfaction and identify potential usability issues.
Objective: This study aims to evaluate the usability of a VR-based upper-limb rehabilitation software from the perspective of occupational therapists. Specifically, the study seeks to identify usability challenges and provide insights to improve user satisfaction.
Methods: The VR-based upper-limb rehabilitation software was tailored for therapists to operate while delivering therapy to patients. Usability testing was conducted with occupational therapists from the Korean National Rehabilitation Center using cognitive walkthroughs and surveys. Participants performed tasks that simulated real clinical scenarios, including turning the device on, assisting patients with wearing the device, and shutting it down. Observers recorded user reactions during task performance, and participants completed surveys to assess the ease of use of the user interface. This mixed-methods approach provided qualitative insights into user difficulties and their root causes.
Results: Usability evaluations were conducted with 6 participants. Cognitive walkthroughs revealed potential areas for improvement in the software, including (1) enhancements to the graphical user interface for ease of use, (2) refinements in the natural user interface, and (3) better user manuals for clearer product instructions. The ease-of-use score for the user interface averaged 1.58 on a 5-point scale (1=very easy to 5=very difficult).
Conclusions: This study provides valuable insights into improving user satisfaction by focusing on the needs of occupational therapists who operate a VR-based rehabilitation software. Future research should explore software refinement and clinical efficacy to maximize the therapeutic potential of such technologies.
{"title":"Medical Device Based on a Virtual Reality-Based Upper Limb Rehabilitation Software: Usability Evaluation Through Cognitive Walkthrough.","authors":"Seojin Hong, Hyun Choi, Hyosun Kweon","doi":"10.2196/68149","DOIUrl":"https://doi.org/10.2196/68149","url":null,"abstract":"<p><strong>Background: </strong>The use of virtual reality (VR) technology in rehabilitation therapy has been growing, leading to the development of VR-based upper-limb rehabilitation softwares. To ensure the effective use of such software, usability evaluations are critical to enhance user satisfaction and identify potential usability issues.</p><p><strong>Objective: </strong>This study aims to evaluate the usability of a VR-based upper-limb rehabilitation software from the perspective of occupational therapists. Specifically, the study seeks to identify usability challenges and provide insights to improve user satisfaction.</p><p><strong>Methods: </strong>The VR-based upper-limb rehabilitation software was tailored for therapists to operate while delivering therapy to patients. Usability testing was conducted with occupational therapists from the Korean National Rehabilitation Center using cognitive walkthroughs and surveys. Participants performed tasks that simulated real clinical scenarios, including turning the device on, assisting patients with wearing the device, and shutting it down. Observers recorded user reactions during task performance, and participants completed surveys to assess the ease of use of the user interface. This mixed-methods approach provided qualitative insights into user difficulties and their root causes.</p><p><strong>Results: </strong>Usability evaluations were conducted with 6 participants. Cognitive walkthroughs revealed potential areas for improvement in the software, including (1) enhancements to the graphical user interface for ease of use, (2) refinements in the natural user interface, and (3) better user manuals for clearer product instructions. The ease-of-use score for the user interface averaged 1.58 on a 5-point scale (1=very easy to 5=very difficult).</p><p><strong>Conclusions: </strong>This study provides valuable insights into improving user satisfaction by focusing on the needs of occupational therapists who operate a VR-based rehabilitation software. Future research should explore software refinement and clinical efficacy to maximize the therapeutic potential of such technologies.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e68149"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanna Iivanainen, Reetta Arokoski, Santeri Mentu, Laura Lang, Jussi Ekström, Henri Virtanen, Vesa Kataja, Jussi Pekka Koivunen
