JMIR Formative Research最新文献

{"title":"Examining Canadian Smart Home Technology Users' Perceptions of Privacy, Risks, Safety, and Data Collection Purposes: Cross-Sectional National Survey.","authors":"Eva V Di Nallo, Charlene H Chu, Zara Hasan, Pratik K Mishra, Jacob Buchan, Tun Zheng, Andria Bianchi, Jesse Hoey, Shehroz S Khan","doi":"10.2196/70638","DOIUrl":"10.2196/70638","url":null,"abstract":"<p><strong>Background: </strong>Smart home technologies (SHTs) encompass internet-connected interfaces, sensors, monitors, devices, and appliances, which are networked together to allow for automation. They can facilitate tasks, such as taking medication or issuing fall alerts, and can control the home environment, such as by automating lighting. Their widespread use comes with concerns about power imbalances between users, technology companies, marketers, and state actors regarding data collection, its use and disclosure, and security issues, such as the potential for data breaches. SHT acceptance and adoption are shaped by user attitudes and trust, so understanding these factors is critical. A scoping review conducted by several authors of this paper explored user perceptions of SHTs and identified 4 key themes related to user attitudes: privacy concerns, knowledge of data collection, perceived risks and benefits, and perceived safety. Of the included studies in the review, none explored Canadian SHT users' attitudes. Thus, little is known about how Canadians perceive and understand the privacy, data collection, and safety elements of their SHTs. Given Canada's unique demographic diversity and distinct context, examining Canadian perspectives is necessary for advancing this body of research.</p><p><strong>Objective: </strong>This study explored users' perceptions of SHTs in Canada, with a focus on privacy, the purpose of data collection, risks, and safety.</p><p><strong>Methods: </strong>An online survey was distributed across Canada between March 7 and April 24, 2023, to collect self-reported demographic information and users' perceptions of SHT privacy, the purpose of data collection, risks and benefits, and safety associated with SHT use. To be eligible for this study, participants had to (1) be adults aged 18 years or older; (2) live in the community; (3) reside in Canada; (4) use at least one SHT; and (5) be comfortable communicating in English. The quantitative data were exported to SPSS (IBM Corp) and the Python programming language for descriptive analysis.</p><p><strong>Results: </strong>Self-reported survey data from a total of 881 SHT users were analyzed. Participants reported user mistrust (294/881, 33.4%), uncertainty (281/881, 31.9%), powerlessness (325/881, 36.9%), and digital resignation (232/881, 26.3%) pertaining to their SHT use. Many users displayed a willingness to trade privacy for perceived benefits, such as convenience, and some highlighted safety as a beneficial feature of SHTs. Contrary to previous internet or smart home research, most participants reported having read their SHT terms of use documents during setup.</p><p><strong>Conclusions: </strong>As the largest national survey of its kind in Canada, this study reveals a complex relationship between Canadians and SHTs, in which privacy concerns coexist with a desire for convenience and safety. These results highlight the need for greater transparency and trust-build","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e70638"},"PeriodicalIF":2.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Gaps in Standards for the Secondary Use of Health Data: Exploratory Standard, Tool Assessment, and Feasibility Study.","authors":"Jaleh Shoshtarian Malak, Leonie von Berlin, Irina Balaur, Rada Hussein, Philip Gribbon, Yojana Gadiya, Somayeh Abedian, Andreas Kremer, Stefan Sauermann, Francisco J Núñez-Benjumea, Jens Declerck, Sumit Madan, Hanna Ćwiek-Kupczyńska, Lukas Rohatsch, Holger Fröhlich, Christian Muehlendyck, Venkata P Satagopam","doi":"10.2196/88619","DOIUrl":"10.2196/88619","url":null,"abstract":"<p><strong>Background: </strong>Standards for the secondary use of health data remain under development and do not comprehensively address specific categories of health data. Existing health data and interoperability standards are primarily designed for the primary use of health care, leaving gaps in their applicability for research, regulatory and decision-making. This research is part of the Integration of Heterogeneous Data and Evidence Towards Regulatory and Health Technology Assessment Acceptance (IDERHA) project, which creates a federated processing environment for secondary health care use cases.