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Digital Inequalities in the Use of eHealth Services in European Public Health Care Systems: Systematic Review of Observational Studies. 欧洲公共卫生保健系统中电子卫生服务使用中的数字不平等：观察性研究的系统回顾。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-09 DOI: 10.2196/81841
Garazi Monasterio, Marcos José Fernández-López, Erika Valero, Unai Martin, Amaia Ayala-García
<p><strong>Background: </strong>European public health care systems are expanding eHealth tools such as teleconsultations, online appointment bookings, and electronic health records to improve efficiency and access to health care. However, their use depends on factors such as digital skills and internet access, which are unequally distributed across socioeconomic and demographic determinants. Most existing evidence on these inequalities is qualitative or outside universal health care systems.</p><p><strong>Objective: </strong>This systematic review aims to synthesize quantitative evidence on social inequalities in access to and use of eHealth services within European public health care systems. Specifically, we sought to identify which social determinants were most consistently associated with unequal use of online appointment booking, teleconsultations, electronic health records, and eHealth portals, across major social determinants of health.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, Scopus, Web of Science, and PsycINFO for studies published in English or Spanish between 2015 and October 2025. Eligible quantitative studies included adults (≥18 years) using public health care systems in European countries. The primary outcome was differential access to or use of eHealth tools by social determinants in any level of care. Screening and data extraction were independently performed by 3 reviewers using Rayyan, resolving disagreements through consensus. Data extracted covered study design, population, eHealth tools, social determinants, and outcomes. Risk of bias was evaluated using Joanna Briggs Institute tools. Due to study heterogeneity in digital tools and inequality dimensions, results were synthesized narratively by tool type and social inequality factors. Point estimates and 95% CIs were extracted when available.</p><p><strong>Results: </strong>Of the 2366 records retrieved, 18 observational studies met the inclusion criteria: 13 cross-sectional, 3 prevalence, 1 retrospective cohort, and 1 ecological cohort. Publication output increased from 2020 onward, mostly driven by cross-sectional studies from northern and western Europe. Findings revealed consistent social gradients in eHealth use: older adults, individuals with lower educational or socioeconomic level, ethnic minorities, and those with limited digital skills or poorer health were less likely to use eHealth tools. Most studies were rated as high quality (78%), and the remainder as moderate, heterogeneity in designs, outcomes, and populations may limit generalizability.</p><p><strong>Conclusions: </strong>Digital transformation in European public health systems has not benefited all groups equally. This review highlights persistent social inequalities in the use of key digital health tools. While many included studies were of high quality, heterogeneity in study designs, populations, and outcomes, as well as risk of bias, limits causal inference and
背景：欧洲公共卫生保健系统正在扩展电子卫生保健工具，如远程咨询、在线预约和电子健康记录，以提高效率和获得卫生保健的机会。然而，它们的使用取决于数字技能和互联网接入等因素，而这些因素在社会经济和人口决定因素中分布不均。关于这些不平等的大多数现有证据是定性的或在全民卫生保健系统之外的。目的：本系统综述旨在综合欧洲公共卫生保健系统中获取和使用电子卫生服务方面的社会不平等的定量证据。具体而言，我们试图确定哪些社会决定因素与主要健康社会决定因素中在线预约、远程咨询、电子健康记录和电子健康门户的不平等使用最为一致。方法：系统检索PubMed、Scopus、Web of Science和PsycINFO，检索2015年至2025年10月期间以英语或西班牙语发表的研究。合格的定量研究包括欧洲国家使用公共卫生保健系统的成年人（≥18岁）。主要结果是在任何级别的护理中，社会决定因素对电子卫生工具的获取或使用存在差异。筛选和数据提取由3名审稿人使用Rayyan独立完成，通过共识解决分歧。提取的数据包括研究设计、人口、电子健康工具、社会决定因素和结果。使用Joanna Briggs研究所的工具评估偏倚风险。由于数字工具研究的异质性和不平等维度，研究结果按工具类型和社会不平等因素进行综合叙述。在可行的情况下提取点估计和95% ci。结果：在检索到的2366份记录中，18项观察性研究符合纳入标准：13项横断面研究、3项流行研究、1项回顾性队列研究和1项生态队列研究。从2020年开始，出版物产量增加，主要是由北欧和西欧的横断面研究推动的。调查结果显示，在电子健康使用方面存在一致的社会梯度：老年人、受教育程度或社会经济水平较低的个人、少数民族、数字技能有限或健康状况较差的人不太可能使用电子健康工具。大多数研究被评为高质量（78%），其余为中等质量，设计、结果和人群的异质性可能限制了通用性。结论：欧洲公共卫生系统的数字化转型并没有平等地惠及所有群体。本次审查强调了在使用关键数字卫生工具方面持续存在的社会不平等。虽然许多纳入的研究都是高质量的，但研究设计、人群和结果的异质性以及偏倚风险限制了因果推理和将研究结果直接转化为政策和实践。尽管如此，研究结果还是揭示了与政策高度相关的系统性排斥模式。强调交叉方法并使数字获取措施标准化，对于制定以公平为重点的有效政策，确保为所有人提供包容性数字卫生服务至关重要。
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引用次数: 0
Data-Driven Guideline Adherence in Data Representation and Compliance Measurement: Scoping Review. 数据表示和合规性测量中数据驱动指南的依从性：范围审查。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-09 DOI: 10.2196/79937
Minh Trang Hoang, Candice Donnelly, Christina Igasto, Amith Shetty, Malcolm Pradhan, Tim Shaw
<p><strong>Background: </strong>Best practice standards aim to standardize care and improve outcomes. However, variation in clinical practice exists, and not all deviations are inappropriate. Measuring adherence to best practice standards remains challenging due to limitations in representation methods and data fidelity.</p><p><strong>Objective: </strong>This scoping review aims to survey and synthesize the existing literature on the computable representation of guideline recommendations and to explore methods for detecting and quantifying deviations from best practice standards.</p><p><strong>Methods: </strong>We followed the Arksey and O'Malley framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Five databases (Ovid Medline, EMBASE, IEEE Xplore, Web of Science, and Scopus) were searched in November 2025. Studies were included if they either (1) described a computer representation of best practice standards or (2) assessed adherence to such standards using patient data, including patient data derived from electronic medical records or event logs. Screening was done using Covidence (Veritas Health Innovation). Data were extracted on representation, clinical context, data sources, adherence metrics, and modeling techniques. A narrative synthesis was conducted to identify themes.</p><p><strong>Results: </strong>Twenty-four studies were included. Most studies were published as conference proceedings (13/24, 54%). Fourteen studies (14/24, 58%) included measurement of adherence to best practice standards. Cardiovascular conditions were the most common focus (13/24, 54%). Data sources included Health Level Seven (HL7) messages, structured electronic medical record data, event logs, and Fast Healthcare Interoperability Resources (FHIR)-transformed data. Best practice standards were formalized using Business Process Model and Notation (BPMN; 6/24, 25%), ontologies (7/24, 29%), FHIR (4/24, 17%), or hybrid approaches (4/24, 17%). The most common method for adherence measurement was rule-based alignment. Several studies incorporated weighted scoring to differentiate the severity of deviations. Process mining was used in a subset to detect sequence and timing variations. However, most models lacked contextual sensitivity and rarely incorporated patient-specific factors, such as comorbidities, patient acuity, or clinician rationale. Consequently, although deviations can be automatically identified, determining whether they were clinically warranted remained largely unresolved.</p><p><strong>Conclusions: </strong>Despite promising advances, challenges persist in computer-interpretable representation and measuring adherence in a clinically meaningful way. Current approaches predominantly assess technical alignment rather than clinical relevance and are limited by data quality and standardization, thereby limiting real-world utility. This scoping review offers an innovative contr
