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Longitudinal Between- and Within-Person Associations Among Screen Time, Bedtime, and Daytime Sleepiness Among Adolescents: Three-Wave Prospective Panel Study. 青少年屏幕时间、就寝时间和白天嗜睡之间的纵向关系：三波前瞻性面板研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-21 DOI: 10.2196/78972
Michał Tkaczyk, Albert J Ksinan, David Smahel
<p><strong>Background: </strong>Daytime sleepiness is prevalent among adolescents and linked to multiple health and functional impairments. Prior research has identified digital media use and insufficient sleep as key predictors, yet the reciprocal longitudinal associations among screen time, sleep, and daytime sleepiness remain understudied.</p><p><strong>Objective: </strong>This study examined the between- and within-person reciprocal longitudinal associations among adolescents' screen time, bedtime, and daytime sleepiness. It also tested whether potential adverse effects of screen time were less pronounced over time among adolescents who limited their screen exposure before sleep at baseline.</p><p><strong>Methods: </strong>We conducted a prospective 3-wave panel study at 6-month intervals in a quota-based sample of 2500 Czech adolescents (mean age 13.43, SD 1.70 years; 1250/2500, 50% girls). Data were collected through an online survey. Screen time was assessed with 3 items covering total use of computers, smartphones, tablets, and television on a typical school day; bedtime with a single item on usual bedtime before school days; and daytime sleepiness with 4 items from the Pediatric Daytime Sleepiness Scale. Screen time restriction within 1 hour before sleep at baseline was examined as a moderator. Age and sex were included as covariates.</p><p><strong>Results: </strong>Between- and within-person associations were estimated using random intercept cross-lagged panel models. Adolescents with higher screen time reported later bedtimes (r=0.23, 95% CI 0.15-0.31; P<.001) and greater daytime sleepiness (r=0.25, 95% CI 0.16-0.34; P<.001). No direct within-person effects emerged between screen time and daytime sleepiness (W1→W2: β=.02, 95% CI -0.11 to 0.16; P=.71; W2→W3: β=.02, 95% CI -0.10 to 0.14; P=.66). However, increases in screen time at Wave 1 predicted later bedtime at Wave 2 (β=.14, 95% CI 0.01-0.27; P<.05), which in turn predicted higher screen time at Wave 3 (β=.24, 95% CI 0.11-0.36; P<.001). Temporary within-person spikes in screen time coincided with delayed bedtimes (W1: r=0.16, 95% CI 0.04-0.27; P<.01; W2: r=0.23, 95% CI 0.09-0.36; P<.001; W3: r=0.09, 95% CI 0.00-0.20; P=.049). Baseline screen time restriction did not moderate within-person effects (Δχ<sup>2</sup><sub>6</sub>=5.3; P=.51).</p><p><strong>Conclusions: </strong>This study is the first to test reciprocal longitudinal associations among adolescents' screen time, bedtime, and daytime sleepiness while separating between- and within-person associations, thereby addressing potential bias common in prior cross-lagged panel studies. The findings refine theoretical understanding by indicating a complex, bidirectional, and mutually reinforcing interplay between screen time and bedtime over time-even when individual differences are accounted for-whereas daytime sleepiness does not appear to be affected by this dynamic. Additionally, negatively correlated, within-person fluctuations
背景：白天嗜睡在青少年中很普遍，并与多种健康和功能障碍有关。先前的研究已经确定数字媒体的使用和睡眠不足是关键的预测因素，但屏幕时间、睡眠和白天嗜睡之间的相互纵向关联仍未得到充分研究。目的：本研究考察了青少年屏幕时间、就寝时间和白天嗜睡时间之间的相互纵向关系。它还测试了屏幕时间的潜在不利影响是否随着时间的推移而不那么明显，这些青少年在睡前将屏幕暴露在基线上。方法：我们对2500名捷克青少年（平均年龄13.43岁，标准差1.70岁；1250/2500,50%为女孩）进行了为期6个月的前瞻性3波面板研究。数据是通过在线调查收集的。屏幕时间通过3个项目进行评估，包括在一个典型的上学日里，电脑、智能手机、平板电脑和电视的总使用情况；在上学前的正常就寝时间只做一件事；日间嗜睡和日间嗜睡，其中4项来自儿科日间嗜睡量表。睡前1小时的屏幕时间限制作为调节因素。年龄和性别被纳入协变量。结果：使用随机截距交叉滞后面板模型估计人与人之间和人与人之间的关联。屏幕时间较长的青少年报告的就寝时间较晚（r=0.23, 95% CI 0.15-0.31; P26=5.3； P= 0.51）。结论：本研究首次测试了青少年屏幕时间、就寝时间和白天嗜睡时间之间的纵向相互关联，同时分离了人与人之间的关联，从而解决了之前交叉滞后小组研究中常见的潜在偏差。研究结果表明，随着时间的推移，屏幕时间和就寝时间之间存在着复杂的、双向的、相互加强的相互作用，从而完善了理论上的理解——即使考虑到个体差异，而白天的困倦似乎并不受这种动态的影响。此外，与屏幕时间和就寝时间负相关的个人波动表明，这些行为在一定程度上是相互排斥的，可能是由共同的环境影响形成的。睡前限制看屏幕的时间并没有减轻对人的影响，这表明干预措施应该优先考虑一致的睡眠时间表，而不是仅仅关注减少看屏幕的时间。
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引用次数: 0
Assessing Usage and Usability of a Narrative-Based Psychoeducational Digital Intervention to Improve Medication Adherence Among Individuals With Schizophrenia in a Stable Phase: Mixed Methods Study. 评估基于叙事的心理教育数字干预的使用和可用性，以改善处于稳定阶段的精神分裂症患者的药物依从性：混合方法研究
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/59175
Dian Zhu, Fangyuan Chang, Hongyi Yang, Yiwen Wei, Zhao Liu
<p><strong>Background: </strong>Nonadherence to antipsychotic medication remains one of the most substantial challenges in the management of schizophrenia, contributing to relapse, rehospitalization, and functional decline. Although psychoeducational interventions are a key intervention for relapse prevention, traditional formats often lack interactivity and cultural resonance, thereby limiting engagement and sustained impact. Digital health innovations offer an opportunity to improve both treatment adherence and user experience, but evidence in schizophrenia populations remains limited.</p><p><strong>Objective: </strong>This study aimed to evaluate the usage patterns, usability, and effectiveness of a narrative-based psychoeducational digital intervention designed to enhance medication adherence among individuals with schizophrenia in the maintenance phase. By employing a mixed methods design, the study integrated quantitative measures of adherence and functioning with qualitative insights into participants' experiences and perceptions.