Ke Liu, Yuting Yang, Zixuan Song, Huixian Li, Yanli Lyu, Ke Zhang, Xinxia Wu, Zheng Hou, Yipei Wang
Background: Telemedicine has rapidly expanded worldwide due to its convenience and accessibility. In China, an increasing number of hospitals have begun offering telemedicine services; however, patient utilization remains relatively low. Limited research has examined patients' behaviors during the process of adopting telemedicine services.
Objective: This study aimed to identify barriers to and enablers for patients using telemedicine services and to formulate implementation strategies.
Methods: We conducted semistructured qualitative interviews based on the Theoretical Domains Framework (TDF) to identify barriers and enablers to telemedicine utilization. Twenty-one patients who had used Peking University Third Hospital's telemedicine services were included in the interviews. Data were analyzed using NVivo 12.0 with deductive thematic analysis guided by the TDF. Moreover, a group of experts was assembled to devise potential intervention strategies.
Results: A total of 28 themes were identified, including 14 barriers and 14 enablers across 5 of the 14 TDF domains. The most frequently reported barriers were operational challenges, prolonged waiting periods from asynchronous communication, and doubts about therapeutic efficacy, whereas the most frequently mentioned enablers were the convenience of telemedicine, time conservation, and support from hospitals. On the basis of these factors, we devised 6 intervention strategies.
Conclusions: This study demonstrated that patients' utilization of telemedicine services was affected by several barriers and enablers, including system architecture and design, patient interactions using telemedicine, and external assistance. To enhance the utilization, these factors must be meticulously considered. This study also suggests strategies to enhance the utilization of telemedicine.
{"title":"Using the Theoretical Domains Framework to Identify Barriers to and Enablers of Patient Telemedicine Services Use in China: Qualitative Study.","authors":"Ke Liu, Yuting Yang, Zixuan Song, Huixian Li, Yanli Lyu, Ke Zhang, Xinxia Wu, Zheng Hou, Yipei Wang","doi":"10.2196/78457","DOIUrl":"10.2196/78457","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine has rapidly expanded worldwide due to its convenience and accessibility. In China, an increasing number of hospitals have begun offering telemedicine services; however, patient utilization remains relatively low. Limited research has examined patients' behaviors during the process of adopting telemedicine services.</p><p><strong>Objective: </strong>This study aimed to identify barriers to and enablers for patients using telemedicine services and to formulate implementation strategies.</p><p><strong>Methods: </strong>We conducted semistructured qualitative interviews based on the Theoretical Domains Framework (TDF) to identify barriers and enablers to telemedicine utilization. Twenty-one patients who had used Peking University Third Hospital's telemedicine services were included in the interviews. Data were analyzed using NVivo 12.0 with deductive thematic analysis guided by the TDF. Moreover, a group of experts was assembled to devise potential intervention strategies.</p><p><strong>Results: </strong>A total of 28 themes were identified, including 14 barriers and 14 enablers across 5 of the 14 TDF domains. The most frequently reported barriers were operational challenges, prolonged waiting periods from asynchronous communication, and doubts about therapeutic efficacy, whereas the most frequently mentioned enablers were the convenience of telemedicine, time conservation, and support from hospitals. On the basis of these factors, we devised 6 intervention strategies.</p><p><strong>Conclusions: </strong>This study demonstrated that patients' utilization of telemedicine services was affected by several barriers and enablers, including system architecture and design, patient interactions using telemedicine, and external assistance. To enhance the utilization, these factors must be meticulously considered. This study also suggests strategies to enhance the utilization of telemedicine.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e78457"},"PeriodicalIF":3.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12823017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unlabelled: Symptom checkers are apps and websites that assist medical laypeople in diagnosing their symptoms and determining which course of action to take. When evaluating these tools, previous studies primarily used an approach introduced a decade ago that lacked any type of quality control. Numerous studies have criticized this approach, and several empirical studies have sought to improve specific aspects of evaluations. However, even after a decade, a high-quality methodological framework for standardizing the evaluation of symptom checkers is still lacking. This paper synthesizes empirical studies to outline the Symptom Checker Accuracy Reporting Framework (SCARF) and a corresponding checklist for standardizing evaluations based on representative case selection, an externally and internally valid evaluation design, and metrics that increase cross-study comparability. This approach is supported by several open access resources to facilitate implementation. Ultimately, it should enhance the quality and comparability of future evaluations of online and artificial intelligence (AI)-based symptom checkers, diagnostic decision support systems, and large language models to enable meta-analyses and help stakeholders make more informed decisions.