背景：最佳实践标准旨在规范护理和改善结果。然而，临床实践中存在差异，并不是所有的偏差都是不合适的。由于表示方法和数据保真度的限制，衡量对最佳实践标准的遵守仍然具有挑战性。目的：本综述旨在调查和综合现有的关于指南建议的可计算表示的文献，并探索检测和量化偏离最佳实践标准的方法。方法：我们遵循Arksey和O'Malley框架和PRISMA-ScR（系统评价和荟萃分析扩展范围评价的首选报告项目）指南。在2025年11月检索了5个数据库（Ovid Medline、EMBASE、IEEE explore、Web of Science和Scopus）。如果研究(1)描述了最佳实践标准的计算机表示，或(2)使用患者数据（包括来自电子病历或事件日志的患者数据）评估了对这些标准的遵守情况，则将其纳入研究。使用covid （Veritas Health Innovation）进行筛选。从代表性、临床背景、数据源、依从性指标和建模技术等方面提取数据。通过叙事综合来确定主题。结果：共纳入24项研究。大多数研究以会议论文集的形式发表（13/24,54%）。14项研究（14/24,58%）包括对最佳实践标准遵守情况的测量。心血管疾病是最常见的焦点（13/24,54%）。数据源包括健康级别7 （HL7）消息、结构化电子医疗记录数据、事件日志和快速医疗保健互操作性资源（FHIR）转换的数据。使用业务流程模型和符号（BPMN; 6/ 24,25%）、本体（7/ 24,29%）、FHIR（4/ 24,17%）或混合方法（4/ 24,17%）形式化最佳实践标准。最常见的依从性测量方法是基于规则的校准。一些研究采用加权评分来区分偏差的严重程度。在子集中使用过程挖掘来检测序列和时间变化。然而，大多数模型缺乏上下文敏感性，很少纳入患者特异性因素，如合并症、患者敏锐度或临床医生的理论依据。因此，尽管偏差可以自动识别，但确定它们是否有临床依据在很大程度上仍未解决。结论：尽管取得了有希望的进展，但在计算机可解释表示和以临床有意义的方式测量依从性方面仍然存在挑战。目前的方法主要评估技术一致性，而不是临床相关性，并受到数据质量和标准化的限制，从而限制了现实世界的效用。这一范围综述通过综合来自两个不同领域的证据——最佳实践标准的可计算表示和依从性测量——提供了创新的贡献。研究结果强调需要情境感知、标准化建模和与临床工作流程的整合，以区分有根据的偏差和无根据的偏差。这些进步对于可扩展、透明和实时的依从性监测至关重要，最终推动更安全、以患者为中心的医疗服务。
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引用次数: 0
Screen Time and Chronic Pain Health: Mendelian Randomization Study. 屏幕时间与慢性疼痛健康：孟德尔随机研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-09 DOI: 10.2196/78233
Jiahui Jiang, Chunyan Pu, Jiarui Cai, Chuan Yu, Zhenmi Liu, Chenghan Xiao
<p><strong>Background: </strong>The rapid proliferation of electronic devices has increased screen time, raising concerns about its potential health effects, including chronic pain. However, existing studies have limitations in scope and causal inference, with inconsistent findings and a lack of exploration of potential biological mechanisms.</p><p><strong>Objective: </strong>The objective of our study was to investigate the causal associations and potential shared biological mechanisms between different forms of screen time and various chronic pain phenotypes.</p><p><strong>Methods: </strong>Leveraging genome-wide association study data, we investigated the association and potential shared biological mechanisms between screen time (time spent watching television, time spent using computer, and length of mobile phone use) and chronic pain phenotypes (including multisite chronic pain [MCP], back, knee, neck or shoulder, hip pain, and headaches). Two-sample Mendelian randomization (MR), reverse MR and multivariable Mendelian randomization (MVMR) analysis were performed to examine associations between screen time and chronic pain. Summary data-based Mendelian randomization (SMR), transcriptome-wide association study (TWAS), and colocalization analysis were used to identify the shared genes and potential biological mechanism.</p><p><strong>Results: </strong>MR analysis revealed that time spent watching television and length of mobile phone use were positively associated with several types of chronic pain, while time spent using computer showed a negative association. Specifically, time spent watching television was positively associated with the risk of MCP (P=1.05×10<sup>-31</sup>; odds ratio [OR] 1.61, 95% CI 1.49-1.74), back pain (P=2.41×10<sup>-8</sup>; OR 1.14, 95% CI 1.09-1.19), knee pain (P=7.10×10<sup>-6</sup>; OR 1.09, 95% CI 1.05-1.13), neck or shoulder pain, and hip pain. Length of mobile phone use was positively associated with the risk of MCP (P=2.15×10<sup>-5</sup>; OR 1.22, 95% CI 1.11-1.34), headaches, and neck or shoulder pain. However, time spent using computer was negatively associated with the risk of MCP (P<.001; OR 0.83, 95% CI 0.75-0.92), back pain, and knee pain. The reverse MR results showed that MCP was positively associated with time spent watching television (P=4.8×10<sup>-7</sup>; OR 1.27, 95% CI 1.16-1.4) and length of mobile phone use (P=3.38×10<sup>-5</sup>; OR 1.29, 95% CI 1.14-1.45), while the association with time spent using computer (P=.61; OR 0.97, 95% CI 0.87-1.09) was not statistically significant. The MVMR results failed to meet the criterion that all conditional F-statistics exceed 10. Integrative 3 analysis methods identified overlapping genes, with CEP170 emerging as a key gene consistently supported by SMR, TWAS, and colocalization analysis in the relationship between time spent using computer and MCP.</p><p><strong>Conclusions: </strong>Our findings demonstrate an association between screen time and vario
背景：电子设备的迅速普及增加了看屏幕的时间，引起了人们对其潜在健康影响的担忧，包括慢性疼痛。然而，现有的研究在范围和因果推理方面存在局限性，研究结果不一致，缺乏对潜在生物学机制的探索。目的：本研究的目的是探讨不同形式的屏幕时间与各种慢性疼痛表型之间的因果关系和潜在的共享生物学机制。方法：利用全基因组关联研究数据，我们调查了屏幕时间（看电视的时间、使用电脑的时间和使用手机的时间）与慢性疼痛表型（包括多位点慢性疼痛[MCP]、背部、膝盖、颈部或肩部、臀部疼痛和头痛）之间的关联和潜在的共享生物学机制。通过双样本孟德尔随机化（MR）、反向孟德尔随机化（reverse MR）和多变量孟德尔随机化（MVMR）分析来检验屏幕时间与慢性疼痛之间的关系。利用基于数据的孟德尔随机化（SMR）、转录组全关联研究（TWAS）和共定位分析来确定共享基因和潜在的生物学机制。结果：核磁共振分析显示，看电视的时间和使用手机的时间与几种慢性疼痛呈正相关，而使用电脑的时间则呈负相关。具体来说，看电视的时间与MCP （P=1.05×10-31；比值比[OR] 1.61, 95% CI 1.49-1.74）、背部疼痛（P=2.41×10-8; OR 1.14, 95% CI 1.09-1.19）、膝盖疼痛（P=7.10×10-6; OR 1.09, 95% CI 1.05-1.13）、颈部或肩部疼痛以及髋关节疼痛的风险呈正相关。使用手机的时间长短与MCP （P=2.15×10-5; OR 1.22, 95% CI 1.11-1.34）、头痛和颈肩痛的风险呈正相关。然而，使用电脑的时间与MCP的风险（P= 7; OR 1.27, 95% CI 1.16-1.4）和使用手机的时间（P=3.38×10-5; OR 1.29, 95% CI 1.14-1.45）呈负相关，而与使用电脑的时间（P= 0.61; OR 0.97, 95% CI 0.87-1.09）的相关性无统计学意义。MVMR结果不满足所有条件f统计量大于10的标准。综合分析方法发现了重叠基因，SMR、TWAS和共定位分析一致支持CEP170是使用计算机时间与MCP之间关系的关键基因。结论：我们的研究结果表明，屏幕时间与慢性疼痛的各个方面之间存在关联。CEP170基因可能与使用电脑时间与MCP风险之间的共享生物学机制有关。然而，由于缺乏可靠的MVMR结果，不能排除混杂因素的潜在影响。
{"title":"Screen Time and Chronic Pain Health: Mendelian Randomization Study.","authors":"Jiahui Jiang, Chunyan Pu, Jiarui Cai, Chuan Yu, Zhenmi Liu, Chenghan Xiao","doi":"10.2196/78233","DOIUrl":"https://doi.org/10.2196/78233","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The rapid proliferation of electronic devices has increased screen time, raising concerns about its potential health effects, including chronic pain. However, existing studies have limitations in scope and causal inference, with inconsistent findings and a lack of exploration of potential biological mechanisms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of our study was to investigate the causal associations and potential shared biological mechanisms between different forms of screen time and various chronic pain phenotypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Leveraging genome-wide association study data, we investigated the association and potential shared biological mechanisms between screen time (time spent watching television, time spent using computer, and length of mobile phone use) and chronic pain phenotypes (including multisite chronic pain [MCP], back, knee, neck or shoulder, hip pain, and headaches). Two-sample Mendelian randomization (MR), reverse MR and multivariable Mendelian randomization (MVMR) analysis were performed to examine associations between screen time and chronic pain. Summary data-based Mendelian randomization (SMR), transcriptome-wide association study (TWAS), and colocalization analysis were used to identify the shared genes and potential biological mechanism.