</p><p><strong>Methods: </strong>A 6-month parallel mixed methods randomized controlled trial was conducted in community mental health settings in Shanghai. Seventy individuals with schizophrenia in a stable phase were randomly assigned (1:1) to the intervention group, which received the digital narrative-based psychoeducation application (Healing Town) in addition to routine community care, or to the control group, which received routine community rehabilitation only. Quantitative evaluation focused on medication adherence, drug attitude, social functioning, and psychiatric symptoms. In parallel, qualitative data were collected through semistructured interviews with patients, caregivers, and clinicians to examine intervention usage, usability, engagement, and perceived impact.</p><p><strong>Results: </strong>Seventy participants (mean age 44.2, SD 8.057 y; 61% male) were enrolled, and 69 (98.6%) completed the 6-month trial, with one dropout during the intervention period. At 6 months, the intervention group showed significantly higher medication adherence (mean difference 1.27, 95% CI 0.30-2.24; P=.02) and more positive drug attitudes (mean difference 3.41, 95% CI 1.18-5.65; P=.002) compared with controls. Improvements in social functioning were significant within the intervention group (P=.03) but not between groups. No significant group differences were observed in psychiatric symptoms. Qualitative findings identified three overarching themes: (1) adherence and usability-patients reported enhanced treatment knowledge, confidence, and motivation, though some described challenges with feedback tone and pacing; (2) experiences and attitudes-users valued cultural relevance, immersive narratives, and gamified elements but noted occasional overstimulation; and (3) expectations and recommendations-participants expressed demand for personalized features, reminders, and dynamic content to sustain engagement.</p><p><stro
背景：抗精神病药物的不依从性仍然是精神分裂症治疗中最重大的挑战之一，导致复发、再住院和功能下降。虽然心理教育干预是预防复发的关键干预措施，但传统形式往往缺乏互动性和文化共鸣，从而限制了参与和持续影响。数字健康创新为改善治疗依从性和用户体验提供了机会，但在精神分裂症人群中的证据仍然有限。目的：本研究旨在评估基于叙事的心理教育数字干预的使用模式、可用性和有效性，旨在提高精神分裂症患者在维持期的药物依从性。通过采用混合方法设计，该研究将依从性和功能的定量测量与参与者经验和感知的定性见解结合起来。方法：在上海市社区精神卫生机构进行为期6个月的平行混合随机对照试验。70名处于稳定期的精神分裂症患者被随机（1:1）分配到干预组，干预组接受基于数字叙事的心理教育应用（Healing Town）以及常规的社区护理，对照组只接受常规的社区康复。定量评价侧重于药物依从性、药物态度、社会功能和精神症状。同时，通过对患者、护理人员和临床医生的半结构化访谈收集定性数据，以检查干预措施的使用情况、可用性、参与度和感知影响。结果：70名参与者（平均年龄44.2岁，标准差8.057岁，61%为男性）入组，69名参与者（98.6%）完成了为期6个月的试验，1名参与者在干预期间退出。6个月时，干预组患者服药依从性显著高于对照组（平均差异1.27,95% CI 0.30-2.24； P= 0.02），积极用药态度显著高于对照组（平均差异3.41,95% CI 1.18-5.65； P= 0.002）。社会功能的改善在干预组内是显著的（P=.03），但组间无显著差异。精神症状组间无显著差异。定性研究结果确定了三个总体主题：(1)依从性和可用性——尽管一些患者描述了反馈语气和节奏方面的挑战，但患者报告了治疗知识、信心和动机的增强；(2)体验和态度——用户重视文化相关性、沉浸式叙事和游戏化元素，但偶尔会注意到过度刺激；(3)期望和建议——参与者表达了对个性化功能、提醒和动态内容的需求，以保持参与度。结论：这项混合方法的研究提供了初步证据，表明基于叙事的数字心理教育干预可能会提高精神分裂症患者在维持阶段的药物依从性和药物态度，同时被认为是有吸引力的、可用的和文化相关的。此外，定性研究结果表明，支持性反馈、自适应难度和个性化特征可以增强用户动机，优化未来的可扩展性。总的来说，这种基于叙事的数字心理教育代表了一种有前途的、具有潜在成本效益的支持社区精神康复的方法，值得进一步的纵向和多地点调查。
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引用次数: 0
Effect of Lung Cancer Screening, Smoking Cessation, and Cessation Smartphone App to Health-Related Quality of Life Among Heavy Smokers: Randomized Controlled Trial. 肺癌筛查、戒烟和戒烟智能手机应用程序对重度吸烟者健康相关生活质量的影响：随机对照试验
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/81687
Antti Kurtti, Sanna Iivanainen, Riitta Kaarteenaho, Heidi Andersen, Antti Jekunen, Tuula Vasankari, Jussi Koivunen
<p><strong>Background: </strong>Lung cancer screening with low-dose computed tomography (LDCT) among heavy smokers can decrease lung cancer mortality. Smoking cessation intervention is recommended within the screening program; however, the methods for smoking cessation in the LDCT screening context are not well established. We have previously shown that a novel smartphone app can increase the chance for smoking cessation along with lung cancer screening. The effects of lung cancer screening, smoking cessation, and the use of smartphone apps on health-related quality of life (HRQoL) are widely unknown.</p><p><strong>Objective: </strong>This study aims to investigate the effect of lung cancer screening, smoking cessation, and the use of smoking cessation app on HRQoL, an exploratory end point of the low-dose computed tomography screening for lung cancer combined to different smoking cessation methods in Finland (LDCT-SC-FI) study.</p><p><strong>Methods: </strong>This study was conducted as a part of the LDCT-SC-FI (NCT05630950), which was a randomized controlled trial investigating different smoking cessation methods in participants undergoing lung cancer screening with LDCT. The main inclusion criteria included an age of 50-74 years, a marked smoking history (smoked ≥15 cigarettes per day for ≥25 years or smoked ≥10 cigarettes per day for ≥30 years), an active smoking status, and access to a smartphone. The recruitment was carried out by newspaper and internet advertisements and informing relevant health care units at hospital districts. The study participants (n=200), all at Oulu University Hospital, were randomized in 1:1 fashion to a yearly LDCT with standard smoking cessation (written material) or a stand-alone smartphone app-based cessation. HRQoL, an exploratory study end point, was assessed at baseline and at 1 year with Quality of Life Questionnaire Core 30 (QLQ-C30) and EQ-5D.</p><p><strong>Results: </strong>In total, 199 and 186 individuals had both questionnaires completed at baseline and at 1 year, respectively. We did not detect a change in HRQoL between the time points using QLQ-C30 global health status score or EQ-5D index score. Smoking cessation at 1-year time did not affect QLQ-C30 global health status or EQ-5D. We observed improved quality of life scores by EQ-5D at 1 year (control: mean 0.720, SD 0.197 vs app: mean 0.799, SD 0.197; improved in 17/93, 18% of controls vs 29/93, 31% in app arm), while there was no difference in means at baseline. Smartphone app arm reported reduced pain (EQ-5D effect size [ES] 0.049, 95% CI 0.006-0.12; P=.01; adjusted ES 0.026; P=.007; QLQ-C30 ES 0.076, 95% CI 0.02-0.16; P<.001; adjusted ES 0.05; P=.02) and increased mobility (EQ-5D ES 0.031, 95% CI 0.01-0.09; P=.02; adjusted ES 0.037; P=.008) at 1 year. The number of completed questionnaires in the app was associated with improved HRQoL by EQ-5D (ES 0.073, 95% CI 0.00-0.180; P=.04; adjusted ES 0.071; P=.04).</p><p><strong>Conclusions: </strong>Th
