JMIR mHealth and uHealth最新文献

{"title":"Efficacy and Safety of a Telemedicine System in Patients With Gestational Diabetes Mellitus (TELEGLAM): Single-Center, 2-Arm, Randomized, Open-Label, Parallel-Group Study.","authors":"Kazuki Aoyama, Yuya Nakajima, Shu Meguro, Yasunori Sato, Rei Goto, Mariko Hida, Takeshi Arimitsu, Yoshifumi Kasuga, Mamoru Tanaka, Hiroshi Itoh, Kaori Hayashi","doi":"10.2196/72242","DOIUrl":"10.2196/72242","url":null,"abstract":"<p><strong>Background: </strong>In the management of gestational diabetes mellitus (GDM), the usual medical treatment requires frequent visits for glucose monitoring and insulin dose adjustment, and this imposes significant physical, psychological, and economic burdens on pregnant women. As mobile health platforms become increasingly integrated into diabetes care, telemedicine may help alleviate these burdens; however, evidence evaluating its effectiveness as a replacement for routine in-person GDM care remains limited.</p><p><strong>Objective: </strong>This study aims to evaluate the impact of telemedicine on the quality of life and costs for patients with GDM requiring insulin therapy.</p><p><strong>Methods: </strong>This single-center, 2-arm, randomized, open-label, parallel-group study included patients with GDM who started insulin injection therapy. Participants were randomized to either the telemedicine or standard face-to-face care groups for 10 (SD 2) weeks. The telemedicine intervention used a smartphone-linked platform that enabled the automatic transfer of glucose data from connected glucose meters and facilitated real-time video consultations. Primary end points included costs and patient satisfaction. Costs were assessed using claims data, transportation calculations, and wage-based productivity losses, while patient satisfaction was evaluated through changes in the Problem Areas in Diabetes Survey and Diabetes Therapy-Related Quality of Life questionnaire scores. Secondary outcomes included glycemic control and perinatal outcomes.</p><p><strong>Results: </strong>In total, 38 participants were included, with 18 assigned to the telemedicine group and 20 to the standard care group. Total costs (32,712, 95% CI 15,412-50,013 vs 59,202, 95% CI 42,603-75,800 Japanese yen; $284, 95% CI 134-435 vs $515, 95% CI 370-659, purchasing power parity [PPP]-adjusted; P=.01), direct non-health care costs (922, 95% CI -240 to 2084 vs 2561, 95% CI 1447-3676 yen; $8, 95% CI -2 to 18 vs $22, 95% CI 13 to 32 PPP-adjusted; P=.02), and indirect costs (8981, 95% CI -7119 to 25,082 vs 32,832, 95% CI 17,384-48,279 yen; $78, 95% CI -62 to 218 vs $285, 95% CI 151-420 PPP-adjusted; P=.01) reduced significantly in the telemedicine group compared with the standard care group. The improvements in the Problem Areas in Diabetes Survey (-7.6, 95% CI -13.7 to -1.4; P=.02) and Diabetes Therapy-Related Quality of Life domain 1 (10.5, 95% CI 0.9-20.1; P=.03) scores from the baseline were significantly greater in the telemedicine group than that in the standard care group. Nonetheless, glycemic control and frequency of perinatal complications were comparable between the 2 groups. Consultation time was similar across groups, suggesting no added workload for clinicians.</p><p><strong>Conclusions: </strong>In this randomized trial, mobile health-enabled telemedicine safely replaced routine in-person visits for patients with GDM requiring insulin therapy. Telemedicine significan","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e72242"},"PeriodicalIF":6.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Low Anterior Resection Syndrome After Low Rectal Cancer Surgery Using an Integrated Intra-Anal Balloon Training and Reminder Device: Feasibility Nonrandomized Controlled Trial.","authors":"Qing Zhang, Yanjun Wang, Meiling Wang, Haiyan Hu, Quan Wang, Yuchen Guo, Jianan Sun, Xuan Sun","doi":"10.2196/91332","DOIUrl":"10.2196/91332","url":null,"abstract":"<p><strong>Background: </strong>Low anterior resection syndrome (LARS) is a common postoperative complication in patients with low rectal cancer, presenting with a spectrum of bowel dysfunction symptoms, including urgency, incontinence, evacuation disorders, and changes in stool frequency. Pelvic floor muscle training (PFMT) can alleviate LARS, but its effectiveness may be limited by poor accuracy of technique and low adherence during home-based training due to a lack of real-time feedback and monitoring devices.</p><p><strong>Objective: </strong>This study aimed to evaluate the effects of a novel integrated balloon biofeedback device for home-based PFMT on accuracy of technique, adherence, quality of life, and LARS reduction in patients after sphincter-preserving surgery for low rectal cancer.