<p><strong>Background: </strong>Chemotherapy cycle prescription is generally carried out through a multistep manual process that is prone to human error. Clinical decision support tools can provide patient-specific assessments that support clinical decisions, improve prescribing practices, and reduce medication errors.</p><p><strong>Objective: </strong>We hypothesized that a knowledge-based, patient-derived, evidence-directed decision support tool consisting of multiple modules focusing on the core duties preceding chemotherapy-cycle prescription could result in a more cost-effective and error-free approach and streamline the workflow.</p><p><strong>Methods: </strong>A 1-arm, multicenter, prospective clinical trial ("Follow-up of Cancer Patients Receiving Chemotherapy or Targeted Therapy by Electronic Patient Reported Outcomes-tool" [ECHO] 7/2019-1/2021; NCT04081558) was initiated to investigate the tool. The most important inclusion criteria were the presence of colorectal cancer (CRC) treated with oxaliplatin-based chemotherapy, age ≥18 years, Eastern Cooperative Oncology Group [ECOG] performance score of 0 to 2, and internet access. A decision support tool that included digital symptom monitoring, a laboratory value interface, and treatment schedule integration for semiautomated chemotherapy cycle prescribing was integrated into the care pathway. Performance was assessed by the percentage of chemotherapy cycles with sent and completed symptom questionnaires, while perceptions of health care professionals (HCPs) on the feasibility of the approach were collected through a 1-time semistructured interview.</p><p><strong>Results: </strong>The ECHO trial included 43 patients with CRC treated with doublet or triplet chemotherapy in an adjuvant or metastatic setting. Altogether, 843 electronic patient-reported outcome (ePRO) symptom questionnaires were completed. Of the 15 recorded symptoms, fatigue (n=446, 52.9%) and peripheral neuropathy (n=429, 50.9%) were reported most often, while 137 grade 3 to 4 symptoms were recorded, of which diarrhea (n=5, 4%) and peripheral neuropathy (n=4, 3%) were the most common. During the study, 339 chemotherapy cycles were prescribed, and for the 77% (n=262) of new chemotherapy cycles, ePRO questionnaire data were available within preset limits (completed within 3 days prior to chemotherapy scheduling) while 65% of the cycles (n=221) had symptom questionnaire grading at ≤1%, and 67% of the cycles (n=228) had laboratory values in a preset range. The recommendations by the tool for a new chemotherapy cycle were tier 1 (green; meaning "go") in 145 (42.8%) of the cycles, tier 2 (yellow; "evaluate") in 83 (25%), and tier 3 (red; "hold") in 111 (32.7%). HCPs (n=3) were interviewed with a questionnaire (comprising 8 questions), revealing that they most valued the improved workflow, faster patient evaluation, and direct messaging option.</p><p><strong>Conclusions: </strong>In this study, we investigated the feasibility of a d
{"title":"Development of a Comprehensive Decision Support Tool for Chemotherapy-Cycle Prescribing: Initial Usability Study.","authors":"Sanna Iivanainen, Reetta Arokoski, Santeri Mentu, Laura Lang, Jussi Ekström, Henri Virtanen, Vesa Kataja, Jussi Pekka Koivunen","doi":"10.2196/62749","DOIUrl":"https://doi.org/10.2196/62749","url":null,"abstract":"<p><strong>Background: </strong>Chemotherapy cycle prescription is generally carried out through a multistep manual process that is prone to human error. Clinical decision support tools can provide patient-specific assessments that support clinical decisions, improve prescribing practices, and reduce medication errors.</p><p><strong>Objective: </strong>We hypothesized that a knowledge-based, patient-derived, evidence-directed decision support tool consisting of multiple modules focusing on the core duties preceding chemotherapy-cycle prescription could result in a more cost-effective and error-free approach and streamline the workflow.</p><p><strong>Methods: </strong>A 1-arm, multicenter, prospective clinical trial (\"Follow-up of Cancer Patients Receiving Chemotherapy or Targeted Therapy by Electronic Patient Reported Outcomes-tool\" [ECHO] 7/2019-1/2021; NCT04081558) was initiated to investigate the tool. The most important inclusion criteria were the presence of colorectal cancer (CRC) treated with oxaliplatin-based chemotherapy, age ≥18 years, Eastern Cooperative Oncology Group [ECOG] performance score of 0 to 2, and internet access. A decision support tool that included digital symptom monitoring, a laboratory value interface, and treatment schedule integration for semiautomated chemotherapy cycle prescribing was integrated into the care pathway. Performance was assessed by the percentage of chemotherapy cycles with sent and completed symptom questionnaires, while perceptions of health care professionals (HCPs) on the feasibility of the approach were collected through a 1-time semistructured interview.