{"title":"How to Evaluate the Accuracy of Symptom Checkers and Diagnostic Decision Support Systems: Symptom Checker Accuracy Reporting Framework (SCARF).","authors":"Marvin Kopka, Markus A Feufel","doi":"10.2196/76168","DOIUrl":"10.2196/76168","url":null,"abstract":"<p><strong>Unlabelled: </strong>Symptom checkers are apps and websites that assist medical laypeople in diagnosing their symptoms and determining which course of action to take. When evaluating these tools, previous studies primarily used an approach introduced a decade ago that lacked any type of quality control. Numerous studies have criticized this approach, and several empirical studies have sought to improve specific aspects of evaluations. However, even after a decade, a high-quality methodological framework for standardizing the evaluation of symptom checkers is still lacking. This paper synthesizes empirical studies to outline the Symptom Checker Accuracy Reporting Framework (SCARF) and a corresponding checklist for standardizing evaluations based on representative case selection, an externally and internally valid evaluation design, and metrics that increase cross-study comparability. This approach is supported by several open access resources to facilitate implementation. Ultimately, it should enhance the quality and comparability of future evaluations of online and artificial intelligence (AI)-based symptom checkers, diagnostic decision support systems, and large language models to enable meta-analyses and help stakeholders make more informed decisions.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e76168"},"PeriodicalIF":3.0,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145990940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nastasia Sălăgean, Ioana Maria Latu, Torill Marie Bogsnes Larsen, Andreea Bogdana Isbășoiu, Florin Alin Sava
<p><strong>Background: </strong>Discrimination can greatly impact both physical and mental health due to frequent stressors. Younger individuals, particularly those under the age of 17 years, are more adversely affected by victimization. Within the European Union, Romania exhibits poor rankings concerning LGBTQ+ (lesbian, gay, bisexual, transgender/transsexual, queer, and other minority sexual orientations and gender identities) inclusion, with large numbers of LGBTQ+ teenagers experiencing bullying due to their sexual orientation. Given that much of this discrimination and harassment occurs within schools, teachers and counselors are vital in affecting institutional change.</p><p><strong>Objective: </strong>This study aims to investigate the impact of an intervention on reducing prejudice against the LGBTQ+ community among Romanian teachers and counselors. Most prior interventions of this nature target Western, educated, industrialized, rich, and democratic populations.</p><p><strong>Methods: </strong>In this randomized controlled trial, we recruited 175 Romanian teachers via a national closed online user group and assigned them to either the experimental or control condition. Participants in the experimental condition received the intervention first and then completed the web-based outcome measures, while those in the control condition completed the measures first and then received the intervention. The intervention, designed for internet-based delivery, consisted of a 1-hour video session led by a pair of researchers. It blended educational information with testimonials of LGBTQ+ people, perspective-taking tasks, and a self-efficacy exercise. We measured LGBTQ+ prejudice (using Attitudes Toward Lesbians and Gay Men Scale, Homophobia Scale, and Attitudes Toward Homosexuals Scale), behavioral intentions, self-efficacy, perspective taking, intergroup disgust sensitivity, intergroup anxiety, empathy, factual knowledge about LGBTQ+ issues, as well as participants' feelings toward lesbian, gay, and bisexual individuals.</p><p><strong>Results: </strong>Participants in the experimental group (n=89) showed significant reductions in prejudice when using the Attitudes Toward Lesbians and Gay Men Scale (F1,173=7.22; P=.008) when compared to the control group (n=86), but not when using the other 2 attitudinal scales. We also found that the experimental group had warmer feelings (F1,173=4.40; P=.04; d=0.32), were more likely to engage in supportive behaviors (F1,173=13.96; P<.001; d=0.56), displayed more self-efficacy (F1,173=9.14; P=.001; d=0.33), had more factual knowledge (F1,173=11.98; P=.001; d=0.52), and had a higher ability to take the LGBTQ+ perspective after controlling for contact (F1,172=4.77; P=.03; d=0.28). We did not observe significant differences in terms of intergroup disgust sensitivity (F1,173=0.816; P=.37), intergroup anxiety for either positive (F1,173=.383; P=.54) or negative emotions (F1,173=0.51; P=.48), or empathy (F1,173=0.02; P=.8
{"title":"An Internet-Delivered Intervention to Reduce LGBTQ+ Prejudice Among Romanian Teachers: Randomized Controlled Trial.","authors":"Nastasia Sălăgean, Ioana Maria Latu, Torill Marie Bogsnes Larsen, Andreea Bogdana Isbășoiu, Florin Alin Sava","doi":"10.2196/63787","DOIUrl":"10.2196/63787","url":null,"abstract":"<p><strong>Background: </strong>Discrimination can greatly impact both physical and mental health due to frequent stressors. Younger individuals, particularly those under the age of 17 years, are more adversely affected by victimization. Within the European Union, Romania exhibits poor rankings concerning LGBTQ+ (lesbian, gay, bisexual, transgender/transsexual, queer, and other minority sexual orientations and gender identities) inclusion, with large numbers of LGBTQ+ teenagers experiencing bullying due to their sexual orientation. Given that much of this discrimination and harassment occurs within schools, teachers and counselors are vital in affecting institutional change.</p><p><strong>Objective: </strong>This study aims to investigate the impact of an intervention on reducing prejudice against the LGBTQ+ community among Romanian teachers and counselors. Most prior interventions of this nature target Western, educated, industrialized, rich, and democratic populations.</p><p><strong>Methods: </strong>In this randomized controlled trial, we recruited 175 Romanian teachers via a national closed online user group and assigned them to either the experimental or control condition. Participants in the experimental condition received the intervention first and then completed the web-based outcome measures, while those in the control condition completed the measures first and then received the intervention. The intervention, designed for internet-based delivery, consisted of a 1-hour video session led by a pair of researchers. It blended educational information with testimonials of LGBTQ+ people, perspective-taking tasks, and a self-efficacy exercise. We measured LGBTQ+ prejudice (using Attitudes Toward Lesbians and Gay Men Scale, Homophobia Scale, and Attitudes Toward Homosexuals Scale), behavioral intentions, self-efficacy, perspective taking, intergroup disgust sensitivity, intergroup anxiety, empathy, factual knowledge about LGBTQ+ issues, as well as participants' feelings toward lesbian, gay, and bisexual individuals.</p><p><strong>Results: </strong>Participants in the experimental group (n=89) showed significant reductions in prejudice when using the Attitudes Toward Lesbians and Gay Men Scale (F1,173=7.22; P=.008) when compared to the control group (n=86), but not when using the other 2 attitudinal scales. We also found that the experimental group had warmer feelings (F1,173=4.40; P=.04; d=0.32), were more likely to engage in supportive behaviors (F1,173=13.96; P<.001; d=0.56), displayed more self-efficacy (F1,173=9.14; P=.001; d=0.33), had more factual knowledge (F1,173=11.98; P=.001; d=0.52), and had a higher ability to take the LGBTQ+ perspective after controlling for contact (F1,172=4.77; P=.03; d=0.28). We did not observe significant differences in terms of intergroup disgust sensitivity (F1,173=0.816; P=.37), intergroup anxiety for either positive (F1,173=.383; P=.54) or negative emotions (F1,173=0.51; P=.48), or empathy (F1,173=0.02; P=.8","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e63787"},"PeriodicalIF":3.0,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145990494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The German electronic health record (EHR) aims to enhance patient care and reduce costs, but users often worry about data privacy and security. To mitigate disease-related privacy concerns, for instance, surrounding stigmatized diseases, we test the effect of privacy fact sheets (PFSs)-a concise but comprehensive transparency feature designed to increase users' perceived control over their data-on increasing EHR use in a simulated online study.