</p><p><strong>Methods: </strong>A nonrandomized controlled trial was conducted among 164 patients with low rectal cancer who underwent temporary ileostomy without neoadjuvant therapy. Participants were assigned by surgical date to an intervention group (n=82) using an adjustable-pressure balloon device with real-time waveform feedback via a mobile app or a control group (n=82) performing PFMT without equipment. PFMT was initiated within 72 hours after temporary ileostomy and continued throughout the stoma period until 1 month after ileostomy reversal. Outcomes including PFMT accuracy of technique, adherence, LARS score and incidence, and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) were assessed 1 month after stoma reversal.</p><p><strong>Results: </strong>At baseline, major LARS was present in 47.6% (39/82) of patients in the intervention group and 62.2% (51/82) of patients in the control group. Compared with the control group, the intervention group showed significantly higher PFMT training accuracy and adherence (P<.001 in both cases). LARS scores were significantly lower in the intervention group (median 16.00, IQR 11.00-29.00 vs 32.00, IQR 13.75-36.00), with a markedly reduced proportion of major LARS (17/82, 20.7% vs 45/82, 54.9%; P<.001). Global health/quality of life scores were significantly higher in the intervention group (P<.001).</p><p><strong>Conclusions: </strong>The integrated balloon biofeedback device improved the accuracy of technique and adherence to home-based PFMT, reduced the incidence and severity of LARS, and enhanced quality of life in patients after low rectal cancer surgery. These findings support further development and clinical implementation of the device. However, the nonrandomized, time-sequenced study design and baseline differences between groups may limit causal interpretation of the results, and randomized controlled trials with longer follow-ups are needed to confirm long-term efficacy.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e91332"},"PeriodicalIF":6.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Effectiveness of a Game-Based Mobile App for Training in Cardiopulmonary Resuscitation and Automated External Defibrillator Use: Nonrandomized Controlled Trial.","authors":"Ruting Gu, Yueshuai Pan, Jing Han, Min Wang, Xiaomin Liu, Xia Liu, Qianqian Li, Jingyuan Wang, Shanshan Ji, Changfang Shi, Haiqing Zhou, Lili Wei","doi":"10.2196/78689","DOIUrl":"10.2196/78689","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are critical for improving survival after out-of-hospital cardiac arrest. Although conventional training methods are initially effective, they are often hampered by rapid skill decay over time. Game-based mobile apps have emerged as a promising and scalable alternative for CPR and AED education; however, evidence of their long-term efficacy remains scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the integration of a game-based mobile app into traditional CPR and AED training. We assessed its impact on university students' theoretical knowledge, practical skills, and theoretical knowledge retention, as well as their willingness to perform CPR and their awareness of disseminating these skills.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A nonrandomized controlled trial was conducted among university students in China from March 21 to September 21, 2024. Participants were assigned to either an experimental group, which received game-based mobile app training supplemented with traditional training, or a control group, which received traditional training only. The game-based app featured a simulated scenario that required users to execute the correct sequence of resuscitation procedures and operate a virtual AED under time constraints. The intervention period lasted for 6 months. Participants' theoretical knowledge and practical skills were assessed immediately after training (baseline) and at the 7-day follow-up. Long-term retention of knowledge, willingness to perform CPR, and dissemination awareness were evaluated at the 6-month follow-up. Data were analyzed using SPSS software (IBM Corp), employing the chi-square test, Mann-Whitney U test, and Wilcoxon signed-rank test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 481 participants completed the entire survey (n=241 in the experimental group and n=240 in the control group). In the short-term (7-d) assessment, the experimental group demonstrated significantly higher scores in both theoretical knowledge (P=.02) and practical skills (P&lt;.001) compared to the control group. This advantage was maintained in the long term, with the experimental group showing superior knowledge retention at the 6-month follow-up (median score: 9/10 vs 8/10; P&lt;.001). Furthermore, a majority of all participants expressed willingness to perform CPR on strangers (70.9%, 341/481) and to disseminate first-aid knowledge (92.1%, 443/481). However, no significant intergroup differences were observed for these latter 2 outcomes (P=.85 and P=.97, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite the methodological limitations inherent in this nonrandomized study, our findings indicate that supplementing traditional training with the game-based mobile app significantly enhanced short-term acquisition of theoretical knowledge and practical skills and promoted sustained knowledge retention. This ","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e78689"},"PeriodicalIF":6.