JMIR Formative Research最新文献

Background: Early detection in primary care could improve pancreatic cancer survival, but diagnosis is often delayed due to the low prevalence of the disease, the nonspecific nature of early symptoms, and the broad range of conditions and volume of consultations managed by general practitioners (GPs). In Australia, improving pancreatic cancer outcomes, including via earlier diagnosis, is a priority being progressed under the National Pancreatic Cancer Roadmap developed by Cancer Australia. Computerized clinical decision support systems (CDSSs) have shown promise in aiding timely cancer diagnosis; however, barriers to adopting CDSS such as mistrust of the recommendations or not being embedded in the clinical workflow remain. Simulation techniques, which offer flexible and cost-effective ways to evaluate digital health interventions, can be used to test CDSS before real-world implementation.

Objective: This study aims to assess the acceptability and feasibility of identifying patients with symptoms associated with pancreatic cancer through a CDSS within a simulated environment.

Methods: We developed a CDSS that interacted with an electronic health record used in general practice to identify patients with symptoms, which may indicate pancreatic cancer (unintended weight loss or new-onset diabetes), in a simulation laboratory for digital interventions. We tested it by inviting GPs (n=11) to use the CDSS, with patient actors simulating specific clinical scenarios. We then interviewed GPs about the interaction to assess the acceptability and feasibility of the CDSS in their clinical practice. We used thematic analysis and 2 relevant frameworks to analyze the data.

Results: GPs found the CDSS easy to use, unobstructive, and effective as a prompt to consider investigations for people with risk factors for pancreatic cancer. However, they expressed concerns about possible overtesting, financial costs, and the potential for anxiety in patients with a very low probability of having cancer.

Conclusions: While GPs found the tool useful and compatible with their workflow, concerns about overtesting, lack of evidence, and cost-effectiveness were identified as barriers. GPs favored a stepwise approach to investigations rather than immediate imaging. Despite the overall acceptability of the tool, additional evidence to underpin clinical recommendations is necessary before implementing a CDSS with these specific recommendations for pancreatic cancer in primary care.

Background: Maternal evaluation during routine antenatal care visits may reduce maternal morbidity and mortality by identifying and addressing issues early on. A health recommender system could help health professionals and pregnant women monitor daily health parameters, provide tailored recommendations, and support timely antenatal care.

Objective: This study aims to qualitatively analyze challenges in the preimplementation of health recommender system for maternal care in Indonesia as perceived by multiple stakeholders, including health care providers, patients, health system managers, government officers, and technology vendors.

Methods: The methodology used a qualitative approach, where qualitative data were obtained from interviews of 37 respondents from multiple stakeholders, consisting of 15 health workers and 15 patients from private and government health care facilities, 4 officers from government health offices, 2 directors of health application vendors, and 1 manager from a private health clinic. These semistructured interview results were analyzed using thematic analysis.

Results: This qualitative study identifies key challenges in implementing a health recommender system for maternal care in Indonesia across the people, process, infrastructure, and policy dimensions. Intercoder reliability for the coding process demonstrated almost perfect agreement (Cohen κ=0.90), supporting the consistency of the coding process. Six major challenges were revealed, mostly regarding skill, accuracy, completeness, timeliness, cost, and standardization. These 6 major challenges were mentioned 96 times, accounting for 64.43% of all codes extracted from the interviews. These findings emphasize the value of user involvement in system design to meet health care professionals' and patients' needs, technical advancements to foster trust and support effective decision-making, as well as enhanced data accuracy, reliable and timely service delivery, cost management, and clear regulatory standards.

Conclusions: This formative, preimplementation qualitative study highlights the importance of involving users in system design and future implementation to meet the needs of health care professionals and patients. Reducing input errors and improving system reliability are critical to building trust and supporting effective point-of-care decision-making and, in later phases, facility-level monitoring as part of public health surveillance. Adherence to regulatory standards and the establishment of standardized guidelines will be key to enabling broader implementation. Further usability, feasibility, and pilot studies are required before any evaluation of effectiveness.

Background: Effective pain management is a cornerstone of cancer palliative care, yet it remains challenging in low- and middle-income countries due to limited resources, regulatory constraints, and a lack of objective tools. While wearable technologies offer promise for augmenting pain-related patient-reported outcomes with physiological data, their usability in palliative settings in low- and middle-income countries is underexplored.

Objective: This study aimed to evaluate the technology usability and implementation feasibility of the NEST (Non-intrusive Devices for Telemedicine) system, a low-cost, smartwatch-based pain monitoring solution for palliative cancer care co-designed with health care staff from a cancer hospital in Ecuador.

Methods: An observational usability study was conducted with 7 patients with cancer receiving palliative care treatment, combining hospital- and home-based monitoring phases. We used a qualitative and quantitative approach to assess the usability of the NEST system and to identify sociotechnical factors affecting feasibility using the NASSS (Nonadoption, Abandonment, Scale-up, Spread, and Sustainability) framework.

Results: Quantitative results showed a strong preference for the smartwatch over the mobile phone for submitting patient-reported outcomes (246/296, 83%), with wear-time adherence of the smartwatch ranging from 36% to 92% of the time. Qualitative feedback from patients and health care staff indicated good usability and perceived clinical value, though technical and organizational challenges, such as charging habits, training needs, and dashboard integration into the daily workflow of health care staff, were noted. As for feasibility, most of the complexity was found in the dynamics of the health condition, while the technology shows clear promising signs of having value to patients and health care staff.

