JMIR mHealth and uHealth最新文献

{"title":"Population-Level Dissemination of a Smoking Cessation Smartphone App: Quasi-Experimental Comparison of Values-Based Messages in Social Media Advertisements.","authors":"Jonathan B Bricker, Margarita Santiago-Torres, Kristin E Mull, Brianna M Sullivan, Ravi Mehrotra","doi":"10.2196/71619","DOIUrl":"https://doi.org/10.2196/71619","url":null,"abstract":"<p><strong>Background: </strong>Cigarette smoking is prevalent in many countries worldwide, especially in low- and middle-income countries (LMICs), presenting an urgent public health challenge. Disseminating freely available smoking cessation treatments that effectively decrease cigarette smoking globally is urgently needed.</p><p><strong>Objective: </strong>Identify the highest impact and most cost-effective values-based social media advertisements to disseminate our smoking cessation smartphone app, \"iCanQuit\", among adults living in 7 major cities of India. Values represented in the advertisements included family, relationships, self-care, health, and self-control. Using a quasi-experimental design, we aimed to determine (1) which values-based advertisements had the highest smoking cessation app dissemination reach, as measured by click-through rate (CTR), app installs, and app usage metrics; and (2) which values-based message advertisements were more cost-effective as measured by cost-per-impression, cost-per-click, and cost-per-install. The study population included a selected media market of individuals living in 7 metro cities of India - Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad, and Pune - who were exposed to one of 6 social media advertisements from January 16 to May 5, 2024.</p><p><strong>Methods: </strong>The advertisement campaign design for each of the identified values, based on previous smoking cessation trial data, followed a collaborative iterative process. Advertisements ran sequentially for 16 weeks. Advertisement exposure and app usage data were objectively collected via Google's Display & Video 360 advertisements campaign management and Firebase app development platforms. Advertisement exposure impact on app engagement was measured via several metrics, including click-through rate (CTR, ie, the likelihood of user clicks on an advertisement after seeing it), the number of app installs (ie, a user opening the app for the first time after downloading it), and the number of app sessions (ie, app usage). Cost efficiency was measured via cost per click and cost per install for each ad.</p><p><strong>Results: </strong>Overall, the CTR was 5%. The app was installed 5111 times. The average cost per click and cost per app install across all advertisements were US $ 0.006 and US $ 6.43, respectively. The advertisements with the lowest cost per install (range: US $4.83-US $5.16) and highest CTR (between 6% and 9%) focused on the values of family, health, and self-control. Advertisements focused on the values of relationships and self-care had modestly higher levels of engagement.</p><p><strong>Conclusions: </strong>Advertisements focusing on the values of family, health, and self-control had the highest potential reach at the lowest cost. Overall, these findings provide insights into the reach and cost-effectiveness of values-based messages in social media advertisements, guiding future outreach efforts for population-level d","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e71619"},"PeriodicalIF":6.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731044","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":"Grouping Digital Health Apps Based on Their Quality and User Ratings Using K-Medoids Clustering: Cross-Sectional Study.","authors":"Maciej Marek Zych, Raymond Bond, Maurice Mulvenna, Lu Bai, Jorge Martinez-Carracedo, Simon Leigh","doi":"10.2196/57279","DOIUrl":"https://doi.org/10.2196/57279","url":null,"abstract":"<p><strong>Background: </strong>Digital health apps allow for proactive rather than reactive health care and have the potential to take the pressure off health care providers. With over 350,000 digital health apps available on the app stores today, those apps need to be of sufficient quality to be safe to use. Discovering the typology of digital health apps regarding professional and clinical assurance (PCA), user experience (UX), data privacy (DP), and user ratings may help in determining the areas where digital health apps can improve.</p><p><strong>Objective: </strong>This study has two objectives: (1) discover the types (clusters) of digital health apps with regards to their quality (scores) across 3 domains (their PCA, UX, and DP) and user ratings and (2) determine whether the National Institute for Health and Care Excellence (NICE) Evidence Standard Framework's (ESF's) tier, target users of the digital health apps, categories, or features have any association with this typology.