背景：在重度吸烟者中使用低剂量计算机断层扫描（LDCT）进行肺癌筛查可以降低肺癌死亡率。建议在筛查项目中进行戒烟干预；然而，在LDCT筛查的背景下戒烟的方法并没有很好地建立。我们之前的研究表明，一款新的智能手机应用程序可以增加戒烟和肺癌筛查的机会。肺癌筛查、戒烟和使用智能手机应用程序对健康相关生活质量（HRQoL）的影响尚不清楚。目的：本研究旨在探讨肺癌筛查、戒烟和使用戒烟app对HRQoL的影响，这是芬兰低剂量肺癌ct筛查结合不同戒烟方法的探索性终点（LDCT-SC-FI）研究。方法：本研究作为LDCT- sc - fi （NCT05630950）的一部分进行，该研究是一项随机对照试验，调查接受LDCT肺癌筛查的参与者的不同戒烟方法。主要纳入标准包括年龄50-74岁、有明显的吸烟史（每天吸烟≥15支≥25年或每天吸烟≥10支≥30年）、吸烟活跃状态和使用智能手机。招募通过报纸和网络广告进行，并通知医院区相关卫生保健单位。研究参与者（n=200）均来自奥卢大学医院，以1:1的方式随机分配到每年一次的LDCT，其中包括标准戒烟（书面材料）或基于智能手机应用程序的独立戒烟。HRQoL是一项探索性研究终点，在基线和1年时使用生活质量问卷Core 30 （QLQ-C30）和EQ-5D进行评估。结果：共有199人和186人分别在基线和1年时完成了问卷调查。使用QLQ-C30整体健康状态评分或EQ-5D指数评分，我们没有发现HRQoL在时间点之间的变化。戒烟1年不影响QLQ-C30整体健康状况或EQ-5D。我们观察到EQ-5D在1年后改善了生活质量评分（对照组：平均0.720,SD 0.197；应用程序组：平均0.799,SD 0.197; 17/93, 18%的对照组改善，29/93,31%的应用程序组改善），而基线平均值没有差异。智能手机应用程序组报告疼痛减轻(EQ-5D效应值[ES] 0.049, 95% CI 0.006-0.12； P= 0.01；调整后的ES 0.026； P= 0.007; QLQ-C30 ES 0.076, 95% CI 0.02-0.16；结论：这是第一个在肺癌筛查背景下测试戒烟智能手机应用程序的研究。使用开发的应用程序与改善HRQoL相关，主要是通过减少疼痛和疲劳。总之，所研究的应用程序提供了一种可行且有效的戒烟干预措施，易于在基于人群的肺癌筛查项目中实施，除了戒烟之外，还具有增强的健康益处。
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引用次数: 0
Public Emotional and Thematic Responses to Major Emergencies on Social Media, 2024-2025: Cross-Sectional Convergent Mixed Methods Study. 社会媒体对重大突发事件的公众情绪和主题反应，2024-2025：横截面收敛混合方法研究
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/84648
Xingrong Guo, Yiqian Fan, Yiming Guo
<p><strong>Background: </strong>During 2024-2025, global emergencies triggered intense online discourse, presenting a unique opportunity to examine how cultural factors shape emotional expression and knowledge dissemination. Understanding these dynamic mechanisms is crucial for enhancing the effectiveness of digital health communication and optimizing crisis response strategies.</p><p><strong>Objective: </strong>We analyzed how cultural and linguistic contexts influence emotional expression and thematic framing in social media comments during major emergencies in 2024-2025. We uncovered cross-cultural differences in collective emotions and narrative focuses, explaining how affective stance and discourse framing jointly shape the public construction of crisis meaning.</p><p><strong>Methods: </strong>We used a cross-sectional, convergent mixed methods design. Data were collected retrospectively from X (formerly Twitter; X Corp) and Weibo (Sina Weibo) between January 1 and December 31, 2024. Using purposive sampling, we selected 5-6 representative emergency events per month based on online visibility (capped at 600 comments/event). The dataset included 19,813 comments from X and 6536 comments from Weibo. Emotions were identified using a Cross-lingual Language Model-Robustly optimized Bidirectional Encoder Representations from Transformers approach, and thematic patterns were extracted with Bidirectional Encoder Representations from Transformers Topic. Integrated Gradients was used to interpret model outputs, while clustering and network analysis were applied to visualize cross-cultural patterns. Hofstede's cultural dimensions theory helped interpret cultural influences on discourse. This mixed computational approach enabled a detailed comparison of emotional structures and thematic discourse across linguistic communities.</p><p><strong>Results: </strong>Significant cross-platform differences were observed in emotional distribution (χ²<sub>8</sub>=8025.60; P<.001). Compared to X users, Weibo users, representing a collectivist culture, expressed concentrated negative emotions (20.37%; odds ratio [OR] 15.76, 95% CI 13.90-17.85), surprise (19.70%; OR 2.53, 95% CI 2.32-2.73), and fear (16.68%; OR 1.72, 95% CI 1.58-1.86), reflecting group-oriented anxiety and emotional contagion. In contrast, X (formerly Twitter) users in individualist contexts displayed dispersed sarcasm (43.49%; OR 55.19, 95% CI 43.95-69.21) and worry (15.30%; OR 55.27, 95% CI 34.74-87.88), indicating personalized and critical emotional styles. Topic modeling revealed dense clusters around "safety," "pray," and "resettlement" on Weibo, whereas X (formerly Twitter) comments emphasized decentralized themes of critique and responsibility. Semantic network analysis revealed a cohesive fear-prayer-rescue chain on Weibo and fragmented, debate-oriented interactions on X (formerly Twitter).</p><p><strong>Conclusions: </strong>Emergency discourse is not neutral but is systematically structured b
背景：在2024-2025年期间，全球突发事件引发了激烈的在线讨论，为研究文化因素如何影响情感表达和知识传播提供了独特的机会。了解这些动态机制对于提高数字卫生通信的有效性和优化危机应对策略至关重要。目的：分析文化和语言背景如何影响2024-2025年重大突发事件期间社交媒体评论中的情感表达和主题框架。我们揭示了集体情绪和叙事焦点的跨文化差异，解释了情感立场和话语框架如何共同塑造危机意义的公共建构。方法：采用横截面、收敛混合方法设计。数据回顾性收集于2024年1月1日至12月31日期间的X（原Twitter； X Corp）和微博（新浪微博）。使用有目的的抽样，我们根据在线可见性每月选择5-6个有代表性的紧急事件（上限为600条评论/事件）。该数据集包括来自X的19813条评论和来自微博的6536条评论。采用跨语言语言模型——稳健优化的《变形金刚》双向编码器表征方法识别情感，并利用《变形金刚》主题双向编码器表征提取主题模式。综合梯度用于解释模型输出，聚类和网络分析用于可视化跨文化模式。Hofstede的文化维度理论有助于解释文化对话语的影响。这种混合计算方法可以对不同语言群体的情感结构和主题话语进行详细的比较。结论：应急话语不是中性的，而是由塑造情绪和主题的文化价值观系统地构建起来的。整合多语言计算和定性方法，我们提供了一个使用大规模数据的可复制框架，将危机和信息流行病学研究超越了单一平台或基于调查的方法。我们的研究结果促进了对文化意义系统如何在风险和不确定性条件下转化为可观察的数字话语的理论理解。它们还为政府、公共卫生机构、国际组织和数字平台提供了实际意义，为具有文化适应性、特定于平平台的风险沟通、社区调节和危机参与战略提供信息，这些战略可以增强公众信任，改善对保护行为的遵守，并减轻与信息流行相关的危害。
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引用次数: 0
Communication Challenges and Mitigation Strategies in Primary Care Virtual Consultations: Qualitative Study. 初级保健虚拟咨询中的沟通挑战和缓解策略：定性研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/79399
Ahmed Alboksmaty, Tetiana Lunova, Ara Darzi, Ana-Luisa Neves

Background: The growing reliance on virtual consultations in primary care has reshaped traditional general practitioner (GP)-patient communication dynamics, presenting new challenges that affect care quality and safety.

