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}
Payal Shah, Sabrina Sy, Mingjing Chen, Michael Ck Khoo, Thomas D Coates, Saranya Veluswamy
<p><strong>Background: </strong>Entrapment of sickled red blood cells in the microvasculature leads to sudden painful vaso-occlusive crises (VOCs) in sickle cell disease (SCD). This is potentially triggered by autonomic nervous system-mediated vasoconstriction in the microvasculature. Indeed, vasoconstriction biomarkers derived from a single night of laboratory-based fingertip photoplethysmography (PPG) recording were predictive of a higher frequency of future VOC in SCD. Noninvasive, remote, and longitudinal monitoring of autonomic vasoreactivity will facilitate the development of predictive biomarkers of imminent VOC.</p><p><strong>Objective: </strong>This study aimed to assess the feasibility and performance of a wearable wristband device to longitudinally monitor nocturnal peripheral autonomic vasoreactivity and to cross-validate the vasoconstriction parameters across the "gold-standard" finger sensor.</p><p><strong>Methods: </strong>A total of 12 patients with SCD and 6 healthy controls were recruited to wear a wristband device (Biostrap) with a PPG sensor on a nightly basis. For cross-validation studies, 50% (3/6) controls wore both the wristband and a sleep monitoring device (AliceNightOne) with a finger PPG sensor. We quantified autonomic vasoreactivity by processing PPG signals and deriving vasoconstriction parameters-magnitude of vasoconstriction (Mvasoc) and photoplethysmography amplitude coefficient of variation (PPGampCV). We performed a correlation analysis of the vasoconstriction parameters within each device to investigate whether Mvasoc and PPGampCV can be used as surrogate markers of vasoconstriction, and then cross-validated the PPGampCV across the wristband and finger PPG devices.</p><p><strong>Results: </strong>A total of 131 nocturnal PPG recordings were made with a wristband device (1-19 nights per participant; patients with SCD: n=79, 60%; controls: n=52, 40%). A total of 9 nocturnal recordings (3 nights per participant) were made with both wristband and finger sensor devices. Longitudinal continuous PPG recordings were feasible with the wearable device, with significant within-night and night-to-night variability in vasoconstriction parameters, suggesting dynamic changes in autonomic vasoreactivity. Mvasoc and PPGampCV significantly correlated within devices-the maximum overnight correlation was 0.82 (P<.001) for the finger sensor and 0.69 (P<.001) for the wristband sensor, suggesting that PPGampCV can serve as a surrogate for Mvasoc. Cross-validation analysis of PPGampCV across wristband and fingertip sensors showed statistically significant correlations on all 9 nights (overnight correlation coefficient ranging from 0.24-0.7), with some nightly segments of PPGampCV showing very strong correlation across devices.</p><p><strong>Conclusions: </strong>Wearable wristband devices are feasible tools for the collection of continuous PPG measurements and vasoconstriction parameters, which serve as objective markers of autonomic
{"title":"Wearable Device Photoplethysmography As a Viable Tool to Longitudinally Monitor Vasoconstriction Biomarkers for Predicting Vaso-Occlusive Crisis in Sickle Cell Disease: Feasibility and Validation Study.","authors":"Payal Shah, Sabrina Sy, Mingjing Chen, Michael Ck Khoo, Thomas D Coates, Saranya Veluswamy","doi":"10.2196/75465","DOIUrl":"10.2196/75465","url":null,"abstract":"<p><strong>Background: </strong>Entrapment of sickled red blood cells in the microvasculature leads to sudden painful vaso-occlusive crises (VOCs) in sickle cell disease (SCD). This is potentially triggered by autonomic nervous system-mediated vasoconstriction in the microvasculature. Indeed, vasoconstriction biomarkers derived from a single night of laboratory-based fingertip photoplethysmography (PPG) recording were predictive of a higher frequency of future VOC in SCD. Noninvasive, remote, and longitudinal monitoring of autonomic vasoreactivity will facilitate the development of predictive biomarkers of imminent VOC.</p><p><strong>Objective: </strong>This study aimed to assess the feasibility and performance of a wearable wristband device to longitudinally monitor nocturnal peripheral autonomic vasoreactivity and to cross-validate the vasoconstriction parameters across the \"gold-standard\" finger sensor.</p><p><strong>Methods: </strong>A total of 12 patients with SCD and 6 healthy controls were recruited to wear a wristband device (Biostrap) with a PPG sensor on a nightly basis. For cross-validation studies, 50% (3/6) controls wore both the wristband and a sleep monitoring device (AliceNightOne) with a finger PPG sensor. We quantified autonomic vasoreactivity by processing PPG signals and deriving vasoconstriction parameters-magnitude of vasoconstriction (Mvasoc) and photoplethysmography amplitude coefficient of variation (PPGampCV). We performed a correlation analysis of the vasoconstriction parameters within each device to investigate whether Mvasoc and PPGampCV can be used as surrogate markers of vasoconstriction, and then cross-validated the PPGampCV across the wristband and finger PPG devices.