</p><p><strong>Methods: </strong>Data were obtained from 1402 digital health app assessments conducted using the Organisation for the Review of Care and Health Apps Baseline Review (OBR), evaluating PCA, UX, and DP. K-medoids clustering identified app typologies, with the optimal number of clusters determined using the elbow method. The Shapiro-Wilk test assessed normality of user ratings and OBR scores. Nonparametric Wilcoxon rank sum tests compared cluster differences in these metrics. Post hoc analysis examined the distribution of NICE ESF tiers, target users, categories, and features across clusters, using Fisher exact test with Bonferroni correction. Effect sizes were calculated using Cohen w.</p><p><strong>Results: </strong>A total of four distinct app clusters emerged: (1) apps with poor user ratings (220/1402, 15.7%), (2) apps with poor PCA and DP scores (252/1402, 18%), (3) apps with poor PCA scores (415/1402, 29.6%), and (4) higher quality apps with high user ratings and OBR scores (515/1402, 36.7%). While some statistically significant associations were found between clusters and NICE ESF tiers (2/3), target users (0/14), categories (4/33), and features (6/19), all had small effect sizes (Cohen w<0.3). The strongest associations were for the \"Service Signposting\" feature (Cohen w=0.24) and NICE ESF tier B (Cohen w=0.19).</p><p><strong>Conclusions: </strong>The largest cluster comprised high-quality apps with strong user ratings and OBR scores (515/1402, 36.7%). A significant proportion (415/1402, 29.6%) performed poorly in PCA despite performing well in other domains. Notably, user ratings did not consistently align with PCA scores; some apps scored highly with users but poorly in PCA and DP. The 4-cluster typology underscores areas needing improvement, particularly PCA. Findings suggest limited association between the examined app characteristics and quality clusters, indicating a need for further investigation into what factors truly influence app qualit","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e57279"},"PeriodicalIF":5.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698598","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":"A Digital Software Support Platform for Hyperthyroidism Management in South Korea: Markov Simulation Model-Based Cost-Effectiveness Analysis.","authors":"Jung Hyun Kim, Jaeyong Shin, Man S Kim, Jae Hoon Moon","doi":"10.2196/56738","DOIUrl":"https://doi.org/10.2196/56738","url":null,"abstract":"<p><strong>Background: </strong>The integration of wearable technology for heart rate monitoring offers potential advancements in managing hyperthyroidism by providing a feasible way to track thyroid function. Although digital health solutions are gaining traction in various chronic conditions, their cost-effectiveness in hyperthyroidism management requires deeper investigation.</p><p><strong>Objective: </strong>This study aimed to evaluate the cost-effectiveness of a wearable or mobile-based thyroid function digital monitoring solution for hyperthyroidism management and to make a comparison with the existing standard approach within the South Korean health care context.</p><p><strong>Methods: </strong>We developed a decision-analytic Markov microsimulation model to simulate the cost and effectiveness of digital monitoring in a cohort of 10,000 hypothetical hyperthyroidism patients aged 40 years. The analysis was conducted from the perspective of the health care system, with a 4.5% annual discount rate applied to costs and effectiveness and an inflation adjustment to 2022 values. Model inputs were sourced from clinical studies, publicly available datasets, and expert input, with outcomes measured in quality-adjusted life years (QALYs). Cost-effectiveness was evaluated through incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMB), with additional deterministic and probabilistic sensitivity analyses performed to address input uncertainties.</p><p><strong>Results: </strong>Integrating digital monitoring yielded an additional 0.32 QALYs per patient at an incremental cost of US $3143, resulting in an ICER of US $9804.30 per QALY, significantly below the South Korean willingness-to-pay threshold of US $32,255/QALY. The digitally supported group exhibited improved rates of long-term remission (22.68%, 2268/10,000) and reduced postremission relapse (17.87%, 1787/10,000) compared to standard care (17.48%, 1748/10,000 and 26.37%, 2637/10,000, respectively). Probabilistic sensitivity analysis showed that digital intervention was the preferred cost-effective strategy in 64.4% (6440/10,000) of iterations. Subscription costs of the digital platform and the utility weight for thyroid-associated orbitopathy emerged as key factors affecting the ICER in sensitivity analyses.</p><p><strong>Conclusions: </strong>The findings suggest that digital monitoring provides a cost-effective strategy for enhancing hyperthyroidism management, supporting sustained remission, and reducing relapse rates. As such, digital solutions could serve as a valuable adjunct to traditional care, with the cost-effectiveness analysis providing an economic basis for determining pricing and value-based reimbursement in health care systems. The study underscores the importance of integrating digital solutions in chronic disease management and suggests that further research should include societal costs, such as productivity, to capture economic benefits fully.