JMIR Formative Research最新文献

{"title":"Avatar Customization and Embodiment in Virtual Reality Self-Compassion Therapy for Depressive Symptoms: Three-Part Mixed Methods Study.","authors":"Thomas C Elliott, Yanzhuo Yang, Jarrod Knibbe, Julie D Henry, Nilufar Baghaei","doi":"10.2196/71004","DOIUrl":"10.2196/71004","url":null,"abstract":"<p><strong>Background: </strong>As virtual reality technologies become more accessible, understanding how design features influence user experience (UX) and psychological benefit is critical, particularly for emotionally sensitive interventions. Thus, while prior studies support the use of self-compassion paradigms in immersive virtual reality (VR) environments, the effects of avatar stylization, customization, and mirrored self-representation on therapeutic outcomes are not well understood. For instance, while it is often assumed that increasingly realistic avatars are preferable to less realistic ones, this basic premise remains largely untested.</p><p><strong>Objective: </strong>This study aimed to evaluate whether avatar appearance, customization features, and virtual mirrors affect UX and therapeutic outcomes in VR self-compassion therapy. Specifically, we examined whether stylized avatars, avatar customization, and virtual mirror feedback influenced user-rated self-compassion and depression symptoms.</p><p><strong>Methods: </strong>Across three between-subjects studies (N=107 neurotypical adults), participants engaged in an immersive individualized VR therapy protocol based on a 2-phase compassion task. The conditions were (1) stylized avatars (n=20), (2) stylized customizable avatars (n=49), and (3) stylized customizable avatars with a virtual mirror (n=38). Participants completed the User Experience Questionnaire, the Self-Compassion Scale, and the 8-item Patient Health Questionnaire (PHQ-8). In study 3, presence was also assessed using the Slater-Usoh-Steed scale. Qualitative feedback was analyzed thematically. Between- and within-study comparisons used t tests and Mann-Whitney U tests.</p><p><strong>Results: </strong>Avatar customization (study 2) led to a significant increase in self-compassion (Self-Compassion Scale: baseline mean 3.05, SD 0.98; follow-up mean 3.55, SD 1.16; t89=2.22; P=.03; d=-0.47), though PHQ-8 scores remained unchanged. The virtual mirror condition (study 3) significantly improved depression scores (PHQ-8: U=477.5; z=2.53; P=.01; r=0.30) and UX across four User Experience Questionnaire categories, including attractiveness and dependability. However, self-compassion did not significantly change in study 3 (mean 3.88, SD 1.33 → mean 4.09, SD 1.05; t63=0.71; P=.47; d=0.18). Presence scores in study 3 (mean 4.56, SD 1.58) were also comparable to real-world benchmarks. Qualitative feedback highlighted strong engagement with avatars and mirrors, and participants reported emotional safety and personalization benefits.</p><p><strong>Conclusions: </strong>Stylized avatars, when paired with customization and mirrored embodiment, can support UX and therapeutic benefit in VR self-compassion therapy. These findings challenge the assumption that hyperrealistic avatars are superior and highlight the importance of emotionally congruent design choices. The combination of stylization, individualization, and visual feedback may offe","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e71004"},"PeriodicalIF":2.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212272","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":"Dietary Fiber Estimate of DialBetesPlus App Users: Secondary Analysis of Data From a Randomized Controlled Trial.","authors":"Wei Thing Sze, Kayo Waki, Ryohei Nakada, Toshimasa Yamauchi, Masaomi Nangaku, Kazuhiko Ohe","doi":"10.2196/69340","DOIUrl":"10.2196/69340","url":null,"abstract":"<p><strong>Background: </strong>Despite the importance of dietary fiber in regulating glycemic control, the reported intake among patients with type 2 diabetes (T2D) in Japan was around 12-16 g, well below the local official recommended intake of 20 g and above. Recent data is lacking, with the most recent available estimates collected between 2014 and 2019. Most mHealth dietary intervention apps for T2D focus on calorie and carbohydrate outcomes, with limited evidence on fiber intake. Fiber data was collected in a recent 12-month trial of DialBetesPlus, a multimodal diabetes mHealth self-management system that supports dietary behavior change by allowing users to record their meals and provides timely and detailed information on users' nutrient intake.</p><p><strong>Objective: </strong>This study aimed to assess the pattern of dietary fiber intake among DialBetesPlus intervention users to provide recent data. As a secondary objective, the study explored factors that may influence dietary fiber intake among participants.</p><p><strong>Methods: </strong>Meal records were extracted using the DialBetesPlus app developer dashboard. Dietary fiber intake was measured for all intervention participants. The analysis included only data from participants with complete (breakfast, lunch, and dinner) meal records for at least 7 days. We calculated the average dietary fiber intake and fiber density per day by first averaging across all participants for each day, then averaging these daily values over 1 year. We averaged fiber intake per meal type across all days with available data for each participant, without excluding incomplete meal record days.