JMIR Human Factors最新文献

Background: Although research has found online peer support forums to be helpful for those with mental health conditions, no studies have explored the experiences of those who use forums for support with postpartum psychosis (PP) specifically.

Objective: This study aimed to understand the lived experiences of using online forums for PP, and how this form of support differs from professional and other informal support.

Methods: This study used a qualitative approach, including semistructured interviews with 8 participants. Recruitment took place via an online forum run by a charity called Action on Postpartum Psychosis. Transcripts were analyzed using interpretative phenomenological analysis.

Results: Four themes were developed in line with participants' experiences (1) from isolation to connection: validation, growth, and hope from shared experiences; (2) complementing not replacing: filling the gaps in support; (3) impacts of privacy, representation, and readiness to share on engagement; and (4) relational experiences within peer support: altruism, boundaries, and comparison. All participants believed forums were helpful to their well-being and recovery; however, some also reported difficulties with engagement, comparison, and regulating their own use. Findings suggest that forums may benefit from being designed in a way that protects users and their identities, for example, via trigger warnings and setting boundaries.

Conclusions: Peer online forums offer a unique and potentially effective addition to existing support provided by professionals and personal connections. Professionals should signpost people experiencing PP to forums, but should also understand the support that may be needed in terms of monitoring use and ensuring that appropriate boundaries are put into place.

Background: Making optimal use of mobile health technologies requires the validation of digital biomarkers, which in turn demands high levels of participant adherence and retention. However, current remote digital health studies have high attrition rates and low participant adherence, which may introduce bias and limit the generalizability of their findings.

Objective: This study aimed to identify longitudinal indicators of participant retention and adherence, which may serve to develop strategies to improve data collection in digital health studies and improve understanding of how study cohorts are shaped by participant withdrawal and nonadherence.

Methods: We performed secondary analyses on the Brighten study, which consisted of 2 remote, smartphone-based randomized controlled trials evaluating mobile apps for depression treatment, enrolling 2193 participants in total. Participants were asked, after baseline assessment, to complete 7 digital questionnaires regularly. We assessed adherence to digital questionnaires, engagement (postbaseline participation), and retention rates (the proportion of participants who continued completing questionnaires over time) as outcomes. We investigated the relationship between these outcomes and both static measures (eg, demographics and average questionnaire scores) and dynamic measures (eg, changes in questionnaire scores over time).

Results: The study included 2201 participants, of whom 1093 completed at least 1 nonbaseline questionnaire, with a median completion rate of 37.6% (IQR 15.5%-67.9%). We found significantly higher adherence rates in participants who were less depressed on average over the course of the study (t752=-5.63; P<.001) and in those who perceived clinical improvement (t744=3.78; P=.001). There were significant demographic differences in adherence and engagement, including differences by gender, race, education, income, and income satisfaction. Participants who were more depressed at baseline were more likely to withdraw before completing any nonbaseline questionnaire (t1917=-2.53; P=.01). However, participants who showed improvement in depressive symptoms during the study showed better adherence (Mann-Whitney U=127,084; P<.001) and retention (hazard ratio 0.78, 95% CI 0.67-0.91; P=.002), despite showing greater depressive symptoms at baseline.

Conclusions: We show that participants' clinical trajectory of depressive symptoms, as well as their perception of improvement, are important indicators of engagement, adherence, and retention. Expanding knowledge regarding these longitudinal indicators may improve interpretation of outcomes and help build strategies to improve retention and adherence in future clinical trials.

Background: Trust in artificial intelligence (AI) remains a critical barrier to the adoption of AI in mental health care. This study explores the formation of trust in an AI mental health model and its human-computer interface among clinicians at a web-based mental health clinic in the Region of Southern Denmark with national coverage.

Objective: This study aims to explore clinicians' perspectives on how trust is built in the context of an AI-supported mental health screening model and to identify the factors that influence this process.

Methods: This was a qualitative case study using semistructured interviews with clinicians involved in the pilot of a mental health AI model. Thematic analysis was used to identify key factors contributing to trust formation.

Results: Clinicians' initial attitudes toward AI were shaped by prior positive experiences with AI and their perception of AI's potential to reduce cognitive load in routine screening. Trust development followed a sequential pattern resembling a "trust journey": (1) sense-making, (2) risk appraisal, and (3) conditional decision to rely. Trust formation was supported by the explainability of the model, particularly through (1) visualization of confidence and uncertainty through violin plots, aligning with the clinicians' expectations of decision ambiguity; (2) feature attribution for and against predictions, which mirrored clinical reasoning; and (3) use of pseudo-sumscores in the AI model, which increased interpretability by presenting explanations in familiar clinical formats. Trust was contextually bounded to low-risk clinical scenarios, such as preinterview patient screening, and contingent on safety protocols (eg, suicide risk flagging). The use of both structured and unstructured patient data was seen as key to expanding trust into more complex clinical contexts. Participants also expressed a need for ongoing evaluation data to reinforce and maintain trust.

Conclusions: Clinicians' trust in AI tools is contextually and sequentially constructed, influenced by both model performance and alignment with clinical reasoning. Interpretability features were essential in establishing intrinsic trust, particularly when presented in ways that resonate with clinical norms. For broader acceptance and responsible deployment, trust must be supported by rigorous evaluation data and the inclusion of clinically relevant data types in model design.

Background: Technology is rapidly reshaping conventional hospital environments into smart spaces, enhancing care, improving clinical workflows, and reducing workloads. However, successful implementation depends not only on the effectiveness of the technology but also on organizational readiness for change.

Objective: This study aimed to identify the key enablers and barriers to readiness for change for a smart hospital ward initiative.