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e56738"},"PeriodicalIF":5.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690370","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":"Associations Between Daily Symptoms and Pain Flares in Rheumatoid Arthritis: Case-Crossover mHealth Study.","authors":"Ting-Chen Chloe Hsu, Belay B Yimer, Pauline Whelan, Christopher J Armitage, Katie Druce, John McBeth","doi":"10.2196/64889","DOIUrl":"https://doi.org/10.2196/64889","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mobile health (mHealth) technologies, such as smartphones and wearables, enable continuous assessments of individual health information. In chronic musculoskeletal conditions, pain flares, defined as periods of increased pain severity, often coincide with worsening disease activity and cause significant impacts on physical and emotional well-being. Using mHealth technologies can provide insights into individual pain patterns and associated factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to characterize pain flares and identify associated factors in rheumatoid arthritis (RA) by (1) describing the frequency and duration of pain flares using progressively stringent definitions based on pain severity, and (2) exploring associations between pain flares and temporal changes in symptoms across emotional, cognitive, and behavioral domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our 30-day mHealth study collected daily pain severity and related symptoms (scores 1-5, higher are worse) via a smartphone app and passively recorded sleep and physical activity via a wrist-worn accelerometer. Pain flares were defined using a 5-point scale: (1) above average (AA): pain severity &gt; personal median, (2) above threshold (AT): pain severity &gt; 3, and (3) move above threshold (MAT): pain severity moves from 1, 2, 3 to 4 or 5. A case-crossover analysis compared within-person variations of daily symptoms across hazard (3 days before a pain flare) and control (3 days not preceding a pain flare) periods using mean and intraindividual standard deviation. Conditional logistic regression estimated the odds ratio (OR) for pain flare occurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 195 participants (160/195, 82.1% females; mean age 57.2 years; average years with RA: 11.3) contributed 5290 days of data. Of these, 88.7% (173/195) experienced at least 1 AA flare (median monthly rate 4, IQR 2.1-5). Nearly half experienced at least 1 AT or MAT flare (median monthly rate 2, IQR 1-4). These pain flares lasted 2 days (IQR 2-3) on average across definitions, with some extending up to 12 days. Worsening mood over 3 days was associated with a 2-fold increase in the likelihood of AT flares the following day (OR 2.04, IQR 1.06-3.94; P&lt;.05). Greater variability in anxiety over 3 days increased the likelihood of both AT (OR 1.67, IQR 1.01-2.78; P&lt;.05) and MAT flares (OR 1.82, IQR 1.08-3.07; P&lt;.05). Similarly, greater variability in sleepiness (OR 1.89, IQR 1.03-3.47; P&lt;.05) also increased the likelihood of AT flares. Sedentary time (%) consistently showed almost no influence across all definitions. Similarly, the simplest definition of AA demonstrated no significant associations across all symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pain flares were commonly observed in RA. Changes in sleep patterns and emotional distress were associated with pain flare occurrences. This analysis demonstrates the potential of daily mHealth data to identify pain flare","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e64889"},"PeriodicalIF":5.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682570","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":"Current Practice and Expert Perspectives on Cultural Adaptations of Digital Health Interventions: Qualitative Study.","authors":"Vasileios Nittas, Sarah J Chavez, Paola Daniore","doi":"10.2196/59965","DOIUrl":"10.2196/59965","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Some people are less likely to benefit from digital health interventions (DHIs) than others. Culture, along with other factors, contributes to these differences. DHIs that do not address a population's cultural norms or concerns are likely to be less effective. One way to create culturally sensitive DHIs is through cultural adaptations. Yet, there is currently little evidence-based guidance on when and how to adapt DHIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to capture the experiences of experts to understand the (1) current practices, (2) challenges, and (3) recommendations around culturally adapting DHIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted semistructured interviews (n=15) via Zoom (Zoom Video Communications, Inc) between May and August 2023, with academic experts who have previously