Elizabeth A Lynch, Adrian O'Malley, Zoe Adey-Wakeling, Billie Bonevski, Dominique A Cadilhac, Saran Chamberlain, Leonid Churilov, Robyn Clark, Richard Cullen, Erin Godecke, Gillian Harvey, Fiona Jones, Natasha A Lannin, Stacy Larcombe, Jarrad Law, Annette McGrath, Lisa Murphy, Katie Nesbitt, Karly Zacharia, Niranjan Bidargaddi, Coralie English
<p><strong>Background: </strong>Digital health innovations are frequently used to support people in managing chronic health conditions. Stroke is common, and people who have survived a stroke and live in the community must learn to manage their health independently. Digital tools can help, but only if designed to match survivors' specific needs. In response to a need expressed by people living with chronic health conditions, the Australian government created a funding stream to support the development of a digital resource to help individuals gain confidence in managing their health.</p><p><strong>Objective: </strong>This study aimed to co-design a digital resource to promote self-efficacy to manage life after stroke in community-dwelling survivors of stroke.</p><p><strong>Methods: </strong>Co-design methodology, which emphasized meaningful engagement with intended end-users throughout the design of the website, was used. The project steering group comprised health professional researchers, digital designers, people with lived experience of stroke (survivors and carers), and representatives from the Stroke Foundation (Australia). A systematic review was conducted to inform the core components of the resource. A lived experience workgroup was convened to advise on features of the digital resource and aspects of its evaluation. Iterative review stages and frequent consultation between the steering group and the lived experience workgroup occurred. Online and in-person usability testing was conducted with survivors and carers.</p><p><strong>Results: </strong>The lived experience workgroup (workgroup) initially comprised 14 survivors and 1 carer. In total, 11 survivors and 1 carer remained engaged throughout the co-design period. One workgroup member was invited to join the steering group and co-facilitated all co-design workgroup meetings. Defining features of the digital resource were identified by the steering group and the workgroup, including that the resource would be a website that augmented (not reproduced) existing resources, and it needed to be accessible to survivors of stroke with communication changes. Website specifications were determined by the workgroup and included that information needed to be tailored to the individual user, and specific accessibility features were recommended. The workgroup prioritized what content to include on the website and recommended the creation of video stories by Australian survivors and carers. A resource-tailoring tool was created so information could be individualized to the interests of the website user. Overall, 9 web pages containing high-priority content were created, comprising text, video stories, and a downloadable PDF that summarized key information for that page. More than 150 short video stories were created by 26 survivors of stroke and 10 carers for the website. Usability testing indicated that the website was more usable than 83% of all websites.</p><p><strong>Conclusions: </strong>Authen
{"title":"Creation of EmpowerMe Website to Promote Self-Efficacy in Survivors of Stroke: Co-Design Study.","authors":"Elizabeth A Lynch, Adrian O'Malley, Zoe Adey-Wakeling, Billie Bonevski, Dominique A Cadilhac, Saran Chamberlain, Leonid Churilov, Robyn Clark, Richard Cullen, Erin Godecke, Gillian Harvey, Fiona Jones, Natasha A Lannin, Stacy Larcombe, Jarrad Law, Annette McGrath, Lisa Murphy, Katie Nesbitt, Karly Zacharia, Niranjan Bidargaddi, Coralie English","doi":"10.2196/76756","DOIUrl":"https://doi.org/10.2196/76756","url":null,"abstract":"<p><strong>Background: </strong>Digital health innovations are frequently used to support people in managing chronic health conditions. Stroke is common, and people who have survived a stroke and live in the community must learn to manage their health independently. Digital tools can help, but only if designed to match survivors' specific needs. In response to a need expressed by people living with chronic health conditions, the Australian government created a funding stream to support the development of a digital resource to help individuals gain confidence in managing their health.</p><p><strong>Objective: </strong>This study aimed to co-design a digital resource to promote self-efficacy to manage life after stroke in community-dwelling survivors of stroke.</p><p><strong>Methods: </strong>Co-design methodology, which emphasized meaningful engagement with intended end-users throughout the design of the website, was used. The project steering group comprised health professional researchers, digital designers, people with lived experience of stroke (survivors and carers), and representatives from the Stroke Foundation (Australia). A systematic review was conducted to inform the core components of the resource. A lived experience workgroup was convened to advise on features of the digital resource and aspects of its evaluation. Iterative review stages and frequent consultation between the steering group and the lived experience workgroup occurred. Online and in-person usability testing was conducted with survivors and carers.</p><p><strong>Results: </strong>The lived experience workgroup (workgroup) initially comprised 14 survivors and 1 carer. In total, 11 survivors and 1 carer remained engaged throughout the co-design period. One workgroup member was invited to join the steering group and co-facilitated all co-design workgroup meetings. Defining features of the digital resource were identified by the steering group and the workgroup, including that the resource would be a website that augmented (not reproduced) existing resources, and it needed to be accessible to survivors of stroke with communication changes. Website specifications were determined by the workgroup and included that information needed to be tailored to the individual user, and specific accessibility features were recommended. The workgroup prioritized what content to include on the website and recommended the creation of video stories by Australian survivors and carers. A resource-tailoring tool was created so information could be individualized to the interests of the website user. Overall, 9 web pages containing high-priority content were created, comprising text, video stories, and a downloadable PDF that summarized key information for that page. More than 150 short video stories were created by 26 survivors of stroke and 10 carers for the website. Usability testing indicated that the website was more usable than 83% of all websites.</p><p><strong>Conclusions: </strong>Authen","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e76756"},"PeriodicalIF":6.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433663","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}
Ruwen Liu, Sirui Zhang, Yi Xiao, Yangfan Cheng, Huifang Shang