</p><p><strong>Results: </strong>A total of 131 nocturnal PPG recordings were made with a wristband device (1-19 nights per participant; patients with SCD: n=79, 60%; controls: n=52, 40%). A total of 9 nocturnal recordings (3 nights per participant) were made with both wristband and finger sensor devices. Longitudinal continuous PPG recordings were feasible with the wearable device, with significant within-night and night-to-night variability in vasoconstriction parameters, suggesting dynamic changes in autonomic vasoreactivity. Mvasoc and PPGampCV significantly correlated within devices-the maximum overnight correlation was 0.82 (P<.001) for the finger sensor and 0.69 (P<.001) for the wristband sensor, suggesting that PPGampCV can serve as a surrogate for Mvasoc. Cross-validation analysis of PPGampCV across wristband and fingertip sensors showed statistically significant correlations on all 9 nights (overnight correlation coefficient ranging from 0.24-0.7), with some nightly segments of PPGampCV showing very strong correlation across devices.</p><p><strong>Conclusions: </strong>Wearable wristband devices are feasible tools for the collection of continuous PPG measurements and vasoconstriction parameters, which serve as objective markers of autonomic ","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e75465"},"PeriodicalIF":3.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12775748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913227","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}
Emma Wong, Mahabhir Kandola, Kamal Arora, Harroop Sharda, Roman Deol, Mary Jung, Robert Paquin, Maria Montenegro, Megan MacPherson
<p><strong>Background: </strong>South Asian communities in Canada face significant disparities in access to health care and experience higher rates of chronic conditions such as cardiovascular disease, diabetes, and hypertension. Hospital-at-Home services have the potential to improve access and outcomes, yet little is known about how these services are perceived and experienced by South Asian patients and caregivers. Understanding both barriers and facilitators is critical for culturally responsive implementation.</p><p><strong>Objective: </strong>This study aimed to explore the experiences of South Asian community members with in-person hospital care and their perceptions, attitudes, and expectations regarding virtual Hospital-at-Home services, with the goal of identifying culturally tailored strategies to improve access, quality, and satisfaction.</p><p><strong>Methods: </strong>A qualitative study using semistructured interviews was conducted with 20 South Asian community members in the Fraser Health region in British Columbia, Canada. Interviews explored experiences with in-person hospital care, perceptions of a virtual hospital service (also known as Hospital-at-Home), and recommendations for enhancing awareness and accessibility. Interviews were audio-recorded, transcribed, and analyzed thematically to identify key patterns in perceptions, experiences, and needs.</p><p><strong>Results: </strong>Participants described multiple systemic barriers to in-person hospital care, including long wait times, overcrowding, transportation challenges, and difficulty navigating the health system. Cultural and religious needs, such as gender-concordant care and culturally appropriate food, were frequently unmet, while language-concordant care and family involvement were critical to positive experiences. Discrimination and assumptions based on ethnicity or age further shaped perceptions of care. Virtual hospital services were valued for convenience, comfort, reduced exposure to hospital-acquired infections, and support for family involvement. However, participants raised concerns about clinical quality, the absence of physical examinations, digital literacy, privacy, and home-based responsibilities. Acceptance varied by age, immigration status, and familiarity with technology. Participants emphasized the importance of culturally tailored outreach, leveraging community leaders, ethnic media, and peer testimonials to increase awareness and trust.</p><p><strong>Conclusions: </strong>South Asian patients and caregivers recognize both challenges in traditional hospital care and potential benefits of Hospital-at-Home services. Implementation strategies that address systemic barriers, integrate cultural and linguistic considerations, and engage trusted community networks are essential to improving equity, access, and satisfaction. Findings highlight the need for culturally responsive, patient-centered approaches in the design and delivery of virtual health servic