undertaken cultural adaptations of DHIs. Experts were identified through publications and snowball sampling. We used a thematic analytical approach, beginning with a preliminary deductive codebook and then following a three-stage analysis. All transcripts were coded with the MAXQDA (VERBI Software GmbH) software. Codes were reviewed, and similar or related codes were categorized into broader themes, consolidating one or multiple codes into a single topic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our analysis produced 30 codes, which were categorized into (1) defining culture, (2) justifying the adaptation, (3) choosing the adaptation elements, (4) implementing the adaptation, (5) understanding the challenges, and (6) recommendations. Based on their experiences, experts recommended that (1) the adaptation team is multiprofessional, digitally competent, and culturally sensitive; (2) DHI users and (3) all other relevant stakeholders are continuously involved; and (4) the adaptations incorporate evaluations and knowledge exchange. They further emphasized that culturally adapted DHIs must be understandable, relatable, appealing, and easy to adhere to, ensuring that health technology and content reflect the target population's lived experiences, sociodemographic characteristics, and digital literacy. When asked which elements of cultural DHI adaptations, the most common responses were language, lived experience, and technology. Responses revealed five common DHI-relevant challenges, including (1) technology, (2) uncertainty, (3) user involvement, (4) communication, and (5) evaluation and sustainability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The cultural adaptation of DHIs was described as an iterative, often unstructured, and resource-intensive process that requires careful justification and a solid understanding of the culture and the specific cultural group for which it is implemented. Our interviews confirmed the absence of technology-specific frameworks to guide the cultural adaptations of DHIs. Based on our findings, such a framework should guide the choice of the correct definition of culture and the criteria for assessing the nee","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e59965"},"PeriodicalIF":6.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12294640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663831","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":"The Impact of an Adaptive mHealth Intervention on Improving Patient-Provider Health Care Communication: Secondary Analysis of the DIAMANTE Trial.","authors":"Lynn Leng, Marvyn R Arévalo Avalos, Adrian Aguilera, Courtney R Lyles","doi":"10.2196/64296","DOIUrl":"10.2196/64296","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Depression and diabetes are highly comorbid conditions and are significant causes of global disability, particularly among individuals with low income or those from racial or ethnic minority backgrounds. While digital interventions offer promise for managing these chronic conditions (such as via lifestyle modification), there is also emerging evidence suggesting that digital support may strengthen or complement existing health care relationships, particularly by improving patient perceptions of communication and connection with their health care providers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to examine the impact of an adaptive mobile health (mHealth) texting-based intervention on patient ratings of communication with their health care providers among individuals with diabetes and depressive symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study used data from the DIAMANTE (Diabetes and Mental Health Adaptive Notification Tracking and Evaluation) trial, a prospective, randomized controlled trial that varied SMS text messaging strategies to encourage physical activity to support both mental and physical health for patients with diabetes and depression. Patients were recruited from safety-net clinics in San Francisco and through social media during the COVID-19 pandemic, and were randomized into three trial arms: (1) personalized SMS text messaging about physical activity via an adaptive learning algorithm, (2) randomly selected SMS text messaging about physical activity, and (3) a control group that received no SMS text messages. As a secondary outcome, we examined pre-post changes in patient-reported health care communication, assessed via surveys with the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) communication subscale. Bivariate comparisons examined changes in CAHPS scores, including age, gender, preferred language, race or ethnicity, nativity, marital status, and education. Our primary analysis used mixed-effects modeling within an intent-to-treat analysis to determine differences in CAHPS scores by trial arm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 195 patients participated in the DIAMANTE trial from 2020 to 2022. After excluding patients who had incomplete or missing baseline or exit surveys, 156 patients