</p><p><strong>Results: </strong>The ECHO trial included 43 patients with CRC treated with doublet or triplet chemotherapy in an adjuvant or metastatic setting. Altogether, 843 electronic patient-reported outcome (ePRO) symptom questionnaires were completed. Of the 15 recorded symptoms, fatigue (n=446, 52.9%) and peripheral neuropathy (n=429, 50.9%) were reported most often, while 137 grade 3 to 4 symptoms were recorded, of which diarrhea (n=5, 4%) and peripheral neuropathy (n=4, 3%) were the most common. During the study, 339 chemotherapy cycles were prescribed, and for the 77% (n=262) of new chemotherapy cycles, ePRO questionnaire data were available within preset limits (completed within 3 days prior to chemotherapy scheduling) while 65% of the cycles (n=221) had symptom questionnaire grading at ≤1%, and 67% of the cycles (n=228) had laboratory values in a preset range. The recommendations by the tool for a new chemotherapy cycle were tier 1 (green; meaning \"go\") in 145 (42.8%) of the cycles, tier 2 (yellow; \"evaluate\") in 83 (25%), and tier 3 (red; \"hold\") in 111 (32.7%). HCPs (n=3) were interviewed with a questionnaire (comprising 8 questions), revealing that they most valued the improved workflow, faster patient evaluation, and direct messaging option.</p><p><strong>Conclusions: </strong>In this study, we investigated the feasibility of a d","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e62749"},"PeriodicalIF":2.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Areum Han, Robert Oster, Hon Yuen, Jeremy Jenkins, Jessica Hawkins, Lauren Edwards
<p><strong>Background: </strong>Family caregivers of individuals with dementia face significant mental health challenges. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers' mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population.</p><p><strong>Objective: </strong>This pilot randomized controlled trial, conducted in the United States, aims to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among family caregivers with depression who give care to individuals with dementia, compared to a control group that received psychoeducation materials only.</p><p><strong>Methods: </strong>This 2-arm, parallel-group pilot randomized controlled trial randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n=16, 48%) or a control group that received psychoeducation materials alone (n=17, 52%). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9. Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, predeath grief, guilt, and ACT process measures. Outcomes were assessed in the pretest, posttest (10-12 weeks after pretest), and a 3-month follow-up (3 months after posttest, approximately 5-6 months after pretest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes.</p><p><strong>Results: </strong>The ACT group reported significantly greater improvements in stress (P=.043) and psychological QoL (P=.014) in the posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (SE) change of -6.09 (1.16) points (95% CI -8.42 to -3.76; P<.001) in the posttest and -6.71 (1.45) points (95% CI -9.63 to -3.81; P<.001) in the 3-month follow-up. These changes exceed the estimated minimal clinically important difference on the Patient Health Questionnaire-9. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, predeath grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month follow-up. A sensitivity analysis, excluding 1 participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P=.037); stress at posttest (P<.001) and in 3-month follow-up (P=.001); psychological QoL at posttest (P<.001); caregiver burden at posttest (P=.003) and in 3-month follow-up (P=.003); predeath grief in 3-month follow-up (P=.031); and values-driven action at posttest (P=.032).</p><p><strong>Conclusions: </strong>The videoconference-delivered ACT progra
{"title":"Videoconference-Delivered Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Pilot Randomized Controlled Trial.","authors":"Areum Han, Robert Oster, Hon Yuen, Jeremy Jenkins, Jessica Hawkins, Lauren Edwards","doi":"10.2196/67545","DOIUrl":"https://doi.org/10.2196/67545","url":null,"abstract":"<p><strong>Background: </strong>Family caregivers of individuals with dementia face significant mental health challenges. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers' mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population.</p><p><strong>Objective: </strong>This pilot randomized controlled trial, conducted in the United States, aims to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among family caregivers with depression who give care to individuals with dementia, compared to a control group that received psychoeducation materials only.</p><p><strong>Methods: </strong>This 2-arm, parallel-group pilot randomized controlled trial randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n=16, 48%) or a control group that received psychoeducation materials alone (n=17, 52%). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9. Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, predeath grief, guilt, and ACT process measures. Outcomes were assessed in the pretest, posttest (10-12 weeks after pretest), and a 3-month follow-up (3 months after posttest, approximately 5-6 months after pretest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes.</p><p><strong>Results: </strong>The ACT group reported significantly greater improvements in stress (P=.043) and psychological QoL (P=.014) in the posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (SE) change of -6.09 (1.16) points (95% CI -8.42 to -3.76; P<.001) in the posttest and -6.71 (1.45) points (95% CI -9.63 to -3.81; P<.001) in the 3-month follow-up. These changes exceed the estimated minimal clinically important difference on the Patient Health Questionnaire-9. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, predeath grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month follow-up. A sensitivity analysis, excluding 1 participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P=.037); stress at posttest (P<.001) and in 3-month follow-up (P=.001); psychological QoL at posttest (P<.001); caregiver burden at posttest (P=.003) and in 3-month follow-up (P=.003); predeath grief in 3-month follow-up (P=.031); and values-driven action at posttest (P=.032).</p><p><strong>Conclusions: </strong>The videoconference-delivered ACT progra","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e67545"},"PeriodicalIF":2.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Silke Wittmar, Tom Frankenstein, Vincent Timm, Peter Frei, Nicolas Kurpiers, Stefan Wölwer, Axel Georg Meender Schäfer
<p><strong>Background: </strong>Regular physical activity (PA) is known to offer substantial health benefits, including improved physical fitness, reduced risk of disease, enhanced psychological well-being, and better cognitive performance. Despite these benefits, many university students fail to meet recommended PA levels, risking long-term health consequences.</p><p><strong>Objective: </strong>This study evaluated the user experience (UX) of futur.move, a digital intervention aimed at promoting PA among university students. The service delivers personalized, evidence-based content to foster sustained engagement in PA.</p><p><strong>Methods: </strong>A mixed methods approach was used to evaluate the prototype of futur.move. UX assessments included on-site and online user tests, standardized questionnaires, and online focus groups. A total of 142 university students participated, with 23 joining additional focus groups. Each participant tested the service for 30 minutes. Quantitative data were collected using the User Experience Questionnaire and analyzed descriptively, followed by correlation analysis with variables such as PA level, age, gender, and experience with PA apps. Qualitative insights were gathered from transcribed focus group discussions and analyzed using content-structuring, qualitative content analysis. Quantitative findings were cross-validated with qualitative data.</p><p><strong>Results: </strong>The UX received positive ratings across 4 User Experience Questionnaire scales (range -3 to +3; higher numbers indicate positive UX): attractiveness (median 1.67, IQR 1.04-2.17), perspicuity (median 1.5, IQR 0.5-2), stimulation (median 1.5, IQR 1-2), and novelty (median 1.25, IQR 0.5-2). Weak correlations were found between adherence to World Health Organization guidelines for PA and the perspicuity subscale (η=0.232, P=.04), and between age and the perspicuity (Kendall τb=0.132, P=.03) and stimulation subscales (Kendall τb=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale (η=0.363, P=.004). Critical feedback from focus group discussions highlighted issues with manual data entry. Qualitative findings aligned with the quantitative results, emphasizing students' appreciation for the personalized, diverse content and social networking features of futur.move.</p><p><strong>Conclusions: </strong>futur.move demonstrates favorable UX and aligns with student needs, particularly through its personalized content and social features. Improvements should focus on reducing manual data entry and enhancing feature clarity, particularly for the features "your condition" and "goal setting." While correlations between UX ratings and demographic variables were weak to moderate, they warrant further investigation to better address the diverse target audience. The feedback from the students serves as a basis for further adapting the service to their needs and expectations. Future work will involve coding an advance