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;MR analysis revealed that time spent watching television and length of mobile phone use were positively associated with several types of chronic pain, while time spent using computer showed a negative association. Specifically, time spent watching television was positively associated with the risk of MCP (P=1.05×10&lt;sup&gt;-31&lt;/sup&gt;; odds ratio [OR] 1.61, 95% CI 1.49-1.74), back pain (P=2.41×10&lt;sup&gt;-8&lt;/sup&gt;; OR 1.14, 95% CI 1.09-1.19), knee pain (P=7.10×10&lt;sup&gt;-6&lt;/sup&gt;; OR 1.09, 95% CI 1.05-1.13), neck or shoulder pain, and hip pain. Length of mobile phone use was positively associated with the risk of MCP (P=2.15×10&lt;sup&gt;-5&lt;/sup&gt;; OR 1.22, 95% CI 1.11-1.34), headaches, and neck or shoulder pain. However, time spent using computer was negatively associated with the risk of MCP (P&lt;.001; OR 0.83, 95% CI 0.75-0.92), back pain, and knee pain. The reverse MR results showed that MCP was positively associated with time spent watching television (P=4.8×10&lt;sup&gt;-7&lt;/sup&gt;; OR 1.27, 95% CI 1.16-1.4) and length of mobile phone use (P=3.38×10&lt;sup&gt;-5&lt;/sup&gt;; OR 1.29, 95% CI 1.14-1.45), while the association with time spent using computer (P=.61; OR 0.97, 95% CI 0.87-1.09) was not statistically significant. The MVMR results failed to meet the criterion that all conditional F-statistics exceed 10. Integrative 3 analysis methods identified overlapping genes, with CEP170 emerging as a key gene consistently supported by SMR, TWAS, and colocalization analysis in the relationship between time spent using computer and MCP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings demonstrate an association between screen time and vario","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e78233"},"PeriodicalIF":6.0,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interventions That Use Highly Visual Social Media Platforms to Tackle Unhealthy Body Image in Adolescents and Young Adults: Systematic Review of Randomized Controlled Trials and Quasi-Experimental Studies. 使用高度可视化的社交媒体平台来解决青少年和年轻人不健康身体形象的干预措施：随机对照试验和准实验研究的系统综述。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-09 DOI: 10.2196/80141
Anthony Copez-Lonzoy, Janina Bazalar-Palacios, Nikol Mayo-Puchoc, Gustavo Calderon de la Cruz, Liliana Cruz-Ausejo, Evelyn Goicochea-Ríos, Juan Carlos Bazo-Alvarez
<p><strong>Background: </strong>Highly visual social media (HVSM) platforms such as Facebook (Meta Platforms, Inc), Instagram (Meta Platforms, Inc), TikTok (ByteDance Ltd), and Snapchat (Snap Inc) have become central to the digital lives of adolescents and young adults. While these platforms have been linked to body dissatisfaction, they are also increasingly used as vehicles for health promotion. However, the evidence on interventions delivered through HVSM to address body image issues remains fragmented.</p><p><strong>Objective: </strong>This review aimed to synthesize available evidence on interventions using HVSM platforms to reduce negative body image in adolescents and young adults.</p><p><strong>Methods: </strong>We conducted a systematic search across 5 electronic databases (Scopus, MEDLINE, APA Psynet, Embase, and Web of Science) for studies published between January 2012 and October 2025. Eligible studies included experimental or quasi-experimental designs evaluating the effect of an HVSM-based intervention on body image outcomes in individuals aged 13 to 35 years. Risk of bias was assessed using the Risk of Bias Tool 2.0 (Cochrane) and was conducted independently by 2 researchers.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria with 4975 participants (2612 in intervention groups and 2363 in control groups). Most studies were conducted in high-income countries and had predominantly female participants. The interventions varied widely in format, duration, and theoretical basis. Microinterventions, brief interactive strategies such as gamified chatbots or short videos, were the most common and had moderate effects. Stimulus-based interventions using content with a positive body image or that did not focus on appearance were also identified, achieving moderate effects (η<sub>p</sub>²<.07), as well as combined approaches that integrated digital and face-to-face components to reduce negative body image (P<.001). The use and functionality of interventions using social media platforms were also compared by gender.</p><p><strong>Conclusions: </strong>Body image management platforms offer an emerging avenue for implementing body image interventions in adolescents and young adults. While current evidence suggests modest benefits, the high heterogeneity among presentation formats and the variability in duration make comparisons between these studies difficult. This review synthesizes social media-delivered interventions for body image disturbance, going beyond broader digital approaches centered on websites or apps. It identifies cross-platform, putative mechanisms of action and common intervention formats, highlighting the potential of brief interventions for scalable reach and user empowerment via content curation. These findings define targets for optimization and underscore the need for platform safeguards and supportive policy and regulatory frameworks to enable safe real-world implementation, particularly for adolesc
背景：高度可视化的社交媒体（HVSM）平台，如Facebook （Meta platforms, Inc）、Instagram （Meta platforms, Inc）、TikTok（字节跳动有限公司）和Snapchat (Snap Inc)，已经成为青少年和年轻人数字生活的核心。虽然这些平台与对身体的不满有关，但它们也越来越多地被用作促进健康的工具。然而，关于通过HVSM解决身体形象问题的干预措施的证据仍然是碎片化的。目的：本综述旨在综合利用HVSM平台干预青少年和年轻人负面身体形象的现有证据。方法：对2012年1月至2025年10月间发表的5个电子数据库（Scopus、MEDLINE、APA Psynet、Embase和Web of Science）进行了系统检索。符合条件的研究包括实验或准实验设计，评估基于hvsm的干预对13至35岁个体身体形象结果的影响。偏倚风险评估采用偏倚风险工具2.0 (Cochrane)，由2名研究人员独立进行。结果：8项研究符合纳入标准，4975名受试者（干预组2612人，对照组2363人）。大多数研究是在高收入国家进行的，参与者主要是女性。干预措施在形式、持续时间和理论基础上差异很大。微干预，简短的互动策略，如游戏化聊天机器人或短视频，是最常见的，效果适中。基于刺激的干预使用积极的身体形象或不关注外表的内容，也被确定，获得中等效果（p²）结论：身体形象管理平台为在青少年和年轻人中实施身体形象干预提供了一个新兴的途径。虽然目前的证据表明有适度的好处，但呈现形式的高度异质性和持续时间的可变性使得这些研究之间的比较变得困难。这篇综述综合了社交媒体提供的身体形象干扰干预措施，超越了以网站或应用程序为中心的更广泛的数字方法。它确定了跨平台，假定的行动机制和常见的干预格式，强调了通过内容管理进行可扩展覆盖和用户授权的简短干预的潜力。这些发现确定了优化目标，并强调了平台保障和支持性政策和监管框架的必要性，以确保安全的现实世界实施，特别是针对青少年。
{"title":"Interventions That Use Highly Visual Social Media Platforms to Tackle Unhealthy Body Image in Adolescents and Young Adults: Systematic Review of Randomized Controlled Trials and Quasi-Experimental Studies.","authors":"Anthony Copez-Lonzoy, Janina Bazalar-Palacios, Nikol Mayo-Puchoc, Gustavo Calderon de la Cruz, Liliana Cruz-Ausejo, Evelyn Goicochea-Ríos, Juan Carlos Bazo-Alvarez","doi":"10.2196/80141","DOIUrl":"https://doi.org/10.2196/80141","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Highly visual social media (HVSM) platforms such as Facebook (Meta Platforms, Inc), Instagram (Meta Platforms, Inc), TikTok (ByteDance Ltd), and Snapchat (Snap Inc) have become central to the digital lives of adolescents and young adults. While these platforms have been linked to body dissatisfaction, they are also increasingly used as vehicles for health promotion. However, the evidence on interventions delivered through HVSM to address body image issues remains fragmented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This review aimed to synthesize available evidence on interventions using HVSM platforms to reduce negative body image in adolescents and young adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic search across 5 electronic databases (Scopus, MEDLINE, APA Psynet, Embase, and Web of Science) for studies published between January 2012 and October 2025. Eligible studies included experimental or quasi-experimental designs evaluating the effect of an HVSM-based intervention on body image outcomes in individuals aged 13 to 35 years. Risk of bias was assessed using the Risk of Bias Tool 2.0 (Cochrane) and was conducted independently by 2 researchers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight studies met the inclusion criteria with 4975 participants (2612 in intervention groups and 2363 in control groups). Most studies were conducted in high-income countries and had predominantly female participants. The interventions varied widely in format, duration, and theoretical basis. Microinterventions, brief interactive strategies such as gamified chatbots or short videos, were the most common and had moderate effects. Stimulus-based interventions using content with a positive body image or that did not focus on appearance were also identified, achieving moderate effects (η&lt;sub&gt;p&lt;/sub&gt;²&lt;.07), as well as combined approaches that integrated digital and face-to-face components to reduce negative body image (P&lt;.001). The use and functionality of interventions using social media platforms were also compared by gender.