{"title":"Hospital-at-Home for South Asian Communities in British Columbia, Canada: Qualitative Interview Study.","authors":"Emma Wong, Mahabhir Kandola, Kamal Arora, Harroop Sharda, Roman Deol, Mary Jung, Robert Paquin, Maria Montenegro, Megan MacPherson","doi":"10.2196/79675","DOIUrl":"10.2196/79675","url":null,"abstract":"<p><strong>Background: </strong>South Asian communities in Canada face significant disparities in access to health care and experience higher rates of chronic conditions such as cardiovascular disease, diabetes, and hypertension. Hospital-at-Home services have the potential to improve access and outcomes, yet little is known about how these services are perceived and experienced by South Asian patients and caregivers. Understanding both barriers and facilitators is critical for culturally responsive implementation.</p><p><strong>Objective: </strong>This study aimed to explore the experiences of South Asian community members with in-person hospital care and their perceptions, attitudes, and expectations regarding virtual Hospital-at-Home services, with the goal of identifying culturally tailored strategies to improve access, quality, and satisfaction.</p><p><strong>Methods: </strong>A qualitative study using semistructured interviews was conducted with 20 South Asian community members in the Fraser Health region in British Columbia, Canada. Interviews explored experiences with in-person hospital care, perceptions of a virtual hospital service (also known as Hospital-at-Home), and recommendations for enhancing awareness and accessibility. Interviews were audio-recorded, transcribed, and analyzed thematically to identify key patterns in perceptions, experiences, and needs.</p><p><strong>Results: </strong>Participants described multiple systemic barriers to in-person hospital care, including long wait times, overcrowding, transportation challenges, and difficulty navigating the health system. Cultural and religious needs, such as gender-concordant care and culturally appropriate food, were frequently unmet, while language-concordant care and family involvement were critical to positive experiences. Discrimination and assumptions based on ethnicity or age further shaped perceptions of care. Virtual hospital services were valued for convenience, comfort, reduced exposure to hospital-acquired infections, and support for family involvement. However, participants raised concerns about clinical quality, the absence of physical examinations, digital literacy, privacy, and home-based responsibilities. Acceptance varied by age, immigration status, and familiarity with technology. Participants emphasized the importance of culturally tailored outreach, leveraging community leaders, ethnic media, and peer testimonials to increase awareness and trust.</p><p><strong>Conclusions: </strong>South Asian patients and caregivers recognize both challenges in traditional hospital care and potential benefits of Hospital-at-Home services. Implementation strategies that address systemic barriers, integrate cultural and linguistic considerations, and engage trusted community networks are essential to improving equity, access, and satisfaction. Findings highlight the need for culturally responsive, patient-centered approaches in the design and delivery of virtual health servic","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"13 ","pages":"e79675"},"PeriodicalIF":3.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12768396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906925","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}
Janelle D Healy, Christina M Pollard, Clare E Collins, Barbara A Mullan, Megan E Rollo, Satvinder S Dhaliwal, Richard Norman, Sharon I Kirkpatrick, Tracy A McCaffrey, Clare Whitton, Amira Hassan, Fengqing Zhu, Deborah A Kerr
<p><strong>Background: </strong>Technology-assisted 24-hour dietary recall (24HR) methods offer the potential for scalable population dietary assessment, but current challenges include balancing accuracy and cost against participant burden and acceptability of these methods. Qualitative methods present a novel approach to understanding potential barriers and enablers to the acceptability of 24HR methods, but remain relatively unexplored.</p><p><strong>Objective: </strong>This study aimed to explore users' experience, acceptability, and preferences for 3 technology-assisted 24HR methods.</p><p><strong>Methods: </strong>Participants in a crossover controlled feeding study were invited to undertake a poststudy interview. Initially, the feeding study participants were randomized into one of three separate feeding days where they consumed breakfast, lunch, and dinner on a single day. On the following day, they undertook a 24HR via the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), Intake24, or an Image-Assisted Interviewer-Administered 24-hour dietary recall (IA-24HR). When assigned to IA-24HR, participants viewed the images they captured with a mobile food record (mFR) app on the feeding day during the interview. On completing all 3 methods, 26 participants (ages 21 to 56 years) undertook semistructured interviews. The interview audio recordings were transcribed, and inductive content analysis was undertaken.</p><p><strong>Results: </strong>Overall, participants wanted the 24HR methods to be easy, with the technology features of all methods considered helpful. A total of 5 content categories described users' experiences of the three 24HR methods: (1) "Put my food in the list," (2) "It's really hard to know portions," (3) ASA24 "was a painful process," (4) access to "images helped jog my memory," (5) Intake24 is "fairly quick," and (6) IA-24HR method preference. Participants expressed a preference for taking images with the mFR app. IA-24HR helped participants recall food and beverages consumed and increased perceptions of recall accuracy.