</p><p><strong>Objective: </strong>This study aims to recommend a set of standards and tools to support harmonization objectives in the secondary use of health data. The proposed standards establish a shared representation model for data providers and stakeholders, improving data adherence to findable, accessible, interoperable, and reusable (FAIR) principles and interoperability.</p><p><strong>Methods: </strong>In this exploratory assessment and feasibility study, we performed a consensus-based evaluation of health data standards and harmonization tools across major health-data categories. State-of-the-art standards from different standard-producing organizations were evaluated based on community adoption, technical suitability, and alignment with European Health Data Space requirements. Data-harmonization tools were tested in a pilot experiment using synthetic Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM)-based data to assess the quality and feasibility of applying harmonization workflows within IDERHA. We also assessed the inherent adherence to FAIR principles of the OMOP-CDM, identifying its strengths in semantic interoperability and data reuse. Finally, we addressed the datasets handling challenges (metadata discoverability, global identifiers, access control, and licensing), which are not inherently solvable by bare data description standards, through complementary mechanisms implemented in IDERHA.</p><p><strong>Results: </strong>We recommend a set of standards to support the secondary use of heterogeneous health data across clinical, imaging, genomic, socioeconomic, environmental, and patient-reported outcome measure (PROM)/patient-reported experience measure (PREM) domains. This standards collection, centered on OMOP-CDM and complemented by established extensions, was paired with selected harmonization and quality-assessment tools. Feasibility testing on synthetic OMOP data confirmed the suitability of the tools for evaluating data quality, mapping accuracy, and extract, transform, and load. A lung-cancer use case demonstrated how diverse datasets can be harmonized and prepared for federated analysis. A FAIR-dataset maturity evaluation showed that integrating OMOP data into the IDERHA environment substantially improved adherence to FAIR principles-particularly in metadata completeness, interoperability, and hosti","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e88619"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Test Length and Scoring Methods on Pass/Fail Classification Accuracy in Single-Choice Examinations: A Simulation Study.","authors":"Christiane Pink, Yola Meisel, Arvid Vetter, Philipp Kanzow","doi":"10.2196/98358","DOIUrl":"https://doi.org/10.2196/98358","url":null,"abstract":"<p><strong>Background: </strong>Multiple-choice examinations are widely used in dental and medical education. To reduce the effects of random guessing, several scoring methods incorporating penalty scores have been proposed. However, it remains unclear whether such scoring methods improve the accuracy of pass/fail decisions when pass marks are appropriately calibrated.</p><p><strong>Objective: </strong>To examine pass/fail classification accuracy under three scoring methods (dichotomous scoring, formula scoring, and right-minus-wrong scoring) in summative examinations using single-choice Type A items with five answer options, and to evaluate the effects of test length and the distribution of the model parameter <i>k</i> (knowledge-based response probability).</p><p><strong>Methods: </strong>Monte Carlo simulations and analytical derivations were used to evaluate examinations with varying test lengths of up to 300 items. Pass marks were calibrated to the same model-defined cutoff for all scoring methods. Classification accuracy, sensitivity, specificity, and misclassification rates were analyzed across different distributions of <i>k</i>.</p><p><strong>Results: </strong>With every item answered and pass marks calibrated to the same model-defined cutoff, the three scoring methods produced identical pass/fail classifications, as expected from their linear relationship. Classification accuracy increased with test length but was strongly influenced by the distribution of <i>k</i>. Under a uniform distribution, mean accuracy reached 0.90 after 24 items and 0.95 after 94 items, whereas substantially longer tests were required when <i>k</i> was concentrated near the cutoff. These item numbers are model- and distribution-dependent and should not be interpreted as recommended examination lengths. Misclassification was highest near the decision threshold.