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Trajectory of Step Counts and Weight Loss in Adults With Overweight/Obesity: Retrospective Cohort Study.","authors":"Kenshiro Taguchi, Asuka Oyama, Jun'ichi Kotoku, Hiroshi Toki, Ryohei Yamamoto","doi":"10.2196/80339","DOIUrl":"https://doi.org/10.2196/80339","url":null,"abstract":"<p><strong>Background: </strong>Being overweight and obese are major health concerns worldwide, contributing to lifestyle-related diseases such as hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease. Increasing physical activity is an effective strategy for weight management. However, earlier step count studies have remained limited to small populations, short-term measurements of 1-2 weeks, and mainly cross-sectional comparisons of average step counts. The effects of long-term step count changes on weight loss remain unclear.</p><p><strong>Objective: </strong>This study was conducted to assess the effects of long-term patterns of step counts on weight loss using data from the \"Asmile\" mobile health app in Japan. We hypothesized that participants with continuously increasing step counts over time would have a higher likelihood of significant weight reduction than participants who show steady or fluctuating patterns, even if their average step counts were similar.</p><p><strong>Methods: </strong>We analyzed data of 2778 Asmile users aged 40-74 years with BMI ≥25 kg/m² who underwent a specific health checkup during fiscal years 2019-2023 and who had valid step count records for 10-14 months. Step count trajectories, reflecting long-term trends in physical activity, were classified using a latent class mixed model into four patterns: UP (increasing), FLAT (steady), DOWN (decreasing), and UP/DOWN (increasing then decreasing). Logistic regression was applied to estimate odds ratios for achieving ≥3% weight loss, with step trajectory as the explanatory variable and weight loss as the outcome.</p><p><strong>Results: </strong>Among participants, 1601 (57.6%) were men and 1177 (42.4%) were women, with respective mean ages of 65.8 (SD 7.9) and 64 (SD 8.2) years. Step count trajectories were distributed as 28.5% UP, 36.2% FLAT, 20.1% DOWN, and 15.2% UP/DOWN. Compared with the FLAT group, participants in the UP group had a significantly higher likelihood of achieving ≥3% weight loss (adjusted odds ratio 2.45, 95% CI 1.78-3.38).</p><p><strong>Conclusions: </strong>Long-term tracking of step counts using the Asmile app revealed distinct activity patterns. Continuous increases in step counts were associated with the greatest likelihood of weight loss, emphasizing the importance of sustained physical activity. These findings support the use of long-term step monitoring to guide interventions for obesity and lifestyle-related disease prevention.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e80339"},"PeriodicalIF":6.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traditional Social Sports Games and Mental Training for Smartphone Addiction and Psychological Distress in School-Aged Adolescents: Randomized Controlled Trial.","authors":"Mohamed Yaakoubi, Ahmed Ghorbel, Hiba Abdelkafi, Liwa Masmoudi, Omar Trabelsi, Safaa M Elkholi, Fatma H Yagin, Georgian Badicu, Adnene Gharbi","doi":"10.2196/85353","DOIUrl":"https://doi.org/10.2196/85353","url":null,"abstract":"<p><strong>Background: </strong>Problematic smartphone use among adolescents is a growing public health concern closely associated with psychological distress and loneliness. Effective, culturally grounded, school-based interventions are needed.</p><p><strong>Objective: </strong>The aim of this study was to assess the effects of a 12-week program combining traditional social sports games and mental exercises on smartphone addiction, nomophobia, psychological distress, and loneliness in adolescents.</p><p><strong>Methods: </strong>In this randomized controlled trial, 69 school-recruited Tunisian adolescents (aged 14-16 years) with clinically elevated smartphone addiction scores were assigned to an experimental group (n=36, 52.2%) or a control group (n=33, 47.8%). The experimental group received a 12-week intervention comprising 4 weekly sessions integrating traditional social sports games with mental exercises, whereas the control group continued standard physical education. Outcomes (smartphone addiction, nomophobia, psychological distress, and loneliness) were assessed at baseline and after the intervention using scales validated in Arabic.</p><p><strong>Results: </strong>Linear mixed-effects models adjusted for age, sex, and BMI revealed significant group × time interactions of moderate magnitude across all outcomes (P<.05 in all cases) favoring the experimental group. Adjusted postintervention comparisons confirmed significantly lower scores in the experimental group for smartphone addiction, nomophobia, psychological distress, and loneliness (P<.05 in all cases; partial ηp2=0.08-0.12). Mediation analysis indicated that reductions in loneliness accounted for 34.4% of the intervention's effect on smartphone addiction, consistent with partial mediation.