were included in this secondary analysis. Overall, there was a substantive but nonsignificant decrease in the average CAHPS score over the 6-month trial period (-2.6; P=.11), with similar trends across patient demographic subgroups. Upon evaluating health care communication across the three randomized controlled trial (RCT) arms, there were no significant differences in patient-provider communication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Digital health interventions are rapidly increasing in clinical practice and have the ability to reach historically underserved communities by overcoming barriers such as language, geography, and time constraints. However, RCTs h","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e64296"},"PeriodicalIF":6.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659212","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":"Parental and Demographic Predictors of Engagement in an mHealth Intervention: Observational Study From the Let's Grow Trial.","authors":"Johanna Sandborg, Brittany Reese Markides, Savannah Simmons, Katherine L Downing, Jan M Nicholson, Liliana Orellana, Harriet Koorts, Valerie Carson, Jo Salmon, Kylie D Hesketh","doi":"10.2196/60478","DOIUrl":"10.2196/60478","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Parents are integral in shaping early childhood health behaviors, and mobile health (mHealth) interventions offer an accessible method of supporting them in this role. Optimizing participant engagement is key to mHealth effectiveness and impact; however, research examining personal predictors of engagement remains underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to describe participant engagement with a novel parental mHealth intervention (Let's Grow) during the first 25 weeks of use and investigate whether engagement levels varied by family demographics and parental cognitions and behaviors relevant to the intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used data from parents in the intervention group of the Let's Grow trial. The intervention targeted toddlers' movement behaviors, and the program (a purpose-designed progressive web app) was delivered via self-paced modules. The content was built around 3 main components (behavior change activities, information provision, and social support). Engagement data (web app analytics) collected across the first 25 weeks of the intervention were summarized as study-specific metrics (time using the app, proportion of accessed features and pages, clicks in the main parts of the app) and overall engagement measures (composite engagement index [EI], individual subindexes [click depth, loyalty, recency, and diversity]). The baseline measures included family demographics (main carer, child and family characteristics, and postcode) and parental cognitions and behaviors relevant to the intervention (coping, concern, and information seeking). Linear regression was used to assess associations between baseline and engagement measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All parents allocated to the intervention group (n=682) were included. Most parents (609/682, 89.3%) logged in and used at least 1 app feature; those who never used the app were excluded from subsequent analyses. App access declined from 90.6% (552/609) in the first week to 31.2% (190/609) at 25 weeks. For users active during weeks 12 to 25, EI remained consistent and was nearly identical to the average EI (28%, range 3%-50%). More work hours, parents living together, having siblings in the family, and living in a regional or remote area were each associated with lower engagement on 10 out of 12 indicators (β=-31.37 to -0.01; all P≤.046). Higher education level was associated with higher engagement on 9 indicators (β=0.77-18.59; all P≤.02). Of the parental characteristics, only higher coping was positively associated with engagement (β=1.25; P=.003).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings indicate that time and sociodemographic factors might be the most relevant predictors of engagement and highlight the characteristics of parents who may benefit from more active strategies to support their engagement with digital interventions. The uptake and continued engagement with this app exceeded what is general","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e60478"},"PeriodicalIF":5.