Journal of Medical Internet Research最新文献

{"title":"SMARTCLOTH Prototype for Dietary Management in Patients With Diabetes Mellitus: Tutorial on Human-Centered Design Methodology for Health Care Hardware Development.","authors":"Jose M Palomares, Rafael Molina-Luque, Fernando León-García, Irene Casares-Rodríguez, María García-Rodríguez, María Pilar Villena Esponera, Guillermo Molina-Recio","doi":"10.2196/75744","DOIUrl":"10.2196/75744","url":null,"abstract":"<p><strong>Background: </strong>Developing user-centered digital health hardware requires systematic design methods applicable across clinical contexts. As diabetes mellitus continues to rise globally and contributes to morbidity, mortality, and costs, effective nutritional management remains essential-yet adherence is often poor. Digital health interventions grounded in human-centered design may enhance adherence by better aligning solutions with patients' real needs.</p><p><strong>Objective: </strong>This tutorial aims to provide replicable guidance on applying the design thinking approach to health care hardware development, illustrated through the design, development, and preliminary usability evaluation of SMARTCLOTH (GA-16: Lifestyles, Innovation, and Health), a smart tablecloth prototype intended to facilitate dietary management and support adherence to nutritional recommendations among individuals with diabetes.</p><p><strong>Methods: </strong>We demonstrate a systematic design thinking approach adaptable to other hardware contexts, using the Double Diamond model. In mapping, we performed a structured preassessment to define project scope and feasible functionalities. To characterize end user needs, we conducted 6 in-depth interviews with health care professionals and applied persona, empathy map, and customer journey map tools. In exploring, 5 focus groups (patients and diabetes educators) identified barriers, facilitators, and desired functionalities for dietary self-management. In building, we created low- and high-fidelity wireframes and interactive web prototypes using Phaser 3 (HTML5/JS) to simulate a kitchen workspace for meal assembly. In testing, 7 patients with different diabetes profiles participated in 3 iterative usability sessions. Using think-aloud, video analysis, and structured tasks, we documented completion times, errors, and the level of required assistance, enabling refinements. Development progressed through 15 internal versions and 3 user-tested prototypes with real-time adjustments when feasible.</p><p><strong>Results: </strong>Interviews and focus groups yielded three user profiles guiding design: (1) adolescents with type 1 diabetes navigating social and dietary challenges, (2) working-age adults with type 2 diabetes who were motivated but inconsistent, and (3) older adults with type 2 diabetes showing low adherence due to entrenched habits. Iterative usability testing indicated that the system was intuitive, with improvements in layout, labeling, and navigation. Quantitative metrics showed refinement, with simple tasks being completed in under 1 minute in later iterations, while complex meal simulations took longer. Error rates and required guidance decreased as prototypes evolved. Qualitative feedback highlighted clarity, motivational value, and educational potential, while older participants requested larger text and simplified controls. Despite usability gains, motivational barriers persisted among low-adhere","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e75744"},"PeriodicalIF":6.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12826948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018776","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":"WHOOP, There It Is: Lessons From WHOOP's FDA Warning Letter.","authors":"Blythe Karow","doi":"10.2196/90882","DOIUrl":"10.2196/90882","url":null,"abstract":"","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e90882"},"PeriodicalIF":6.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12822547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010809","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":"Communication Strategies to Promote Patient Engagement in Telemedicine: Systematic Review.","authors":"Yangna Hu, Cindy Sing Bik Ngai, Rui Jiang","doi":"10.2196/85456","DOIUrl":"10.2196/85456","url":null,"abstract":"<p><strong>Background: </strong>The rapid growth of telemedicine offers convenience, flexibility, and accessibility for patients to have health care services worldwide. To succeed in telemedicine, health care practitioners and telemedicine tools must engage patients through effective communication. However, a research gap exists in understanding the communication strategies used in telemedicine and how they effectively engage patients.</p><p><strong>Objective: </strong>This study aims to identify communication strategies influencing patient engagement in telemedicine with provider-patient interactions, as well as how included studies evaluate patient engagement through a systematic review.</p><p><strong>Methods: </strong>We searched the literature comprehensively using 6 databases, Web of Science, PubMed, Scopus, MEDLINE, CINAHL, and Embase, from inception to October 2025. We included empirical, English-language studies that examined communication strategies affecting patient engagement in telemedicine with provider-patient interactions. Studies lacking actual patients or provider-patient interactions in telemedicine were excluded. We used content analysis to identify texts that were related to Theme 1: the communication strategies affecting patient engagement, and Theme 2: evaluation of patient engagement. Coded texts were analyzed to develop subthemes and themes of identified communication strategies. Methods for evaluating patient engagement were summarized. A narrative synthesis was conducted because of heterogeneity across study design and outcomes. We used the Mixed Methods Appraisal Tool to assess the quality of research included in this study.