Objective: The study aimed to investigate whether displaying a PFS shortly before upload decisions must be made mitigates disease-related privacy concerns and makes uploads more likely.
Methods: In an online survey study, 393 German participants from the recruitment platform Prolific were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and time course (TC; acute vs chronic). They were then asked to decide whether to upload the report to an EHR click dummy, while we systematically varied the presentation of privacy information (PFS vs no PFS). Participants were randomly (single-blinded) assigned to one of the 2×2×2 conditions (stigma, TC, privacy information).
Results: All 393 participants were randomly assigned to one of the following groups: low, acute, no PFS (n=52, 13.2%); low, chronic, no PFS (n=45, 11.5%); high, acute, no PFS (n=46, 11.7%); high, chronic, no PFS (n=55, 14%); low, acute, PFS (n=44, 11.2%); low, chronic, PFS (n=41, 10.4%); high, acute, PFS (n=56, 14.2%); and high, chronic, PFS (n=54, 13.7%). The results show that, in general, upload behavior is negatively influenced by disease-related stigma (odds ratio [OR] 0.130; P<.001) and positively influenced when a PFS is given (OR 4.527; P<.001). This increase was particularly pronounced for stigmatized diseases (OR 5.952; P=.006), but independent of the TC of the diseases.
Conclusions: Our results demonstrate that PFSs may help to increase EHR uploads in people interacting with a realistic EHR click dummy, by mitigating privacy concerns in scenarios involving stigmatized diseases. Results further indicate that a PFS is mainly relevant and effective for people with increased privacy risk perceptions, whereas they neither benefit nor hurt others. Thus, implementing PFSs may increase the likelihood that users who perceive high privacy risks when confronted with sensitive or stigmatized health information decide to upload their data to the EHR, ultimately increasing digital health equity.
{"title":"Privacy Fact Sheets for Mitigating Disease-Related Privacy Concerns and Facilitating Equal Access to the Electronic Health Record: Randomized Controlled Trial.","authors":"Niklas von Kalckreuth, Markus A Feufel","doi":"10.2196/71124","DOIUrl":"10.2196/71124","url":null,"abstract":"<p><strong>Background: </strong>The German electronic health record (EHR) aims to enhance patient care and reduce costs, but users often worry about data privacy and security. To mitigate disease-related privacy concerns, for instance, surrounding stigmatized diseases, we test the effect of privacy fact sheets (PFSs)-a concise but comprehensive transparency feature designed to increase users' perceived control over their data-on increasing EHR use in a simulated online study.</p><p><strong>Objective: </strong>The study aimed to investigate whether displaying a PFS shortly before upload decisions must be made mitigates disease-related privacy concerns and makes uploads more likely.</p><p><strong>Methods: </strong>In an online survey study, 393 German participants from the recruitment platform Prolific were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and time course (TC; acute vs chronic). They were then asked to decide whether to upload the report to an EHR click dummy, while we systematically varied the presentation of privacy information (PFS vs no PFS). Participants were randomly (single-blinded) assigned to one of the 2×2×2 conditions (stigma, TC, privacy information).</p><p><strong>Results: </strong>All 393 participants were randomly assigned to one of the following groups: low, acute, no PFS (n=52, 13.2%); low, chronic, no PFS (n=45, 11.5%); high, acute, no PFS (n=46, 11.7%); high, chronic, no PFS (n=55, 14%); low, acute, PFS (n=44, 11.2%); low, chronic, PFS (n=41, 10.4%); high, acute, PFS (n=56, 14.2%); and high, chronic, PFS (n=54, 13.7%). The results show that, in general, upload behavior is negatively influenced by disease-related stigma (odds ratio [OR] 0.130; P<.001) and positively influenced when a PFS is given (OR 4.527; P<.001). This increase was particularly pronounced for stigmatized diseases (OR 5.952; P=.006), but independent of the TC of the diseases.</p><p><strong>Conclusions: </strong>Our results demonstrate that PFSs may help to increase EHR uploads in people interacting with a realistic EHR click dummy, by mitigating privacy concerns in scenarios involving stigmatized diseases. Results further indicate that a PFS is mainly relevant and effective for people with increased privacy risk perceptions, whereas they neither benefit nor hurt others. Thus, implementing PFSs may increase the likelihood that users who perceive high privacy risks when confronted with sensitive or stigmatized health information decide to upload their data to the EHR, ultimately increasing digital health equity.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e71124"},"PeriodicalIF":3.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12806596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marie Pisani, Madeline K Oguss, Julia Dickson-Gomez, Constance Kostelac, Amy Parry, Starr Moss, Elizabeth Salisbury-Afshar, Brian Patterson, Michael Spigner, Megan Gussick, Alison Krautkramer, Timothy Gruenloh, Askar Safipour Afshar, Preeti Gupta, Anoop Mayampurath, Majid Afshar
<p><strong>Background: </strong>Overdose fatality review (OFR) is a public health process in which cases of fatal overdose are carefully reviewed to identify prevention strategies. Current OFR requires review of multiple unconnected data sources, which is a manually intensive process. The Substance Misuse Data Commons (SMDC) was created to link electronic health record data with data from local and state agencies into a single, cloud-based e-platform but does not currently have a data visualization tool.</p><p><strong>Objective: </strong>We aimed to use human factors design principles to develop a comprehensive dashboard for the SMDC that could facilitate enhanced processes to support OFR.</p><p><strong>Methods: </strong>We first surveyed OFR leaders in Wisconsin using the National Aeronautics and Space Administration-Task Load Index to understand the cognitive workload of 3 tasks: (1) analysis of population-level overdose trends, (2) selection and preparation of individual cases for review, and (3) abstraction of data from individual causes. We then conducted semistructured interviews to identify targets for workflow optimization. Next, we developed a prototype dashboard for evaluation using a synthetic dataset built with GPT-4. We subsequently performed iterative design sessions with heuristic evaluations and collected end-user feedback on the final prototype via a second round of semistructured interviews and targeted surveys, including the Unified Theory of Acceptance and Use of Technology and the Perceived Usefulness Questionnaire.</p><p><strong>Results: </strong>The National Aeronautics and Space Administration-Task Load Index revealed a moderately high mental workload with the current workflow for all 3 tasks, with mean scores of 12.60 (SD 3.31), 11.90 (SD 3.57), and 12.43 (SD 5.41) for tasks 1, 2, and 3, respectively. Interviews pointed to causes including technological challenges and a reliance on manual processes. The prototype dashboard addressed these concerns by integrating multiple data sources to generate population-level visualizations and patient-level event timelines. End users reported the potential for improved efficiency and data accessibility compared to antecedent processes. The Unified Theory of Acceptance and Use of Technology results indicated the dashboard would likely be adopted if made available, with a mean of 4.07 out of 5.00 (SD 0.65). The Perceived Usefulness Questionnaire results suggested moderate usefulness for both the aggregate and individual-level data, with means of 3.61 (SD 0.82) and 3.64 (SD 0.85) out of 5.00, respectively.</p><p><strong>Conclusions: </strong>OFR is a data-intensive process that traditionally demands substantial cognitive and manual effort, and there are multiple barriers to efficiently collecting data and presenting them for review. The dashboard offers a user-centered, informatics-based approach to streamline data aggregation and presentation, potentially enhancing the efficiency of cas