{"title":"User Experience With a Personalized mHealth Service for Physical Activity Promotion in University Students: Mixed Methods Study.","authors":"Silke Wittmar, Tom Frankenstein, Vincent Timm, Peter Frei, Nicolas Kurpiers, Stefan Wölwer, Axel Georg Meender Schäfer","doi":"10.2196/64384","DOIUrl":"https://doi.org/10.2196/64384","url":null,"abstract":"<p><strong>Background: </strong>Regular physical activity (PA) is known to offer substantial health benefits, including improved physical fitness, reduced risk of disease, enhanced psychological well-being, and better cognitive performance. Despite these benefits, many university students fail to meet recommended PA levels, risking long-term health consequences.</p><p><strong>Objective: </strong>This study evaluated the user experience (UX) of futur.move, a digital intervention aimed at promoting PA among university students. The service delivers personalized, evidence-based content to foster sustained engagement in PA.</p><p><strong>Methods: </strong>A mixed methods approach was used to evaluate the prototype of futur.move. UX assessments included on-site and online user tests, standardized questionnaires, and online focus groups. A total of 142 university students participated, with 23 joining additional focus groups. Each participant tested the service for 30 minutes. Quantitative data were collected using the User Experience Questionnaire and analyzed descriptively, followed by correlation analysis with variables such as PA level, age, gender, and experience with PA apps. Qualitative insights were gathered from transcribed focus group discussions and analyzed using content-structuring, qualitative content analysis. Quantitative findings were cross-validated with qualitative data.</p><p><strong>Results: </strong>The UX received positive ratings across 4 User Experience Questionnaire scales (range -3 to +3; higher numbers indicate positive UX): attractiveness (median 1.67, IQR 1.04-2.17), perspicuity (median 1.5, IQR 0.5-2), stimulation (median 1.5, IQR 1-2), and novelty (median 1.25, IQR 0.5-2). Weak correlations were found between adherence to World Health Organization guidelines for PA and the perspicuity subscale (η=0.232, P=.04), and between age and the perspicuity (Kendall τb=0.132, P=.03) and stimulation subscales (Kendall τb=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale (η=0.363, P=.004). Critical feedback from focus group discussions highlighted issues with manual data entry. Qualitative findings aligned with the quantitative results, emphasizing students' appreciation for the personalized, diverse content and social networking features of futur.move.</p><p><strong>Conclusions: </strong>futur.move demonstrates favorable UX and aligns with student needs, particularly through its personalized content and social features. Improvements should focus on reducing manual data entry and enhancing feature clarity, particularly for the features \"your condition\" and \"goal setting.\" While correlations between UX ratings and demographic variables were weak to moderate, they warrant further investigation to better address the diverse target audience. The feedback from the students serves as a basis for further adapting the service to their needs and expectations. Future work will involve coding an advance","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e64384"},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Bermúdez-Millán, Rafael Pérez-Escamilla, Sofia Segura-Pérez, James Grady, Richard S Feinn Vi, Hanako Agresta, Dean Kim, Julie Ann Wagner
Background: Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas. We conducted a microlongitudinal study to examine the relationship of monthly cycling of FI and diabetes risk factors.
Objective: This study aimed to determine the quantitative methodology, recruitment and retention strategies, predictors of retention across time, and baseline sample demographics.
Methods: Participants were adult Latinas living in Hartford, Connecticut who were recruited through a community agency, invited to participate if they were receiving Supplementary Nutrition Assistance Program (SNAP) benefits, screened positive for FI using the 2-item Hunger Vital Sign Screener, and had elevated risk factors for T2D using the American Diabetes Association risk factor test. Using a microlongitudinal design, we collected data twice per month for 3 months (week 2, which is a period of food budget adequacy; and week 4, which is a period of food budget inadequacy) to determine if the monthly cycling of FI was associated with near-term diabetes risk (fasting glucose, fructosamine, and glycosylated albumin) and long-term risk (BMI, waist circumference, and glycated hemoglobin) markers. We determined whether household food inventory, psychological distress, and binge eating mediated associations. We examined Health Action Process Approach model constructs. To assess the relationship between monthly cycling of FI with diabetes risk markers, we used repeated measures general linear mixed models. To assess the role of mediators, we performed a causal pathway analysis.