<p><strong>Background: </strong>Parkinson disease (PD) is a progressive neurodegenerative disorder with increasing global prevalence, necessitating innovative management. Digital health interventions (DHIs) offer potential advantages for PD care; yet, a comprehensive systematic review and synthesis across all DHI types and core outcomes is still lacking.</p><p><strong>Objective: </strong>This review aimed to assess the effectiveness of DHIs for improving motor symptoms, nonmotor symptoms, and quality of life in patients with PD and to summarize the reach, uptake, and feasibility.</p><p><strong>Methods: </strong>We searched PubMed, Ovid Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, and APA PsycINFO up to November 2025. Pooled standardized mean differences (SMDs) were calculated using random-effects models. We calculated 95% prediction intervals (PIs) to estimate the true effects. The revised Cochrane Risk of Bias 2 tool was used to assess risk of bias. Heterogeneity was assessed using I<sup>2</sup>, τ<sup>2</sup>, and 95% PI. Subgroup analyses, meta-regression, and sensitivity analyses were conducted to address heterogeneity and potential bias. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).</p><p><strong>Results: </strong>The review included 112 randomized controlled trials involving 5594 participants. Significant postintervention improvements were identified in motor symptoms (SMD=-0.39, 95% CI -0.60 to -0.18, 95% PI -1.75 to 0.99; I<sup>2</sup>=80.3%) and overall nonmotor symptoms (SMD=-0.26, 95% CI -0.49 to -0.03, 95% PI -0.56 to 0.03; I<sup>2</sup>=13.8%), including cognitive function (SMD=0.47, 95% CI 0.22 to 0.72, 95% PI -0.41 to 1.35; I<sup>2</sup>=63.5%) and psychiatric symptoms (SMD=-0.42, 95% CI -0.74 to -0.09, 95% PI -1.82 to -0.99; I<sup>2</sup>=85.4%); however, there was no significant enhancement in quality of life (SMD=-0.19, 95% CI -0.47 to 0.09, 95% PI -1.50 to 1.12; I<sup>2</sup>=81.2%). The certainty of evidence was very low for quality of life, motor, and psychiatric symptoms and low for cognitive function and overall nonmotor symptoms. Improvements in motor symptoms and cognitive function remained stable at follow-up. Meta-regression analysis indicated that age, percentage of female participants, and supervision mode were possible sources of heterogeneity. Overall, 94 studies reported reach (median 37.5%), 38 reported fidelity (95.7%), and 105 reported dropout rates (9.1%).</p><p><strong>Conclusions: </strong>In contrast to previous reviews focused on single technologies or outcomes, this review provided the first comprehensive synthesis across all DHI types on multiple outcomes and indicated their potential as nonpharmacological interventions for PD management. However, current evidence is of low to very low certainty, and wide 95% PIs, together with high risk of bias and substantial heterogeneity, indicate considerable u
背景：帕金森病（PD）是一种进行性神经退行性疾病，全球患病率不断上升，需要创新的治疗方法。数字健康干预（DHIs）为PD护理提供了潜在的优势；然而，仍然缺乏对所有DHI类型和核心结果的全面系统审查和综合。目的：本综述旨在评估DHIs在改善PD患者运动症状、非运动症状和生活质量方面的有效性，并总结其范围、吸收和可行性。方法：检索PubMed， Ovid Embase, Web of Science， CINAHL, Cochrane Central Register of Controlled Trials， APA PsycINFO至2025年11月。采用随机效应模型计算合并标准化平均差（SMDs）。我们计算了95%的预测区间（pi）来估计真实效果。采用修订后的Cochrane Risk of Bias 2工具评估偏倚风险。采用I2、τ2和95% PI评估异质性。进行亚组分析、meta回归和敏感性分析以解决异质性和潜在偏倚。使用GRADE（建议评估、发展和评价分级）评估证据质量。结果：纳入112项随机对照试验，涉及5594名受试者。干预后运动症状（SMD=-0.39, 95% CI -0.60至-0.18,95% PI -1.75至0.99,I2=80.3%）和整体非运动症状（SMD=-0.26, 95% CI -0.49至-0.03,95% PI -0.56至0.03,I2=13.8%），包括认知功能（SMD=0.47, 95% CI 0.22至0.72,95% PI -0.41至1.35,I2=63.5%）和精神症状（SMD=-0.42, 95% CI -0.74至-0.09,95% PI -1.82至-0.99,I2=85.4%）；然而，生活质量没有显著提高（SMD=-0.19, 95% CI -0.47 ~ 0.09, 95% PI -1.50 ~ 1.12, I2=81.2%）。证据的确定性在生活质量、运动和精神症状方面非常低，在认知功能和整体非运动症状方面也很低。运动症状和认知功能的改善在随访中保持稳定。meta回归分析显示，年龄、女性参与者百分比和监督模式是可能的异质性来源。总体而言，94项研究报告了覆盖率（中位数37.5%），38项研究报告了保真度（95.7%），105项研究报告了辍学率（9.1%）。结论：与以往关注单一技术或结果的综述相反，本综述首次全面综合了所有DHI类型的多种结果，并指出了它们作为PD治疗的非药物干预措施的潜力。然而，目前的证据是低到非常低的确定性，95%的pi宽，加上高偏倚风险和大量异质性，表明未来实施的真实效果存在相当大的不确定性。因此，研究结果应谨慎解读。这些发现为指导未来研究的设计和优先排序提供了综合证据。研究结果具有重要的现实意义，支持谨慎实施，同时强调需要进行更有力的试验，特别是在资源有限的情况下。试验注册：PROSPERO CRD42023492123；https://www.crd.york.ac.uk/PROSPERO/view/CRD42023492123。
{"title":"The Effects of Digital Health Interventions on Motor Symptoms, Nonmotor Symptoms, and Quality of Life in Patients With Parkinson Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Ruwen Liu, Sirui Zhang, Yi Xiao, Yangfan Cheng, Huifang Shang","doi":"10.2196/79935","DOIUrl":"https://doi.org/10.2196/79935","url":null,"abstract":"<p><strong>Background: </strong>Parkinson disease (PD) is a progressive neurodegenerative disorder with increasing global prevalence, necessitating innovative management. Digital health interventions (DHIs) offer potential advantages for PD care; yet, a comprehensive systematic review and synthesis across all DHI types and core outcomes is still lacking.</p><p><strong>Objective: </strong>This review aimed to assess the effectiveness of DHIs for improving motor symptoms, nonmotor symptoms, and quality of life in patients with PD and to summarize the reach, uptake, and feasibility.</p><p><strong>Methods: </strong>We searched PubMed, Ovid Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, and APA PsycINFO up to November 2025. Pooled standardized mean differences (SMDs) were calculated using random-effects models. We calculated 95% prediction intervals (PIs) to estimate the true effects. The revised Cochrane Risk of Bias 2 tool was used to assess risk of bias. Heterogeneity was assessed using I<sup>2</sup>, τ<sup>2</sup>, and 95% PI. Subgroup analyses, meta-regression, and sensitivity analyses were conducted to address heterogeneity and potential bias. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).</p><p><strong>Results: </strong>The review included 112 randomized controlled trials involving 5594 participants. Significant postintervention improvements were identified in motor symptoms (SMD=-0.39, 95% CI -0.60 to -0.18, 95% PI -1.75 to 0.99; I<sup>2</sup>=80.3%) and overall nonmotor symptoms (SMD=-0.26, 95% CI -0.49 to -0.03, 95% PI -0.56 to 0.03; I<sup>2</sup>=13.8%), including cognitive function (SMD=0.47, 95% CI 0.22 to 0.72, 95% PI -0.41 to 1.35; I<sup>2</sup>=63.5%) and psychiatric symptoms (SMD=-0.42, 95% CI -0.74 to -0.09, 95% PI -1.82 to -0.99; I<sup>2</sup>=85.4%); however, there was no significant enhancement in quality of life (SMD=-0.19, 95% CI -0.47 to 0.09, 95% PI -1.50 to 1.12; I<sup>2</sup>=81.2%). The certainty of evidence was very low for quality of life, motor, and psychiatric symptoms and low for cognitive function and overall nonmotor symptoms. Improvements in motor symptoms and cognitive function remained stable at follow-up. Meta-regression analysis indicated that age, percentage of female participants, and supervision mode were possible sources of heterogeneity. Overall, 94 studies reported reach (median 37.5%), 38 reported fidelity (95.7%), and 105 reported dropout rates (9.1%).</p><p><strong>Conclusions: </strong>In contrast to previous reviews focused on single technologies or outcomes, this review provided the first comprehensive synthesis across all DHI types on multiple outcomes and indicated their potential as nonpharmacological interventions for PD management. However, current evidence is of low to very low certainty, and wide 95% PIs, together with high risk of bias and substantial heterogeneity, indicate considerable u","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e79935"},"PeriodicalIF":6.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147443791","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}