{"title":"Designing a Substance Misuse Data Dashboard for Overdose Fatality Review Teams: User-Centered Design Approach.","authors":"Marie Pisani, Madeline K Oguss, Julia Dickson-Gomez, Constance Kostelac, Amy Parry, Starr Moss, Elizabeth Salisbury-Afshar, Brian Patterson, Michael Spigner, Megan Gussick, Alison Krautkramer, Timothy Gruenloh, Askar Safipour Afshar, Preeti Gupta, Anoop Mayampurath, Majid Afshar","doi":"10.2196/79407","DOIUrl":"10.2196/79407","url":null,"abstract":"<p><strong>Background: </strong>Overdose fatality review (OFR) is a public health process in which cases of fatal overdose are carefully reviewed to identify prevention strategies. Current OFR requires review of multiple unconnected data sources, which is a manually intensive process. The Substance Misuse Data Commons (SMDC) was created to link electronic health record data with data from local and state agencies into a single, cloud-based e-platform but does not currently have a data visualization tool.</p><p><strong>Objective: </strong>We aimed to use human factors design principles to develop a comprehensive dashboard for the SMDC that could facilitate enhanced processes to support OFR.</p><p><strong>Methods: </strong>We first surveyed OFR leaders in Wisconsin using the National Aeronautics and Space Administration-Task Load Index to understand the cognitive workload of 3 tasks: (1) analysis of population-level overdose trends, (2) selection and preparation of individual cases for review, and (3) abstraction of data from individual causes. We then conducted semistructured interviews to identify targets for workflow optimization. Next, we developed a prototype dashboard for evaluation using a synthetic dataset built with GPT-4. We subsequently performed iterative design sessions with heuristic evaluations and collected end-user feedback on the final prototype via a second round of semistructured interviews and targeted surveys, including the Unified Theory of Acceptance and Use of Technology and the Perceived Usefulness Questionnaire.</p><p><strong>Results: </strong>The National Aeronautics and Space Administration-Task Load Index revealed a moderately high mental workload with the current workflow for all 3 tasks, with mean scores of 12.60 (SD 3.31), 11.90 (SD 3.57), and 12.43 (SD 5.41) for tasks 1, 2, and 3, respectively. Interviews pointed to causes including technological challenges and a reliance on manual processes. The prototype dashboard addressed these concerns by integrating multiple data sources to generate population-level visualizations and patient-level event timelines. End users reported the potential for improved efficiency and data accessibility compared to antecedent processes. The Unified Theory of Acceptance and Use of Technology results indicated the dashboard would likely be adopted if made available, with a mean of 4.07 out of 5.00 (SD 0.65). The Perceived Usefulness Questionnaire results suggested moderate usefulness for both the aggregate and individual-level data, with means of 3.61 (SD 0.82) and 3.64 (SD 0.85) out of 5.00, respectively.</p><p><strong>Conclusions: </strong>OFR is a data-intensive process that traditionally demands substantial cognitive and manual effort, and there are multiple barriers to efficiently collecting data and presenting them for review. The dashboard offers a user-centered, informatics-based approach to streamline data aggregation and presentation, potentially enhancing the efficiency of cas","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e79407"},"PeriodicalIF":3.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12806594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trust Saidi, Ann Marie Hestetun-Mandrup, Nenad Pavel, Ingvild Kristina Hurum Rosseland, Kathinka Granum Selmer-Olsen, Nora Synnøve Mørk, Åse Bergheim, Minna Annika Pikkarainen
Background: Stroke often leads to persistent impairments that limit daily functioning and psychosocial well-being. Virtual reality (VR) has emerged as a promising adjunct in stroke rehabilitation, although research has largely focused on clinical outcomes, with limited attention to user involvement and the experiences of multiple stakeholders in the design process.
Objective: This study aimed to explore the challenges and benefits of co-designing and using VR to support home-based poststroke rehabilitation.
Methods: A qualitative co-design case study was applied to gain an in-depth understanding of the challenges and benefits. Rapid co-design principles were used in developing VR prototypes delivered via head-mounted displays through 3 workshops with participants with stroke, health care professionals, and VR developers from November 2023 to May 2024. A design prototype revision was done based on feedback from the workshops. Data were collected via audio-taped co-design workshops with all participants and 10 successive semistructured interviews with health care professionals and VR developers conducted in a rehabilitation hospital. A thematic analysis was performed on transcribed recordings.
Results: In total, five main themes emerged: (1) adaptability for stroke-related impairments in home rehabilitation, (2) safety and ease of use, (3) goal orientation, (4) motivation, and (5) VR as a complementary tool. One of the primary challenges identified lies in the adaptability of VR systems for individuals with hemiparesis. Additionally, customization and safety concerns remain a complex barrier, as VR solutions must be capable of addressing a wide range of stroke-related impairments and aligning specific rehabilitation goals. VR demonstrated potential to enhance rehabilitation by simulating real-life tasks that encourage goal-oriented and motivating therapy. As a complementary tool, VR can enhance traditional rehabilitation by increasing the intensity and volume of therapy.
Conclusions: This study offers insight into how VR can be effectively integrated into rehabilitation practices. Its integration into rehabilitation requires alignment with established therapeutic principles within VR applications, such as adjustable task-specific training and meaningful outcomes tailored to individual needs, to ensure clinical relevance and user engagement. VR should complement, rather than replace, conventional therapy by increasing training intensity, reducing therapist workload, and extending rehabilitation into the home. Thoughtful co-design with stakeholders is key to creating VR tools that bridge the gap between structured clinical care and independent recovery, offering continuous support throughout the rehabilitation process.