</p><p><strong>Results: </strong>Out of 66 participants from the intervention group who were assigned to the DialBetesPlus intervention, 47 (71.2%) had at least 7 days of complete meal records and were included in the analysis. A 1-year trend analysis revealed a slight upward trend of daily fiber intake with the rolling average consistently below 18 g. The average fiber intake was 17.1 g/day, with a corresponding mean fiber density of 10.5 g/1000 kcal. The overall mean fiber intake was 17.1 g/day. Separate analysis by meal types revealed that the highest fiber intake was during dinner (6.7 g), followed by lunch (4.8 g), breakfast (4.4 g), and snacks (1.5 g), while fiber density was lowest for snacks (7.8 g/1000 kcal), followed by dinner (10.2 g/1000 kcal), lunch (10.5 g/1000 kcal), and breakfast (10.8 g/1000 kcal). No significant correlations were observed between average fiber intake and participant characteristics such as age, sex, BMI, hemoglobin A1c, blood pressure, and frequency of meal logging.</p><p><strong>Conclusions: </strong>Despite using a general diabetes self-management mHealth app (DiabetesPlus) that included dietary self-monitoring and basic nutritional feedback, users consumed less than the recommended 20 g/day of dietary fiber on average over a 1-year period. This study highlights the need to expl","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e69340"},"PeriodicalIF":2.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212288","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":"Internet-Delivered Psychological Treatment for Parents With Health Anxiety by Proxy: Replicated Randomized Single-Case Experimental Design.","authors":"Katrine Ingeman, Ditte Hoffmann Frydendal, Lisbeth Frostholm, Ellen Bjerre-Nielsen, Kaare Bro Wellnitz, Patrick Onghena, Kristi Wright, Charlotte Ulrikka Rask","doi":"10.2196/65396","DOIUrl":"10.2196/65396","url":null,"abstract":"<p><strong>Background: </strong>Health anxiety by proxy is characterized by ruminations about severe illness in one's child that can cause severe distress in affected parents. Health anxiety by proxy may lead to repeated unnecessary medical consultations and checking the child's body for symptoms, as well as heightened attention to their child's behavior, sign of illness, and bodily symptoms. It has been hypothesized that health anxiety by proxy may pose a risk for transmission of maladaptive symptom coping and health anxiety from the parent to their child. In spite of this, no targeted treatment has previously been evaluated. Therefore, we developed an internet-delivered psychological treatment containing 8 modules based on cognitive behavioral therapy and acceptance and commitment therapy.</p><p><strong>Objective: </strong>The objective of this study was to investigate the feasibility and effect of the internet-delivered treatment PROXY for parents with health anxiety by proxy.</p><p><strong>Methods: </strong>A total of 4 participants with health anxiety by proxy entered a replicated randomized single-case experimental design. They were randomly allocated to a baseline period of 7-26 days before entering the 8-week treatment and 14-33 days follow-up phase. The primary outcomes were daily measures of anxiety, impact of anxiety, and value-based actions measured using 5 questions answered on a scale of 1-10 through a text-message link. The primary outcomes were analyzed using visual analysis and supplemented with statistical randomization tests. Secondary outcomes were standardized questionnaire measures of anxiety-related symptoms, experience of the treatment, and negative effects of the treatment reported using descriptive statistics for each participant individually.</p><p><strong>Results: </strong>Visual and statistical analyses indicated that PROXY was an effective treatment for 2 participants as the primary outcomes changed in the preferable direction for both of them. The effect of PROXY was questionable for the remaining 2 participants, although visual analysis showed that the impact of anxiety decreased for one of them. The 2 participants with questionable effect also thought that the treatment was too short. All 4 participants were happy with the treatment, but 2 participants experienced that health anxiety for their own health deteriorated during treatment.</p><p><strong>Conclusions: </strong>PROXY holds potential as a treatment for HA by proxy. However, more work is required to determine when and how PROXY should be introduced to parents with HA by proxy, particularly in relation to duration of treatment, possible comorbidities, and the need for findings to be replicated in larger groups.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e65396"},"PeriodicalIF":2.