</p><p><strong>Conclusions: </strong>Under the modeled conditions of complete responding, calibrated pass marks, and unchanged response behavior, the investigated scoring methods yielded identical pass/fail classifications. Classification accuracy increased with test length and depended strongly on the distribution of <i>k</i>, with greatest uncertainty near the pass/fail cutoff. These findings apply to the structural effects of the scoring transformations examined here and should not be generalized to behavioral effects of scoring rules in real examinations.</p><p><strong>Clinicaltrial: </strong></p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Usability of Digital Slow Breathing and Detached Mindfulness Interventions in Late Adolescents: Mixed Methods Study.","authors":"Ruya Akdag, Anja van der Voort, Lisa Tessensohn, Julian Versteeg, Simone Vogelaar","doi":"10.2196/94578","DOIUrl":"10.2196/94578","url":null,"abstract":"<p><strong>Background: </strong>Many adolescents experience elevated stress and anxiety; yet, access to effective psychological support is limited. Brief digital mental health interventions, such as slow breathing (SB) and detached mindfulness (DM), offer a potentially scalable approach to promoting emotion regulation in daily life.</p><p><strong>Objective: </strong>This study aimed to investigate whether 1 week of daily practice with a SB or DM intervention reduced stress, anxiety, and negative metacognitive beliefs in youth, and explored participants' experiences to inform the development of accessible, youth-tailored digital interventions.</p><p><strong>Methods: </strong>A mixed method approach was used, including quantitative and qualitative data. A total of 147 university students between 16 and 19 years old were randomly allocated to the DM (n=49), SB (n=49), or passive control group (n=49). Participants who were allocated to DM or SB practiced the intervention for 1 week. Stress, anxiety, and negative metacognitive beliefs were assessed at pre- and postintervention using self-report questionnaires. The quantitative data were analyzed with linear mixed-effects models, and we explored daily changes in intervention effect. After posttest, participants were invited to focus groups to evaluate their experience with the interventions (n=37). The qualitative data were analyzed with a content analysis.</p><p><strong>Results: </strong>Our results showed that a week-long DM intervention significantly reduced stress compared with the control condition. No other differences emerged for the main outcomes on pre- and postmeasurements. However, in the SB group, higher perceived usability was associated with greater reductions in stress. Qualitative findings showed that both interventions were viewed as calming, easy to use, and acceptable, while also highlighting challenges such as maintaining motivation and integrating the exercises into daily routines.</p><p><strong>Conclusions: </strong>This study provides early formative evidence that brief digital interventions such as SB and DM are feasible and usable, with preliminary indication that DM intervention may support short-term stress reduction. Future research should focus on enhancing motivation and sustained engagement to maximize the effectiveness of digital mental health tools for late adolescents.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e94578"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-Time Artificial Intelligence Diagnostic Copilot in Simulated Primary Care Consultations: Randomized Simulation Study.","authors":"Ivan Cusacovich, Manuel Pinilla, Ruben Garcia Castro","doi":"10.2196/104579","DOIUrl":"10.2196/104579","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diagnostic errors in primary care contribute substantially to avoidable morbidity. Real-time, voice-based artificial intelligence (AI) diagnostic assistants may support diagnostic reasoning during clinical encounters, but formative evidence that can be used to assess both diagnostic benefit and overreliance risk before clinical deployment is needed from interactive settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to conduct a formative, high-difficulty simulation stress test of whether a real-time, voice-based AI diagnostic assistant was associated with improved physician diagnostic accuracy and measurable overreliance during simulated primary care consultations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a case-level randomized, adjudicator-blinded simulation study in a web-based virtual primary care clinic. Thirteen board-certified family and community medicine physicians managed 260 simulated voice-based consultations. Cases were assigned to either an AI-assisted condition or an unassisted, resource-restricted simulation condition without any external diagnostic aids. No real patients