{"title":"Challenges and Benefits of Virtual Reality in Home-Based Poststroke Rehabilitation: Co-Design Qualitative Study.","authors":"Trust Saidi, Ann Marie Hestetun-Mandrup, Nenad Pavel, Ingvild Kristina Hurum Rosseland, Kathinka Granum Selmer-Olsen, Nora Synnøve Mørk, Åse Bergheim, Minna Annika Pikkarainen","doi":"10.2196/78798","DOIUrl":"10.2196/78798","url":null,"abstract":"<p><strong>Background: </strong>Stroke often leads to persistent impairments that limit daily functioning and psychosocial well-being. Virtual reality (VR) has emerged as a promising adjunct in stroke rehabilitation, although research has largely focused on clinical outcomes, with limited attention to user involvement and the experiences of multiple stakeholders in the design process.</p><p><strong>Objective: </strong>This study aimed to explore the challenges and benefits of co-designing and using VR to support home-based poststroke rehabilitation.</p><p><strong>Methods: </strong>A qualitative co-design case study was applied to gain an in-depth understanding of the challenges and benefits. Rapid co-design principles were used in developing VR prototypes delivered via head-mounted displays through 3 workshops with participants with stroke, health care professionals, and VR developers from November 2023 to May 2024. A design prototype revision was done based on feedback from the workshops. Data were collected via audio-taped co-design workshops with all participants and 10 successive semistructured interviews with health care professionals and VR developers conducted in a rehabilitation hospital. A thematic analysis was performed on transcribed recordings.</p><p><strong>Results: </strong>In total, five main themes emerged: (1) adaptability for stroke-related impairments in home rehabilitation, (2) safety and ease of use, (3) goal orientation, (4) motivation, and (5) VR as a complementary tool. One of the primary challenges identified lies in the adaptability of VR systems for individuals with hemiparesis. Additionally, customization and safety concerns remain a complex barrier, as VR solutions must be capable of addressing a wide range of stroke-related impairments and aligning specific rehabilitation goals. VR demonstrated potential to enhance rehabilitation by simulating real-life tasks that encourage goal-oriented and motivating therapy. As a complementary tool, VR can enhance traditional rehabilitation by increasing the intensity and volume of therapy.</p><p><strong>Conclusions: </strong>This study offers insight into how VR can be effectively integrated into rehabilitation practices. Its integration into rehabilitation requires alignment with established therapeutic principles within VR applications, such as adjustable task-specific training and meaningful outcomes tailored to individual needs, to ensure clinical relevance and user engagement. VR should complement, rather than replace, conventional therapy by increasing training intensity, reducing therapist workload, and extending rehabilitation into the home. Thoughtful co-design with stakeholders is key to creating VR tools that bridge the gap between structured clinical care and independent recovery, offering continuous support throughout the rehabilitation process.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e78798"},"PeriodicalIF":3.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145990989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction: Auxiliary Teaching and Student Evaluation Methods Based on Facial Expression Recognition in Medical Education.","authors":"Xueling Zhu, Roben A Juanatas","doi":"10.2196/89669","DOIUrl":"10.2196/89669","url":null,"abstract":"","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e89669"},"PeriodicalIF":3.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ameenah Alawadhi, Kay Scarsbrook Khan, Grace Messenger, Alice Cusworth, Mohammad Assi, Stuart R Gray, Ebaa Al-Ozairi
Background: Diabetic foot ulceration (DFU) is the leading cause of nontraumatic amputations in people with diabetes. Research shows that improving patient awareness can result in short-term improvements, but Cochrane reviews report insufficient high-quality evidence.
Objective: This study aims to investigate the effects of multimedia presentation and smartphone alerts to enhance long-term knowledge and foot care behaviors in individuals at moderate-to-high risk of DFU.
Methods: Participants were randomized to a control group, receiving usual diabetic foot care advice (n=40), or an intervention group, receiving a multimedia diabetic foot care presentation and regular "foot alerts" through the MyU smartphone app on top of usual care (n=37). Patient's knowledge and behaviors related to diabetic foot care were assessed at baseline and after 12 months. Repeated measures ANOVA was conducted in both intention-to-treat and per-protocol analyses to evaluate the intervention's effectiveness.
Results: The findings were consistent across intention-to-treat and per-protocol analyses. In the intervention group, the number of podiatry visits was positively correlated with improved foot care behavior (r=0.408; P=.02), while the control group showed a negative correlation (r=-0.402; P=.02). No significant correlations were observed with knowledge scores. Although no significant time×group interactions were seen, the main effects of time were found for both knowledge (η²=0.12; P=.004) and behavior scores (η²=0.31; P<.001). Post hoc analysis showed a decline in knowledge scores in the control group (Cohen d=-0.24; P=.007) and improvements in behavior scores in both groups (Cohen d: intervention=0.61, control=0.63; all P<.001).
Conclusions: The MyU app-based multimedia intervention was associated with improved foot care behaviors over 12 months, indicating potential benefits as an adjunct to usual diabetic foot care. However, no significant changes in diabetic foot care knowledge were observed. These findings suggest that while the applied digital multimedia tool may support behavior change, further research is needed to enhance knowledge retention and clinical impact. The study revealed that multimedia education alone may not be effective for long-term improvement in foot self-care knowledge and behavior among individuals at moderate-high DFU risk, but the reinforcement of educational material during follow-up podiatry visits could be effective.