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212278","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":"Multiuser Application for the Diagnosis and Treatment of Depression in Women's Self-Help Groups: Pilot Randomized Controlled Trial.","authors":"Amritha Bhat, Ruben Johnson-Pradeep, Bharat Kalidindi, Dhinagaran Devadass, B Ramakrishna Goud, Tony Raj, Sumithra Selvam, Yesenia Navarro-Aguirre, Pamela Y Collins, Krishnamachari Srinivasan","doi":"10.2196/68052","DOIUrl":"10.2196/68052","url":null,"abstract":"<p><strong>Background: </strong>Depression in women results in elevated morbidity rates, functional impairment, diminished quality of life, and an increased risk of suicide. Numerous obstacles impede access to mental health treatment for women in India. Digital mental health solutions can bridge the treatment gap, but it is important to tailor these solutions to the context and to end-users.</p><p><strong>Objective: </strong>We conducted a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary effectiveness of a mental health app deployed in community-based organizations in improving depression outcomes.</p><p><strong>Methods: </strong>The Multiuser Interactive Health Response Application (MITHRA) is a multiple-user mobile app used in community-based organizations for screening, tracking, and supporting stepped-care treatment for depression. MITHRA is based on the healthy activity program, a brief psychological intervention based on behavioral activation. It includes audio, video, and enhanced touchscreen capabilities to overcome the barrier of illiteracy and lack of access. It was developed in collaboration with a participatory design group consisting of primary and secondary end-users and is available on tablets installed in self-help groups (SHGs), which are community-based organizations in India. The SHGs were randomized to MITHRA (n=3) or enhanced usual care (EUC; n=3). During SHG meetings, women completed the Patient Health Questionnaire-9 (PHQ-9). Based on their PHQ-9 scores, they were assigned different modules. In the EUC SHGs, women viewed one module of education on symptoms of depression. Primary outcomes include feasibility and acceptability, and secondary outcomes include depressive symptoms and functioning. Repeated-measures ANOVA was performed to compare the change in the outcome scores over time between study groups. A P value of<.05 was considered statistically significant.</p><p><strong>Results: </strong>MITHRA was found to be feasible and acceptable. A total of 96% of intervention arm participants completed at least half of their assigned modules. Although not powered for effectiveness outcomes, in this trial, we found that the change at 6 months from baseline in depressive symptoms (PHQ-9) were significantly different between MITHRA and EUC (P=.037), with greater improvement in the intervention group. Similarly, significant improvement in the World Health Organization Disability Assessment Scale score was noted in the MITHRA group (P=.005).</p><p><strong>Conclusions: </strong>MITHRA is feasible and acceptable for use in women's SHGs. Larger studies should examine the effectiveness of this approach in identifying and treating depression.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e68052"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206614","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":"Optimizing the Color Shapes Task for Ambulatory Assessment and Drift Diffusion Modeling: A Factorial Experiment.","authors":"Sharon Haeun Kim, Jonathan G Hakun, Yanling Li, Karra D Harrington, Daniel B Elbich, Martin J Sliwinski, Joachim Vandekerckhove, Zita Oravecz","doi":"10.2196/66300","DOIUrl":"https://doi.org/10.2196/66300","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recent advances in cognitive digital assessment methodology, including high-frequency, ambulatory assessments, promise to improve the detection of subtle cognitive changes. Computational modeling approaches may further improve the sensitivity of digital cognitive assessments to detect subtle cognitive changes by capturing features that map onto core cognitive processes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We explored the validity of a brief smartphone-based adaptation of a visual working memory task that has shown sensitivity for detecting preclinical Alzheimer disease risk. We aimed to optimize properties of the task for computational cognitive feature extraction with drift diffusion modeling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed data from 68 participants (n=47, 69% women; n=55, 81% White; mean age 49, SD 14; range 24-80 years) who completed 60 trials for each of 16 variations of a visual working memory binding task (the Color Shapes task) on smartphones, over an 8-day period. A drift diffusion model was fit to the response time and accuracy data from the task. We experimentally manipulated 3 properties of the Color Shapes task (study time, probability of change, and choice urgency) to test how they yielded differences in key drift diffusion model parameters (drift rate, initial bias toward a response option, and caution in decision-making). We also evaluated how an additional task property, the test array size, impacted responses across all conditions. For array size, we tested a whole display of 3 shapes against a single probe of 1 shape only.