</p><p><strong>Conclusions: </strong>A culturally adapted, school-based intervention combining traditional social sports games and mental exercises significantly reduced problematic smartphone use and improved psychological well-being. The partial mediation through reduced loneliness highlights the critical role of social connectedness in adolescent digital health interventions.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e85353"},"PeriodicalIF":6.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"mHealth-Based Gamification Interventions to Promote Health Among Older Adults: Scoping Review.","authors":"Xi Chen, Yishu Zhu, Dian Jiang, Jundan Huang, Qi Xie, Yishi Chen, Jing Chang, Weiping Huang, Hongting Ning, Hui Feng","doi":"10.2196/82368","DOIUrl":"https://doi.org/10.2196/82368","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Healthy aging has emerged as a global priority. However, older adults' participation in health promotion programs remains low, and traditional health promotion models have achieved limited success in fostering sustained engagement among this population. Mobile health (mHealth)-based gamification interventions offer a promising way to address these challenges. However, no published reviews support or oppose the use of mHealth-based gamification interventions as health promotion strategies in older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The study aimed to identify mHealth interventions using gamification to promote health among older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our scoping review was conducted following the Joanna Briggs Institute recommendations for scoping reviews and Arksey and O'Malley's framework. The process followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklist. A comprehensive literature search was conducted across 8 databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, CINAHL, PsycARTICLES, and IEEE Xplore Digital Library, from their inception to December 10, 2025. Two reviewers independently screened titles, abstracts, and full texts via Rayyan, with disagreements resolved by a third reviewer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This scoping review identified 11 studies. Only 1 article was published before 2022. The interventions were found to improve enjoyment and motivation (n=5), cognitive function (n=3), physical activity (n=2), and digital literacy (n=2). Individual studies also reported improvements in mental health (n=1) and adherence (n=1), a reduction in suicidal ideation (n=1), improvements in physical function (n=1), the promotion of social engagement (n=1), and the identification of mild cognitive impairment (n=1). Game elements used were ranked by frequency as progress, challenges, goals, levels, reward, sensation, storytelling or narration, leaderboard, surprise, and avatar. No research was found to use the game element of \"social sharing.\" mHealth types included augmented and virtual reality-based training systems, wearable devices, mobile phones, tablets, and Windows platforms and devices. Notably, only 4 studies applied theoretical frameworks, and 3 omitted the concrete approach to gamification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;As the first scoping review to identify and map mHealth-based gamification interventions for older adults, this study highlights their potential as an innovative approach to health promotion. By systematically synthesizing evidence regarding intervention designs, gamification strategies, and preliminary health outcomes, it establishes a foundation for future inquiry. However, this review is limited by the small number of included studies, precludi","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e82368"},"PeriodicalIF":6.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Text Messaging Interventions on BMI Among Adults With Prediabetes: Systematic Review and Meta-Analysis.","authors":"Arkers Kwan Ching Wong, Shun Yan Choi, Tiffany Tsz Yan Cheng, Chelsea Cheuk Yiu Cheng, Ivy Yuk Man Kwong, Cheuk Yin Fong, Chi Sum Wong, Ka Lo Chan","doi":"10.2196/78521","DOIUrl":"https://doi.org/10.2196/78521","url":null,"abstract":"<p><strong>Background: </strong>Prediabetes is a growing global health concern. Lifestyle modification is the cornerstone of management, yet scalable delivery strategies are needed. SMS text messaging is a promising mobile health approach for behavior change, but its effectiveness for metabolic outcomes in prediabetes remains uncertain.</p><p><strong>Objective: </strong>This study aims to evaluate the effectiveness of text message-delivered lifestyle programs for BMI among adults with prediabetes and, secondarily, for weight, waist circumference, hemoglobin A1c (HbA1c), total cholesterol, and diabetes incidence.</p><p><strong>Methods: </strong>We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review and meta-analysis of randomized controlled trials (searching the PubMed, MEDLINE, CINAHL, Embase, Web of Science, and the Cochrane Library databases; from April 2005 to March 2025). Three reviewers independently screened studies, extracted data, and assessed risk of bias (using the Cochrane Risk of Bias tool), and random-effects meta-analyses were performed.