{"title":"Long-Term Effects of Multimedia Education and \"Foot Alerts\" Through the MyU App on Diabetic Foot Care in Individuals With Moderate-High Risk: Pilot Randomized Controlled Trial.","authors":"Ameenah Alawadhi, Kay Scarsbrook Khan, Grace Messenger, Alice Cusworth, Mohammad Assi, Stuart R Gray, Ebaa Al-Ozairi","doi":"10.2196/78261","DOIUrl":"10.2196/78261","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulceration (DFU) is the leading cause of nontraumatic amputations in people with diabetes. Research shows that improving patient awareness can result in short-term improvements, but Cochrane reviews report insufficient high-quality evidence.</p><p><strong>Objective: </strong>This study aims to investigate the effects of multimedia presentation and smartphone alerts to enhance long-term knowledge and foot care behaviors in individuals at moderate-to-high risk of DFU.</p><p><strong>Methods: </strong>Participants were randomized to a control group, receiving usual diabetic foot care advice (n=40), or an intervention group, receiving a multimedia diabetic foot care presentation and regular \"foot alerts\" through the MyU smartphone app on top of usual care (n=37). Patient's knowledge and behaviors related to diabetic foot care were assessed at baseline and after 12 months. Repeated measures ANOVA was conducted in both intention-to-treat and per-protocol analyses to evaluate the intervention's effectiveness.</p><p><strong>Results: </strong>The findings were consistent across intention-to-treat and per-protocol analyses. In the intervention group, the number of podiatry visits was positively correlated with improved foot care behavior (r=0.408; P=.02), while the control group showed a negative correlation (r=-0.402; P=.02). No significant correlations were observed with knowledge scores. Although no significant time×group interactions were seen, the main effects of time were found for both knowledge (η²=0.12; P=.004) and behavior scores (η²=0.31; P<.001). Post hoc analysis showed a decline in knowledge scores in the control group (Cohen d=-0.24; P=.007) and improvements in behavior scores in both groups (Cohen d: intervention=0.61, control=0.63; all P<.001).</p><p><strong>Conclusions: </strong>The MyU app-based multimedia intervention was associated with improved foot care behaviors over 12 months, indicating potential benefits as an adjunct to usual diabetic foot care. However, no significant changes in diabetic foot care knowledge were observed. These findings suggest that while the applied digital multimedia tool may support behavior change, further research is needed to enhance knowledge retention and clinical impact. The study revealed that multimedia education alone may not be effective for long-term improvement in foot self-care knowledge and behavior among individuals at moderate-high DFU risk, but the reinforcement of educational material during follow-up podiatry visits could be effective.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e78261"},"PeriodicalIF":3.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine Jacob, Sangeetha-Rose Puthanveettil, Patrick Vavken, Emel Kaplan, Christine S Zuern
<p><strong>Background: </strong>Women with cardiovascular disease (CVD) remain underserved due to gaps in recognition, diagnosis, and care tailored to sex-specific risks. Digital health tools have the potential to address these inequities, but many fail to reflect the distinct needs of women. In a prior review, we assessed 20 CVD apps and 22 wearables and found that only 25% (5/20) of apps and 40% (9/22) of wearables included any sex-specific content, such as hormone cycle tracking and life-stage considerations related to pregnancy or menopause. These findings confirm that current digital tools largely mirror the gender gaps seen in traditional care.</p><p><strong>Objective: </strong>This study aimed to define the user requirements for a CVD app designed specifically for women. We sought to explore the unmet needs and challenges faced by female patients and their clinicians that current tools fail to address, and also to identify and prioritize features that would be most valuable and feasible to implement.</p><p><strong>Methods: </strong>We conducted a qualitative study using semistructured interviews to explore the needs, preferences, and expectations of women living with CVD and their treating clinicians. Guided by the human-centered design framework, this work focused on the "Define" phase. A total of 20 participants in Switzerland were interviewed, including 11 women with CVD, 7 cardiologists, and 2 experts in regulatory and reimbursement. Participants were recruited through purposive sampling, and interviews were conducted online between April and July 2025. Thematic analysis was used to synthesize the data, highlighting design priorities and contextual factors relevant for developing a patient-centered and system-aware digital health tool.