</p><p><strong>Conclusions: </strong>This novel qualitative research found that 24HR methods need to be as easy as possible for users. The participant burden of food and beverage identification and portion size estimation was evident across methods. Findings highlight the importance of using qualitative methods to explore user preferences for dietary assessment methods and confirm the need to reduce the user burden associated with 24HR methods. People want embedded technologies to enhance digitized versions of the traditional 24HR methods. The use of their own food images within the mFR app is an example of digital advancements within scalable 24-hour dietary assessments.</p><p><strong>Trial registration: </strong>Australia New Zealand Clinical Trials Registry ACTRN12621000209897; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381165.</p><p><strong>International registered report ident
{"title":"User Preferences for an Image-Assisted Dietary Recall: Qualitative Study Comparing 3 Dietary Assessment Methods.","authors":"Janelle D Healy, Christina M Pollard, Clare E Collins, Barbara A Mullan, Megan E Rollo, Satvinder S Dhaliwal, Richard Norman, Sharon I Kirkpatrick, Tracy A McCaffrey, Clare Whitton, Amira Hassan, Fengqing Zhu, Deborah A Kerr","doi":"10.2196/79565","DOIUrl":"10.2196/79565","url":null,"abstract":"<p><strong>Background: </strong>Technology-assisted 24-hour dietary recall (24HR) methods offer the potential for scalable population dietary assessment, but current challenges include balancing accuracy and cost against participant burden and acceptability of these methods. Qualitative methods present a novel approach to understanding potential barriers and enablers to the acceptability of 24HR methods, but remain relatively unexplored.</p><p><strong>Objective: </strong>This study aimed to explore users' experience, acceptability, and preferences for 3 technology-assisted 24HR methods.</p><p><strong>Methods: </strong>Participants in a crossover controlled feeding study were invited to undertake a poststudy interview. Initially, the feeding study participants were randomized into one of three separate feeding days where they consumed breakfast, lunch, and dinner on a single day. On the following day, they undertook a 24HR via the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), Intake24, or an Image-Assisted Interviewer-Administered 24-hour dietary recall (IA-24HR). When assigned to IA-24HR, participants viewed the images they captured with a mobile food record (mFR) app on the feeding day during the interview. On completing all 3 methods, 26 participants (ages 21 to 56 years) undertook semistructured interviews. The interview audio recordings were transcribed, and inductive content analysis was undertaken.</p><p><strong>Results: </strong>Overall, participants wanted the 24HR methods to be easy, with the technology features of all methods considered helpful. A total of 5 content categories described users' experiences of the three 24HR methods: (1) \"Put my food in the list,\" (2) \"It's really hard to know portions,\" (3) ASA24 \"was a painful process,\" (4) access to \"images helped jog my memory,\" (5) Intake24 is \"fairly quick,\" and (6) IA-24HR method preference. Participants expressed a preference for taking images with the mFR app. IA-24HR helped participants recall food and beverages consumed and increased perceptions of recall accuracy.</p><p><strong>Conclusions: </strong>This novel qualitative research found that 24HR methods need to be as easy as possible for users. The participant burden of food and beverage identification and portion size estimation was evident across methods. Findings highlight the importance of using qualitative methods to explore user preferences for dietary assessment methods and confirm the need to reduce the user burden associated with 24HR methods. People want embedded technologies to enhance digitized versions of the traditional 24HR methods. The use of their own food images within the mFR app is an example of digital advancements within scalable 24-hour dietary assessments.</p><p><strong>Trial registration: </strong>Australia New Zealand Clinical Trials Registry ACTRN12621000209897; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381165.</p><p><strong>International registered report ident","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"12 ","pages":"e79565"},"PeriodicalIF":3.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865816","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: Dementia increases the risk of individuals getting lost due to cognitive decline, impacting daily functioning and heightening caregiver worry. Traditional search methods are often time-consuming and stressful, whereas GPS-based technologies face limitations such as battery dependency. A crowdsourcing Internet of Things (IoT) technology using energy-efficient Bluetooth Low Energy (BLE) offers a potential solution to locate missing individuals with dementia more effectively by harnessing the power of the crowd and fostering a caring and inclusive community.