were enrolled, and no clinical care was delivered or modified. The primary outcome was Top-3 diagnostic accuracy, defined as at least one correct diagnosis among up to 3 submitted diagnoses assessed by 3 blinded adjudicators and analyzed using a frequentist binomial generalized linear mixed model fitted by maximum likelihood with random intercepts for physician and case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 260 consultations were completed and analyzed. Adjusted Top-3 diagnostic accuracy was 62.3% (95% CI 49.1% to 75.7%) in the unassisted condition and 74.6% (95% CI 63.7% to 85.4%) in the AI-assisted condition (adjusted odds ratio [AOR] 2.68, 95% CI 1.24 to 6.12; χ&lt;sup&gt;2&lt;/sup&gt;&lt;sub&gt;1&lt;/sub&gt;=6.4, &lt;i&gt;P&lt;/i&gt;=.01). This corresponds to an adjusted absolute difference of +12.3 percentage points (95% CI +2.7 to +22.6) and a simulation-context number needed to treat equivalent of 8.1 (95% CI 4.4 to 37.2). The post hoc Top-2 analysis was supportive (AOR 2.59, 95% CI 1.23 to 5.77; χ&lt;sup&gt;2&lt;/sup&gt;&lt;sub&gt;1&lt;/sub&gt;=6.3, &lt;i&gt;P&lt;/i&gt;=.01). Top-1 point estimates favored AI assistance but were inconclusive: Adjusted accuracy was 47.8% in the unassisted condition versus 57% with AI assistance (AOR 1.83, 95% CI 0.93 to 3.80; χ&lt;sup&gt;2&lt;/sup&gt;&lt;sub&gt;1&lt;/sub&gt;=3.1, &lt;i&gt;P&lt;/i&gt;=.08). Leave-one-physician-out and virtual-patient simulator-exclusion sensitivity analyses were consistent with the primary finding. In risk scenarios with an incorrect operative AI suggestion, adjusted concordance was 38.8% in the unassisted condition and 55.8% in the AI-assisted condition, but the between-condition comparison was not statistically significant (AOR 2.08, 95% CI 0.89 to 5.19; χ&lt;sup&gt;2&lt;/sup&gt;&lt;sub&gt;1&lt;/sub&gt;=2.9, &lt;i&gt;P&lt;/i&gt;=.09). Mean consultation time increased by 10.7%, and physicians rated the system highly for usefulness and satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In ","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e104579"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Adoption of Digital Devices and Change in Loneliness Over 10 Years Among Late Middle-Aged and Older Adults: Longitudinal Cohort Study.","authors":"Anna K Dahl Aslan, Martin Gellerstedt, Chandra A Reynolds, Deborah Finkel","doi":"10.2196/95955","DOIUrl":"10.2196/95955","url":null,"abstract":"<p><strong>Background: </strong>Loneliness is recognized as a global health threat. Older adults are vulnerable to loneliness due to life changes common in old age. While individual risk factors for loneliness in old age are well-documented, contextual factors are scarcely explored, such as digitalization. Rapid digitalization underscores the need to explore the long-term association between the use of digital devices and loneliness.</p><p><strong>Objective: </strong>This study aimed to explore whether and how the use of digital devices is associated with changes in loneliness in a population-based sample of middle-aged and older adults in a context where digital technology and digital environments were introduced and rapidly evolving.</p><p><strong>Methods: </strong>Data were obtained from the longitudinal cohort study, the Swedish Adoption/Twin Study of Aging (SATSA; N=771; mean age 69.64 years, SD 11.00). Daily digital use and loneliness were assessed across 5 waves between 2004 and 2014. Age, sex, education, living situation, self-rated health, and the personality traits openness and extraversion were assessed at baseline. Growth mixture modeling was used to identify latent trajectories of loneliness, and multinomial logistic regression was used to predict class membership based on baseline daily digital use and covariates.</p><p><strong>Results: </strong>Three latent loneliness classes were identified: class 1 (10.5%; high intercept and significant increases in loneliness), class 2 (33.2%; intermediate stable loneliness), and class 3 (56.3%; low stable loneliness). Daily digital use at baseline is significantly associated with lower odds of belonging to the high-increasing loneliness group (class 1) compared to the low-stable group (class 3; odds ratio 0.27, 95% CI 0.08-0.90; P=.03). Differences between classes were not explained by the personality traits.</p><p><strong>Conclusions: </strong>Daily use of digital devices is associated with lower and more stable levels of loneliness over time, compared to not using digital devices daily, which is associated with higher and increasing levels of loneliness. These findings, based on data from early adopters of digital technology, lend further support to the idea that digital use is associated with lower levels of loneliness and less increase in loneliness. Hence, these findings suggest that use of digital devices may represent a noninvasive approach to addressing loneliness in older adults.