Conclusions: Our findings suggest that the commonly reported usability hurdles of a smartwatch-based sociotechnical health solution are surmountable given fluid communication between stakeholders during all stages of design and deployment. The primary threats to feasibility in our context seem to lie in the highly complex and dynamic environment of palliative cancer care, regulatory ambiguity regarding the use of medical devices, and the workload burden on health care staff.

Background: Hispanic youth in the United States have the highest rates of pediatric obesity and do not often meet national guidelines for physical activity and dietary intake. Family-based interventions can improve health outcomes in both youth and their parents and are highly relevant to Hispanics due to the cultural value of familismo (familism). However, few existing family-based obesity prevention interventions for Hispanics target adolescents and their parents, and those that do are not designed to facilitate widespread reach.

Objective: This study describes the development of Healthy Juntos (Healthy Together), a family-based intervention for Hispanic adolescents and their parents that leverages the web and smartphone technology to prevent the onset of adolescent obesity by promoting healthy lifestyle behaviors (physical activity and diet).

Methods: We used an iterative co-design process guided by the Integrate, Design, Assess, and Share (IDEAS) framework, which outlines 10 phases for developing digital interventions. Hispanic adolescents at risk for obesity and their parents (n=90; 45 dyads) participated across different phases of the intervention development process. We conducted qualitative interviews to understand their needs and preferences and to gather feedback on a series of intervention prototypes (conceptual, paper and minimally functional, and fully functional).

Results: Participants reported using technology for their health in limited ways (eg, to search for medical symptoms and recipes). They described the importance of having interactive and social features as part of a family-based digital health intervention. Their suggestions related to content, functionality, and aesthetics resulted in a fully functional prototype of a digital lifestyle intervention for Hispanic adolescents and their parents.

Conclusions: The iterative co-design process was crucial for refining the Healthy Juntos intervention. Our next steps are to evaluate its feasibility, acceptability, and preliminary effects through a pilot randomized controlled trial.

Unlabelled: To elucidate the complex relationship between spirituality and obsessive-compulsive disorder (OCD), we performed a qualitative analysis of messages (n=225) referencing spiritualities in r/OCD, a public online peer support forum for people with OCD with over 250,000 users; two central themes emerged: (1) influence of spirituality on OCD symptom manifestation and (2) impact of OCD on relationship with spirituality.

Background: Mobile (m)health interventions can expand access to and engagement in lifesaving treatment for pregnant and postpartum people with a substance use disorder (SUD). Yet, many people with lived experience and substance use providers alike are often excluded from mobile health intervention development, limiting opportunities to provide feedback on critical design components such as usability, cultural relevance, and compatibility with real-world practice.

Objective: The study engaged pregnant and postpartum people and substance use providers in formative evaluation to refine a mobile health intervention designed to support recovery.

Methods: Pregnant and postpartum participants (n=11) and providers working in recovery settings (n=13) across Missouri reviewed the same mHealth intervention. Participants completed survey and semi-structured qualitative questions on usability and compatibility after reviewing the same mHealth intervention. Survey responses and qualitative themes were compared across groups. Post hoc analyses examined differences between pregnant and postpartum participants who had used the app and those who had not (n=8) to identify barriers to participation.

Results: Both participant groups reported similar themes related to the usability and compatibility of the mobile health intervention, including a need for simplified navigation and greater personalization of app content. The e-coaching feature and directory of recovery-focused resources were viewed as valuable by both groups. Uniquely, pregnant and postpartum participants emphasized the need for app content addressing craving management, emotional triggers, and parenting stress. These participants also requested more frequent communication with the e-coach than providers recommended. Non-app users differed from app users by race, education, and household characteristics, underscoring structural barriers to engagement.

Conclusions: Engaging both pregnant and postpartum people and providers in formative evaluation reveals overlapping and distinct priorities for mHealth design. Findings highlight that user-informed development is essential for improving usability, engagement, and recovery outcomes, including reaching those least likely to engage with traditional or digital treatment supports.

Clinicaltrial:

Background: Registered dietitian nutritionists (RDNs)-referred to as registered dietitians in Japan-contribute to disease management, prevention of complications, and improvement in quality of life through individualized nutritional guidance. However, these techniques often rely on individual experience, leading to variations in quality. The nutrition care process provides a standardized framework for nutritional care, but the specific techniques used in clinical practice and their interrelationships remain unclear. Interpretive structural modeling (ISM) is a method that visualizes and hierarchically organizes interrelationships among multiple elements, making it useful for structuring complex practical skills. Therefore, clarifying the structure of nutritional guidance techniques may support the standardization of practice and the development of educational frameworks.

Objective: This study aimed to identify the elements influencing nutritional guidance techniques in clinical practice, clarify their hierarchical structure using ISM, and explore their potential applicability to the education of registered dietitians.

Methods: Three experienced RDNs participated in an expert panel. Elements influencing nutritional guidance techniques were identified through structured brainstorming and consensus-building sessions. The extracted elements were analyzed using ISM to generate a reachability matrix and derive a hierarchical structure that visualized the interrelationships among the elements.

Results: A total of 14 elements were identified and organized into a 6-level hierarchical structure. The upper levels included nutrition care process-related elements, with the "nutritional intervention plan" positioned at the top, whereas the lower levels consisted of foundational elements such as "clinical knowledge" and "understanding of patient background."

Conclusions: This study identified 14 elements influencing nutritional guidance techniques in clinical practice and systematically visualized their interrelationships as a 6-level hierarchy using ISM. The resulting model provides an initial framework that may inform the development of clinical education curricula and competency evaluation frameworks for RDNs, and it could contribute to the advancement of standardized approaches in nutritional guidance education.