Objective: This study aimed to evaluate the effectiveness of a BLE-based privacy-preserving crowdsourcing IoT system consisting of a BLE tag and an Android and iOS app in improving lost-related behavior and psychological well-being by facilitating searches, after-care arrangements, and reducing caregiver worry, as well as to assess its usability among caregivers of individuals with dementia in Hong Kong.
Methods: A single-arm, prospective observational study was conducted from November 2020 to October 2023. Caregivers (N=1034) of individuals with dementia used a staff-assisted crowdsourcing IoT technology comprising a BLE tag, mobile app sensor, and location cloud server. Outcomes included search strategies, post-getting lost care arrangements, caregiver worry and distress (10-point scale), and usability (modified Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 survey). Data were collected at 6- and 12-month follow-ups and analyzed using generalized estimating equations and linear mixed models.
Results: Of the 1034 participants, 143 (13.82%) reported lost episodes, with 51 (35.7%) using BLE tags for searches. Worry about future lost episodes decreased significantly over time (P=.008), especially among BLE tag users (P=.04). There was an association between BLE tag use and adoption of proactive search strategies (eg, going out to search: adjusted odds ratio 2.78, 95% CI 1.33-5.82; P=.007) and preventative measures (eg, IoT devices or CCTV: adjusted odds ratio 2.92, 95% CI 1.61-5.29; P<.001). Usability satisfaction was high for design and data security, whereas approximately half of the participants (309/707, 43.7%) were satisfied with accuracy.
Conclusions: The BLE crowdsourcing system may reduce caregiver worry and encourage proactive search behaviors, although accuracy depends on broader community adoption. Integration into dementia care plans could enhance safety and autonomy. Further research with a randomized controlled trial design is needed to confirm these findings.
背景：痴呆症增加了个体因认知能力下降而迷路的风险，影响了日常功能并增加了照顾者的担忧。传统的搜索方法通常耗时且压力大，而基于gps的技术则面临电池依赖等限制。使用节能低功耗蓝牙（BLE）的众包物联网（IoT）技术提供了一种潜在的解决方案，可以通过利用人群的力量，培养一个充满爱心和包容性的社区，更有效地找到失智症患者。目的：本研究旨在评估基于BLE的隐私保护众包物联网系统的有效性，该系统由BLE标签和Android和iOS应用组成，通过促进搜索、事后护理安排和减少照顾者的担忧，改善失物相关行为和心理健康，并评估其在香港痴呆症患者照顾者中的可用性。方法：一项单臂前瞻性观察研究于2020年11月至2023年10月进行。痴呆症患者的护理人员（N=1034）使用了由BLE标签、移动应用传感器和位置云服务器组成的员工辅助众包物联网技术。结果包括搜索策略、失联后的护理安排、护理人员的担忧和痛苦（10分制）和可用性（修改后的魁北克辅助技术用户满意度评估2.0调查）。在6个月和12个月的随访中收集数据，并使用广义估计方程和线性混合模型进行分析。结果：在1034名参与者中，143名（13.82%）报告丢失事件，51名（35.7%）使用BLE标签进行搜索。随着时间的推移，对未来丢失剧集的担忧显著减少（P= 0.008），尤其是BLE标签用户（P= 0.04）。BLE标签的使用与采用主动搜索策略（例如，外出搜索：调整优势比2.78,95% CI 1.33-5.82； P=.007）和预防措施（例如，物联网设备或闭路电视：调整优势比2.92,95% CI 1.61-5.29）之间存在关联。结论：BLE众包系统可以减少护理人员的担忧，鼓励主动搜索行为，尽管准确性取决于更广泛的社区采用。融入痴呆症护理计划可以提高安全性和自主性。需要进一步的随机对照试验设计研究来证实这些发现。
{"title":"Using Crowdsourcing Internet of Things Technology to Reduce Caregiver Worry in Dementia-Related Lost Episodes: Longitudinal Observational Study.","authors":"Bel Wong, Tobi Cheng, Nicole Fung, Zhongming Lin, Ki-Kit Lai, Florence Ho, S-H Gary Chan, Timothy Kwok","doi":"10.2196/73670","DOIUrl":"10.2196/73670","url":null,"abstract":"<p><strong>Background: </strong>Dementia increases the risk of individuals getting lost due to cognitive decline, impacting daily functioning and heightening caregiver worry. Traditional search methods are often time-consuming and stressful, whereas GPS-based technologies face limitations such as battery dependency. A crowdsourcing Internet of Things (IoT) technology using energy-efficient Bluetooth Low Energy (BLE) offers a potential solution to locate missing individuals with dementia more effectively by harnessing the power of the crowd and fostering a caring and inclusive community.</p><p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of a BLE-based privacy-preserving crowdsourcing IoT system consisting of a BLE tag and an Android and iOS app in improving lost-related behavior and psychological well-being by facilitating searches, after-care arrangements, and reducing caregiver worry, as well as to assess its usability among caregivers of individuals with dementia in Hong Kong.</p><p><strong>Methods: </strong>A single-arm, prospective observational study was conducted from November 2020 to October 2023. Caregivers (N=1034) of individuals with dementia used a staff-assisted crowdsourcing IoT technology comprising a BLE tag, mobile app sensor, and location cloud server. Outcomes included search strategies, post-getting lost care arrangements, caregiver worry and distress (10-point scale), and usability (modified Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 survey). Data were collected at 6- and 12-month follow-ups and analyzed using generalized estimating equations and linear mixed models.