Objective: This study explores communication challenges and gaps, particularly relevant to virtual consultations compared with face-to-face interactions, as well as identifying mitigation strategies from both GPs' and patients' perspectives.

Methods: This qualitative study employed 4 online focus group discussions with a purposive sample of UK-based GPs and patients. Data were analyzed using a deductive-inductive thematic approach with NVivo software. The extended Shannon-Weaver communication model and the Capability, Opportunity, Motivation and Behavior model guided the analysis of communication challenges and mitigation strategies, respectively. The Consolidated Criteria for Reporting Qualitative Research were followed to ensure rigorous reporting.

Results: A total of 21 participants (12 patients and 9 GPs) took part in 4 online focus group discussions, 2 for patients and 2 for GPs. Six key themes on communication challenges emerged: 5 aligned with the extended Shannon-Weaver communication model (related to the sender-encoder, message, channel, receiver-decoder-feedback, and context), and a new one was inductively identified (patient autonomy and inclusivity). GPs, as senders, highlighted missing visual cues, affecting message clarity in remote communication channels. Patients, as receivers, reported difficulties explaining symptoms remotely, reduced emotional connection, and perceived empathy, linked to contextual challenges and the need for inclusive communication. Mitigation strategies were mapped to the Capability, Opportunity, Motivation and Behavior model: capability (training/resources), opportunity (triage/tools), and motivation (patient engagement/system adaptability), with participants emphasizing tailored training, standardized approaches, and flexible models to support effective and inclusive virtual communication.

Conclusions: This study highlights communication gaps in virtual consultations and proposes actionable mitigation strategies. Tailored use of virtual modalities, supported by structured training and policy efforts, is essential to ensure effective and safe remote communication.

背景：初级保健对虚拟咨询的日益依赖重塑了传统的全科医生(GP)-患者沟通动态，提出了影响护理质量和安全的新挑战。目的：本研究探讨沟通的挑战和差距，特别是与面对面互动相比，虚拟咨询相关，并从全科医生和患者的角度确定缓解策略。方法：本定性研究采用4个在线焦点小组讨论，目的样本为英国的全科医生和患者。数据分析使用演绎-归纳专题方法与NVivo软件。扩展的Shannon-Weaver沟通模型和能力、机会、动机和行为模型分别指导了沟通挑战和缓解策略的分析。遵循报告定性研究的综合准则，以确保严格的报告。结果：共有21名参与者（12名患者和9名全科医生）参加了4次在线焦点小组讨论，其中2次为患者，2次为全科医生。关于沟通挑战的六个关键主题出现了：5与扩展的香农-韦弗沟通模型（与发送者-编码器、信息、通道、接收者-解码器反馈和上下文相关）一致，一个新的被归纳确定（患者自主权和包容性）。全科医生，作为发送者，强调了缺失的视觉线索，影响了远程通信渠道的信息清晰度。作为接受者，患者报告难以远程解释症状，情感联系减少，并感知到同理心，这与情境挑战和包容性沟通的需求有关。缓解策略被映射到能力、机会、动机和行为模型：能力（培训/资源）、机会（分流/工具）和动机（患者参与/系统适应性），参与者强调定制培训、标准化方法和灵活模型，以支持有效和包容的虚拟通信。结论：本研究突出了虚拟咨询中的沟通差距，并提出了可行的缓解策略。在有组织的培训和政策努力的支持下，有针对性地使用虚拟方式，对于确保有效和安全的远程通信至关重要。
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引用次数: 0
Designing Electronic Problem-Solving Training for Individuals With Traumatic Brain Injury: Mixed Methods, Community-Based, Participatory Research Case Study. 为外伤性脑损伤患者设计电子问题解决训练：混合方法，社区，参与性研究案例研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/83995
Matthew Schmidt, Yueqi Weng, Shannon Juengst, Alexandra Holland
<p><strong>Background: </strong>Traditional rehabilitation research often excludes the voices of individuals with lived experience of traumatic brain injury (TBI), resulting in interventions that lack relevance, accessibility, and effectiveness. Community-based participatory research (CBPR) offers an alternative framework that emphasizes collaboration, power sharing, and sustained engagement with patients, caregivers, and clinicians.</p><p><strong>Objective: </strong>This study aimed to apply CBPR to guide front-end design (empathy interviews, empathy mapping, personas) and to evaluate the sociotechnical-pedagogical usability of the Electronic Problem-Solving Training (ePST) mobile health (mHealth) intervention with TBI partners.</p><p><strong>Methods: </strong>A multistep, mixed methods design case methodology was adopted, guided by CBPR principles and learning experience design. Participatory mechanisms included a 33-member Community Advisory Board and 10 Community Engagement Studios that engaged TBI survivors, caregivers, clinicians, and researchers throughout the Discover, Define, Develop, and Deliver phases of the Double Diamond model. Iterative activities included empathy interviews (n=14), persona development (n=10), rapid prototyping, and usability testing with 5 participants with TBI using think-aloud protocols and the Comprehensive Assessment of Usability for Learning Technologies instrument.</p><p><strong>Results: </strong>The co-design process successfully translated community feedback into an empathy-informed, user-centered prototype and systematically identified design considerations that single-partner approaches overlook. TBI-specific design requirements emerged, including the need for linear content progression over branching navigation, higher technical performance standards, and explicit content signaling with clarity prioritized over novel interface design. Think-aloud protocols revealed that participants struggled with mobile navigation and branching structures but excelled with sequential content progression. In addition, the input from individuals with TBI, caregivers, clinicians, and researchers led to practical refinements such as shorter microlearning lessons (5-12 min), clearer voiceover tone, and simplified navigation, directly addressing the study's objective of improving accessibility and emotional resonance. Overall usability was high, measured using the Comprehensive Assessment of Usability for Learning Technologies (CAUSLT), with an average score of 4.25 out of 5 (SD 0.72; 95% CI 3.36-5.15; n=5). Knowledge accuracy was 80% (8/10 items; 95% CI 49%-94%; n=5 participants; 2 items each), indicating that the system effectively supported learning and comprehension. Module completion was 100% (5/5; 95% CI 56.6%-100%). Average time-on-task for 10 lesson completions was 11.47 (SD 5.28; range 4.6-21.42) minutes per lesson, demonstrating strong task efficiency and engagement. Highest ratings were observed in the pedagogical