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Body image management platforms offer an emerging avenue for implementing body image interventions in adolescents and young adults. While current evidence suggests modest benefits, the high heterogeneity among presentation formats and the variability in duration make comparisons between these studies difficult. This review synthesizes social media-delivered interventions for body image disturbance, going beyond broader digital approaches centered on websites or apps. It identifies cross-platform, putative mechanisms of action and common intervention formats, highlighting the potential of brief interventions for scalable reach and user empowerment via content curation. These findings define targets for optimization and underscore the need for platform safeguards and supportive policy and regulatory frameworks to enable safe real-world implementation, particularly for adolesc","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e80141"},"PeriodicalIF":6.0,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Problems and Barriers Regarding the Admission, Financing, and Service Provision of Digital Health Apps: Qualitative Stakeholder Survey. 关于数字健康应用程序的准入、融资和服务提供的问题和障碍：定性利益相关者调查。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-09 DOI: 10.2196/73332
Felix Plescher, Godwin Denk Giebel, Carina Abels, Silke Neusser, Bonnie Kampka, Kirstin Börchers, Jürgen Wasem, Nikola Blase
<p><strong>Background: </strong>Since their introduction with the Digital Care Act in 2019, selected digital health apps (DiGA) have been a part of the German statutory health care system. In order to become a DiGA, digital health apps have to complete a certification process covering both technical and evidence-related aspects. After completion, DiGA are added to the DiGA directory, containing a list of all reimbursable DiGA within German statutory health insurance. The first apps were added at the end of 2020, with the number steadily increasing. The novelty of this digital health care service and the fast implementation led to problems and barriers to optimal use along the way, which are studied from different stakeholder perspectives in this paper.</p><p><strong>Objective: </strong>The aim of this survey was to identify problems and barriers in the context of the admission, financing, and service provision of DiGA in the statutory health care system in Germany.</p><p><strong>Methods: </strong>We used semistructured expert interviews to evaluate the perspective of stakeholders of the German health care system on DiGA. The interview guide was developed according to Helfferich. The interviews were transcribed and analyzed using the qualitative content approach by Mayring, with the adjustments by Kuckartz. We conducted web-based interviews with stakeholders between February and June 2022. The stakeholder collective consisted of DiGA, statutory health insurance, physician, patient, technological, and quality assurance representatives.</p><p><strong>Results: </strong>To identify problems from stakeholder perspectives regarding the admission, financing, and service distribution of DiGA, 21 interviews were conducted. The interviewed stakeholders reported problems with the authorization of DiGA and the corresponding process, for example, the duration of the DiGA Fast Track process. DiGA prices and the different negotiation positions were criticized, and financial challenges for smaller DiGA manufacturers were noted. Another problem was seen in the reimbursement of DiGA, independent of actual use by the patients. Within service provision, the participants reported superordinate aspects, for example, the negative public perception of DiGA and negative statements from stakeholders. In relation to the direct care process, technical problems (eg, with activation codes or software surrounding DiGA prescription) and insufficient knowledge and skills on the side of the patients, as well as the medical providers, were mentioned.</p><p><strong>Conclusions: </strong>Digital health apps have the potential to improve health care by addressing health problems in new, innovative ways. Since the evidence-based and regulated use of this technology is relatively new, problems and barriers limiting the optimized, patient-centered use arose throughout the first years. This study provides an overview of problems and barriers in the context of DiGA in Germany from differen
背景：自2019年《数字医疗法案》推出以来，选定的数字健康应用程序（DiGA）已成为德国法定医疗保健系统的一部分。为了成为DiGA，数字健康应用程序必须完成一个涵盖技术和证据相关方面的认证过程。完成后，DiGA被添加到DiGA目录中，其中包含德国法定健康保险中所有可报销的DiGA列表。第一批应用程序于2020年底加入，数量稳步增长。这种数字医疗服务的新颖性和快速实施导致了优化使用过程中的问题和障碍，本文从不同利益相关者的角度对其进行了研究。目的：本调查的目的是确定在德国法定医疗保健系统中DiGA的准入、融资和服务提供的背景下存在的问题和障碍。方法：我们采用半结构化的专家访谈来评估德国医疗保健系统对DiGA的利益相关者的观点。面试指南是根据Helfferich的观点制定的。访谈记录由Mayring使用定性内容法进行转录和分析，并由Kuckartz进行调整。我们在2022年2月至6月期间对利益相关者进行了基于网络的访谈。涉众集体由DiGA、法定健康保险、医生、患者、技术和质量保证代表组成。结果：为了从利益相关者的角度确定DiGA的准入、融资和服务分配方面的问题，我们进行了21次访谈。受访的利益相关者报告了有关DiGA授权和相应流程的问题，例如，DiGA快速通道流程的持续时间。DiGA的价格和不同的谈判立场受到了批评，并指出了小型DiGA制造商面临的财务挑战。另一个问题是DiGA的报销，与患者的实际使用无关。在服务提供方面，参与者报告了上级方面，例如公众对DiGA的负面看法和利益相关者的负面陈述。在直接护理过程中，提到了技术问题（例如，与数字医疗信息系统处方相关的激活码或软件）以及患者和医疗提供者方面的知识和技能不足。结论：数字健康应用程序有潜力通过新的、创新的方式解决健康问题，改善医疗保健。由于这项技术的循证和规范使用相对较新，在最初几年出现了限制优化的、以患者为中心的使用的问题和障碍。本研究从不同利益相关者的角度概述了德国数字信息产业发展中的问题和障碍。然而，随着这些问题的不断解决，数字健康应用程序正趋向于成为德国医疗保健的一个贡献因素。由于其他国家对实施与德国类似的联邦监管方法表现出兴趣，因此可以从这项调查中得出有价值的启示。
{"title":"Problems and Barriers Regarding the Admission, Financing, and Service Provision of Digital Health Apps: Qualitative Stakeholder Survey.","authors":"Felix Plescher, Godwin Denk Giebel, Carina Abels, Silke Neusser, Bonnie Kampka, Kirstin Börchers, Jürgen Wasem, Nikola Blase","doi":"10.2196/73332","DOIUrl":"https://doi.org/10.2196/73332","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Since their introduction with the Digital Care Act in 2019, selected digital health apps (DiGA) have been a part of the German statutory health care system. In order to become a DiGA, digital health apps have to complete a certification process covering both technical and evidence-related aspects. After completion, DiGA are added to the DiGA directory, containing a list of all reimbursable DiGA within German statutory health insurance. The first apps were added at the end of 2020, with the number steadily increasing. The novelty of this digital health care service and the fast implementation led to problems and barriers to optimal use along the way, which are studied from different stakeholder perspectives in this paper.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this survey was to identify problems and barriers in the context of the admission, financing, and service provision of DiGA in the statutory health care system in Germany.