</p><p><strong>Results: </strong>Of the 1034 participants, 143 (13.82%) reported lost episodes, with 51 (35.7%) using BLE tags for searches. Worry about future lost episodes decreased significantly over time (P=.008), especially among BLE tag users (P=.04). There was an association between BLE tag use and adoption of proactive search strategies (eg, going out to search: adjusted odds ratio 2.78, 95% CI 1.33-5.82; P=.007) and preventative measures (eg, IoT devices or CCTV: adjusted odds ratio 2.92, 95% CI 1.61-5.29; P<.001). Usability satisfaction was high for design and data security, whereas approximately half of the participants (309/707, 43.7%) were satisfied with accuracy.</p><p><strong>Conclusions: </strong>The BLE crowdsourcing system may reduce caregiver worry and encourage proactive search behaviors, although accuracy depends on broader community adoption. Integration into dementia care plans could enhance safety and autonomy. Further research with a randomized controlled trial design is needed to confirm these findings.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"12 ","pages":"e73670"},"PeriodicalIF":3.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865866","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}
Katherine Williams, Fiona Lobban, Elizabeth Chamberlain
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.
{"title":"Experiences of Using Online Peer Forums Among People With Postpartum Psychosis: Interpretative Phenomenological Study.","authors":"Katherine Williams, Fiona Lobban, Elizabeth Chamberlain","doi":"10.2196/80717","DOIUrl":"10.2196/80717","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"12 ","pages":"e80717"},"PeriodicalIF":3.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828690","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}
Thomas Gant, Kathryn M Taylor, Thomas Ward, Philippa Garety, Amy Hardy
<p><strong>Background: </strong>Despite the promise of digital therapeutics in providing scalable interventions for psychosis, translating them from clinical trials to routine care is challenging. SloMo is an evidence-based, digitally supported cognitive behavioral therapy for psychosis comprising a web-based therapy platform and mobile app. The therapy encourages individuals to slow down for a moment, to address fast-thinking habits fueling paranoia. SloMo has received a NICE Early Value Assessment recommendation for use in the National Health Service to address evidence gaps related to its use in the real world, and an implementation study is underway.</p><p><strong>Objective: </strong>This study aimed to optimize the SloMo software for implementation by addressing limitations of the first release, reducing technology complexity, and improving user experience, to increase equitable outcomes.</p><p><strong>Methods: </strong>An inclusive, human-centered design methodology was used to optimize SloMo. The redesign sought to reduce the technology's complexity and improve the user experience for diverse patients and therapists. The Double Diamond framework structured the iterative redesign, integrating insights from patient and public involvement consultants, therapists, and a transdisciplinary co-design team. The Double Diamond process was facilitated through 24 transdisciplinary workshops. These were supported by the following methods: identifying implementation barriers through desk research of SloMo's evidence and qualitative interviews with experts by experience (n=2); redefining user needs; iteratively developing solutions through user testing sessions with service user consultants (n=32); and validating the minimum viable product through think-aloud testing sessions with therapist (n=10) and service user (n=11) consultants.</p><p><strong>Results: </strong>Users wanted a form of cognitive behavioral therapy for psychosis that was usable, trustworthy, enjoyable, personalized, normalizing, and memorable. The redesign, therefore, included a minimalist user interface, more diverse lived experience vignette content, enhanced agency over data, greater representation of protected characteristics and their intersectionality, and intuitive navigation. Feedback from a purposively sampled patient and therapist sample validated the redesign as it was associated with a strong user experience, particularly in relation to usability and usefulness.</p><p><strong>Conclusions: </strong>The study produced a redesign of the SloMo software optimized for real-world use, whilst retaining fidelity to the therapeutic content of the previous version. Through an inclusive, human-centered approach, the optimized design of SloMo addresses barriers to adoption by reducing complexity and fostering accessibility. This study underscores the value of integrating lived experience involvement into digital therapeutics to support scalable, equitable, and sustainable mental health