背景：传统的康复研究经常排除有创伤性脑损伤（TBI）生活经历的个体的声音，导致干预缺乏相关性、可及性和有效性。基于社区的参与性研究（CBPR）提供了另一种框架，强调协作、权力分享以及与患者、护理人员和临床医生的持续参与。目的：本研究旨在应用CBPR指导前端设计（共情访谈、共情映射、人物角色），并评估电子问题解决培训（ePST）移动健康（mHealth）干预对TBI合作伙伴的社会技术-教学可用性。方法：以CBPR原则为指导，以学习经验设计为指导，采用多步骤、混合方法设计案例法。参与机制包括一个由33名成员组成的社区咨询委员会和10个社区参与工作室，这些工作室在双钻石模型的发现、定义、开发和交付阶段与创伤性脑损伤幸存者、护理人员、临床医生和研究人员进行接触。迭代活动包括共情访谈（n=14）、角色开发（n=10）、快速原型设计和5名TBI参与者使用有声思考协议和学习技术可用性综合评估工具进行可用性测试。结果：协同设计过程成功地将社区反馈转化为基于移情的、以用户为中心的原型，并系统地确定了单个合作伙伴方法所忽略的设计考虑因素。特定于tbi的设计需求出现了，包括对线性内容进展的需求，而不是分支导航，更高的技术性能标准，以及明确的内容信号，其清晰度优先于新颖的界面设计。有声思考协议显示，参与者在移动导航和分支结构方面遇到困难，但在顺序内容进展方面表现出色。此外，来自TBI患者、护理人员、临床医生和研究人员的输入导致了实际的改进，例如更短的微学习课程（5-12分钟）、更清晰的画外音音调和简化的导航，直接解决了提高可访问性和情感共鸣的研究目标。总体可用性高，使用学习技术可用性综合评估（CAUSLT）测量，平均得分为4.25分（SD 0.72; 95% CI 3.36-5.15; n=5）。知识正确率为80%（8/10项，95% CI为49%-94%，n=5名参与者，每人2项），表明系统有效支持学习和理解。模块完成率为100% （5/5;95% CI 56.6%-100%）。完成10节课的平均完成任务时间为每节课11.47分钟（标准差5.28；范围4.6-21.42），显示出很强的任务效率和参与度。在教学可用性领域观察到最高的评级，反映了界面清晰，直观，有利于学习。总的来说，这些发现表明，在所有设计阶段应用CBPR，可以产生专门为TBI患者量身定制的技术可靠、易于使用且具有教学意义的移动健康工具。结论：在整个设计和开发周期中持续的CBPR导致ePST对TBI患者的高可用性。最终，该研究实现了一个完整的周期管道，将持续的社区伙伴关系与可测量的可用性结果联系起来，为TBI的形成性移动健康发展制定了社区知情的设计原则和可重复的混合方法。
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引用次数: 0
Quantifying Innovation in Stroke: Large Language Model Bibliometric Analysis. 笔画的量化创新：大型语言模型文献计量分析。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/70754
Adam Marcus, Georgina Lockwood-Taylor, Daniel Rueckert, Paul Bentley
<p><strong>Background: </strong>Thrombolysis and mechanical thrombectomy represent the most successful stroke innovations over the last 30 years. Quantifying innovation in stroke is essential for identifying productive research lines and prioritizing funding, but health care lacks validated methods for measuring innovation.</p><p><strong>Objective: </strong>This study aimed to systematically evaluate the relationship between stroke-related patents and publications, demonstrate the feasibility of using large language models (LLMs) in this process, and identify the most rapidly advancing innovations in stroke care by mapping them to a theoretical innovation life cycle.</p><p><strong>Methods: </strong>The Open Patent Services (European Patent Office) and PubMed databases were searched between 1993 and 2023 for "stroke OR cerebrovascular." In this bibliometric patent-publication analysis, a 13 billion-parameter Llama LLM was trained to identify patents related to stroke disease, as opposed to other references to the word "stroke," on a manually labeled subset of 5000 patents and assessed using 5-fold cross-validation. The LLM filtered irrelevant results, and the resulting patent codes were grouped into innovation clusters. For each cluster, annual patent and publication counts were normalized to adjust for global trends. Cluster-specific growth curves were plotted to analyze the rates and characteristics of growth. The innovation life cycle stage for each innovation cluster was estimated by fitting a sigmoid curve to the patent and publication data consistent with the diffusion of innovations theory by Rogers.</p><p><strong>Results: </strong>The cross-validated accuracy of the LLM was 99.2%, with a sensitivity of 96.5% and a specificity of 99.6%. An initial bibliometric search retrieved 237,035 patents and 486,664 research publications. A manual review of a random sample of patents before filtering revealed that only 11.2% (56/500) were relevant to stroke. After LLM filtering, of the 237,035 patents, 28,225 (11.9%) stroke-related patents remained. These were grouped into 7 innovation clusters: pharmacological treatment, alternative medicine, rehabilitation devices, medical imaging, diagnostic testing, surgical devices, and artificial intelligence (AI) methods. Patent and publication counts were strongly correlated across clusters (Spearman r<sub>s</sub>=0.65-0.92; P<.006) except for pharmacological treatment (r<sub>s</sub>=0.09) and alternative medicine (r<sub>s</sub>=0.55). Pharmacological treatments were the top-performing cluster over the last 30 years, accounting for 49.3% (36,005/73,094) of all patents, but patent activity in this area has plateaued since the late 2000s. AI methods, rehabilitation devices, and medical imaging exhibited exponential rates of patent growth, with annual normalized increases of 39.2%, 15.9%, and 5.8% compared to 16.9%, 5.3%, and 2.2% for publications, respectively.</p><p><strong>Conclusions: </strong>Applying an LLM
背景：溶栓和机械取栓是近30年来最成功的卒中创新。量化中风方面的创新对于确定富有成效的研究路线和确定优先资助至关重要，但卫生保健缺乏衡量创新的有效方法。目的：本研究旨在系统评估卒中相关专利和出版物之间的关系，论证在这一过程中使用大语言模型（llm）的可行性，并通过将其映射到理论创新生命周期来确定卒中护理中最快速发展的创新。方法：检索欧洲专利局和PubMed数据库1993年至2023年间的“卒中或脑血管”。在这个文献计量专利-出版物分析中，一个130亿个参数的Llama LLM被训练来识别与中风疾病相关的专利，而不是其他引用“中风”这个词，在5000个人工标记的专利子集上，并使用5倍交叉验证进行评估。LLM过滤不相关的结果，并将所得专利代码分组到创新集群中。对于每个集群，年度专利和出版物计数被标准化以调整全球趋势。绘制特定群集的生长曲线，以分析生长速率和特征。根据罗杰斯的创新扩散理论，通过拟合专利和出版数据的s型曲线来估计每个创新集群的创新生命周期阶段。结果：交叉验证的LLM准确率为99.2%，灵敏度为96.5%，特异性为99.6%。最初的文献计量学检索检索到237,035项专利和486,664份研究出版物。在过滤前对随机专利样本进行人工审查后发现，只有11.2%（56/500）与中风有关。经过LLM筛选，237,035项专利中，与中风相关的专利保留了28,225项（11.9%）。这些创新被分为7个创新集群：药物治疗、替代医学、康复设备、医学成像、诊断测试、手术设备和人工智能（AI）方法。专利和出版物数量在集群（Spearman rs=0.65-0.92; Ps=0.09）和替代医学（rs=0.55）之间呈强相关。在过去30年中，药物治疗是表现最好的一类，占所有专利的49.3%(36,005/73,094)，但自2000年代末以来，该领域的专利活动趋于平稳。人工智能方法、康复设备和医学成像的专利呈指数级增长，年标准化增长率分别为39.2%、15.9%和5.8%，而出版物的年标准化增长率分别为16.9%、5.3%和2.2%。结论：将法学硕士应用于公开可用的专利和出版物数据提供了一种可扩展的方法来量化中风方面的创新。药物治疗似乎已进入饱和阶段，而人工智能方法、康复设备和医学成像仍在快速增长，突出了未来研究和投资的最大吸引力领域。
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引用次数: 0
Digital Engagement and Cognitive Function Among Older Adults in China: Cross-Sectional Questionnaire Study and Moderated Mediation Model Analysis. 中国老年人的数字参与与认知功能：横断面问卷研究和有调节的中介模型分析。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/83955
Yongqi Du, Qing Niu, Gangrui Tan, Jianqian Chao, Shengxuan Jin, Leixia Wang

Background: Given the global demographic shifts and rapid digitalization, digital engagement has emerged as a critical determinant of healthy aging. While previous research has linked digital engagement to cognitive outcomes, the underlying mechanisms remain underexplored among Chinese older adults.