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used semistructured expert interviews to evaluate the perspective of stakeholders of the German health care system on DiGA. The interview guide was developed according to Helfferich. The interviews were transcribed and analyzed using the qualitative content approach by Mayring, with the adjustments by Kuckartz. We conducted web-based interviews with stakeholders between February and June 2022. The stakeholder collective consisted of DiGA, statutory health insurance, physician, patient, technological, and quality assurance representatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;To identify problems from stakeholder perspectives regarding the admission, financing, and service distribution of DiGA, 21 interviews were conducted. The interviewed stakeholders reported problems with the authorization of DiGA and the corresponding process, for example, the duration of the DiGA Fast Track process. DiGA prices and the different negotiation positions were criticized, and financial challenges for smaller DiGA manufacturers were noted. Another problem was seen in the reimbursement of DiGA, independent of actual use by the patients. Within service provision, the participants reported superordinate aspects, for example, the negative public perception of DiGA and negative statements from stakeholders. In relation to the direct care process, technical problems (eg, with activation codes or software surrounding DiGA prescription) and insufficient knowledge and skills on the side of the patients, as well as the medical providers, were mentioned.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Digital health apps have the potential to improve health care by addressing health problems in new, innovative ways. Since the evidence-based and regulated use of this technology is relatively new, problems and barriers limiting the optimized, patient-centered use arose throughout the first years. This study provides an overview of problems and barriers in the context of DiGA in Germany from differen","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e73332"},"PeriodicalIF":6.0,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Feasibility of Smartwatch Micro-Ecological Momentary Assessment for Tracking Eating Patterns of Malaysian Children and Adolescents in the South-East Asian Community Observatory Child Health Update 2020: Cross-Sectional Study. 东南亚社区观察站儿童健康更新2020：横断面研究中，智能手表微生态瞬时评估用于跟踪马来西亚儿童和青少年饮食模式的可行性
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-06 DOI: 10.2196/73435
Richard Lane, Louise A C Millard, Ruth Salway, Chris J Stone, Andy L Skinner, Sophia M Brady, Jeevitha Mariapun, Sutha Rajakumar, Amutha Ramadas, Hussein Rizal, Laura Johnson, Tin Tin Su, Miranda Elaine Glynis Armstrong

Background: Mobile phone ecological momentary assessment (EMA) methods are a well-established measure of eating and drinking behaviors, but compliance can be poor. Micro-EMA (μEMA), which collects information with a single tap response to brief questions on smartwatches, offers a novel application that may improve response rates. To our knowledge, there is no data evaluating μEMA to measure eating habits in children or in low-to-middle-income countries.

Objective: In this study, we investigated the feasibility of micro-EMA to measure eating patterns in Malaysian children and adolescents.

Methods: We invited 100 children and adolescents aged 7-18 years in Segamat, Malaysia, to participate in 2021-2022. Smartwatches were distributed to 83 children and adolescents who agreed to participate. Participants were asked to wear the smartwatch for 8 days and respond to 12 prompts per day, hourly, from 9AM to 8PM, asking for information on their meals, snacks, and drinks consumed. A questionnaire captured their experiences using the smartwatch and μEMA interface. Response rate (proportion of prompts responded to) assessed participants' adherence. We explored associations between response rate with time of day, across days, age, and sex using multilevel binomial logistic regression modeling.

Results: Eighty-two participants provided usable smartwatch data. The median number (IQR) of meals, drinks, and snacks per day was 2 (2-4), 3 (1-5), and 1 (0-2), respectively, on the first day of the study. The median response rate across the study was 68% (IQR 50-83). The response rate decreased across study days from 74% (68-78) on Day 1 to 40% (30-50) on Day 7 (odds ratio [OR] per study day 0.73, 95% CI 0.64-0.83). Response rate was lowest at the start of the day and highest between the hours of 12 PM and 2 PM. Female participants responded to more prompts than male participants (OR 1.72, 95% CI 1.03-2.86). There was no evidence of differential response by age (OR 0.73, 95% CI 0.41-1.28). Most participants (65%) rated their experience using the smartwatch positively, with 33% saying they were happy to participate in future studies using the smartwatch. For children that did not wear the smartwatch for the full study duration (n=22), discomfort was the most common complaint (41%).

Conclusions: In this study of the feasibility of μEMA on smartwatches to measure eating in Malaysian children, we found the method was acceptable. However, response rates declined across study days, resulting in substantial missingness. Future studies (eg, through focus groups) should explore approaches to improving response to event prompts, trial alternative devices to increase children's comfort, and evaluate revised protocols for reporting of intake events.

背景：手机生态瞬时评估（EMA）方法是一种完善的饮食行为测量方法，但依从性可能较差。Micro-EMA （μEMA）是在智能手表上对简短的问题只需点击一下就能收集信息的应用程序，它提供了一种可以提高答复率的新应用程序。据我们所知，尚无数据评估μEMA在儿童或中低收入国家的饮食习惯。目的：在本研究中，我们探讨了微型ema测量马来西亚儿童和青少年饮食模式的可行性。方法：我们邀请了马来西亚西加马的100名7-18岁的儿童和青少年参加2021-2022年的活动。智能手表被分发给83名同意参与的儿童和青少年。参与者被要求佩戴智能手表8天，每天从早上9点到晚上8点，每小时回答12个提示，询问他们所消耗的膳食、零食和饮料的信息。一份调查问卷记录了他们使用智能手表和μEMA界面的体验。应答率（应答提示的比例）评估参与者的依从性。我们使用多水平二项逻辑回归模型探讨了反应率与一天中的时间、跨天、年龄和性别之间的关系。结果：82名参与者提供了可用的智能手表数据。在研究的第一天，每天用餐、饮料和零食的中位数（IQR）分别为2（2-4）、3（1-5）和1（0-2）。整个研究的中位缓解率为68% （IQR 50-83）。在整个研究期间，缓解率从第1天的74%（68-78）下降到第7天的40%(30-50)（每个研究日的优势比[OR]为0.73,95% CI为0.64-0.83）。回复率在一天开始时最低，在中午12点到下午2点之间最高。女性受试者对提示的反应多于男性受试者（OR 1.72, 95% CI 1.03-2.86）。没有证据表明不同年龄的患者有不同的反应（OR 0.73, 95% CI 0.41-1.28）。大多数参与者（65%）积极评价他们使用智能手表的体验，33%的人表示他们很乐意使用智能手表参与未来的研究。对于在整个研究期间没有佩戴智能手表的儿童（n=22），不适是最常见的抱怨（41%）。结论：在对智能手表上μEMA测量马来西亚儿童饮食的可行性研究中，我们发现该方法是可以接受的。然而，在整个学习期间，回复率下降，导致大量缺失。未来的研究（例如，通过焦点小组）应该探索改善对事件提示的反应的方法，试验替代设备以增加儿童的舒适度，并评估摄入事件报告的修订协议。
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引用次数: 0
Key Components and Barriers in Web-Based Suicide Prevention Gatekeeper Training: Systematic Narrative Review. 网络自杀预防看门人培训的关键组成部分和障碍：系统叙述回顾。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-05 DOI: 10.2196/81572
Olivier Ferlatte, Emmanuelle Gareau, Keven Lee, Kinda Wassef, John Lindsay Oliffe, Hannah Kia, Brock Dumville
<p><strong>Background: </strong>Gatekeeper training programs (GTPs) are a key component of contemporary suicide prevention strategies, equipping community members and non-mental health professionals with the skills to identify, engage with, and refer individuals at risk of suicide. Increasingly, these programs are delivered via the web, offering a compelling alternative to in-person training through greater scalability, flexibility, and cost-effectiveness. However, little consensus exists regarding the design, modes of delivery, and implementation strategies of web-based GTPs. Further, there is a limited understanding of which components affect their usability and engagement.</p><p><strong>Objective: </strong>This systematic narrative review aims to identify the key components-including facilitators and barriers-of web-based GTPs.</p><p><strong>Methods: </strong>We systematically searched web-based databases (CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science) to identify peer-reviewed articles published between 2000 and 2025 that involved web-based GTPs. After screening, 59 studies met the inclusion criteria and were analyzed using content analysis to identify key components and barriers affecting the delivery and receipt of web-based GTPs.