</p><p><strong>Results: </strong>In total, 7 randomized controlled trials (n=4632) met the inclusion criteria. SMS text messaging did not significantly affect BMI compared with standard care (mean difference [MD] -0.17 kg/m², 95% CI -0.85 to 0.25; I²=32%). Secondary outcomes were similarly nonsignificant: weight (MD -0.46 kg, 95% CI -1.74 to 0.83; I²=27%); waist circumference (MD -0.36 cm, 95% CI -1.09 to 0.36; I²=13%); HbA1c (MD -0.05%, 95% CI -0.17 to 0.07; I²=89%); total cholesterol (standardized MD -0.00, 95% CI -0.06 to 0.06; I²=0%); and diabetes incidence (odds ratio 0.84, 95% CI 0.63-1.12, I²=51%; n=3515 across 3 trials). Estimates were small and, for several outcomes, notably HbA1c and diabetes incidence, were imprecise and heterogeneous, indicating substantial between-study variability.</p><p><strong>Conclusions: </strong>In adults with prediabetes, lifestyle programs incorporating SMS text messaging showed no meaningful effect on BMI or other metabolic outcomes; pooled estimates were near null with considerable uncertainty and heterogeneity for some end points. Variability in intervention design, dose, and tailoring likely contributed to these results. Future trials should extend follow-up, report body composition outcomes in addition to BMI, and test tailored, interactive, closed-loop SMS text messaging strategies with adequate power to resolve heterogeneous effects.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e78521"},"PeriodicalIF":6.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Effectiveness of mHealth Interventions for Rehabilitation in Patients With Head and Neck Cancer: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Yang Xiao, Qiuyu Zhou, Feiruo Hong, Yuwei Lin, Enhong Li, Xuefen Yu","doi":"10.2196/78109","DOIUrl":"https://doi.org/10.2196/78109","url":null,"abstract":"<p><strong>Background: </strong>Patients with head and neck cancer (HNC) frequently experience functional impairments and psychological distress following surgery or radiotherapy. While mobile health (mHealth) interventions are increasingly integrated into clinical care to support patient self-management and home-based recovery, evidence of their effectiveness in HNC remains inconsistent.</p><p><strong>Objective: </strong>This study aims to evaluate the effectiveness of mHealth interventions on quality of life (QoL), psychological symptoms, physical symptoms, and functional recovery among HNC survivors.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Overall, 12 electronic databases were searched for randomized controlled trials published up to December 1, 2025. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2.0 tool. Certainty of evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Pooled effects were calculated as standardized mean differences (SMDs) with 95% CIs. The primary outcome was QoL; secondary outcomes included anxiety, depression, fatigue, pain, swallowing function, and maximal interincisal opening (MIO).</p><p><strong>Results: </strong>A total of 26 randomized controlled trials involving 2385 participants were included. mHealth interventions significantly improved QoL (SMD 0.64, 95% CI 0.41-0.88; P<.001), anxiety (SMD -0.75, 95% CI -1.42 to -0.08; P=.03), depression (SMD -0.89, 95% CI -1.37 to -0.40; P<.001), and fatigue (SMD -0.85, 95% CI -1.19 to -0.51; P<.001). Pain showed a small reduction (SMD -0.37, 95% CI -0.49 to -0.24; P<.001). However, the improvement in swallowing function reached only borderline significance (SMD 0.66, 95% CI 0.28-1.04; P=.04), suggesting that current evidence for this outcome is fragile. No significant effect was found for MIO (P=.68). Subgroup analysis revealed that interventions featuring home practice support, self-monitoring, and shorter durations (<3 months) yielded stronger clinical effects. The overall certainty of evidence ranged from low to very low.</p><p><strong>Conclusions: </strong>mHealth interventions effectively enhance QoL and alleviate psychosocial distress in patients. However, evidence for improving swallowing function and MIO remains insufficient. Future research should prioritize standardized protocols and high-quality trials to validate long-term clinical value.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e78109"},"PeriodicalIF":6.