</p><p><strong>Results: </strong>This study systematically reviewed 34 peer-reviewed articles, revealing 3 overarching themes of effective communication strategies that enhance patient engagement: interpersonal communication strategies, with 6 subthemes (building relationships, supportive attitude, interactive dialogic loop, nonverbal communication, professionalism and accuracy, and tailored communication); team-level communication strategies, with 3 subthemes (training and preparation, teamwork and care coordination, and cultural and linguistic sensitivity); and system-level communication strategies, with 3 subthemes (usefulness of information, ease of use, and data privacy and security). We also found that included studies predominantly used qualitative research methods, such as semistructured interviews and focus groups, to collect patient engagement data.</p><p><strong>Conclusions: </strong>This review provides an innovative synthesis of communication strategies that promote patient engagement in telemedicine by integrating interpersonal (micro), team (meso), and system-level (macro) perspectives. Unlike previous reviews that focused on single aspects or levels of communication, this study offers a holistic framework that advances theoretical understanding of how multilevel communication strategi","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e85456"},"PeriodicalIF":6.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12873561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010625","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":"A Complex Digital Health Intervention to Support People With HIV: Organizational Readiness Survey Study and Preimplementation Planning for a Hybrid Effectiveness-Implementation Study.","authors":"Jacqueline Hodges, Wendy Cohn, Amanda Castel, Tabor Flickinger, Ava Lena Waldman, Michelle Hilgart, Olivia Kirby, Sylvia Caldwell, Karen Ingersoll","doi":"10.2196/76327","DOIUrl":"10.2196/76327","url":null,"abstract":"<p><strong>Background: </strong>Evaluating implementation of digital health interventions (DHIs) in practice settings is complex, involving diverse users and multistep processes. Proactive planning can ensure implementation determinants and outcomes are captured for hybrid studies, but operational guidance for designing or planning hybrid DHI studies is limited.</p><p><strong>Objective: </strong>This study aimed to proactively define, prioritize, and operationalize measurement of implementation outcomes and determinants for a DHI hybrid effectiveness-implementation trial. We describe unique advantages and limitations of planning the trial implementation evaluation among a large-scale cohort study population and share results of a pretrial organizational readiness assessment.</p><p><strong>Methods: </strong>We planned a cluster-randomized, type II hybrid effectiveness-implementation trial testing PositiveLinks, a smartphone app for HIV care, compared to usual care (n=6 sites per arm), among HIV outpatient sites in the DC Cohort Longitudinal HIV Study in Washington, DC. We (1) defined components of the DHI and associated implementation strategy; (2) selected implementation science frameworks to accomplish evaluation aims; (3) mapped framework dimensions, domains, and constructs to implementation strategy steps; (4) modified or created instruments to collect data for implementation outcome measures and determinants; and (5) developed a compatible implementation science data collection and management plan. Provider baseline surveys administered at intervention sites probed usage of digital tools and assessed provider readiness for implementation with the Organizational Readiness to Implement Change tool.</p><p><strong>Results: </strong>We specified DHI and implementation strategy toward planning measurement of DHI and broader program reach and adoption. Mapping of implementation strategy steps to the Reach Effectiveness Adoption Implementation Maintenance framework prompted considerations for how to capture understudied aspects of each dimension: denominators and demographic representativeness within reach or adoption, and provider or organization-level adaptations, dose, and fidelity within the implementation dimension. Our process also prompted the creation of tools to obtain detailed determinants across domains and constructs of the Consolidated Framework for Implementation Research within a large sample at multiple time points. Some aspects of real-world PositiveLinks implementation were not reflected within the planned hybrid trial (eg, research assistants selected as de facto site implementation leads) or were modified to preserve internal validity of effectiveness measurement (eg, \"Community of Practice\"). Providers and research assistants (n=17) at intervention sites self-reported high baseline use of digital tools to communicate with patients. Readiness assessment revealed high median (48, IQR 45-54) total Organizational Readiness to Impleme","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e76327"},"PeriodicalIF":6.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12823349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018602","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":"Patterns of Artificial Intelligence Use in Clinical Work by Hospitalists: A Survey Study.","authors":"Prabhava Bagla, Jasmah Hanna, Bhargav Marthambadi, Stacey Watkins","doi":"10.2196/85973","DOIUrl":"https://doi.org/10.2196/85973","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) tools are widely and freely available for clinical use. Understanding hospitalists' real-world adoption patterns in the absence of organizational endorsement is essential for healthcare institutions to develop governance frameworks and optimize AI integration.