</p><p><strong>Results: </strong>Results were organized under 3 categories: design, content, and pedagogy. Key design considerations emphasized accessibility for diverse learning styles and digital literacy levels, customizability for different user groups, privacy protection, and the long-term sustainability of training content and delivery platforms. Core training content covered four domains: (1) suicide-related knowledge (eg, prevalence, myths, and at-risk groups), (2) gatekeeping skills (eg, understanding risk factors, recognizing warning signs, problem-solving and safety planning), (3) resource awareness (eg, available local resources and referral procedures), and (4) general mental health education (eg, mental fitness, mindfulness, and self-care strategies for gatekeepers). In terms of pedagogy, the reviewed studies used a wide range of strategies that comprised interactive learning activities (eg, simulation, practice exercises), periodic knowledge checks (eg, quizzes), and reinforcement mechanisms (eg, booster sessions). Additionally, fostering a sense of community (eg, online support spaces or discussion forums) and promoting trainees' autonomy (eg, self-paced training) were highlighted as key components of training delivery.</p><p><strong>Conclusions: </strong>Web-based GTPs represent a promising avenue for expanding access to suicide prevention training. Their effectiveness may be strengthened through the integration of frameworks tailored to web-based learning environments, as well as interactive and user-centered design elements that support learning and retention. Future research should examine the acceptability, feasibility, and sustainability of these programs, while also refining their ada
背景：看门人培训计划（GTPs）是当代自杀预防策略的关键组成部分，使社区成员和非精神卫生专业人员具备识别、接触和转诊自杀风险个体的技能。这些课程越来越多地通过网络交付，通过更大的可扩展性、灵活性和成本效益，提供了面对面培训的引人注目的替代方案。然而，关于基于web的gtp的设计、交付模式和实施策略，几乎没有达成共识。此外，对于哪些组件会影响其可用性和用户粘性的理解也很有限。目的：这篇系统的叙述性综述旨在确定基于网络的gtp的关键组成部分，包括促进因素和障碍。方法：我们系统地检索了基于Web的数据库（CINAHL、Embase、MEDLINE、PsycINFO和Web of Science），以确定2000年至2025年间发表的涉及基于Web的gtp的同行评议文章。筛选后，59项研究符合纳入标准，并使用内容分析来确定影响基于web的gtp交付和接收的关键组成部分和障碍。结果：结果分为设计、内容和教学三大类。关键的设计考虑强调了不同学习方式和数字素养水平的可访问性、不同用户群体的可定制性、隐私保护以及培训内容和交付平台的长期可持续性。核心培训内容涵盖四个领域：(1)自杀相关知识（例如，流行、误解和高危人群）；(2)把关技能（例如，了解风险因素、识别警告信号、解决问题和安全规划）；(3)资源意识（例如，可用的当地资源和转诊程序）；(4)一般心理健康教育（例如，把关人的心理健康、正念和自我保健策略）。在教学法方面，所审查的研究使用了广泛的策略，包括互动学习活动（例如，模拟，练习），定期知识检查（例如，测验）和强化机制（例如，助推器会议）。此外，培养社区意识（例如，在线支持空间或讨论论坛）和促进学员的自主权（例如，自定进度培训）被强调为培训交付的关键组成部分。结论：基于网络的gtp代表了一个有希望的途径，以扩大获得自杀预防培训。通过整合为基于网络的学习环境量身定制的框架，以及支持学习和保留的交互式和以用户为中心的设计元素，可以加强其有效性。未来的研究应该检查这些项目的可接受性、可行性和可持续性，同时也要改进它们对不同人群的适应性。在这方面，协同设计方法可以促进根据目标人群的需求和具体情况定制此类方案。总体而言，加强基于网络的gtp的设计和交付可能最终改善其对自杀预防工作的贡献。
{"title":"Key Components and Barriers in Web-Based Suicide Prevention Gatekeeper Training: Systematic Narrative Review.","authors":"Olivier Ferlatte, Emmanuelle Gareau, Keven Lee, Kinda Wassef, John Lindsay Oliffe, Hannah Kia, Brock Dumville","doi":"10.2196/81572","DOIUrl":"https://doi.org/10.2196/81572","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Gatekeeper training programs (GTPs) are a key component of contemporary suicide prevention strategies, equipping community members and non-mental health professionals with the skills to identify, engage with, and refer individuals at risk of suicide. Increasingly, these programs are delivered via the web, offering a compelling alternative to in-person training through greater scalability, flexibility, and cost-effectiveness. However, little consensus exists regarding the design, modes of delivery, and implementation strategies of web-based GTPs. Further, there is a limited understanding of which components affect their usability and engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This systematic narrative review aims to identify the key components-including facilitators and barriers-of web-based GTPs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We systematically searched web-based databases (CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science) to identify peer-reviewed articles published between 2000 and 2025 that involved web-based GTPs. After screening, 59 studies met the inclusion criteria and were analyzed using content analysis to identify key components and barriers affecting the delivery and receipt of web-based GTPs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Results were organized under 3 categories: design, content, and pedagogy. Key design considerations emphasized accessibility for diverse learning styles and digital literacy levels, customizability for different user groups, privacy protection, and the long-term sustainability of training content and delivery platforms. Core training content covered four domains: (1) suicide-related knowledge (eg, prevalence, myths, and at-risk groups), (2) gatekeeping skills (eg, understanding risk factors, recognizing warning signs, problem-solving and safety planning), (3) resource awareness (eg, available local resources and referral procedures), and (4) general mental health education (eg, mental fitness, mindfulness, and self-care strategies for gatekeepers). In terms of pedagogy, the reviewed studies used a wide range of strategies that comprised interactive learning activities (eg, simulation, practice exercises), periodic knowledge checks (eg, quizzes), and reinforcement mechanisms (eg, booster sessions). Additionally, fostering a sense of community (eg, online support spaces or discussion forums) and promoting trainees' autonomy (eg, self-paced training) were highlighted as key components of training delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Web-based GTPs represent a promising avenue for expanding access to suicide prevention training. Their effectiveness may be strengthened through the integration of frameworks tailored to web-based learning environments, as well as interactive and user-centered design elements that support learning and retention. Future research should examine the acceptability, feasibility, and sustainability of these programs, while also refining their ada","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e81572"},"PeriodicalIF":6.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interactions of Technology and Obsessive-Compulsive Disorder Symptomatology in Adults: Qualitative Interview Study. 技术与成人强迫症症状学的相互作用：定性访谈研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-05 DOI: 10.2196/85033
Lucas Occhino-Moede, Kaitlyn Sulivan-Pascual, Kendall Phelan, Harrison Wang, Daniel Mokhtar, Elisa Liu, Erica Schug, Megan Mirkis, Thomas Baek, Tamerlane Visher, Ujjwal Pasupulety, Adam Charles Frank
<p><strong>Background: </strong>Obsessive-compulsive disorder (OCD) affects 1%-3% of the population and is marked by intrusive obsessions and compulsive behaviors that impair daily functioning. As digital technologies have become ubiquitous, their features may interact with OCD symptom dimensions in ways that both exacerbate and alleviate symptoms. While case reports and clinical anecdotes suggest such interactions, systematic investigation of patients' lived experiences with technology remains limited.</p><p><strong>Objective: </strong>This study aimed to explore how individuals with OCD perceive and navigate their interactions with modern technologies, and to identify how specific features of technology may contribute to, reinforce, or relieve obsessive-compulsive symptom cycles.</p><p><strong>Methods: </strong>We conducted semistructured interviews (n=24) with adults self-reporting a diagnosis of OCD, recruited through online OCD communities and advocacy networks. Interviews were conducted via the HIPAA (Health Insurance Portability and Accountability Act)-compliant platform Zoom (Zoom Communications) between May and December 2024 (median duration 51, IQR 6.5 minutes). Transcripts were coded in Dedoose (version 9.2.22; SocioCultural Research Consultants) using a constructivist grounded theory approach. Coding proceeded iteratively through open and focused coding, with theoretical saturation reached after 15 interviews. Constant comparison and analytic memoing guided the development of a conceptual framework linking technology features to OCD symptom dimensions.