JMIR Formative Research最新文献

Background: Caregivers' self-perceived preparedness for caregiving influences care recipients' and caregivers' emotional health, and care recipients' aging in place. Dementia's unique, long, and progressive nature compared to other age-related illnesses, along with associated behavioral symptoms and personality changes, may cause caregivers' preparedness to vary significantly from that of those caring for patients with other chronic conditions.

Objective: This study aimed to describe and compare specific domains and tasks in which family caregivers of veterans with and without dementia reported wanting to be better prepared.

Methods: Using the Veterans Affairs' HERO CARE (Home Excellence Resource Outcome Center to Advance, Redefine, and Evaluate Non-Institutional Care) Survey data, we analyzed caregivers' responses to one open-ended question: "Out of all the tasks that you help the veteran with, is there anything specific you would like to be better prepared for?" Response themes were deductively coded into 9 domains, and differences in reported domains between caregivers of care recipients with and without dementia were compared.

Results: A total of 732 caregivers were included: 301 (41.1%) caregivers of veterans with dementia and 431 (58.9%) without. Caregivers of veterans with and without dementia, respectively, were similar except in age, being spousal caregivers, working at least part-time, hours of care provision per week, and proportion with a high burden. Veterans with dementia, versus without, were older and had higher frailty and risk scores. Preparedness concerns among caregivers (N=732) included care coordination (n=164, 22.4%), emotional and social support (n=145, 19.8%), advance planning (n=116, 15.8%), nursing and health monitoring (n=94, 12.8%), personal care (n=65, 8.9%), mobility (n=79, 10.8%), household (n=58, 7.9%), caregiver self-care (n=36, 4.9%), and emergent situations (n=28, 3.8%). The commonest tasks caregivers expressed needs for included managing emotional and behavioral symptoms (n=74, 10.1%), recognizing and responding to significant changes in the veterans' condition (n=66, 9.0%), seeking medical information relevant to the veterans' needs (n=54, 7.4%), handling financial and legal matters (n=52, 7.1%), and advocating for services (n=49, 6.7%). Similar proportions of caregivers of veterans with and without dementia reported preparedness needs in all domains and tasks.

Conclusions: The preparedness needs of caregivers of veterans with and without dementia were mostly similar in most domains and tasks. The commonest preparedness gaps were in the domains of care coordination, emotional and social support, and advance planning. The findings can inform interventions to prepare all caregivers to support aging in place.

Background: Mobile health (mHealth) interventions are prevalent, yet people from marginalized communities are less likely to use digital health technologies to support self-management behaviors. Community engagement can inform health care design to enhance a hypertension self-management mHealth intervention.

Objective: We applied human-centered design (HCD) to determine appropriate iterations of an existing hypertension intervention.

Methods: Through an equity-focused, community-centered approach, we strove to optimize an mHealth app. We used validated theories and frameworks as well as an HCD methodology organized into three fundamental design skills: (1) methods to directly observe user experiences, (2) methods to analyze barriers to ideal intervention use, and (3) methods to design future iterations.

Results: In October 2023, we conducted a series of HCD activities with a community advisory board (n=8) to refine an mHealth intervention for hypertension. Participants tested app prototypes with blood pressure monitors and suggested content modifications to enhance intervention fidelity. Among 6 participants, usability testing scored 67.5 (benchmark 68, "above average"), with all users finding the tool easy to use. Feedback identified critical needs, barriers, and work-arounds for future mHealth iterations.

Conclusions: This study was a novel use case example of HCD as a patient-centered methodology to improve a hypertension management tool.

Background: The broad spectrum of issues that survivors face after critical illness and the contextual factors that help or hinder remain underexplored, as do their perspectives on what is important during recovery. Photovoice methods offer a means to convey experiences through participant-generated photographs and related narratives that can extend existing notions of illness and wellness.

Objective: This pilot study aimed to (1) describe intensive care unit (ICU) survivor recovery after hospital discharge depicted through survivor-generated photographs and photograph discussions, (2) assess the feasibility of recruiting and retaining participants in a web-based group photovoice focused on ICU recovery, and (3) describe the impact of study participation.

Methods: The web-based group photovoice involved 5 weekly 2-hour group discussion sessions, after which individual interviews were conducted with each participant. Photographs and transcript data from the group discussions and individual interviews were analyzed using a qualitative interpretive description approach.

Results: A total of 5 ICU survivors (4 women and 1 man) participated. The aspects of critical illness recovery that featured prominently included (1) protracted physical recovery; (2) profound psychosocial challenges encompassing fear of the future, emotional turmoil, shifting self-perception, changes in family dynamics, and feelings of disconnection; (3) discrepancies in health needs and support offered; and (4) need for perseverance and resilience. The web-based group photovoice was feasible, with participation characterized as an opportunity to build social connections and draw strength from fellow survivors of critical illness unavailable elsewhere.