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642598","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":"Patterns of Engagement With the mHealth Component of a Sexual and Reproductive Health Risk Reduction Intervention for Young People With Depression: Latent Trajectory Analysis.","authors":"Lydia A Shrier, Carly E Milliren, Brittany Ciriello, Madison M O'Connell, Sion Kim Harris","doi":"10.2196/70219","DOIUrl":"10.2196/70219","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mobile health (mHealth) interventions are increasingly used to reduce risk and promote health in real-time, real-life contexts. Engagement is critical for effectiveness of mHealth interventions but may be challenging for young people experiencing depressive symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We examined engagement with the 4-week mHealth component of a counseling-plus-mHealth intervention to reduce sexual and reproductive health (SRH) risk among young people with depression (Momentary Affect Regulation - Safer Sex Intervention [MARSSI]) to determine (1) mHealth engagement patterns over time and (2) how sociodemographic characteristics, SRH risks, and depressive symptom severity were associated with these engagement patterns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We undertook secondary analysis of data collected from June 2021 to September 2023 in a randomized controlled trial of MARSSI versus a breast health podcast. Eligibility included age 16-21 years, ability to become pregnant, smartphone ownership, English fluency, past-3-month penile-vaginal sex ≥1x/week and ≥1 SRH risk, and Patient Health Questionnaire-8 item score ≥8. Intervention participants received one-on-one telehealth counseling and then used an app for 4 weeks, responding to surveys (3 prompted at quasi-random, 1 scheduled daily) about affect, effective contraception and condom use self-efficacy, sexual and pregnancy desire, and recent sex, and receiving tailored messages reinforcing the counseling. We computed mHealth engagement days (responding to ≥1 app survey) by week and overall. Latent trajectory analysis identified engagement patterns over the 4 mHealth weeks among participants with any engagement. Using regression analysis, we examined the associations of sociodemographic characteristics, SRH risks, and depressive symptom severity with mHealth engagement patterns and examined moderation by depressive symptom severity. Of the 201 intervention participants, 194 (96.5%) enrolled in the app.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among those responding to app surveys (167/194, 86.1%), the median engagement was 14 (IQR 4-23) days; 32.9% (55/167) responded on ≥20 days. Overall app engagement (median) declined from 5 (IQR 3-7) days in week 1 to 1 (IQR 0-5) day in week 4. On latent trajectory analysis, 4 patterns of app engagement emerged: high-throughout (48/167, 28.7%), high-then-declining (40/167, 23.9%), mid-then-declining (47/167, 28.1%), and low-throughout (33/167, 19.7%). Participants identifying gender other than female and those perceiving higher socioeconomic status were more likely to have high-throughout or high-then-declining engagement. Asian or Black non-Hispanic participants and those using low-effectiveness contraception were more likely to have no engagement. In the multivariable model, Asian (adjusted odds ratio [AOR] 0.28, 95% CI 0.10-0.81), Black non-Hispanic (AOR 0.28, 95% CI 0.12-0.66), and higher perceived socioeconomic status (AO","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e70219"},"PeriodicalIF":5.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612159","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":"Exploring the Barriers and Facilitators to Implementing a Smartphone App for Physicians to Improve the Management of Acute Myocardial Infarctions: Multicenter, Mixed Methods, Observational Study.","authors":"Katelyn J Cullen, Hassan Mir, Madhu K Natarajan, Marija Corovic, Karen Mosleh, Jacob Crawshaw, Mathew Mercuri, Hassan Masoom, J D Schwalm","doi":"10.2196/60173","DOIUrl":"10.2196/60173","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Timely and appropriate care is critical for patients with ST-elevation myocardial infarction (STEMI). Effective communication and prompt sharing of test results, particularly electrocardiograms (ECGs), between the referring emergency medicine (EM) physician or emergency medical service (EMS) paramedic and the interventional cardiologist (IC) are essential. This exchange relies on fax or SMS text messages. The SmartAMI-ACS (Strategic Management of Acute Reperfusion and Therapies in Acute Myocardial Infarction) App was developed to streamline communication. It is user friendly and privacy compliant, and enables rapid, secure ECG sharing to support faster, informed clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This paper details the results of targeted preimplementation surveys to establish barriers and enablers of using a smartphone app to transmit ECG images among ICs, EM physicians, and EMS paramedics to help tailor implementation interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To assess the proposed acceptability and uptake of the app, preimplementation surveys were disseminated to ICs, EM physicians, and EMS paramedics in one region of Ontario, Canada. Questions were generated based on selected components of the Consolidated Framework for Implementation Research, results from a pilot study carried out at a regional hospital where the SmartAMI-ACS app was previously implemented, and predicted barriers based on expert guidance. The preimplementation surveys consisted of 7-point Likert scale questions (1=strongly disagree and 7=strongly agree) and open-ended