</p><p><strong>Results: </strong>The interviews with women living with CVD and cardiologists confirmed the consistent gaps between existing care pathways and the specific needs of female patients. Both groups highlighted the lack of early symptom recognition, insufficient sex-specific guidance, and limited tools tailored to women's lived experience. While patients prioritized personalized education, emotional support, and features that address hormonal and life-stage-specific risks, clinicians emphasized clinical use, workload integration, and actionable summaries. Success was defined experientially by patients (eg, empowerment and reduced anxiety), and operationally by clinicians (eg, earlier detection and improved adherence). Willingness to pay was moderate among both groups, with patients favoring simplicity and clinicians emphasizing workflow integration and proven clinical use.</p><p><strong>Conclusions: </strong>These findings highlight the importance of designing an artificial intelligence-enabled CVD app for women that meaningfully integrates patient empowerment with clinical workflows. A dual-value approach is essential, offering personalized tools that address emotional and lifestyle needs for p
{"title":"Bridging Gaps in Women's Heart Health: User-Centered Needs Assessment Informed by Patient and Clinician Interviews.","authors":"Christine Jacob, Sangeetha-Rose Puthanveettil, Patrick Vavken, Emel Kaplan, Christine S Zuern","doi":"10.2196/82916","DOIUrl":"10.2196/82916","url":null,"abstract":"<p><strong>Background: </strong>Women with cardiovascular disease (CVD) remain underserved due to gaps in recognition, diagnosis, and care tailored to sex-specific risks. Digital health tools have the potential to address these inequities, but many fail to reflect the distinct needs of women. In a prior review, we assessed 20 CVD apps and 22 wearables and found that only 25% (5/20) of apps and 40% (9/22) of wearables included any sex-specific content, such as hormone cycle tracking and life-stage considerations related to pregnancy or menopause. These findings confirm that current digital tools largely mirror the gender gaps seen in traditional care.</p><p><strong>Objective: </strong>This study aimed to define the user requirements for a CVD app designed specifically for women. We sought to explore the unmet needs and challenges faced by female patients and their clinicians that current tools fail to address, and also to identify and prioritize features that would be most valuable and feasible to implement.</p><p><strong>Methods: </strong>We conducted a qualitative study using semistructured interviews to explore the needs, preferences, and expectations of women living with CVD and their treating clinicians. Guided by the human-centered design framework, this work focused on the \"Define\" phase. A total of 20 participants in Switzerland were interviewed, including 11 women with CVD, 7 cardiologists, and 2 experts in regulatory and reimbursement. Participants were recruited through purposive sampling, and interviews were conducted online between April and July 2025. Thematic analysis was used to synthesize the data, highlighting design priorities and contextual factors relevant for developing a patient-centered and system-aware digital health tool.</p><p><strong>Results: </strong>The interviews with women living with CVD and cardiologists confirmed the consistent gaps between existing care pathways and the specific needs of female patients. Both groups highlighted the lack of early symptom recognition, insufficient sex-specific guidance, and limited tools tailored to women's lived experience. While patients prioritized personalized education, emotional support, and features that address hormonal and life-stage-specific risks, clinicians emphasized clinical use, workload integration, and actionable summaries. Success was defined experientially by patients (eg, empowerment and reduced anxiety), and operationally by clinicians (eg, earlier detection and improved adherence). Willingness to pay was moderate among both groups, with patients favoring simplicity and clinicians emphasizing workflow integration and proven clinical use.</p><p><strong>Conclusions: </strong>These findings highlight the importance of designing an artificial intelligence-enabled CVD app for women that meaningfully integrates patient empowerment with clinical workflows. A dual-value approach is essential, offering personalized tools that address emotional and lifestyle needs for p","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e82916"},"PeriodicalIF":3.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaokang Shi, Zewu Jiang, Li Xiong, Ka-Chun Siu, Zhen Chen
Background: The emergence of artificial intelligence (AI) is driving digital transformation and reshaping medical education in China. Numerous medical schools and institutions are actively implementing AI tools for case-based learning, literature analysis, and lecture support. This expanding application is accelerating the adoption of localized AI platforms, which are poised to become integral components in the coming years.