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13131825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Beginner's Guide to Applying Large Language Models in Behavioral Interventions.","authors":"Nirali Shah, Lorraine Buis, Derek Papierski, Alexis Castellanos, Marvin Mlakha, Susan Murphy","doi":"10.2196/79302","DOIUrl":"https://doi.org/10.2196/79302","url":null,"abstract":"<p><p>Digital behavioral interventions are increasingly used to support chronic disease self-management, yet many systems rely on predetermined content that limits personalization and sustained engagement. Large language models (LLMs) offer new opportunities to deliver conversational behavioral support. However, integrating LLMs into behavioral interventions requires careful architectural, methodological, and ethical planning, which may be challenging for researchers without formal training in artificial intelligence. This viewpoint provides a structured introduction to LLMs tailored to behavioral science. We describe foundational concepts in natural language processing and transformer-based architectures, outline the core components of LLM-based systems, including prompting strategies, context management, retrieval-augmented generation, and guardrails, and illustrate these principles through our experience integrating a proprietary LLM into a mobile self-management intervention for individuals with systemic sclerosis. Building on this case example, we propose a phased design workflow to guide early-stage development and responsible implementation, along with a decision framework to help researchers navigate scientific and logistical trade-offs between proprietary models and other alternatives. The considerations presented here are informed by formative implementation efforts and are intended to support early-stage design decisions for LLM-based behavioral interventions. As these interventions continue to evolve, rigorous evaluation and interdisciplinary collaboration will be important to ensure that these systems improve personalization and scalability while maintaining safety and scientific rigor.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e79302"},"PeriodicalIF":6.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lived Experiences of Older Adults Using Wearables With Real-Time Feedback: Phenomenological Study.","authors":"Tien-Ying Lu, Aurora Rosato, Seraina Anne Dual, Sanna Kuoppamäki","doi":"10.2196/71509","DOIUrl":"https://doi.org/10.2196/71509","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Wearable devices with real-time feedback (WRFs) provide increasing opportunities to enhance physical activity and improve rehabilitation through collecting and processing health-related data. Real-time feedback (RTF) from the device is expected to result in a more dynamic, coordinated, and synchronous rhythmic activity, defined as step-by-step movements mediated by the real-time heart rate feedback. However, age-specific characteristics in the user engagement with WRFs integrating real-time audio feedback have largely remained unexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study explores the lived experiences of older adults using wearables with RTF to uncover motivations, aspirations, and hindering factors in their engagement with WRFs in rhythmic activity. The study explores narratives that older adults articulate in their previous use of wearables for physical activity, their experiences with WRFs during rhythmic activity, and their meaning-making of the interactive features enhancing the synchronization of the movement during rhythmic activity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was conducted as a qualitative interview study with 18 older adults who used a WRF for rhythmic activity during a 3-week period in their home environment. The wearable used in the study is a chest-band sensor device that helps users to synchronize their steps with their heartbeat through the provision of real-time audio feedback. The material consists of semistructured interviews before and after using the device. Material from the semistructured interviews was analyzed with an interpretative phenomenological analysis method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study identified four main themes characterizing older adults' lived experiences with wearables, which are (1) use of wearable technologies without RTF in daily life, (2) embodied rhythmic negotiation with RTF, (3) interpretation of health data with RTF, and (4) temporal trajectories of device engagement with RTF. Older adults demonstrated intentional distancing from wearable technologies rather than simple disuse, prioritizing authentic bodily experiences over external validation. Their engagement was fundamentally relational, mediated through trusted social networks, and required dialogical support for data interpretation. Device-guided movement synchronization created contextually situated challenges that varied significantly based on environmental demands, individual bodily capacity, and exercise routines. Extended temporal engagement transformed participants' relationships with the technology from initial disruption to potential integration, with RTF serving as a bridge toward enhanced embodied awareness when carefully designed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study concludes that RTF from the device can enhance synchronization and bodily awareness, but meaningful engagement requires adaptive designs that respect older adults' authentic movement practices,","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"14 ","pages":"e71509"},"PeriodicalIF":6.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}