</p><p><strong>Objective: </strong>The objective of this study was to investigate hospitalist use of AI, examining the AI platforms being utilized, frequency of use, and clinical contexts of application. We hypothesized that AI use is more common among younger, less experienced hospitalists, albeit at an overall low frequency.</p><p><strong>Methods: </strong>An anonymous online survey was distributed via email to all 70 hospitalists (physicians, nurse practitioners, physician assistants) providing direct patient care at a large urban academic tertiary care hospital. Demographic data, AI platform used if any, purpose(s) for AI use, and frequency of use information was collected. CHERRIES checklist was used for creating, testing, administering, and reporting the results of the survey. Chi-square test was used where possible; when expected cell values were low, Fisher's exact test was used instead. Friedman test and pairwise Wilcoxon signed-rank test were used for analyzing the differences between frequency of AI use for various tasks. Likert-scale responses to frequency questions (Never, Rarely, Sometimes, Often, Always) were converted to ordinal values (1 - 5, respectively) to facilitate analysis.</p><p><strong>Results: </strong>Of 70 providers, 54 (77.1%) responded to the survey. No significant differences in AI usage were observed across shift type, years of practice, time allocation to hospitalist duties, sex, age, or provider designation, contrary to our hypothesis. Overall, 36 of 54 respondents (66.7%, 95% CI 53.4%-77.8%) reported using AI in clinical practice. OpenEvidence was the most used platform (28/54, 51.9%), far exceeding general-purpose tools like ChatGPT (4/54, 7.4%), suggesting preference for medical-specific platforms. Among non-users, primary concerns were AI accuracy and preference for established resources. The most common application was answering miscellaneous clinical questions (32/36, 88.9%), generating differential diagnoses (31/36, 86.1%) and determining management options (31/36, 86.1%), with much lower use for patient education materials (16/36, 44.4%). There was a statistically significant difference in the frequency of AI use across these clinical scenarios (Friedman test chi-square statistic 37.596, df 4, P<.001). Pairwise comparisons using the Wilcoxon signed-rank test revealed significant differences between use for answering miscellaneous questions and confirming suspected diagnosis (P=.003) and generating patient education materials (P=.004) respectively. Most respondents reported using AI for under 25% of clinical encounters across all use cases.</p><p><strong>Conclusions: </strong>Two-thirds of h","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046700","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":"Longitudinal Between- and Within-Person Associations Among Screen Time, Bedtime, and Daytime Sleepiness Among Adolescents: Three-Wave Prospective Panel Study.","authors":"Michał Tkaczyk, Albert J Ksinan, David Smahel","doi":"10.2196/78972","DOIUrl":"10.2196/78972","url":null,"abstract":"<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 ","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e78972"},"PeriodicalIF":6.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12873560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018791","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":"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.","authors":"Dian Zhu, Fangyuan Chang, Hongyi Yang, Yiwen Wei, Zhao Liu","doi":"10.2196/59175","DOIUrl":"10.2196/59175","url":null,"abstract":"<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","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e59175"},"PeriodicalIF":6.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010629","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":"Effect of Lung Cancer Screening, Smoking Cessation, and Cessation Smartphone App to Health-Related Quality of Life Among Heavy Smokers: Randomized Controlled Trial.","authors":"Antti Kurtti, Sanna Iivanainen, Riitta Kaarteenaho, Heidi Andersen, Antti Jekunen, Tuula Vasankari, Jussi Koivunen","doi":"10.2196/81687","DOIUrl":"10.2196/81687","url":null,"abstract":"<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","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e81687"},"PeriodicalIF":6.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010616","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":"Public Emotional and Thematic Responses to Major Emergencies on Social Media, 2024-2025: Cross-Sectional Convergent Mixed Methods Study.","authors":"Xingrong Guo, Yiqian Fan, Yiming Guo","doi":"10.2196/84648","DOIUrl":"10.2196/84648","url":null,"abstract":"<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","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e84648"},"PeriodicalIF":6.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010772","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":"Communication Challenges and Mitigation Strategies in Primary Care Virtual Consultations: Qualitative Study.","authors":"Ahmed Alboksmaty, Tetiana Lunova, Ara Darzi, Ana-Luisa Neves","doi":"10.2196/79399","DOIUrl":"10.2196/79399","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"28 ","pages":"e79399"},"PeriodicalIF":6.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010642","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}