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e95955"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Microbial Foodborne Pathogen Detection in Beijing, China, Before and After the COVID-19 Pandemic: Single-Center Retrospective Study.","authors":"Chao Liang, Luping Tan, Hongyi Zhang","doi":"10.2196/96940","DOIUrl":"10.2196/96940","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Foodborne diseases remain a significant global public health concern, imposing substantial health and economic burdens. The COVID-19 pandemic altered health care-seeking behaviors, infection control practices, and infectious disease epidemiology; however, its association with microbial foodborne pathogens remains incompletely characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This single-center retrospective study aimed to analyze changes in bacterial and viral foodborne pathogen detection using clinical and etiological data from patients at an infectious diarrhea clinic in a tertiary Beijing hospital over 6 years and to inform prevention strategies in the postpandemic era.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We collected data from patients presenting to the Infectious Diarrhea Clinic of Peking University Third Hospital (a grade A tertiary care center serving the Haidian District and surrounding areas of Beijing) from January 2018 to December 2019 (prepandemic) and from January 2022 to December 2023 (postpandemic). The years 2020 and 2021 were excluded due to major disruptions in clinical services and surveillance during the peak pandemic period. Etiological results were obtained from the Beijing Haidian District Center for Disease Control and Prevention. Diagnostic methods, laboratory protocols, specimen collection procedures, reagent kits, instrumentation, and testing criteria remained consistent throughout the study period. Cases were divided into 2 groups based on time period, and &lt;i&gt;χ&lt;/i&gt;2 tests were used for comparisons. The positivity rate was calculated as patients with at least 1 target pathogen detected divided by all patients who provided stool specimens.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 1064 patients were included (561 in group A and 503 in group B). From 2018 to 2019, 155/561 specimens tested positive for foodborne pathogens (27.6%, 95% CI 23.9%-31.3%), including 22 &lt;i&gt;Salmonella&lt;/i&gt;, 24 &lt;i&gt;Vibrio parahaemolyticus&lt;/i&gt;, 66 diarrheagenic &lt;i&gt;Escherichia coli&lt;/i&gt; (DEC), and 43 &lt;i&gt;Norovirus&lt;/i&gt; cases. From 2022 to 2023, 82/503 specimens tested positive (16.3%, 95% CI 13.1%-19.5%), including 13 &lt;i&gt;Salmonella&lt;/i&gt;, 7 &lt;i&gt;V parahaemolyticus&lt;/i&gt;, 45 DEC, and 17 &lt;i&gt;Norovirus&lt;/i&gt; cases. The overall positivity rate was significantly lower in the postpandemic period than in the prepandemic period (27.6% vs 16.3%, &lt;i&gt;P&lt;/i&gt;&lt;.05). Students and males aged 16-25 years were the most represented demographic groups. DEC remained the predominant pathogen in both periods. The detection rates of &lt;i&gt;V parahaemolyticus&lt;/i&gt;, from 24/561 (4.3%) to 7/503 (1.4%) (&lt;i&gt;P&lt;/i&gt;=.005), and &lt;i&gt;Norovirus&lt;/i&gt;, from 43/561 (7.7%) to 17/503 (3.4%) (&lt;i&gt;P&lt;/i&gt;=.002), were significantly lower in the postpandemic period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among patients attending a single infectious diarrhea clinic in Beijing, the detection rates of microbial foodborne pathogens were significantly lower in the postpandemic period compared with th","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e96940"},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinician-Centered Evaluation Framework for Large Language Models in Patient Education: Integrating the Technology Acceptance Model and Medical Condition Regard Scale.","authors":"Davis Austria, Grace Lord Williams, Christopher Girardo, Micheal Olaolu Arowolo, Meenakshi Mishra, Charlene Pope, R Neal Axon, Jason Bradley Hill","doi":"10.2196/100423","DOIUrl":"10.2196/100423","url":null,"abstract":"<p><strong>Unlabelled: </strong>Inadequate postcare patient education contributes to preventable readmissions and adverse outcomes that disproportionately affect medically complex, high-need communities. Large language models (LLMs) show promise for generating personalized, plain-language patient education at scale. However, existing LLM evaluation frameworks prioritize technical accuracy over patient accessibility and