</p><p><strong>Results: </strong>Participants (median age 26, IQR 12.8, range 20-64 years; 67%, 16/24 women, 29%, 7/24 men, and 4%, 1/24 nonbinary) described technology as both a trigger for and a coping tool against OCD symptoms. Analysis produced four central technology-related categories: (1) information-provision platforms (eg, social media, search engines, large language models, etc) that triggered disturbing-thought obsessions and enabled compulsive checking and reassurance-seeking; (2) gamification and quantification features (eg, streaks, progress bars, and tracking metrics) that reinforced "not-just-right" and symmetry-based compulsions; (3) notifications that provoked urges to clear, check, and maintain control, spanning both disturbing-thought and symmetry domains; and (4) user interfaces whose complexity and customizability elicited compulsive ordering, avoidance behaviors, and digital overwhelm.</p><p><strong>Conclusions: </strong>This study characterizes how interactions between OCD and digital technologies manifest across established symptom domains, most notably disturbing-thought and "not-just-right" categories. Participants overwhelmingly experienced compulsive checking, reassurance-seeking, and ordering behaviors reinforced by features such as information-provision, gamification, notifications, and user interfaces. These findings highlight the clinical relevance of tec
背景：强迫症（OCD）影响1%-3%的人口，其特征是侵入性的强迫和强迫行为，损害日常功能。随着数字技术变得无处不在，它们的特征可能以加重或减轻症状的方式与强迫症症状维度相互作用。虽然病例报告和临床轶事表明了这种相互作用，但对患者与技术的生活经历的系统调查仍然有限。目的：本研究旨在探讨强迫症患者如何感知和驾驭他们与现代技术的互动，并确定技术的特定特征如何有助于、加强或缓解强迫症症状周期。方法：我们进行了半结构化访谈（n=24），受访对象是通过在线强迫症社区和倡导网络招募的自我报告强迫症诊断的成年人。访谈于2024年5月至12月期间通过符合HIPAA（健康保险流通与责任法案）的平台Zoom （Zoom通信）进行（中位数持续时间51，IQR 6.5分钟）。在Dedoose（版本9.2.22；社会文化研究顾问）中使用建构主义扎根理论方法对成绩单进行编码。通过开放和集中的编码进行迭代，在15次访谈后达到理论饱和。不断的比较和分析备忘录指导了将技术特征与强迫症症状维度联系起来的概念框架的发展。结果：参与者（中位年龄26岁，IQR 12.8，范围20-64岁；67%，16/24女性，29%，7/24男性，4%，1/24非二元）将技术描述为强迫症症状的触发和应对工具。分析产生了四个与技术相关的核心类别：(1)信息提供平台（如社交媒体、搜索引擎、大型语言模型等），这些平台引发了令人不安的思想困扰，并使强迫性检查和寻求安慰成为可能；(2)游戏化和量化功能（如条纹、进度条和跟踪指标），强化“不正确”和基于对称的强迫；(3)引起清理、检查和维持控制冲动的通知，跨越干扰思想和对称域；(4)用户界面的复杂性和可定制性引发了强迫性订购、回避行为和数字淹没。结论：这项研究描述了强迫症和数字技术之间的相互作用是如何在已建立的症状领域中表现出来的，最明显的是令人不安的想法和“不正确”的类别。绝大多数参与者都经历了强迫性检查、寻求安慰和订购行为，这些行为被信息提供、游戏化、通知和用户界面等功能所强化。这些发现强调了与技术相关的强迫行为的临床相关性，并建议对其进行系统评估，将其纳入心理教育，并在数字设计中加以考虑。
{"title":"Interactions of Technology and Obsessive-Compulsive Disorder Symptomatology in Adults: Qualitative Interview Study.","authors":"Lucas Occhino-Moede, Kaitlyn Sulivan-Pascual, Kendall Phelan, Harrison Wang, Daniel Mokhtar, Elisa Liu, Erica Schug, Megan Mirkis, Thomas Baek, Tamerlane Visher, Ujjwal Pasupulety, Adam Charles Frank","doi":"10.2196/85033","DOIUrl":"10.2196/85033","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obsessive-compulsive disorder (OCD) affects 1%-3% of the population and is marked by intrusive obsessions and compulsive behaviors that impair daily functioning. As digital technologies have become ubiquitous, their features may interact with OCD symptom dimensions in ways that both exacerbate and alleviate symptoms. While case reports and clinical anecdotes suggest such interactions, systematic investigation of patients' lived experiences with technology remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore how individuals with OCD perceive and navigate their interactions with modern technologies, and to identify how specific features of technology may contribute to, reinforce, or relieve obsessive-compulsive symptom cycles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted semistructured interviews (n=24) with adults self-reporting a diagnosis of OCD, recruited through online OCD communities and advocacy networks. Interviews were conducted via the HIPAA (Health Insurance Portability and Accountability Act)-compliant platform Zoom (Zoom Communications) between May and December 2024 (median duration 51, IQR 6.5 minutes). Transcripts were coded in Dedoose (version 9.2.22; SocioCultural Research Consultants) using a constructivist grounded theory approach. Coding proceeded iteratively through open and focused coding, with theoretical saturation reached after 15 interviews. Constant comparison and analytic memoing guided the development of a conceptual framework linking technology features to OCD symptom dimensions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants (median age 26, IQR 12.8, range 20-64 years; 67%, 16/24 women, 29%, 7/24 men, and 4%, 1/24 nonbinary) described technology as both a trigger for and a coping tool against OCD symptoms. Analysis produced four central technology-related categories: (1) information-provision platforms (eg, social media, search engines, large language models, etc) that triggered disturbing-thought obsessions and enabled compulsive checking and reassurance-seeking; (2) gamification and quantification features (eg, streaks, progress bars, and tracking metrics) that reinforced \"not-just-right\" and symmetry-based compulsions; (3) notifications that provoked urges to clear, check, and maintain control, spanning both disturbing-thought and symmetry domains; and (4) user interfaces whose complexity and customizability elicited compulsive ordering, avoidance behaviors, and digital overwhelm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study characterizes how interactions between OCD and digital technologies manifest across established symptom domains, most notably disturbing-thought and \"not-just-right\" categories. Participants overwhelmingly experienced compulsive checking, reassurance-seeking, and ordering behaviors reinforced by features such as information-provision, gamification, notifications, and user interfaces. These findings highlight the clinical relevance of tec","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e85033"},"PeriodicalIF":6.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Communicative Behaviors in an Internet-Based Intervention for Individuals With Autism: Mixed Methods Analysis. 基于互联网的自闭症个体交流行为干预：混合方法分析。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-04 DOI: 10.2196/76527
Britta Westerberg, Karin Jacobson, Maria Unenge Hallerbäck, Susanne Bejerot, Fredrik Holländare

Background: To meet the needs of individuals diagnosed with autism, internet-based interventions have been developed with a variety of objectives. A deeper understanding of the mechanisms of change may help tailor interventions to individual needs. The communicative behaviors of individuals with autism participating in text-based internet-based interventions remain largely unexplored, as do their potential relations to clinical outcomes. An improved understanding of participants' behaviors may help therapists better tailor support, promote engagement, and enhance treatment outcomes.

Objective: This study aimed to explore the communicative behaviors of individuals with autism participating in an internet-based intervention and to examine whether different behavioral patterns were associated with treatment outcomes or treatment adherence.

Methods: Messages from 34 participants enrolled in an 18-week internet-based cognitive behavioral therapy program were analyzed using abductive qualitative content analysis. Correlational analyses were used to examine the relationships between qualitative categories and change scores on outcome measures and rates of module completion.