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 3 task property manipulations yielded the following results: (1) increasing the ratio of different responses was credibly associated with higher initial bias toward the different response (mean 0.06, SD 0.02 for the whole display; mean 0.15, SD 0.02, for the single probe condition); (2) increasing the choice urgency during the test phase was credibly associated with decreased caution in decision-making in the single probe condition (mean -0.04, SD 0.02) but not in the whole display (mean -0.01, SD 0.02); and (3) contrary to expectation, longer study times did not yield a credibly faster drift rate but produced credibly slower ones for the whole display condition (mean -0.28, SD 0.05) and a null effect for the single probe condition (mean 0.01, SD 0.05). In addition, as expected, we found that individual differences in drift rate were associated with age in both array sizes (r=-0.45 with Bayes factor=191), with older participants having a slower drift rate. Older participants also showed higher caution (r=0.42 with Bayes factor=80.76) in the single probe condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We identified a version of the Color Shapes task optimized for smartphone-based cognitive assessments in real-world settings, with data designed for analysis through computational cognitive modeling. Our proposed approach can advance the","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e66300"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206537","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":"Understanding Experiences of and Unmet Needs in Online Searches for Menopause Information: An Exploratory Survey.","authors":"Erin Lucy Funnell, Freya McConnell, Nayra A Martin-Key, Leyao Qian, Kathryn Babbitt, Sabine Bahn","doi":"10.2196/75335","DOIUrl":"https://doi.org/10.2196/75335","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Menopause is a significant time in a woman's life, but only recently has there been an open discussion about it in the media, workplaces, and general society. With increasing frequency, women are using the internet to research menopause, making it essential that online sources provide safe, high-quality, and relevant information.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate the current state of the online information landscape for menopause from the perspective of information seekers, exploring (1) information-seeking behavior and (2) perceptions of online resources for menopause.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 10- to 15-minute online survey was conducted asking about the respondents' use of and opinions about online resources specifically for menopause. We distributed the survey via social media, email, and word of mouth. Quantitative data were explored using means and frequencies. Group differences between menopausal groups were analyzed using chi-square, Fisher exact, or Kruskall-Wallis tests as appropriate. Qualitative data were analyzed using data-driven thematic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Data from 627 participants were analyzed (early perimenopause: n=171, 27.3%, late perimenopause: n=125, 19.9%, postmenopause: n=262, 41.8%, and surgical menopause: n=69, 11%). The majority of respondents had used the internet as a source of information (581/627, 92.7%), with the internet being the first choice of information source (489/581, 84.2%). The most searched-for information online was about menopause symptoms (479/581, 82.4%), menopause treatment options (442/581, 76.1%), and self-help tips or strategies (318/581, 54.7%). The majority of participants trusted online information to some extent (615/627, 98.1%), with many also considering online information accurate to some extent (555/627, 88.5%). Many participants reported finding some but not all of the information they were looking for online (379/581, 65.2%). Thematic analysis revealed 10 themes related to information quality and accessibility and sought-after information (eg, symptom specifics, treatment, and nonformal management strategies). Analysis also indicated that information is lacking for several groups, including those in medically induced or surgical menopause.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study showed that online informational resources are widely accessed and widely perceived as useful and trustworthy. However, it is crucial that the quality of online information is evaluated, especially considering the large number of users who rely on it as their first or only informational source. Online searches were usually performed to find information related to symptoms, treatment, and self-help recommendations, with differences in search behaviors observed across menopausal stages and groups, highlighting the need for tailored informational resources. Thematic analysis revealed gaps in the provision of online","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e75335"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206531","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":"Correction: \"Smartwatch-Based Ecological Momentary Assessment for High-Temporal-Density, Longitudinal Measurement of Alcohol Use (AlcoWatch): Feasibility Evaluation\".","authors":"Chris Stone, Sally Adams, Robyn E Wootton, Andy Skinner","doi":"10.2196/82194","DOIUrl":"https://doi.org/10.2196/82194","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/63184.].