alignment with health literacy, and few explicitly account for the attitudinal influences that clinician evaluators may introduce into the rating process. In this viewpoint, we introduce an evaluation framework that pairs the Technology Acceptance Model (TAM) with the Medical Condition Regard Scale (MCRS). We call it the TAM-MCRS LLM evaluation framework, a novel clinician-centered approach for comparing which LLMs produce the highest-quality postcare patient education across accuracy, appropriateness, clarity, and completeness. We intend for this framework to be used to evaluate LLM-generated patient education outputs through a 2-arm design that pairs an expert clinician panel with automated assessment methods, allowing for interarm comparison using clinical vignettes while accounting for measured evaluator attitudinal variance. The framework was developed through the National Institutes of Health Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD) Clinicians Leading Ingenuity IN AI Quality (CLINAQ) fellowship program, in partnership with Ochsner Health and Xavier University of Louisiana. The TAM-MCRS framework integrates two theoretical lenses. TAM maps perceived usefulness onto accuracy and completeness, and perceived ease of use onto clarity and appropriateness. Clinicians rate each output with a TAM-based questionnaire, and we then administer the MCRS as a postscoring attitudinal covariate to see whether their regard for the conditions represented in the vignettes influences those ratings. Together, the 2 lenses are intended to produce evidence that is objective, theoretically grounded, clinically realistic, and disparity-responsive. Implications for clinician informaticists, health system governance, and responsible AI deployment are discussed. This viewpoint reflects the authors' position and is written for clinician informaticists, health system AI governance leaders, implementation scientists, and investigators evaluating LLM-generated patient education.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e100423"},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implementation of Wearable-Derived Sleep and Activity Reporting for Inpatient Psychiatric Monitoring.","authors":"Brien William Culhane, Robert Dennis Patterson, Habiballah Rahimi-Eichi, Agustin Go Yip, Kayla Huesman, Kristin Kostick-Quenet, Joshua Salvi, Philippe Beauchamp, Kerry James Ressler, Justin Taylor Baker","doi":"10.2196/88466","DOIUrl":"10.2196/88466","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sleep is a core component of psychiatric assessment, yet inpatient monitoring typically relies on brief observational checks that are subjective, variable, and sometimes disruptive. Wearable devices offer a means of capturing continuous, objective sleep and activity data without disturbing patients. Although digital health technologies are increasingly used in psychiatric research, little is known about how wearable-derived data can be integrated into routine inpatient workflows or used meaningfully by clinicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This implementation aimed to evaluate the feasibility, usability, and workflow integration of a wearable-derived sleep and activity reporting system within an adult psychiatric inpatient unit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The implementation unfolded in 2 phases at a single 21-bed adult inpatient unit at a psychiatric hospital in Massachusetts. Patients were offered a wrist-worn GENEActiv actigraphy device upon admission. Raw accelerometry data were processed using the DPSleep pipeline to derive daily sleep and activity metrics for patients participating in the implementation. Sleep and activity reports combining graphical summaries and natural language summaries of sleep, activity, and medication data were iteratively refined and delivered to psychiatrists providing patient care. Semistructured qualitative interviews were conducted with clinicians and unit staff to gather feedback on the sleep and activity report prototype and discuss barriers to and facilitators of implementation. Interview data were coded and analyzed by a team of 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Unlabelled: &lt;/strong&gt;During phase 1 of the implementation, 155 patients were admitted, of whom 88 (56.8%) were offered a device and 68 (77.3%) accepted it. Sleep and activity reports were generated for 61.8% (42/68) of patients wearing a device during this phase. During phase 2 of the implementation, automation reduced report generation time from approximately 5 days to under 24 hours. Only 1 of the 3 psychiatrists on the unit regularly used the reports in routine care. Reports were