Methods: We conducted a qualitative study to gauge organizational readiness for change for a smart ward initiative. Using purposive sampling, we captured diverse views from clinicians, IT staff, operational support staff, and health care redesign staff. Data were coded deductively under 3 key domains in Weiner's theory of organizational readiness: change efficacy, change commitment, and contextual factors. Subthemes were derived inductively under each domain.

Results: We interviewed 19 participants, including clinicians and support staff. Six subthemes emerged: (1) perceived valence and feasibility; (2) transparency and trust in management; (3) shared understanding and readiness to act; (4) resources, training, and staff capability; (5) innovation culture; and (6) past experiences. Participants viewed the initiative as valuable and were motivated to change, citing that the institution's innovation culture was a key enabler. However, there were key barriers, including unclear timelines, inconsistent training, limited resources, and a lack of infrastructure to support innovation. Concerns about overreliance on technology were also prominent, with staff wary of its impact on clinical judgment and system reliability.

Conclusions: Enabling readiness for the smart ward initiative requires transparent communication of timelines and project awareness, particularly for ground staff, the development of training frameworks, and adequate prioritization of innovation. Alleviating commonly reported technology concerns, such as overreliance, loss of human touch, and system reliability, will also be key to adoption and sustainability.

Background: Health messages are integral to smoking cessation interventions. Common approaches to health message development include expert-crafted messages and audience-generated messages, which produce messages that can be monotonic, didactic, and limited in number. We introduce an alternative approach to health message development that relies on user-generated content available on open-content platforms as a source of health messages.

Objective: We examined the acceptability of user-generated content curated from Twitter (subsequently rebranded X) as a source of health support messages in a newly developed smoking cessation mobile intervention called Quit Journey and the optimal timing and frequency with which health messages can be deployed to support app users in real time.

Methods: A total of 12 semistructured focus groups were held with 38 young adults with low socioeconomic status who smoked cigarettes, wanted to quit, and were aged 18 to 29 years. Focus groups were held virtually on GoTo Meeting, audio recorded, and transcribed verbatim. Deductive thematic analysis was used, with themes based on 5 constructs from the second unified theory of acceptance and use of technology (ie, effort expectancy, facilitating conditions, hedonic motivation, performance expectancy, and social influence) and negative, neutral, and positive sentiment.

Results: Participants perceived user-generated content positively (56/108, 51.9% of the quotes) and focused on their perceived usefulness (37/108, 34.3% of the quotes). User-generated content was perceived as authentic, nonrepetitive support from people with similar real-life experiences. Negative or sarcastic user-generated content elicited negative reactions from participants. Participants preferred receiving 3 or fewer daily messages, ideally before cravings. Suggestions focused on the need to screen user-generated content before its inclusion in the app library and allow app users to customize message frequency and timing.

Conclusions: User-generated content was deemed an acceptable source of health messages. This content can improve the efficacy and effectiveness of smoking cessation interventions by increasing their pool of unique messages that may be better received and more persuasive than expert-curated content. User-generated content can be used to curate health messages for all medical conditions and behaviors with relevant publicly available online content for integration in behavioral interventions given its high volume, brevity, and narrative-like nature. Future research is needed to investigate the effects of user-generated content on health behaviors and identify the theoretical mechanisms for these effects.

Background: Needleless access devices are essential for intravenous therapy but can be a source of contamination and catheter-related bloodstream infections (CRBSIs) if not disinfected properly. The BD PosiFlush SafeScrub (Becton, Dickinson and Company) is designed to support aseptic nontouch technique (ANTT) by incorporating a built-in reminder to "scrub-the-hub" before flushing. This feature can help improve compliance with disinfection practices and may reduce the risk of microbial contamination.

Objective: This study aimed to evaluate compliance with scrubbing before flushing using the BD PosiFlush SafeScrub in a simulated clinical environment compared with standard disinfection and flushing practices (alcohol swabs and prefilled saline syringes).

Methods: A cross-sectional, within-subjects, simulated-use compliance study was conducted with health care professionals familiarized with BD PosiFlush SafeScrub (a prefilled BD PosiFlush Syringe with an integrated disinfecting unit). Compliance was defined according to the disinfection procedure specified for each scenario; participants were considered compliant with standard practice if they followed their own institutional policy (ranging from 5 to 30 seconds or based on stroke counts), while compliance with BD PosiFlush SafeScrub required scrubbing for at least 10 seconds with a minimum of 8 clockwise and 8 counterclockwise rotations, in accordance with the instructions for use (IFU). Compliance with disinfection was monitored and recorded for both the BD PosiFlush SafeScrub and standard disinfection and flushing practice.

Results: Compliance with catheter hub disinfection was assessed among 60 participants for BD PosiFlush SafeScrub and 57 participants for standard practice. During preaccess procedures (Flush 1), BD PosiFlush SafeScrub achieved 46% compliance versus 21% with standard practice, representing an absolute improvement of 25% and a 119% relative improvement (P<.001). During the postmedication procedure (Flush 2), compliance was 22% with BD PosiFlush SafeScrub compared with 13% for standard practice, corresponding to a 9% absolute improvement and 69% relative improvement, although not statistically significant (P=.12). Overall, the compliance rate was 34% (81/240 interactions) in the BD PosiFlush SafeScrub group compared with 17% (39/228 interactions) in the standard practice group, representing an absolute improvement of 17% and a relative improvement of 100% (P<.001).

Conclusions: The BD PosiFlush SafeScrub, with its integrated disinfection unit, yielded approximately double the scrub-the-hub compliance (34%) before flushing compared to the standard practice of alcohol pads and prefilled saline syringes (17%), supporting its role in facilitating adherence to ANTT, which may reduce microbial growth.