</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e82194"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199419","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":"The Impact of Dose in an mHealth Intervention to Support Parents and Carers Via Healthy Beginnings for Hunter New England Kids Program: Pragmatic Randomized Controlled Trial.","authors":"Alison L Brown, Nayerra Hudson, Jessica Pinfold, Rebecca Sewter, Lynda Davies, Christophe Lecathelinais, Jacklyn K Jackson, Tessa Delaney, Sienna Kavalec, Rachel Sutherland","doi":"10.2196/70158","DOIUrl":"10.2196/70158","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The dose of mobile health (mHealth) interventions can influence participant engagement, acceptability, and overall impact. However, few mHealth interventions have explored this dose-response relationship.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to explore how dose influences the acceptability, engagement, cost, and impact on infant feeding status of a parent-targeted mHealth text messaging program which aims to enhance child health, including breastfeeding exclusivity and duration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This pragmatic randomized controlled trial was conducted from October 2021 to May 2024. The Healthy Beginnings for Hunter New England Kids (HB4HNEKids) program provides- text messages aimed to support parents and carers and their children by providing evidence-based preventive health information across the first 2000 days. Participants were enrolled in HB4HNEKids from 5 Child and Family Health Services in the Hunter New England region of New South Wales, Australia, and randomized into either a high-dose or low-dose text message group for the first 2 years of the pilot program. Dose refers to the quantity and frequency of text messages sent to participants. Participants in the high-dose text message group received an average of 111-121 text messages, and the low-dose text message group received 80-82 text messages across the 2 years. Outcomes of interest included acceptability, engagement, cost, and infant feeding status in relation to dose. Engagement with the messages was determined using click rates and program opt-out rates. Participant acceptability was assessed via a brief survey. Impact on infant feeding status (ie, breastfeeding, formula feeding, or mixed feeding) was determined by participants reporting their feeding status at several time points across the program. Cost was determined by assessing the per participant and total cost of sending text messages for each dose group across the 2-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were no statistically significant differences in click rates between high or low-dose text message groups. In the first 6 months, significantly more participants opted out of the high-dose text message group (191/2724; 7%) compared to the low-dose (108/2812; 3.8%; P&lt;.001). In terms of program acceptability, 183 out of 214 (85.5%) participants of the high-dose and 228 out of 252 (90.5%) participants of the low-dose text message group were satisfied with the frequency of text messages. In addition, 188 out of 215 (87%) participants of high-dose and 220 out of 255 (86%) participants of low-dose text message group indicated they would recommend the program to other caregivers. The average per participant and total cost to the health service for sending messages was lower in the low-dose group (A$9.32 per participant and A$15,271.48 total; A$1 is approximately equal to US $0.68) compared to the high-dose text message group (A$12.96 per participant and A$21,2","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e70158"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206582","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":"Differential Diagnosis Assessment in Ambulatory Care With a Digital Health History Device: Pseudorandomized Study.","authors":"Beth Healey, Adrien Schwitzguebel, Herve Spechbach","doi":"10.2196/56384","DOIUrl":"10.2196/56384","url":null,"abstract":"<p><strong>Background: </strong>Digital health history devices represent a promising wave of digital tools with the potential to enhance the quality and efficiency of medical consultations. They achieve this by providing physicians with standardized, high-quality patient history summaries and facilitating the development of differential diagnoses (DDs) before consultation, while also engaging patients in the diagnostic process.</p><p><strong>Objective: </strong>This study evaluates the efficacy of one such digital health history device, diagnosis and anamnesis (DIANNA), in assisting with the formulation of appropriate DDs in an outpatient setting.</p><p><strong>Methods: </strong>A pseudorandomized controlled trial was conducted with 101 patients seeking care at the University Hospital Geneva emergency outpatient department. Participants presented with various conditions affecting the limbs, back, and chest. The first 51 patients were assigned to the control group, while the subsequent 50 formed the intervention group. In the control group, physicians developed DD lists based on traditional history-taking and clinical examination. In the intervention group, physicians reviewed DIANNA-generated DD reports before interacting with the patient. In both groups, a senior physician independently formulated a DD list, serving as the gold standard for comparison.