{"title":"Data Governance Lessons From an Unvalidated Dataset.","authors":"Cliff Dominy","doi":"10.2196/94518","DOIUrl":"10.2196/94518","url":null,"abstract":"","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e94518"},"PeriodicalIF":6.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463419","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}
Richard Guse, Shanshan Hu, Scott Thiebes, Christina Erler, Catherine Caridia, Wilhelm Stork, Martin Gersch, Ali Sunyaev
<p><strong>Background: </strong>Blockchain-based health information exchange (HIE) has received increased attention in health care research and practice over the last years. It enables the sharing of patient information across healthcare organizations, provides higher levels of data confidentiality and security, and reduces time and costs in collaborative medical decision-making. To make informed decisions on the implementation of blockchain-based HIE in practice and to fully understand the implications of its use for patient care, it is important to gain insights into patient perceptions of and interactions with blockchain-based HIE.</p><p><strong>Objective: </strong>This study aimed to assess patient perceptions of a blockchain-based HIE mobile app to inform its iterative development.</p><p><strong>Methods: </strong>We used a mixed methods user-centered design in 3 phases to iteratively assess patient perceptions of blockchain-based HIE: (1) structured questionnaires collecting patient requirements for blockchain-based HIE, (2) semistructured interviews evaluating mobile app mock-ups, and (3) a survey with blockchain-based HIE scenarios related to their patient care using the technology acceptance model, System Usability Scale, and open feedback. Both the semistructured interviews and the survey were conducted in a clinical setting with patients with cancer undergoing treatment at a major university hospital in Germany. As an exemplary case, we deem patients with cancer as well-positioned to evaluate a blockchain-based HIE mobile app since their treatment requires extensive coordination and data sharing across health care providers.</p><p><strong>Results: </strong>Our findings support that patients have a high intention to use the blockchain-based functions that enable them to define, track, and revoke access to their health data per health care facility and service provider. Patients rated the 4 key functionalities (connection with providers, document sharing, a health diary, and a health care service provider search) as both useful and easy to use. The overall System Usability Scale of the blockchain-based HIE mobile app improved over the 3 phases up to 77.34, showing a good overall usability. The open feedback showed that patients' perceived usefulness of a blockchain-based HIE mobile app is especially influenced by 3 factors: the acceleration of the process of data sharing, patient-centered access control, and alignment with the respective health care settings. Moreover, patients' perceived ease of use of a blockchain-based HIE mobile app is impacted by 3 additional factors: the intuitiveness of the interaction, an aesthetic and functional design, and individual differences such as age or literacy with document management systems.</p><p><strong>Conclusions: </strong>The evaluation demonstrates that patients are inclined to use blockchain-based HIE to manage their health data, as it empowers them to control which health care providers or ind
{"title":"Patient Perceptions of Blockchain-Based Health Information Exchange: User-Centered Design Study.","authors":"Richard Guse, Shanshan Hu, Scott Thiebes, Christina Erler, Catherine Caridia, Wilhelm Stork, Martin Gersch, Ali Sunyaev","doi":"10.2196/78849","DOIUrl":"10.2196/78849","url":null,"abstract":"<p><strong>Background: </strong>Blockchain-based health information exchange (HIE) has received increased attention in health care research and practice over the last years. It enables the sharing of patient information across healthcare organizations, provides higher levels of data confidentiality and security, and reduces time and costs in collaborative medical decision-making. To make informed decisions on the implementation of blockchain-based HIE in practice and to fully understand the implications of its use for patient care, it is important to gain insights into patient perceptions of and interactions with blockchain-based HIE.</p><p><strong>Objective: </strong>This study aimed to assess patient perceptions of a blockchain-based HIE mobile app to inform its iterative development.</p><p><strong>Methods: </strong>We used a mixed methods user-centered design in 3 phases to iteratively assess patient perceptions of blockchain-based HIE: (1) structured questionnaires collecting patient requirements for blockchain-based HIE, (2) semistructured interviews evaluating mobile app mock-ups, and (3) a survey with blockchain-based HIE scenarios related to their patient care using the technology acceptance model, System Usability Scale, and open feedback. Both the semistructured interviews and the survey were conducted in a clinical setting with patients with cancer undergoing treatment at a major university hospital in Germany. As an exemplary case, we deem patients with cancer as well-positioned to evaluate a blockchain-based HIE mobile app since their treatment requires extensive coordination and data sharing across health care providers.</p><p><strong>Results: </strong>Our findings support that patients have a high intention to use the blockchain-based functions that enable them to define, track, and revoke access to their health data per health care facility and service provider. Patients rated the 4 key functionalities (connection with providers, document sharing, a health diary, and a health care service provider search) as both useful and easy to use. The overall System Usability Scale of the blockchain-based HIE mobile app improved over the 3 phases up to 77.34, showing a good overall usability. The open feedback showed that patients' perceived usefulness of a blockchain-based HIE mobile app is especially influenced by 3 factors: the acceleration of the process of data sharing, patient-centered access control, and alignment with the respective health care settings. Moreover, patients' perceived ease of use of a blockchain-based HIE mobile app is impacted by 3 additional factors: the intuitiveness of the interaction, an aesthetic and functional design, and individual differences such as age or literacy with document management systems.</p><p><strong>Conclusions: </strong>The evaluation demonstrates that patients are inclined to use blockchain-based HIE to manage their health data, as it empowers them to control which health care providers or ind","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e78849"},"PeriodicalIF":6.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463480","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}