most useful for reconciling discrepancies between patient and nursing sleep estimates and for supporting clinical conversations about sleep patterns and medication adherence between clinician and patient. Clinicians who had not yet used the reports expressed conceptual interest but emphasized the need for integration in the electronic medical record, reliably available \"last-night\" sleep data, and simplified design. Barriers included challenges in the speed, reliability, and clarity of the data; variable staff buy-in; and disconnects between the research and clinical teams running the implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This implementation suggests that wearable-derived sleep and activity data reporting is technically feasible in inpatient psychiatry. This data reporting potentially offers clinically meaningful insights. Use of t","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e88466"},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemoglobin A_1c and Weight Changes Associated With Grocery Delivery and Low-Carbohydrate Education in Adults With Type 2 Diabetes and Food Insecurity: Observational Quality Improvement Cohort Study.","authors":"Marika Waselewski, Eric Waselewski, Lauren Oshman, Kaitlyn Hatch, Tammy Chang","doi":"10.2196/89459","DOIUrl":"10.2196/89459","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Type 2 diabetes mellitus (T2D) is one of the most significant chronic health challenges in Michigan, especially for individuals with food insecurity. Improving nutrition, including lowering carbohydrate intake, is foundational to T2D prevention and management. Grocery delivery paired with low-carbohydrate education has the potential to reduce logistical barriers to dietary change but is not well understood in individuals with food insecurity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of our study was to evaluate changes in clinical metrics of hemoglobin A&lt;sub&gt;1c&lt;/sub&gt; (HbA&lt;sub&gt;1c&lt;/sub&gt;), weight, and diabetes medication use after a paired grocery delivery and low-carbohydrate education program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Healthy Eating Jumpstart Program (hereafter, Jumpstart) enrolled adult Michiganders with T2D and low income or food insecurity from 21 Michigan primary care practices between October 2022 and May 2023. Jumpstart was a 3-month, nonrandomized grocery delivery and low-carbohydrate education quality improvement program without a control group. Participants received US $80 every month through Shipt to purchase eligible healthy foods, along with low-carbohydrate educational materials. Clinical metrics of HbA&lt;sub&gt;1c&lt;/sub&gt;, weight, and diabetes medication use were collected from medical records from 6 months before enrollment through 12 months after enrollment. Changes in HbA&lt;sub&gt;1c&lt;/sub&gt; and weight from baseline were evaluated at 3, 6, 9, and 12 months, with stratification by baseline glycemic control and glucagon-like peptide-1 receptor agonist (GLP-1 RA) medication use, respectively. Overall change was assessed with paired &lt;i&gt;t&lt;/i&gt; tests comparing baseline values to each participant's latest value for HbA&lt;sub&gt;1c&lt;/sub&gt; and weight. Medication changes were assessed by comparing baseline and 12-month dosing to categorize changes as increased, decreased, eliminated, or unchanged.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 83 patients participated in Jumpstart. Participants were primarily female (57/79, 72%), White (70/79, 89%), and had a high school degree or less (35/79, 44%). At baseline, the average HbA&lt;sub&gt;1c&lt;/sub&gt; was 7.6% (SD 2%), average weight was 105 (SD 25.8) kg, and average BMI was 38.2 (SD 8.8) kg/m&lt;sup&gt;2&lt;/sup&gt;. The overall reduction in HbA&lt;sub&gt;1c&lt;/sub&gt; from baseline was 0.4% (SD 1.4%; &lt;i&gt;P&lt;/i&gt;=.02; n=68), and this reduction was greater when limited to individuals with uncontrolled HbA&lt;sub&gt;1c&lt;/sub&gt; at baseline (mean 0.7%, SD 1.8; &lt;i&gt;P&lt;/i&gt;=.02; n=38). The overall percent reduction in weight from baseline was 1.7% (SD 4.4%; &lt;i&gt;P&lt;/i&gt;=.002; n=66), but this change was not significant when limited to non-GLP-1 RA users. Most medications had no change in dosing (77/166, 46%), and slightly more medications were increased or added (n=52, 31%) than decreased or discontinued (n=37, 22%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results from this clinical evaluation suggest that the Jumpstart qu","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e89459"},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016619","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}