</p><p><strong>Results: </strong>The study findings indicate that DIANNA use was associated with a notable improvement in DD accuracy (mean 79.3%, SD 24%) compared with the control group (mean 70.5%, SD 33%; P=.01). Subgroup analysis revealed variations in effectiveness based on case complexity: low-complexity cases (1-2 possible DDs) showed 8% improvement in the intervention group (P=.08), intermediate-complexity cases (3 possible DDs) showed 17% improvement (P=.03), and high-complexity cases (4-5 possible DDs) showed 15% improvement (P=.92). The intervention was not superior to the control in low-complexity cases (P=.08) or high-complexity cases (P=.92). Overall, DIANNA successfully determined appropriate DDs in 81.6% of cases, and physicians reported that it helped establish the correct DD in 26% of cases.</p><p><strong>Conclusions: </strong>The study suggests that DIANNA has the potential to support physicians in formulating more precise DDs, particularly in intermediate-complexity cases. However, its effectiveness varied by case complexity and further validation is needed to assess its full clinical impact. These findings highlight the potential role of digital health history devices such as DIANNA in improving clinical decision-making and diagnostic accuracy in medical practice.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT03901495; https://clinicaltrials.gov/study/NCT03901495.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":" ","pages":"e56384"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993601","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":"Machine Learning-Enhanced Surveillance for Surgical Site Infections in Patients Undergoing Colon Surgery: Model Development and Evaluation Study.","authors":"Ugur Celik, Feifan Liu, Kimiyoshi Kobayashi, Richard T Ellison Iii, Yurima Guilarte-Walker, Deborah Ann Mack, Qiming Shi, Adrian Zai","doi":"10.2196/75121","DOIUrl":"10.2196/75121","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical site infections (SSIs) are one of the most common health care-associated infections, accounting for nearly 20% of all health care-associated infections in hospitalized patients. SSIs are associated with longer hospital stays, increased readmission rates, higher health care costs, and a mortality rate twice that of patients without infections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to develop and evaluate machine learning (ML) models for augmenting SSI surveillance after colon surgery with the goal of improving the efficiency of infection control practices by prioritizing patients at high risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective study using data from 1508 patients undergoing colon surgery treated between 2018 and 2023 at a single academic medical center. Of these 1508 patients, 66 (4.4%) developed SSIs as adjudicated by infection control practitioners following Centers for Disease Control and Prevention National Healthcare Safety Network criteria. Data included 78 structured variables (eg, demographics, comorbidities, vital signs, laboratory tests, medications, and operative details) and 2 features derived from unstructured clinical notes using natural language processing. ML models&lt;strong&gt;-&lt;/strong&gt;logistic regression, random forest, and Extreme Gradient Boosting (XGBoost)&lt;strong&gt;-&lt;/strong&gt;were trained using stratified 80/20 train-test splits. Class imbalance was addressed using cost-sensitive learning and the synthetic minority oversampling technique. Model performance was evaluated using precision, recall, F&lt;sub&gt;1&lt;/sub&gt;-score, area under the receiver operating characteristic curve, and Brier scores for calibration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 1508 patients, those who developed SSIs had longer hospital stays (mean 8.1, SD 6.8 days vs mean 6.3, SD 10.5 days; P&lt;.001), higher rates of an American Society of Anesthesiologists score of 3 (52/66, 79% vs 653/1442, 45.3%; P&lt;.001), and elevated white blood cell counts (51/66, 77% vs 734/1442, 50.9%; P&lt;.001). XGBoost achieved the best overall performance with an area under the receiver operating characteristic curve of 0.788, precision of 50%, recall of 38%, and Brier score of 0.035. Random forest yielded perfect precision (100%) but lower recall (23%), with a Brier score of 0.034. Logistic regression showed the highest recall (46%) but the lowest precision (10%), with a Brier score of 0.139. Feature importance analysis using Shapley additive explanations (SHAP) values revealed that the top predictors included recovery duration (SHAP=1.18), SSI keyword frequency (SHAP=1.12), patient age (SHAP=1.12), and American Society of Anesthesiologists score (SHAP=0.94), with natural language processing-derived features ranking among the top 10.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;ML models can augment traditional SSI surveillance by improving early identification of patients at high risk. The XGBoost model offered the best trad","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e75121"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199425","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}