{"title":"Correction: A Supervised Explainable Machine Learning Model for Perioperative Neurocognitive Disorder in Liver-Transplantation Patients and External Validation on the Medical Information Mart for Intensive Care IV Database: Retrospective Study.","authors":"Zhendong Ding, Linan Zhang, Yihan Zhang, Jing Yang, Yuheng Luo, Mian Ge, Weifeng Yao, Ziqing Hei, Chaojin Chen","doi":"10.2196/88952","DOIUrl":"https://doi.org/10.2196/88952","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/55046.].</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e88952"},"PeriodicalIF":6.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Social anxiety often manifests through behaviors such as reduced gaze to the eyes and lower speech volume. While these markers have been examined in face-to-face interactions, large-scale assessments remain challenging. Social virtual reality (VR) offers a promising alternative by enabling naturalistic interactions in which behavior can be captured at scale, but it remains unclear if people show naturalistic behavior in such artificial environments.</p><p><strong>Objective: </strong>We examined whether behavioral and physiological markers associated with social anxiety in real-life interactions similarly emerge in dyadic social VR. We additionally examined whether these patterns overlap with patterns linked to the broader constructs of psychopathology and verticality.</p><p><strong>Methods: </strong>In this cross-sectional study, 128 participants (105 females, 22 males, 1 diverse; age 18-51 years; mean age 22.60, SD 3.57 years), recruited from a university student population, engaged in a 30-minute avatar-mediated dyadic conversation in social VR while physically located in separate rooms. We assessed gaze toward the partner's eyes, smiling, and speaking behavior by using the VR headsets' built-in eye trackers, face trackers, and microphones, and assessed high-frequency heart rate variability (HF-HRV) by using an electrocardiogram.</p><p><strong>Results: </strong>Relationships between traits and behavioral and physiological measures were analyzed using linear mixed-effects models (α=.05). Social anxiety was linked to reduced gaze toward the partner's eyes while speaking (β=-.20, 95% CI -0.35 to -0.04; t<sub>126</sub>=-2.51; P=.01), quieter speech (β=-.18, 95% CI -0.35 to -0.01; t<sub>126</sub>=-2.12; P=.04), and reduced HF-HRV (β=-.23, 95% CI -0.39 to -0.08; t<sub>119</sub>=-3.00; P=.003). These findings were not entirely specific to social anxiety, as Pearson correlations revealed similar patterns for social anxiety and psychopathology (r=0.94, 95% CI 0.75-0.99; t<sub>7</sub>=7.61; P<.001), whereas verticality was linked to an overall opposite pattern (social anxiety: r=-0.92, 95% CI -0.98 to -0.65; t<sub>7</sub>=-6.14; P<.001; psychopathology: r=-0.83, 95% CI -0.96 to -0.38; t<sub>7</sub>=-3.98; P=.005).</p><p><strong>Conclusions: </strong>In dyadic interactions in social VR, social anxiety was associated with behavioral and physiological modulations similar to those observed in face-to-face interactions, indicating heightened social stress and submissiveness even in avatar-mediated communication. Patterns were similar for heightened psychopathology and reversed for verticality, indicating that these traits may lie on a shared social-behavioral spectrum. Extending previous research focused on face-to-face interactions or reactions toward artificial agents displayed in VR, this study is the first to provide a comprehensive account of the behavioral and physiological modulations associated with social anxiety in av
背景：社交焦虑通常表现为减少凝视眼睛和降低说话音量等行为。虽然这些标记已经在面对面的互动中进行了检查，但大规模的评估仍然具有挑战性。社交虚拟现实（VR）提供了一种很有前途的选择，它可以实现自然的互动，在这种互动中，行为可以被大规模捕捉，但人们是否会在这种人工环境中表现出自然的行为，目前还不清楚。目的：我们研究了与现实生活中社交焦虑相关的行为和生理标记是否同样出现在二元社交虚拟现实中。我们还研究了这些模式是否与更广泛的精神病理学和垂直性结构相关的模式重叠。方法：在这项横截面研究中，从大学生群体中招募了128名参与者（105名女性，22名男性，1名异性；年龄18-51岁；平均年龄22.60岁，标准差3.57岁），他们在社交VR中进行了30分钟的虚拟化身介导的二元对话，而实际位置分别位于不同的房间。我们通过VR头戴设备内置的眼动仪、面部追踪器和麦克风来评估伴侣的眼神、微笑和说话行为，并通过心电图评估高频心率变异性（HF-HRV）。结果：采用线性混合效应模型分析性状与行为和生理指标的关系（α= 0.05）。社交焦虑与说话时减少对伴侣眼睛的凝视（β=- 0.20, 95% CI -0.35至-0.04;t126=-2.51； P= 0.01）、更安静的说话（β=- 0.18, 95% CI -0.35至-0.01;t126=-2.12； P= 0.04）和降低的HF-HRV （β=- 0.23, 95% CI -0.39至-0.08;t119=-3.00； P= 0.003）有关。这些发现并不完全针对社交焦虑，因为Pearson相关性揭示了社交焦虑和精神病理的相似模式（r=0.94, 95% CI 0.75-0.99; t7=7.61; P7=-6.14; P7=-3.98； P= 0.005）。结论：在社交虚拟现实中的二元互动中，社交焦虑与行为和生理调节相关，这与面对面互动中观察到的相似，表明即使在虚拟形象介导的交流中，社会压力和顺从性也会增加。高度精神病理学的模式相似，垂直性的模式相反，表明这些特征可能存在于共同的社会行为谱上。这项研究扩展了之前的研究，重点是面对面的互动或对虚拟现实中显示的人工代理的反应，这是第一个全面描述基于虚拟现实的人际互动中与社交焦虑相关的行为和生理调节的研究。由于社交虚拟现实设置允许研究人员评估一组丰富的行为数据，作为设置核心功能的副产品，该技术为检测社会压力、跟踪治疗进展或在虚拟现实中发生互动时为个人行为量身定制干预措施提供了新的可能性。
{"title":"Automated Inference of Social Anxiety From Behavior in Social Virtual Reality: Cross-Sectional Observational Study.","authors":"Gayoung Son, Marius Rubo","doi":"10.2196/79147","DOIUrl":"https://doi.org/10.2196/79147","url":null,"abstract":"<p><strong>Background: </strong>Social anxiety often manifests through behaviors such as reduced gaze to the eyes and lower speech volume. While these markers have been examined in face-to-face interactions, large-scale assessments remain challenging. Social virtual reality (VR) offers a promising alternative by enabling naturalistic interactions in which behavior can be captured at scale, but it remains unclear if people show naturalistic behavior in such artificial environments.</p><p><strong>Objective: </strong>We examined whether behavioral and physiological markers associated with social anxiety in real-life interactions similarly emerge in dyadic social VR. We additionally examined whether these patterns overlap with patterns linked to the broader constructs of psychopathology and verticality.</p><p><strong>Methods: </strong>In this cross-sectional study, 128 participants (105 females, 22 males, 1 diverse; age 18-51 years; mean age 22.60, SD 3.57 years), recruited from a university student population, engaged in a 30-minute avatar-mediated dyadic conversation in social VR while physically located in separate rooms. We assessed gaze toward the partner's eyes, smiling, and speaking behavior by using the VR headsets' built-in eye trackers, face trackers, and microphones, and assessed high-frequency heart rate variability (HF-HRV) by using an electrocardiogram.</p><p><strong>Results: </strong>Relationships between traits and behavioral and physiological measures were analyzed using linear mixed-effects models (α=.05). Social anxiety was linked to reduced gaze toward the partner's eyes while speaking (β=-.20, 95% CI -0.35 to -0.04; t<sub>126</sub>=-2.51; P=.01), quieter speech (β=-.18, 95% CI -0.35 to -0.01; t<sub>126</sub>=-2.12; P=.04), and reduced HF-HRV (β=-.23, 95% CI -0.39 to -0.08; t<sub>119</sub>=-3.00; P=.003). These findings were not entirely specific to social anxiety, as Pearson correlations revealed similar patterns for social anxiety and psychopathology (r=0.94, 95% CI 0.75-0.99; t<sub>7</sub>=7.61; P<.001), whereas verticality was linked to an overall opposite pattern (social anxiety: r=-0.92, 95% CI -0.98 to -0.65; t<sub>7</sub>=-6.14; P<.001; psychopathology: r=-0.83, 95% CI -0.96 to -0.38; t<sub>7</sub>=-3.98; P=.005).</p><p><strong>Conclusions: </strong>In dyadic interactions in social VR, social anxiety was associated with behavioral and physiological modulations similar to those observed in face-to-face interactions, indicating heightened social stress and submissiveness even in avatar-mediated communication. Patterns were similar for heightened psychopathology and reversed for verticality, indicating that these traits may lie on a shared social-behavioral spectrum. Extending previous research focused on face-to-face interactions or reactions toward artificial agents displayed in VR, this study is the first to provide a comprehensive account of the behavioral and physiological modulations associated with social anxiety in av","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e79147"},"PeriodicalIF":6.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433597","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}