Conclusions: Given the compelling insights our pilot study provided into lesser-explored aspects of critical illness recovery, along with its potential therapeutic value and ability to foster social connectedness, future research is warranted to assess the impact of a scaled-up application.

Background: Eating difficulties are increasingly prevalent among young people, yet service capacity remains limited. Digital interventions may provide accessible, scalable support, particularly for those with mild, subthreshold, or early-stage symptoms who do not meet criteria for specialist care. Low self-esteem is widely recognized as a key psychological risk factor in the onset and persistence of eating disorders, and negative self-evaluation, particularly around body image and social acceptance, can heighten vulnerability to the maladaptive thoughts and behaviors seen in conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. Clarifying this relationship is essential for developing effective prevention and early intervention strategies.

Objective: This pilot case series reports on 5 individuals aged 19-25 (mean 22, SD 2.19) years with mild eating disorders who used the Worth Warrior app, a mobile intervention incorporating principles of enhanced cognitive behavioral therapy strategies targeting low self-esteem, body image concerns, and disordered eating behaviors.

Methods: An uncontrolled 3-phase design (baseline, post-app familiarization, and follow-up) was used. Participants completed standardized self-report tools, including the Eating Disorder Examination Questionnaire and Rosenberg Self-Esteem Scale. Feedback on usability, acceptability, and safety was also collected via online questionnaires.

Results: Outcome measures at follow-up showed improvements in eating disorder symptomatology in 3/5 cases, and in self-esteem in 4/5 cases; those with milder symptomatology indicated the most benefit. Reductions in eating concerns, weight concerns, and related behaviors were observed in most, though not all, cases. Participants valued interactive enhanced cognitive behavioral therapy features and journaling functions, while noting areas for improvement such as reminders and incentives for use and preventions for maladaptive use of the free-text facilities.

Conclusions: Findings suggest the Worth Warrior app may be suited as an acceptable and effective standalone tool for individuals with mild eating disorder symptoms, and used as an adjunct to traditional treatment alongside clinician supervision for those with more severe presentations to promote the greatest patient safety. These exploratory case study findings suggest that the app has the potential to support improvements in self-esteem and mild eating disorder symptomatology; however, as a preliminary case series, these results are not generalizable but provide a foundation for larger, controlled studies of digital early intervention.

Background: Tooth decay is an important public health concern affecting individuals of all ages. Dietary intake is critical to tooth decay prevention as both the types of foods and beverages consumed and how food and beverages are consumed (eg, frequency) can impact risk. Foods and beverages can both protect against and promote tooth decay.

Objective: This study aims to explore information targeted to the public on diet and tooth decay available from websites of professional organizations and regulatory bodies in Canada and the readability of this information.

Methods: Canadian websites of regulatory bodies and professional organizations for dietitians, oral health professionals, nurses, and physicians in Canada were thoroughly searched by 2 researchers (MF and JL) from June to August 2020 for information related to diet and tooth decay targeted to the public. Web pages were downloaded and underwent content analysis using NVivo software (version 12; QSR International). For each website, approximately 2 web pages focused on diet and tooth decay were selected to undergo readability testing.

Results: Overall, 213 web pages from 23 websites were found to contain information on diet and tooth decay. Of the 23 websites analyzed, 12 (52%) were from dental organizations, 7 (30%) from dental hygiene organizations, and only 1 (4%) from a dietitian organization. Messaging was present on numerous web pages focusing on diet and tooth decay and those that have other focuses (eg, oral hygiene tips for infants and children and general oral health tips). Messaging depth varied across all web pages, ranging from general advice (eg, consume a "healthy diet") to specific recommendations (eg, amount of juice to consume per day). Many web pages targeted parents and school-aged children; fewer web pages targeted other age groups (eg, adolescents and older adults). Three major themes were identified: Foods, Beverages, and Behaviors to Limit; Foods, Beverages, and Behaviors to Choose; and Mixed and Other Unclear Messages. The most frequently discussed topic was sugar (mentioned in 67% of web pages). Sugar was often discussed in the context of limitation, infant feeding, and strategies for tooth-friendly consumption. The average Flesch-Kincaid grade level was 7.1 (SD 1.8), which exceeds the grade 6-level recommendation.

Conclusions: This analysis of web pages found that diet and tooth decay was heavily discussed throughout websites for Canadian health professional organizations, with many web pages targeting parents and school-aged children. The readability of many analyzed web pages was above the recommended grade 6 reading level. The development of comprehensive national guidelines related to diet and tooth decay would be helpful to ensure that consistent and clear messaging is available on this topic.