Objective: This study aimed to analyze the relationships between digital engagement and cognitive function among older adults in China through a moderated mediation model guided by the technological reserve hypothesis, with digital health literacy (DHL) and social support as mediators and living arrangements as a moderator.

Methods: We conducted a cross-sectional questionnaire survey using stratified multistage sampling from June to November 2024, including 8123 participants aged 55 years and older. Digital engagement, defined as older adults' use of contemporary digital technologies to support routine daily activities, autonomy, independence, and social inclusion, was assessed using a multidimensional questionnaire. The Chinese eHealth Literacy Scale, the 3-item short version of the Perceived Social Support Scale, and the Mini-Cog test were used to assess DHL, social support, and cognitive function. Guided by a directed acyclic graph based on the technological reserve hypothesis, mediation and moderated mediation analyses were performed using the PROCESS macro in SPSS (IBM Corp) with 5000 bootstrap resamples.

Results: Digital engagement was positively associated with cognitive function among older adults (β=0.241, 95% CI 0.216-0.265). This association was partially mediated by DHL (β=0.059, 95% CI 0.049-0.069) and social support (β=0.012, 95% CI 0.008-0.016), with the combined indirect effects accounting for 29.5% of the total effect (β=0.071, 95% CI 0.061-0.082). Additionally, living arrangements significantly moderated the associations between digital engagement and cognitive function (β=0.109, 95% CI 0.052-0.166), digital engagement and DHL (β=0.063, 95% CI 0.014-0.112), and digital engagement and social support (β=0.151, 95% CI 0.089-0.212). These effects were stronger among older adults living alone.

Conclusions: This study contributes to the understanding of cognitive aging in the digital environment from the perspective of the technological reserve hypothesis and digital engagement. Digital engagement influenced cognitive function via DHL and social support, and these associations of digital engagement with cognitive function, DHL, and social support were stronger among older adults living alone. Digital health interventions and public health policies should target both DHL and social support among older populations and prioritize older adults living alone.

背景：鉴于全球人口结构变化和快速数字化，数字参与已成为健康老龄化的关键决定因素。虽然之前的研究将数字参与与认知结果联系起来，但在中国老年人中，潜在的机制仍未得到充分探索。目的：以数字健康素养（digital health literacy， DHL）和社会支持为中介，以生活安排为调节因子，通过技术储备假设构建有调节的中介模型，分析中国老年人数字参与与认知功能的关系。方法：于2024年6月至11月采用分层多阶段抽样的横断面问卷调查方法，共纳入55岁及以上年龄8123人。数字参与，定义为老年人使用现代数字技术来支持日常活动、自主、独立和社会包容，使用多维问卷进行评估。采用《中国电子健康素养量表》、《感知社会支持量表》3项短版和Mini-Cog测试来评估DHL、社会支持和认知功能。在基于技术储备假设的有向无环图的指导下，使用SPSS （IBM Corp）中的PROCESS宏对5000个bootstrap样本进行了中介和调节中介分析。结果：数字参与与老年人的认知功能呈正相关（β=0.241, 95% CI 0.216-0.265）。这种关联部分由DHL （β=0.059, 95% CI 0.049-0.069）和社会支持（β=0.012, 95% CI 0.008-0.016）介导，其中间接效应占总效应的29.5% （β=0.071, 95% CI 0.061-0.082）。此外，生活安排显著调节了数字参与与认知功能（β=0.109, 95% CI 0.052-0.166）、数字参与与DHL （β=0.063, 95% CI 0.014-0.112）、数字参与与社会支持（β=0.151, 95% CI 0.089-0.212）之间的关联。这些影响在独居的老年人中更为明显。结论：本研究有助于从技术储备假设和数字参与的角度理解数字环境下的认知衰老。数字参与通过DHL和社会支持影响认知功能，并且这些数字参与与认知功能、DHL和社会支持的关联在独居老年人中更强。数字卫生干预措施和公共卫生政策应以老年人口的DHL和社会支持为目标，并优先考虑独居的老年人。
{"title":"Digital Engagement and Cognitive Function Among Older Adults in China: Cross-Sectional Questionnaire Study and Moderated Mediation Model Analysis.","authors":"Yongqi Du, Qing Niu, Gangrui Tan, Jianqian Chao, Shengxuan Jin, Leixia Wang","doi":"10.2196/83955","DOIUrl":"10.2196/83955","url":null,"abstract":"<p><strong>Background: </strong>Given the global demographic shifts and rapid digitalization, digital engagement has emerged as a critical determinant of healthy aging. While previous research has linked digital engagement to cognitive outcomes, the underlying mechanisms remain underexplored among Chinese older adults.</p><p><strong>Objective: </strong>This study aimed to analyze the relationships between digital engagement and cognitive function among older adults in China through a moderated mediation model guided by the technological reserve hypothesis, with digital health literacy (DHL) and social support as mediators and living arrangements as a moderator.</p><p><strong>Methods: </strong>We conducted a cross-sectional questionnaire survey using stratified multistage sampling from June to November 2024, including 8123 participants aged 55 years and older. Digital engagement, defined as older adults' use of contemporary digital technologies to support routine daily activities, autonomy, independence, and social inclusion, was assessed using a multidimensional questionnaire. The Chinese eHealth Literacy Scale, the 3-item short version of the Perceived Social Support Scale, and the Mini-Cog test were used to assess DHL, social support, and cognitive function. Guided by a directed acyclic graph based on the technological reserve hypothesis, mediation and moderated mediation analyses were performed using the PROCESS macro in SPSS (IBM Corp) with 5000 bootstrap resamples.</p><p><strong>Results: </strong>Digital engagement was positively associated with cognitive function among older adults (β=0.241, 95% CI 0.216-0.265). This association was partially mediated by DHL (β=0.059, 95% CI 0.049-0.069) and social support (β=0.012, 95% CI 0.008-0.016), with the combined indirect effects accounting for 29.5% of the total effect (β=0.071, 95% CI 0.061-0.082). Additionally, living arrangements significantly moderated the associations between digital engagement and cognitive function (β=0.109, 95% CI 0.052-0.166), digital engagement and DHL (β=0.063, 95% CI 0.014-0.112), and digital engagement and social support (β=0.151, 95% CI 0.089-0.212). These effects were stronger among older adults living alone.</p><p><strong>Conclusions: </strong>This study contributes to the understanding of cognitive aging in the digital environment from the perspective of the technological reserve hypothesis and digital engagement. Digital engagement influenced cognitive function via DHL and social support, and these associations of digital engagement with cognitive function, DHL, and social support were stronger among older adults living alone. Digital health interventions and public health policies should target both DHL and social support among older populations and prioritize older adults living alone.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e83955"},"PeriodicalIF":6.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010702","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