Martin Srp, Martina Hoskovcova, Rebeka Lagnerova, Katerina Dvorakova, Radim Kliment, Jan Muzik, Radim Krupicka, Ota Gal, Evzen Ruzicka
<p><strong>Background: </strong>Aspiration pneumonia is a leading cause of death in Parkinson disease (PD). Expiratory muscle strength training (EMST) is a promising intervention for respiratory and swallowing dysfunction. However, long-term EMST adherence is frequently poor in PD.</p><p><strong>Objective: </strong>This study aims to determine whether mobile health (mHealth)-assisted EMST with the SpiroGym app (Czech Technical University) improves long-term adherence and physiological outcomes versus conventional EMST among participants at risk for nonadherence.</p><p><strong>Methods: </strong>In this single-center, parallel, phase 2 randomized controlled trial, 75 individuals with PD were randomized 1:1 to conventional EMST (control; n=38) or the same protocol enhanced with the SpiroGym app (experimental; n=37), using a simple computer-generated randomization sequence. The SpiroGym is an mHealth app that provides real-time performance monitoring, direct visual feedback, and longitudinal progress tracking. All participants completed 8 weeks of semisupervised intensive EMST with biweekly in-person reassessments, followed by 16 weeks of unsupervised maintenance training. The primary outcome was adherence during weeks 8 to 24 among participants at risk for nonadherence, defined a priori at week 8 as Self-Efficacy for Home Exercise Program Scale (SEHEPS) less than 59. Because risk status was determined at week 8 and all participants subsequently entered the unsupervised phase, individuals not classified as at-risk were not excluded. Their data from week 8 onward were reported alongside the at-risk group. Secondary outcomes were changes in maximum expiratory pressure and SEHEPS.</p><p><strong>Results: </strong>No study-related adverse events occurred. Groups were well matched at baseline (control vs experimental: mean disease duration 7.0 (SD 5.7) vs 7.3 SD 4.7) y; mean Hoehn-Yahr 1.97 (SD 0.6) vs 2.0 (SD 0.5)). The mixed-effects model showed no significant 3-way interaction (group×interval×SEHEPS risk; P=.14). At week 24, the at-risk category for the nonadherence cohort comprised 34 participants (control, n=17; experimental, n=17). In this at-risk cohort, the experimental group demonstrated a smaller decline in adherence during weeks 8 to 24 than controls (β=496.9, 95% CI 130.7-863.3; P=.008), completing 1073 (95% CI 643-1502) expiratory maneuvers versus 525 (95% CI 358-692). Maximum expiratory pressure increased in both groups from weeks 0 to 24, with larger gains in the experimental group (+43.1, 95% CI 32.4-53.8 cmH₂O) than in controls (+22.8, 95% CI 13.8-31.8 cmH₂O; P=.006; Cohen d=0.74). SEHEPS improved after intensive training in both groups, but only the experimental group exceeded the 12-point minimal detectable change at the 95% confidence limit.</p><p><strong>Conclusions: </strong>This is the first randomized controlled trial to integrate mHealth with EMST. Unlike prior studies in the EMST field, we focused on sustaining long-term exercise
背景：吸入性肺炎是帕金森病（PD）的主要死亡原因。呼气肌力训练（EMST）是一种治疗呼吸和吞咽功能障碍的有效方法。然而，长期EMST依从性往往较差。目的：本研究旨在确定使用SpiroGym应用程序（捷克技术大学）的移动医疗（mHealth）辅助EMST与传统EMST相比，是否能改善有不依从性风险的参与者的长期依从性和生理结果。方法：在这项单中心、平行、2期随机对照试验中，75名PD患者按1:1的比例随机分配到常规EMST组（对照组，n=38）或使用SpiroGym应用程序增强的相同方案组（实验组，n=37），使用简单的计算机生成的随机化序列。SpiroGym是一款移动健康应用程序，提供实时性能监控、直接视觉反馈和纵向进度跟踪。所有参与者都完成了8周的半监督强化EMST，每两周进行一次面对面的重新评估，随后进行了16周的无监督维护培训。主要结果是有不遵守风险的参与者在第8周至第24周的依从性，第8周的先验定义为家庭运动计划自我效能量表（SEHEPS）小于59。由于风险状态在第8周确定，所有参与者随后进入无监督阶段，未被归类为风险的个体未被排除在外。他们从第8周开始的数据与高危组一起报告。次要结局是最大呼气压和SEHEPS的变化。结果：未发生与研究相关的不良事件。各组在基线时匹配良好（对照组与实验组：平均疾病持续时间7.0 (SD 5.7) vs 7.3 SD 4.7） y；平均Hoehn-Yahr 1.97 （SD 0.6) vs 2.0 (SD 0.5)）。混合效应模型显示无显著的3向相互作用（group×interval×SEHEPS风险；P=.14）。在第24周，不依从队列的高危类别包括34名参与者（对照组，n=17；实验组，n=17）。在这一高危队列中，实验组在第8至24周的依从性下降幅度小于对照组（β=496.9, 95% CI 130.7-863.3； P= 0.008），完成1073次（95% CI 643-1502）呼气操作，而525次（95% CI 358-692）。从第0周到第24周，两组患者的最大呼气压均有所增加，实验组的增幅（+43.1,95% CI 32.4-53.8 cmH₂O）大于对照组（+22.8,95% CI 13.8-31.8 cmH₂O； P= 0.006; Cohen d=0.74）。两组的SEHEPS在强化训练后均有所改善，但只有实验组在95%置信限下超过了12点的最小可检测变化。结论：这是第一个将移动健康与EMST相结合的随机对照试验。与之前在EMST领域的研究不同，我们关注的是长期坚持锻炼。与常规EMST相比，spirogym辅助EMST的长期依从性更高，呼气肌力量也有更大的提高。在现实世界的PD护理中，在有监督的EMST阶段后评估自我效能可能有助于识别从数字支持中受益的个体，使移动医疗辅助的EMST成为维持运动依从性的实用方法。
{"title":"Enhancing Adherence to Home-Based Expiratory Muscle Strength Training in Parkinson Disease: Randomized Controlled Trial of an mHealth Intervention.","authors":"Martin Srp, Martina Hoskovcova, Rebeka Lagnerova, Katerina Dvorakova, Radim Kliment, Jan Muzik, Radim Krupicka, Ota Gal, Evzen Ruzicka","doi":"10.2196/78022","DOIUrl":"10.2196/78022","url":null,"abstract":"<p><strong>Background: </strong>Aspiration pneumonia is a leading cause of death in Parkinson disease (PD). Expiratory muscle strength training (EMST) is a promising intervention for respiratory and swallowing dysfunction. However, long-term EMST adherence is frequently poor in PD.</p><p><strong>Objective: </strong>This study aims to determine whether mobile health (mHealth)-assisted EMST with the SpiroGym app (Czech Technical University) improves long-term adherence and physiological outcomes versus conventional EMST among participants at risk for nonadherence.</p><p><strong>Methods: </strong>In this single-center, parallel, phase 2 randomized controlled trial, 75 individuals with PD were randomized 1:1 to conventional EMST (control; n=38) or the same protocol enhanced with the SpiroGym app (experimental; n=37), using a simple computer-generated randomization sequence. The SpiroGym is an mHealth app that provides real-time performance monitoring, direct visual feedback, and longitudinal progress tracking. All participants completed 8 weeks of semisupervised intensive EMST with biweekly in-person reassessments, followed by 16 weeks of unsupervised maintenance training. The primary outcome was adherence during weeks 8 to 24 among participants at risk for nonadherence, defined a priori at week 8 as Self-Efficacy for Home Exercise Program Scale (SEHEPS) less than 59. Because risk status was determined at week 8 and all participants subsequently entered the unsupervised phase, individuals not classified as at-risk were not excluded. Their data from week 8 onward were reported alongside the at-risk group. Secondary outcomes were changes in maximum expiratory pressure and SEHEPS.</p><p><strong>Results: </strong>No study-related adverse events occurred. Groups were well matched at baseline (control vs experimental: mean disease duration 7.0 (SD 5.7) vs 7.3 SD 4.7) y; mean Hoehn-Yahr 1.97 (SD 0.6) vs 2.0 (SD 0.5)). The mixed-effects model showed no significant 3-way interaction (group×interval×SEHEPS risk; P=.14). At week 24, the at-risk category for the nonadherence cohort comprised 34 participants (control, n=17; experimental, n=17). In this at-risk cohort, the experimental group demonstrated a smaller decline in adherence during weeks 8 to 24 than controls (β=496.9, 95% CI 130.7-863.3; P=.008), completing 1073 (95% CI 643-1502) expiratory maneuvers versus 525 (95% CI 358-692). Maximum expiratory pressure increased in both groups from weeks 0 to 24, with larger gains in the experimental group (+43.1, 95% CI 32.4-53.8 cmH₂O) than in controls (+22.8, 95% CI 13.8-31.8 cmH₂O; P=.006; Cohen d=0.74). SEHEPS improved after intensive training in both groups, but only the experimental group exceeded the 12-point minimal detectable change at the 95% confidence limit.</p><p><strong>Conclusions: </strong>This is the first randomized controlled trial to integrate mHealth with EMST. Unlike prior studies in the EMST field, we focused on sustaining long-term exercise ","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e78022"},"PeriodicalIF":6.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433795","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}