{"title":"Optimizing SloMo, a Digitally Supported Therapy Targeting Paranoia, for Implementation: Inclusive, Human-Centered Design Study.","authors":"Thomas Gant, Kathryn M Taylor, Thomas Ward, Philippa Garety, Amy Hardy","doi":"10.2196/75377","DOIUrl":"10.2196/75377","url":null,"abstract":"<p><strong>Background: </strong>Despite the promise of digital therapeutics in providing scalable interventions for psychosis, translating them from clinical trials to routine care is challenging. SloMo is an evidence-based, digitally supported cognitive behavioral therapy for psychosis comprising a web-based therapy platform and mobile app. The therapy encourages individuals to slow down for a moment, to address fast-thinking habits fueling paranoia. SloMo has received a NICE Early Value Assessment recommendation for use in the National Health Service to address evidence gaps related to its use in the real world, and an implementation study is underway.</p><p><strong>Objective: </strong>This study aimed to optimize the SloMo software for implementation by addressing limitations of the first release, reducing technology complexity, and improving user experience, to increase equitable outcomes.</p><p><strong>Methods: </strong>An inclusive, human-centered design methodology was used to optimize SloMo. The redesign sought to reduce the technology's complexity and improve the user experience for diverse patients and therapists. The Double Diamond framework structured the iterative redesign, integrating insights from patient and public involvement consultants, therapists, and a transdisciplinary co-design team. The Double Diamond process was facilitated through 24 transdisciplinary workshops. These were supported by the following methods: identifying implementation barriers through desk research of SloMo's evidence and qualitative interviews with experts by experience (n=2); redefining user needs; iteratively developing solutions through user testing sessions with service user consultants (n=32); and validating the minimum viable product through think-aloud testing sessions with therapist (n=10) and service user (n=11) consultants.</p><p><strong>Results: </strong>Users wanted a form of cognitive behavioral therapy for psychosis that was usable, trustworthy, enjoyable, personalized, normalizing, and memorable. The redesign, therefore, included a minimalist user interface, more diverse lived experience vignette content, enhanced agency over data, greater representation of protected characteristics and their intersectionality, and intuitive navigation. Feedback from a purposively sampled patient and therapist sample validated the redesign as it was associated with a strong user experience, particularly in relation to usability and usefulness.</p><p><strong>Conclusions: </strong>The study produced a redesign of the SloMo software optimized for real-world use, whilst retaining fidelity to the therapeutic content of the previous version. Through an inclusive, human-centered approach, the optimized design of SloMo addresses barriers to adoption by reducing complexity and fostering accessibility. This study underscores the value of integrating lived experience involvement into digital therapeutics to support scalable, equitable, and sustainable mental health ","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"12 ","pages":"e75377"},"PeriodicalIF":3.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12770921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811545","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}
Dylan Hamitouche, Youcef Barkat, Deven Parekh, Eva Hammer, David Benrimoh
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.
{"title":"Dynamic Indicators of Adherence and Retention in Adults Using a Digital Mental Health App: Longitudinal Observational Analysis From the Brighten Study.","authors":"Dylan Hamitouche, Youcef Barkat, Deven Parekh, Eva Hammer, David Benrimoh","doi":"10.2196/69464","DOIUrl":"10.2196/69464","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36351,"journal":{"name":"JMIR Human Factors","volume":"12 ","pages":"e69464"},"PeriodicalIF":3.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811581","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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