Program Theory and Core Outcome Set Development for a Technology-Assisted Counseling Intervention in Dementia: Multimethods Study. 痴呆技术辅助咨询干预的项目理论和核心结果集开发：多方法研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/81669
Dorothee Bauernschmidt, Anja Bieber, Ronja Hubrich, Janina Wittmann, Gabriele Meyer
<p><strong>Background: </strong>Counseling in family dementia care aims to support caregivers in mastering challenges. The use of information and communication technologies (ICT) to administer counseling can improve accessibility. Evidence syntheses report inconsistent findings on the effectiveness of technology-assisted counseling. There is a considerable heterogeneity in outcomes assessed in clinical trials, and approaches to develop and evaluate interventions are not guided by theory in most cases.</p><p><strong>Objective: </strong>This study aims to develop an initial program theory of a technology-assisted counseling intervention for family dementia caregivers and to create the data basis for the consensus process of a core outcome set.</p><p><strong>Methods: </strong>We integrated the methodological strands for the development of a program theory and a core outcome set in an innovative way. A scoping review was conducted to collect data on characteristics and theoretical foundations of technology-mediated counseling interventions as well as outcomes of clinical studies. We explored the lived experience of relevant interest-holders and conducted semistructured interviews applying a phenomenological approach to data analysis. Synthesis of findings was performed by developing a logic model and formulating an initial program theory.</p><p><strong>Results: </strong>We included 69 records reporting on 34 interventions. Designs and other study characteristics vary, and interventions are heterogeneous in terms of components and ICT used for delivering counseling. We conducted interviews with 15 family caregivers and 12 counselors. The themes being affected, feeling insecure and helpless in the face of the health care system, and search for information and communicative exchange illustrate the caregivers' lifeworld perception. Themes identified in counselors' interviews comprise work attitude and standards, unpredictability, expectations, working conditions, organizational influence, and tools: techniques and networking. The constitutive pattern of having/being somebody to count on was incorporated into the program theory. In the theory of change, we describe the way to a sustainable supportive cooperation between caregivers and counselors ensuring ongoing support throughout the caregiving process. We explicate the effects of the technology-assisted counseling intervention such as improved knowledge, attitude, and interaction, as well as stability and safety of care in the outcomes chain. The theory of action comprises the inputs, activities, and outputs of the intervention. The graphical synthesis of findings is presented in the logic model.</p><p><strong>Conclusions: </strong>To effectively develop, implement, and evaluate technology-assisted counseling in family dementia care, a theory-led approach is essential. A carefully modeled intervention that combines technological options with in-person counseling may help to overcome disparities in acces
背景：家庭痴呆护理咨询旨在支持照顾者应对挑战。使用信息和通信技术（ICT）来管理咨询可以改善可及性。证据综合报告了关于技术辅助咨询有效性的不一致的发现。在临床试验中评估的结果存在相当大的异质性，并且在大多数情况下，开发和评估干预措施的方法并不以理论为指导。目的：本研究旨在为家庭痴呆症护理人员提供技术辅助咨询干预的初始程序理论，并为核心结果集的共识过程创建数据基础。方法：我们以一种创新的方式整合了开发程序理论和核心结果集的方法论。我们进行了一项范围综述，以收集有关技术介导的咨询干预的特征和理论基础以及临床研究结果的数据。我们探索了相关利益相关者的生活经验，并进行了半结构化访谈，应用现象学方法进行数据分析。通过开发逻辑模型和制定初始程序理论来综合研究结果。结果：我们纳入了69份报告，涉及34项干预措施。设计和其他研究特征各不相同，干预措施在组成部分和用于提供咨询的ICT方面是异构的。我们对15名家庭照顾者和12名辅导员进行了访谈。受影响的主题、面对医疗系统的不安全感和无助感、对信息的寻找和沟通交流说明了护理者对生活世界的感知。咨询师访谈中确定的主题包括工作态度和标准、不可预测性、期望、工作条件、组织影响力和工具：技术和网络。拥有/成为一个可以依靠的人的构成模式被纳入了程序理论。在变革理论中，我们描述了护理人员和咨询师之间可持续支持合作的方式，确保在整个护理过程中持续提供支持。我们解释了技术辅助咨询干预的效果，如改善知识、态度和互动，以及结果链中护理的稳定性和安全性。行动理论包括干预的输入、活动和输出。在逻辑模型中给出了结果的图形综合。结论：为了有效地开发、实施和评估家庭痴呆症护理中的技术辅助咨询，理论主导的方法是必不可少的。将技术选择与面对面咨询相结合的精心建模的干预措施可能有助于克服在获得医疗保健方面的差距，并改善获得咨询的机会。为咨询师提供一个支持性的工作环境，其中使用人工智能来减少花在文件和管理任务上的时间，可能有助于缓解熟练专业人员日益短缺的影响。
{"title":"Program Theory and Core Outcome Set Development for a Technology-Assisted Counseling Intervention in Dementia: Multimethods Study.","authors":"Dorothee Bauernschmidt, Anja Bieber, Ronja Hubrich, Janina Wittmann, Gabriele Meyer","doi":"10.2196/81669","DOIUrl":"10.2196/81669","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Counseling in family dementia care aims to support caregivers in mastering challenges. The use of information and communication technologies (ICT) to administer counseling can improve accessibility. Evidence syntheses report inconsistent findings on the effectiveness of technology-assisted counseling. There is a considerable heterogeneity in outcomes assessed in clinical trials, and approaches to develop and evaluate interventions are not guided by theory in most cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to develop an initial program theory of a technology-assisted counseling intervention for family dementia caregivers and to create the data basis for the consensus process of a core outcome set.