Objective: The primary aim of this study was to investigate the current use of AI tools among medical students, including usage frequency, commonly used platforms, and purposes of use. The second aim was to explore students' needs and expectations toward AI-powered medical education platforms by collecting and assessing student feedback, and to identify practical requirements across disciplines and academic stages to inform more effective platform design.
Methods: Based on the task-technology fit model and 5 hypotheses, an anonymous online questionnaire was conducted to assess AI usage in learning, gather student feedback on AI-powered medical education platforms, and evaluate expected functionalities. The survey was conducted from March 1 to May 31, 2025, using a convenience sampling method to recruit medical students from various disciplines across Shanghai, China. The sample size was determined at 422, accounting for a 10% rate of invalid responses. The questionnaire was developed and distributed online via Wenjuanxing and promoted through WeChat groups and in-person interviews. Data analysis was conducted employing IBM SPSS Statistics (v 27.0).
Results: A total of 428 valid questionnaires were collected. The average frequency of AI-assisted learning among medical students was 5.06 (SD 2.05) times per week. Over 90% (388/428) of the students used more than 2 AI tools in their daily tasks. Students from different disciplines, educational stages, and academic systems demonstrated different usage patterns and expectations for AI-powered medical education platforms.
Conclusions: AI technology is widely accepted by medical students and is extensively applied across various aspects of medical education. Significant differences are observed in usage patterns across disciplines, educational stages, and academic systems. Understanding the actual needs of students is crucial for the construction of AI-powered medical education platforms.
{"title":"Utilization of AI Among Medical Students and Development of AI Education Platforms in Medical Institutions: Cross-Sectional Study.","authors":"Xiaokang Shi, Zewu Jiang, Li Xiong, Ka-Chun Siu, Zhen Chen","doi":"10.2196/81652","DOIUrl":"10.2196/81652","url":null,"abstract":"<p><strong>Background: </strong>The emergence of artificial intelligence (AI) is driving digital transformation and reshaping medical education in China. Numerous medical schools and institutions are actively implementing AI tools for case-based learning, literature analysis, and lecture support. This expanding application is accelerating the adoption of localized AI platforms, which are poised to become integral components in the coming years.</p><p><strong>Objective: </strong>The primary aim of this study was to investigate the current use of AI tools among medical students, including usage frequency, commonly used platforms, and purposes of use. The second aim was to explore students' needs and expectations toward AI-powered medical education platforms by collecting and assessing student feedback, and to identify practical requirements across disciplines and academic stages to inform more effective platform design.</p><p><strong>Methods: </strong>Based on the task-technology fit model and 5 hypotheses, an anonymous online questionnaire was conducted to assess AI usage in learning, gather student feedback on AI-powered medical education platforms, and evaluate expected functionalities. The survey was conducted from March 1 to May 31, 2025, using a convenience sampling method to recruit medical students from various disciplines across Shanghai, China. The sample size was determined at 422, accounting for a 10% rate of invalid responses. The questionnaire was developed and distributed online via Wenjuanxing and promoted through WeChat groups and in-person interviews. Data analysis was conducted employing IBM SPSS Statistics (v 27.0).</p><p><strong>Results: </strong>A total of 428 valid questionnaires were collected. The average frequency of AI-assisted learning among medical students was 5.06 (SD 2.05) times per week. Over 90% (388/428) of the students used more than 2 AI tools in their daily tasks. Students from different disciplines, educational stages, and academic systems demonstrated different usage patterns and expectations for AI-powered medical education platforms.</p><p><strong>Conclusions: </strong>AI technology is widely accepted by medical students and is extensively applied across various aspects of medical education. Significant differences are observed in usage patterns across disciplines, educational stages, and academic systems. Understanding the actual needs of students is crucial for the construction of AI-powered medical education platforms.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e81652"},"PeriodicalIF":3.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12782625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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