Jianxiong Wu, Weijiang Zhan, Jun Hua, Qinling Ge, Yuexian Zhu, Huixian Yu, Min Zhao, Xiaoyan Zhan, Bingwei Zhu, Tongqi Xiang, Longxi Lu, Tieying Dai
<p><strong>Background: </strong>Antimicrobial resistance (AMR) poses a critical global health threat, with inappropriate antibiotic use being a major driver. Timely microbiological specimen submission before initiating antibiotic therapy is a cornerstone of antimicrobial stewardship (AMS), enabling pathogen-directed therapy and reducing unnecessary broad-spectrum exposure. However, suboptimal compliance remains common due to workflow interruptions, technological barriers, and behavioral factors. Failure Mode and Effects Analysis (FMEA), a proactive risk-assessment method widely used in health care quality improvement, provides a systematic framework to identify process vulnerabilities and prioritize corrective actions. Despite its increasing application, few studies have integrated FMEA with hospital informatization to optimize microbiological specimen submission workflows in routine AMS practice.</p><p><strong>Objective: </strong>This study aimed to systematically identify workflow risks affecting preantibiotic microbiological specimen submission and to design, implement, and evaluate informatization-enabled interventions using an FMEA-based framework.</p><p><strong>Methods: </strong>FMEA was conducted at a tertiary hospital in China. A multidisciplinary team identified potential failure modes across 4 domains: health information systems, personnel, administration, and external support. Risk Priority Numbers (RPNs) and Action Priority (AP) indices were calculated for each failure mode. Targeted interventions were implemented, including dual-verification barcode scanning, artificial intelligence-driven clinical decision support alerts, EHR-integrated training modules, and automated compliance dashboards. Pre- and postintervention specimen submission rates (January 2024-December 2024) were analyzed using the Mann-Kendall trend test.</p><p><strong>Results: </strong>The top 5 failure modes included PDA barcode scanning failures (RPN=175), inadequate clinical decision support (RPN=140), insufficient clinician awareness (RPN=56), suboptimal oversight mechanisms, and patient-related barriers. Postintervention, significant upward trends were observed in overall specimen submission rates (P<.001), with similar improvements for restricted-use (P<.001) and special-use antibiotics (P<.001).</p><p><strong>Conclusions: </strong>FMEA-based risk management combined with hospital informatization effectively optimized specimen submission workflows. Real-time decision support, process standardization, and interdisciplinary collaboration significantly enhanced compliance. Future research should evaluate long-term impacts on AMR reduction and diagnostic integration. Integrating FMEA with hospital informatization effectively strengthened the microbiological specimen submission process. Digital decision support, standardized workflows, and real-time monitoring substantially improved compliance with preantibiotic specimen submission. This approach provides an actionabl
{"title":"Investigating the Effect of Hospital Infection Control Informatization on Optimizing Microbiological Specimen Submission Before Antibiotic Therapy: Failure Mode and Effects Analysis.","authors":"Jianxiong Wu, Weijiang Zhan, Jun Hua, Qinling Ge, Yuexian Zhu, Huixian Yu, Min Zhao, Xiaoyan Zhan, Bingwei Zhu, Tongqi Xiang, Longxi Lu, Tieying Dai","doi":"10.2196/78118","DOIUrl":"https://doi.org/10.2196/78118","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) poses a critical global health threat, with inappropriate antibiotic use being a major driver. Timely microbiological specimen submission before initiating antibiotic therapy is a cornerstone of antimicrobial stewardship (AMS), enabling pathogen-directed therapy and reducing unnecessary broad-spectrum exposure. However, suboptimal compliance remains common due to workflow interruptions, technological barriers, and behavioral factors. Failure Mode and Effects Analysis (FMEA), a proactive risk-assessment method widely used in health care quality improvement, provides a systematic framework to identify process vulnerabilities and prioritize corrective actions. Despite its increasing application, few studies have integrated FMEA with hospital informatization to optimize microbiological specimen submission workflows in routine AMS practice.</p><p><strong>Objective: </strong>This study aimed to systematically identify workflow risks affecting preantibiotic microbiological specimen submission and to design, implement, and evaluate informatization-enabled interventions using an FMEA-based framework.</p><p><strong>Methods: </strong>FMEA was conducted at a tertiary hospital in China. A multidisciplinary team identified potential failure modes across 4 domains: health information systems, personnel, administration, and external support. Risk Priority Numbers (RPNs) and Action Priority (AP) indices were calculated for each failure mode. Targeted interventions were implemented, including dual-verification barcode scanning, artificial intelligence-driven clinical decision support alerts, EHR-integrated training modules, and automated compliance dashboards. Pre- and postintervention specimen submission rates (January 2024-December 2024) were analyzed using the Mann-Kendall trend test.</p><p><strong>Results: </strong>The top 5 failure modes included PDA barcode scanning failures (RPN=175), inadequate clinical decision support (RPN=140), insufficient clinician awareness (RPN=56), suboptimal oversight mechanisms, and patient-related barriers. Postintervention, significant upward trends were observed in overall specimen submission rates (P<.001), with similar improvements for restricted-use (P<.001) and special-use antibiotics (P<.001).</p><p><strong>Conclusions: </strong>FMEA-based risk management combined with hospital informatization effectively optimized specimen submission workflows. Real-time decision support, process standardization, and interdisciplinary collaboration significantly enhanced compliance. Future research should evaluate long-term impacts on AMR reduction and diagnostic integration. Integrating FMEA with hospital informatization effectively strengthened the microbiological specimen submission process. Digital decision support, standardized workflows, and real-time monitoring substantially improved compliance with preantibiotic specimen submission. This approach provides an actionabl","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e78118"},"PeriodicalIF":6.