Results: Fourteen behavioral categories were identified and grouped into three overarching domains: (1) "This is me," which encompasses the participants' narratives on identity, personality, autistic functioning, current and past circumstances, and worldview; (2) "Working with the treatment," which included statements related to engagement with the treatment process; and (3) "I struggle," which comprised of past and present negative experiences and challenges. Correlational analyses revealed associations between several behavioral categories and improvements in quality of life and treatment adherence.

Conclusions: The findings highlight the importance of self-narrative formulation among individuals with autism and suggest that certain communicative behaviors-particularly those involving identity reflection and recognition of treatment-related gains-were positively associated with therapeutic outcomes. The findings enhance our understanding of how individuals with autism engage in internet-based cognitive behavioral therapy and may serve as a valuable source of information for therapists when guiding expectations regarding client outcomes and identifying participants who may benefit from additional support.

Trial registration: ClinicalTrials.gov NCT03570372; https://clinicaltrials.gov/study/NCT03570372.

背景：为了满足被诊断为自闭症的个体的需求，基于互联网的干预措施已经被开发出来，目的多种多样。对变化机制的更深入了解可能有助于根据个人需求量身定制干预措施。参与基于文本的互联网干预的自闭症个体的交流行为在很大程度上仍未被探索，它们与临床结果的潜在关系也是如此。对参与者行为的更好理解可以帮助治疗师更好地定制支持，促进参与，并提高治疗效果。目的：本研究旨在探讨参与网络干预的自闭症个体的交流行为，并检验不同的行为模式是否与治疗结果或治疗依从性相关。方法：采用溯因定性内容分析，对34名参加为期18周的网络认知行为治疗项目的参与者的信息进行分析。相关分析用于检验定性类别与结果测量和模块完成率的变化分数之间的关系。结果：确定了14种行为类别，并将其分为三个主要领域：(1)“这就是我”，包括参与者对身份、个性、自闭症功能、当前和过去情况以及世界观的叙述；(2)“与治疗一起工作”，包括与参与治疗过程有关的陈述；(3)“我挣扎”，包括过去和现在的负面经历和挑战。相关分析揭示了几种行为类别与生活质量改善和治疗依从性之间的关联。结论：研究结果强调了自闭症患者自我叙述形成的重要性，并表明某些交流行为——特别是那些涉及身份反思和对治疗相关成果的认识的行为——与治疗结果呈正相关。这些发现增强了我们对自闭症患者如何参与基于互联网的认知行为治疗的理解，并且可以作为治疗师在指导对客户结果的期望和确定可能从额外支持中受益的参与者时的宝贵信息来源。试验注册：ClinicalTrials.gov NCT03570372；https://clinicaltrials.gov/study/NCT03570372。
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引用次数: 0
Digital Phenotyping for Adolescent Mental Health: Feasibility Study Using Machine Learning to Predict Mental Health Risk From Active and Passive Smartphone Data. 青少年心理健康的数字表型：利用机器学习从主动和被动智能手机数据预测心理健康风险的可行性研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-02-04 DOI: 10.2196/72501
Balasundaram Kadirvelu, Teresa Bellido Bel, Aglaia Freccero, Martina Di Simplico, Dasha Nicholls, A Aldo Faisal
<p><strong>Background: </strong>Adolescents are particularly vulnerable to mental disorders, with over 75% of lifetime cases emerging before the age of 25 years. Yet most young people with significant symptoms do not seek support. Digital phenotyping, leveraging active (self-reported) and passive (sensor-based) data from smartphones, offers a scalable, low-burden approach for early risk detection. Despite this potential, its application in school-going adolescents from general (nonclinical) populations remains limited, leaving a critical gap in community-based prevention efforts.</p><p><strong>Objective: </strong>This study evaluated the feasibility of using a smartphone app to predict mental health risks in nonclinical adolescents by integrating active and passive data streams within a machine learning (ML) framework. We examined the utility of this approach for identifying risks related to internalizing and externalizing difficulties, eating disorders, insomnia, and suicidal ideation.</p><p><strong>Methods: </strong>Participants (n=103; mean age 16.1 years, SD 1.0) from 3 UK secondary schools used the Mindcraft app (Brain and Behaviour Lab) for 14 days, providing daily self-reports (eg, mood, sleep, and loneliness) and continuous passive sensor data (eg, location, step count, and app usage). We developed a deep learning model incorporating contrastive pretraining with triplet margin loss to stabilize user-specific behavioral patterns, followed by supervised fine-tuning for binary classification of 4 mental health outcomes, namely, the Strengths and Difficulties Questionnaire (SDQ)-high risk, insomnia, suicidal ideation, and eating disorder. Performance was assessed using leave-one-subject-out cross-validation (LOSO-CV), with balanced accuracy as the primary metric. Comparative analyses were conducted using CatBoost (Yandex) and multilayer perceptron (MLP) models without pretraining. Feature importance was assessed using Shapley Additive Explanations (SHAP) values, and associations between key digital features and clinical scales were analyzed.</p><p><strong>Results: </strong>Integration of active and passive data outperformed single-modality models, achieving mean balanced accuracies of 0.71 (0.03) for SDQ-high risk, 0.67 (0.04) for insomnia, 0.77 (0.03) for suicidal ideation, and 0.70 (0.03) for eating disorder. The contrastive learning approach improved representation stability and predictive robustness. SHAP analysis highlighted clinically relevant features, such as negative thinking and location entropy, underscoring the complementary value of combining subjective and objective data. Correlation analyses confirmed meaningful associations between key digital features and mental health outcomes. Performance in an independent external validation cohort (n=45) achieved balanced accuracies of 0.63-0.72 across outcomes, suggesting generalizability to new settings.</p><p><strong>Conclusions: </strong>This study demonstrates the feasibility and uti
背景：青少年特别容易受到精神障碍的影响，超过75%的终生病例出现在25岁之前。然而，大多数有明显症状的年轻人并不寻求帮助。利用智能手机主动（自我报告）和被动（基于传感器）数据的数字表型，为早期风险检测提供了一种可扩展、低负担的方法。尽管有这种潜力，但它在普通（非临床）人群中学龄青少年中的应用仍然有限，在以社区为基础的预防工作中留下了重大空白。目的：本研究通过在机器学习（ML）框架内整合主动和被动数据流，评估使用智能手机应用程序预测非临床青少年心理健康风险的可行性。我们研究了这种方法在识别与内在化和外在化困难、饮食失调、失眠和自杀意念相关的风险方面的效用。方法：来自3所英国中学的参与者（n=103，平均年龄16.1岁，SD 1.0）使用Mindcraft应用程序（大脑和行为实验室）14天，提供每日自我报告（如情绪、睡眠和孤独感）和连续的被动传感器数据（如位置、步数和应用程序使用情况）。我们开发了一个深度学习模型，将对比预训练与三联体边际损失相结合，以稳定用户特定的行为模式，然后对4种心理健康结果进行监督微调，即优势和困难问卷(SDQ)-高风险，失眠，自杀意念和饮食失调。使用留一受试者的交叉验证（LOSO-CV）评估效果，以平衡准确性为主要指标。使用CatBoost （Yandex）和未经预训练的多层感知器（MLP）模型进行比较分析。使用Shapley加性解释（SHAP）值评估特征重要性，并分析关键数字特征与临床量表之间的关联。结果：主动和被动数据的整合优于单模态模型，sdq -高风险的平均平衡精度为0.71(0.03)，失眠的平均平衡精度为0.67(0.04)，自杀意念的平均平衡精度为0.77(0.03)，饮食失调的平均平衡精度为0.70（0.03）。对比学习方法提高了表征稳定性和预测鲁棒性。SHAP分析突出了消极思维、位置熵等临床相关特征，强调主客观数据相结合的互补价值。相关分析证实了关键数字特征与心理健康结果之间有意义的关联。在独立的外部验证队列（n=45）中，各结果的准确性达到了0.63-0.72的平衡，表明了对新设置的可推广性。结论：本研究证明了基于智能手机的数字表型预测非临床学龄期青少年心理健康风险的可行性和实用性。通过将主动和被动数据与先进的机器建模技术相结合，该方法有望在社区环境中进行早期检测和可扩展的干预策略。
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