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We integrated the methodological strands for the development of a program theory and a core outcome set in an innovative way. A scoping review was conducted to collect data on characteristics and theoretical foundations of technology-mediated counseling interventions as well as outcomes of clinical studies. We explored the lived experience of relevant interest-holders and conducted semistructured interviews applying a phenomenological approach to data analysis. Synthesis of findings was performed by developing a logic model and formulating an initial program theory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 69 records reporting on 34 interventions. Designs and other study characteristics vary, and interventions are heterogeneous in terms of components and ICT used for delivering counseling. We conducted interviews with 15 family caregivers and 12 counselors. The themes being affected, feeling insecure and helpless in the face of the health care system, and search for information and communicative exchange illustrate the caregivers' lifeworld perception. Themes identified in counselors' interviews comprise work attitude and standards, unpredictability, expectations, working conditions, organizational influence, and tools: techniques and networking. The constitutive pattern of having/being somebody to count on was incorporated into the program theory. In the theory of change, we describe the way to a sustainable supportive cooperation between caregivers and counselors ensuring ongoing support throughout the caregiving process. We explicate the effects of the technology-assisted counseling intervention such as improved knowledge, attitude, and interaction, as well as stability and safety of care in the outcomes chain. The theory of action comprises the inputs, activities, and outputs of the intervention. The graphical synthesis of findings is presented in the logic model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;To effectively develop, implement, and evaluate technology-assisted counseling in family dementia care, a theory-led approach is essential. A carefully modeled intervention that combines technological options with in-person counseling may help to overcome disparities in acces","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e81669"},"PeriodicalIF":6.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010637","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
Gender Concordance and Patient Outcomes in Indian Telemedicine: Retrospective Cross-Sectional Quantitative Study of 286,000 Consultations. 印度远程医疗中的性别一致性和患者结果：286,000次咨询的回顾性横断面定量研究。
IF 6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Journal of Medical Internet Research
Pub Date : 2026-01-20 DOI: 10.2196/78311
Nafisa Vaz, Vishalkumar Jani
<p><strong>Background: </strong>Gender concordance (GC) between patients and physicians has been linked to trust and satisfaction in traditional health care. However, its role in telemedicine, especially in culturally complex settings like India, is underexplored. In India's culturally diverse and gender-sensitive context, understanding GC becomes particularly relevant for specialties such as gynecology, dermatology, psychiatry, and urology, where discussions often involve intimate or stigmatized concerns. Despite rapid telemedicine expansion, little empirical evidence exists on whether GC affects patient-reported outcomes in this context.</p><p><strong>Objective: </strong>This study examined whether GC significantly influences patient satisfaction and self-reported recovery in teleconsultations across India, with a focus on specialty-specific effects in culturally sensitive specialties.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional analysis of 286,196 anonymized teleconsultation records from a national telemedicine platform (January 2023-December 2024) spanning across 20 medical specialties using binary logistic regression. Records missing gender or satisfaction data were excluded from the analysis; recovery analyses included only consultations with completed day-21 follow-up surveys (n=1170, 0.4%). Outcomes included patient satisfaction (ratings 4-5 on a five-point scale) and self-reported recovery at follow-up. Logistic regression models (Stata 17.0) tested associations between GC and outcomes, controlling for consultation time, duration, and physician experience. Subgroup analyses were conducted for the top 5 specialties. Each record included key data on consultation duration, timing, physician experience, specialty type, patient satisfaction rating, and self-reported recovery status. The study excluded the pediatrics specialty from the analysis to control for the parental bias.</p><p><strong>Results: </strong>Of the 286,196 consultations, 164,008 (60.4%) were gender-concordant. Overall, 261,213 of 286,196 (91.3%) patients reported good satisfaction. GC had a statistically significant negative association with patient satisfaction (odds ratio [OR] 0.87, 95% CI 0.85-0.90; P<.001). Across gender, the male doctor received higher satisfaction. In gynecology, female patient-female doctor pairs had significantly higher odds of reporting recovery (OR 4.53, 95% CI 0.8-25.3; P=.099). Overall, consultation timing (OR 0.99, 95% CI 0.998-0.999; P<.001) and patient satisfaction (OR 20.13, 95% CI 12.06-35.38; P<.001) were stronger predictors of self-reported recovery than GC.</p><p><strong>Conclusions: </strong>GC in telemedicine has a context-dependent impact. While it does not independently predict clinical recovery, it meaningfully shapes patient satisfaction. These findings highlight that gender sensitivity training and context-specific communication approaches may enhance telemedicine experiences in culturally sensitive
背景：在传统医疗保健中，患者和医生之间的性别一致性（GC）与信任和满意度有关。然而，它在远程医疗中的作用，特别是在像印度这样文化复杂的环境中，还没有得到充分的探索。在印度多元文化和性别敏感的背景下，理解GC对妇科、皮肤病学、精神病学和泌尿科等专业尤为重要，这些专业的讨论通常涉及亲密或污名化的问题。尽管远程医疗迅速扩张，但很少有经验证据表明在这种情况下GC是否会影响患者报告的结果。目的：本研究考察了印度远程会诊中GC是否显著影响患者满意度和自我报告的康复，重点研究了文化敏感专科的特殊效果。方法：我们使用二元逻辑回归对来自国家远程医疗平台（2023年1月至2024年12月）的286196份匿名远程会诊记录进行回顾性横断面分析，涵盖20个医学专业。缺少性别或满意度数据的记录被排除在分析之外；恢复分析仅包括完成21天随访调查的咨询（n=1170, 0.4%）。结果包括患者满意度（5分制评分4-5分）和随访时自我报告的恢复情况。Logistic回归模型（Stata 17.0）检验了GC与结果之间的关系，控制了会诊时间、持续时间和医生经验。对排名前5位的专科进行亚组分析。每条记录包括咨询时间、时间、医生经验、专业类型、患者满意度评分和自我报告的恢复状态等关键数据。本研究将儿科专业排除在分析之外，以控制父母偏差。结果：286196例咨询中，164008例（60.4%）性别一致。总体而言，286196名患者中有261213名（91.3%）表示满意。GC与患者满意度呈统计学显著负相关(优势比[OR] 0.87, 95% CI 0.85-0.90；结论：远程医疗中的GC具有情境依赖性影响。虽然它不能独立预测临床康复，但它有意义地塑造了患者的满意度。这些发现强调，性别敏感性培训和特定情境的沟通方法可以提高文化敏感领域的远程医疗体验。将性别动态意识纳入远程保健设计和政策可以加强患者对虚拟护理的信任和参与。未来的研究应探索专科特异性动态和提高随访反应率，以更好地评估临床结果。
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