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>As the population ages, older adults face an increasing risk of physical inactivity and related health complications, highlighting the need for scalable interventions. Smartphone-based programs have emerged as a promising strategy to support sustained physical activity among older adults.</p><p><strong>Objective: </strong>This study aimed to evaluate whether a smartphone lecture program incorporating a digital peer support app would increase physical activity among older adults, compared to a conventional smartphone lecture program.</p><p><strong>Methods: </strong>This 2-arm, 1:1 parallel-arm, cluster-randomized trial was conducted in 2 urban regions of Japan (Sumida Ward, Tokyo, and Chiba City, Chiba). Eligible participants were community-dwelling adults aged ≥60 years, able to walk independently, and smartphone users; exclusion criteria included prior use of the peer support app or medical restrictions on walking. Participants were recruited offline during community smartphone lectures (closed-group recruitment). The intervention combined face-to-face lectures with app-based peer support, while outcomes were assessed both objectively (via smartphones) and through self-administered paper questionnaires. All participants received a baseline smartphone lecture. Intervention participants attended 2 additional sessions using a digital peer support app (Minchalle; A10 Lab Inc), which included features such as daily step goals, peer sharing, and group encouragement. Control participants attended 2 standard follow-up smartphone lectures. The primary outcome was the change in weekly average daily step count from baseline to Week 12. Secondary outcomes included total metabolic equivalent of task (MET)-minutes per week (assessed via the International Physical Activity Questionnaire), walking time (≥30 minutes per day), daily smartphone use, and number of smartphone use purposes.</p><p><strong>Results: </strong>A total of 156 community-dwelling older adults were grouped into 40 clusters and randomized (20 intervention clusters, n=80 and 20 control clusters, n=76). In total, 124 participants (79.5%) completed the follow-up, and valid step data were available for 117 participants, with missing data ranging from 5.1% to 29.1%. Baseline daily steps averaged 3951 (SD 1686) in controls versus 4583 (SD 1973) in the intervention arm. An unadjusted mixed model for repeated measures showed significantly higher step changes for intervention participants at Week 12 (difference=579, 95% CI 36-1123; P=.04). No significant differences emerged for total METs (difference=646 MET-min per week, 95% CI -12 to 1303; P=.054) or walking ≥30 minutes per day (odds ratio [OR] 1.56, 95% CI 0.63-3.90; P=.33). However, the intervention arm demonstrated a significant increase in daily smartphone use (OR 4.10, 95% CI 1.15-14.6; P=.03) and in the number of smartphone use purposes (difference=0.58, 95% CI 0.12-1.05; P=.01).</p><p><strong>Conclusions: </stro
背景：随着人口老龄化，老年人面临越来越多的缺乏身体活动和相关健康并发症的风险，强调需要可扩展的干预措施。基于智能手机的程序已经成为支持老年人持续体育锻炼的一种有前景的策略。目的：本研究旨在评估与传统智能手机讲座计划相比，包含数字同伴支持应用程序的智能手机讲座计划是否会增加老年人的身体活动。方法：在日本的两个城市地区（东京隅田区和千叶市）进行了这项双组、1:1平行组、集群随机试验。符合条件的参与者为≥60岁、能够独立行走的社区居民和智能手机用户；排除标准包括先前使用同伴支持应用程序或对行走有医疗限制。参与者通过社区智能手机讲座进行线下招募（闭门招募）。干预结合了面对面的讲座和基于应用程序的同伴支持，同时通过客观（通过智能手机）和自我管理的纸质问卷来评估结果。所有的参与者都接受了一个关于智能手机的基础讲座。干预参与者使用数字同伴支持应用程序（Minchalle; A10 Lab Inc .）参加了2个额外的会议，其中包括日常步骤目标、同伴分享和小组鼓励等功能。对照组参与者参加了2个标准的后续智能手机讲座。主要结果是从基线到第12周的每周平均每日步数的变化。次要结局包括每周总任务代谢当量（MET）分钟（通过国际身体活动问卷评估）、步行时间（每天≥30分钟）、每日智能手机使用情况和智能手机使用目的数量。结果：156名社区居住老年人分为40组随机分组，其中干预组20组，n=80，对照组20组，n=76。共有124名参与者（79.5%）完成随访，117名参与者获得有效步数数据，缺失数据在5.1%至29.1%之间。对照组平均每日基线步数为3951 (SD 1686)，干预组为4583 （SD 1973）。重复测量的未调整混合模型显示，干预参与者在第12周的阶跃变化显著较高（差异=579,95% CI 36-1123； P= 0.04）。总代谢当量（差异=646 MET-min / week, 95% CI -12 ~ 1303； P= 0.054）或每天步行≥30分钟（优势比[or] 1.56, 95% CI 0.63 ~ 3.90； P= 0.33）无显著差异。然而，干预组显示每天使用智能手机的数量显著增加（OR 4.10, 95% CI 1.15-14.6； P= 0.03），使用智能手机的目的数量显著增加（差异=0.58,95% CI 0.12-1.05； P= 0.01）。结论：在为期12周的干预的第12周，智能手机讲座项目与基于应用程序的同伴支持相结合，对日本老年人的步数有了适度但有意义的改善。未来的研究应该调查长期维持、额外的身体活动措施和亚人群的反应，以优化老年人的数字健康计划。
{"title":"Digital Peer Support to Increase Walking Among Older Adults: Cluster Randomized Trial.","authors":"Atsushi Nakagomi, Noriyuki Abe, Takayuki Ueno, Gemmei Izuka, Yohei Kawasaki, Katsunori Kondo","doi":"10.2196/75708","DOIUrl":"10.2196/75708","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, older adults face an increasing risk of physical inactivity and related health complications, highlighting the need for scalable interventions. Smartphone-based programs have emerged as a promising strategy to support sustained physical activity among older adults.</p><p><strong>Objective: </strong>This study aimed to evaluate whether a smartphone lecture program incorporating a digital peer support app would increase physical activity among older adults, compared to a conventional smartphone lecture program.</p><p><strong>Methods: </strong>This 2-arm, 1:1 parallel-arm, cluster-randomized trial was conducted in 2 urban regions of Japan (Sumida Ward, Tokyo, and Chiba City, Chiba). Eligible participants were community-dwelling adults aged ≥60 years, able to walk independently, and smartphone users; exclusion criteria included prior use of the peer support app or medical restrictions on walking. Participants were recruited offline during community smartphone lectures (closed-group recruitment). The intervention combined face-to-face lectures with app-based peer support, while outcomes were assessed both objectively (via smartphones) and through self-administered paper questionnaires. All participants received a baseline smartphone lecture. Intervention participants attended 2 additional sessions using a digital peer support app (Minchalle; A10 Lab Inc), which included features such as daily step goals, peer sharing, and group encouragement. Control participants attended 2 standard follow-up smartphone lectures. The primary outcome was the change in weekly average daily step count from baseline to Week 12. Secondary outcomes included total metabolic equivalent of task (MET)-minutes per week (assessed via the International Physical Activity Questionnaire), walking time (≥30 minutes per day), daily smartphone use, and number of smartphone use purposes.</p><p><strong>Results: </strong>A total of 156 community-dwelling older adults were grouped into 40 clusters and randomized (20 intervention clusters, n=80 and 20 control clusters, n=76). In total, 124 participants (79.5%) completed the follow-up, and valid step data were available for 117 participants, with missing data ranging from 5.1% to 29.1%. Baseline daily steps averaged 3951 (SD 1686) in controls versus 4583 (SD 1973) in the intervention arm. An unadjusted mixed model for repeated measures showed significantly higher step changes for intervention participants at Week 12 (difference=579, 95% CI 36-1123; P=.04). No significant differences emerged for total METs (difference=646 MET-min per week, 95% CI -12 to 1303; P=.054) or walking ≥30 minutes per day (odds ratio [OR] 1.56, 95% CI 0.63-3.90; P=.33). However, the intervention arm demonstrated a significant increase in daily smartphone use (OR 4.10, 95% CI 1.15-14.6; P=.03) and in the number of smartphone use purposes (difference=0.58, 95% CI 0.12-1.05; P=.01).</p><p><strong>Conclusions: </stro","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e75708"},"PeriodicalIF":6.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433689","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}