questions. Open-ended data were extracted verbatim and analyzed using an inductive qualitative approach, with transcripts coded into descriptive qualitative codes and then collapsed into themes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Survey uptake was acceptable, with 9 of the invited 10 ICs, 51 of the invited 223 EM physicians, and 93 of the invited 1138 EMS paramedics responding. All groups recognized that current practices for sharing ECGs allowed room for improvement, accepting that fax can be inconvenient and SMS text messages may not be secure. When asked whether there was a need for a smartphone app to transmit ECGs, ICs (mean 6.67, SD 0.5), EM physicians (mean 5.57, SD 1.3), and EMS paramedics (mean 5.79, SD 1.45) consistently agreed. Commonly reported barriers were concerns over technological challenges, privacy issues, and cell phone reception strength. Through the identification of the barriers in each stakeholder group, implementation strategies were developed that facilitated the scale-up of this system-change intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Results from the 3 web-based preimplementation surveys to identify key barriers and enablers to the implementation of the app helped inform the selection of tailored implementation strategies to support the rollout of the app across the health region. The surveys identified key barriers a","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e60173"},"PeriodicalIF":6.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591291","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 New Wearable System for Personal Air Pollution Exposure Estimation: Pilot Observational Study.","authors":"Sara Bernasconi, Alessandra Angelucci, Andrea Rossi, Andrea Aliverti","doi":"10.2196/60426","DOIUrl":"10.2196/60426","url":null,"abstract":"<p><strong>Background: </strong>Air pollution is a major environmental cause of premature deaths, responsible for around 7 million deaths annually. In this context, personal air pollution exposure (PAPE), the product of pollutant concentration and minute ventilation (V'm), is a crucial measure for understanding individual health risks. Standard exposure techniques do not address the space-time variability of air pollution, both indoor and outdoor, and the intra- and intersubject variability in V'm.</p><p><strong>Objective: </strong>This study evaluates the feasibility of using a wearable body sensor network (BSN) to estimate PAPE in real-life settings, assess its capability to detect spatiotemporal variations in pollution levels, and compare inhaled dose estimates from the BSN with those from fixed monitoring stations and standard V'm values. The study also examines the system's usability.</p><p><strong>Methods: </strong>The system, a BSN capturing physiological (pulse rate [PR] and respiratory rate [RR]) and environmental data, including health-affecting pollutants (particulate matter [PM] 1, PM2.5, PM10, CO2, CO, total volatile organic compounds, and NO2), was tested in a 4.5 km walk in Milan by 20 healthy volunteers. PR and RR collected by the system were used, together with biometric data and forced vital capacity estimations, in a model for V'm estimation to compute PAPE. Pollution levels were compared between morning and afternoon measurements, as well as between indoor and outdoor settings.</p><p><strong>Results: </strong>Variations in RR were found among volunteers and at different locations for the same participant. Significant differences (P<.001) in pollutant concentrations were observed between morning and afternoon for CO2 (higher in the morning) and PM (higher in the afternoon). Spatial variability along the walking path was also detected, highlighting the system's high spatiotemporal resolution. Indoor environments showed high variability in CO2 and total volatile organic compounds, while outdoor settings exhibited elevated and variable PM levels. The mean PAPE to PM2.5 estimated with tabulated V'm and fixed station data was 13.31 (SD 4.16) μg while the one estimated with the BSN was 16.27 (SD 9.78) μg, 2.96 μg higher (22.3%; 95% CI -6.55 to 0.63; P=.05) than the former one, and with a broader IQR. Nevertheless, the 2 estimation methods show a good and strongly significant correlation (r=0.665; P<.001). The system's usability was generally rated as good.</p><p><strong>Conclusions: </strong>The BSN provides high-resolution spatiotemporal data on personal exposure, capturing differences in pollution levels dependent on time, location, and surrounding environment, along with individual physiological variations. It offers a more accurate estimation of inhaled dose in real-life settings, supporting personalized exposure assessments and potential applications in activity planning and complementing epidemiological research.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e60426"},"PeriodicalIF":5.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12248256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564797","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}