Results: Participant enrollment was from April 1, 2021 to February 21, 2023. A total of 87 participants completed 420 assessments or a mean of 4.83 (SD 2.02) assessments. About half (47/87, 54%) of the sample self-identified as Puerto Rican, mean age was 35.1 (SD 5.8) years, with 17.1 (SD 11.6) years in the mainland United States. Just under half (41/87, 47.1%) spoke Spanish only, 69% (60/87) had no formal schooling, and 31% (27/87) had less than eighth grade education. Modal household size was 4 including 2 children; 44.8% (39/87) were not living with a partner. About half (47/87, 54%) were unemployed, 63.2% (55/87) reported a monthly income
Conclusions: This study demonstrated how FI cycles over the month and whether and to what degree the cycling itself is related to the risk for T2D development, as well as the evidence for some putative mechanisms of this association that can serve as future intervention targets including SNAP disbursement schedules.
{"title":"The Monthly Cycling of Food Insecurity in Latinas at Risk for Diabetes: Methods, Retention, and Sample Characteristics for a Microlongitudinal Design.","authors":"Angela Bermúdez-Millán, Rafael Pérez-Escamilla, Sofia Segura-Pérez, James Grady, Richard S Feinn Vi, Hanako Agresta, Dean Kim, Julie Ann Wagner","doi":"10.2196/66970","DOIUrl":"https://doi.org/10.2196/66970","url":null,"abstract":"<p><strong>Background: </strong>Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas. We conducted a microlongitudinal study to examine the relationship of monthly cycling of FI and diabetes risk factors.</p><p><strong>Objective: </strong>This study aimed to determine the quantitative methodology, recruitment and retention strategies, predictors of retention across time, and baseline sample demographics.</p><p><strong>Methods: </strong>Participants were adult Latinas living in Hartford, Connecticut who were recruited through a community agency, invited to participate if they were receiving Supplementary Nutrition Assistance Program (SNAP) benefits, screened positive for FI using the 2-item Hunger Vital Sign Screener, and had elevated risk factors for T2D using the American Diabetes Association risk factor test. Using a microlongitudinal design, we collected data twice per month for 3 months (week 2, which is a period of food budget adequacy; and week 4, which is a period of food budget inadequacy) to determine if the monthly cycling of FI was associated with near-term diabetes risk (fasting glucose, fructosamine, and glycosylated albumin) and long-term risk (BMI, waist circumference, and glycated hemoglobin) markers. We determined whether household food inventory, psychological distress, and binge eating mediated associations. We examined Health Action Process Approach model constructs. To assess the relationship between monthly cycling of FI with diabetes risk markers, we used repeated measures general linear mixed models. To assess the role of mediators, we performed a causal pathway analysis.</p><p><strong>Results: </strong>Participant enrollment was from April 1, 2021 to February 21, 2023. A total of 87 participants completed 420 assessments or a mean of 4.83 (SD 2.02) assessments. About half (47/87, 54%) of the sample self-identified as Puerto Rican, mean age was 35.1 (SD 5.8) years, with 17.1 (SD 11.6) years in the mainland United States. Just under half (41/87, 47.1%) spoke Spanish only, 69% (60/87) had no formal schooling, and 31% (27/87) had less than eighth grade education. Modal household size was 4 including 2 children; 44.8% (39/87) were not living with a partner. About half (47/87, 54%) were unemployed, 63.2% (55/87) reported a monthly income <US $1000, and 63.2% (55/87) used food pantries. In total, 61 participants (70.1%) completed all 6 assessments. On Pearson correlation analysis, having internet at home and having a tablet at home were associated with a higher number of completed assessments.</p><p><strong>Conclusions: </strong>This study demonstrated how FI cycles over the month and whether and to what degree the cycling itself is related to the risk for T2D development, as well as the evidence for some putative mechanisms of this association that can serve as future intervention targets including SNAP disbursement schedules.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e66970"},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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