Kate Winskell, Gaëlle Sabben, Haowen Qin, Calvin Mbeda, Sophie Goldenberg, Ken Ondeng'e, Richard Ndivo, Judith Arego, Xinwei He, Robert A Bednarczyk, Kelli Komro, Robert H Lyles, Victor Mudhune
<p><strong>Background: </strong>African adolescents and young adults account for a disproportionate number of new HIV infections. There is an urgent need to identify scalable and cost-effective behavioral HIV prevention strategies for this population. Using a condom at first sex is associated with a higher likelihood of consistent use later. Tumaini ("Hope for the Future" in Swahili; Emory University) is a choose-your-own-adventure smartphone game that has been shown to reduce the risk of unprotected first sex by end line in a 45-month randomized controlled trial in western Kenya.</p><p><strong>Objective: </strong>This study aimed to assess the impact of Tumaini on proximal outcomes related to condom use at first sex (specifically, behavioral intentions, self-efficacy, attitudes, and knowledge) longitudinally across mid-adolescence in the above trial.</p><p><strong>Methods: </strong>Adolescent participants (n=996, mean baseline age 14, SD 0.56 years) were randomized 1:1 to receive either a smartphone loaded with Tumaini or an attention-control math game for 5 to 7 weeks at 3 time points (mean age 14.0, SD 0.56; 15.3, SD 0.55; and 16.0, SD 0.56 years, respectively). They completed a behavioral survey at 13 time points, through mean age 17.7 (SD 0.56) years. Using generalized estimating equations and controlling for age at baseline, we modeled mean scores (overall and stratified by gender) on a range of condom-related survey items over time to assess mean differences at specific time points. We applied appropriate Bonferroni corrections to inferences about cross-arm differences in mean changes relative to baseline at 4 time points (after each intervention period and at end line; α=.05/4) and within-arm mean changes relative to baseline at each of the 12 post-baseline time points (α=.05/12). Analyses were conducted as intent-to-treat.</p><p><strong>Results: </strong>At end line, 97.8% (n=974) of the sample had been retained. Participants in both arms dedicated a mean total of >30 hours to their assigned game. There was significant improvement across all condom-related proximal outcomes in the intervention arm relative to the control arm immediately after initial intervention exposure. For almost all outcomes, a significant cross-arm difference was also present at end line and for most outcomes at the 2 intervening comparison time points. Some outcomes saw stronger intervention effects on female participants (eg, self-efficacy to refuse unprotected sex) or male participants (eg, knowledge that condoms are an effective way to prevent HIV). In each arm, intention to use a condom at first sex was consistently higher among male participants; however, female intervention-arm scores overtook male control-arm scores following initial intervention exposure.</p><p><strong>Conclusions: </strong>Tumaini significantly improved theory-based proximal outcomes related to condom use, with effects sustained 45 months post initial exposure and 16 months post most rece
{"title":"Longitudinal Effects of a Smartphone Game (Tumaini) for HIV Prevention Among Kenyan Adolescents: 45-Month Trajectories of Condom Use-Related Proximal Outcomes From a Randomized Controlled Trial.","authors":"Kate Winskell, Gaëlle Sabben, Haowen Qin, Calvin Mbeda, Sophie Goldenberg, Ken Ondeng'e, Richard Ndivo, Judith Arego, Xinwei He, Robert A Bednarczyk, Kelli Komro, Robert H Lyles, Victor Mudhune","doi":"10.2196/83982","DOIUrl":"https://doi.org/10.2196/83982","url":null,"abstract":"<p><strong>Background: </strong>African adolescents and young adults account for a disproportionate number of new HIV infections. There is an urgent need to identify scalable and cost-effective behavioral HIV prevention strategies for this population. Using a condom at first sex is associated with a higher likelihood of consistent use later. Tumaini (\"Hope for the Future\" in Swahili; Emory University) is a choose-your-own-adventure smartphone game that has been shown to reduce the risk of unprotected first sex by end line in a 45-month randomized controlled trial in western Kenya.</p><p><strong>Objective: </strong>This study aimed to assess the impact of Tumaini on proximal outcomes related to condom use at first sex (specifically, behavioral intentions, self-efficacy, attitudes, and knowledge) longitudinally across mid-adolescence in the above trial.</p><p><strong>Methods: </strong>Adolescent participants (n=996, mean baseline age 14, SD 0.56 years) were randomized 1:1 to receive either a smartphone loaded with Tumaini or an attention-control math game for 5 to 7 weeks at 3 time points (mean age 14.0, SD 0.56; 15.3, SD 0.55; and 16.0, SD 0.56 years, respectively). They completed a behavioral survey at 13 time points, through mean age 17.7 (SD 0.56) years. Using generalized estimating equations and controlling for age at baseline, we modeled mean scores (overall and stratified by gender) on a range of condom-related survey items over time to assess mean differences at specific time points. We applied appropriate Bonferroni corrections to inferences about cross-arm differences in mean changes relative to baseline at 4 time points (after each intervention period and at end line; α=.05/4) and within-arm mean changes relative to baseline at each of the 12 post-baseline time points (α=.05/12). Analyses were conducted as intent-to-treat.</p><p><strong>Results: </strong>At end line, 97.8% (n=974) of the sample had been retained. Participants in both arms dedicated a mean total of >30 hours to their assigned game. There was significant improvement across all condom-related proximal outcomes in the intervention arm relative to the control arm immediately after initial intervention exposure. For almost all outcomes, a significant cross-arm difference was also present at end line and for most outcomes at the 2 intervening comparison time points. Some outcomes saw stronger intervention effects on female participants (eg, self-efficacy to refuse unprotected sex) or male participants (eg, knowledge that condoms are an effective way to prevent HIV). In each arm, intention to use a condom at first sex was consistently higher among male participants; however, female intervention-arm scores overtook male control-arm scores following initial intervention exposure.</p><p><strong>Conclusions: </strong>Tumaini significantly improved theory-based proximal outcomes related to condom use, with effects sustained 45 months post initial exposure and 16 months post most rece","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e83982"},"PeriodicalIF":6.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433778","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}
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