JMIR Formative Research最新文献

{"title":"Effects of Test Length and Scoring Methods on Pass or Fail Classification Accuracy in Single-Choice Examinations: Simulation Study.","authors":"Christiane Pink, Yola Meisel, Arvid Vetter, Philipp Kanzow","doi":"10.2196/98358","DOIUrl":"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 or fail decisions when pass marks are appropriately calibrated.</p><p><strong>Objective: </strong>This study aimed to examine pass or fail classification accuracy under 3 scoring methods (dichotomous scoring, formula scoring, and right-minus-wrong scoring) in summative examinations using single-choice Type A items with 5 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 3 scoring methods produced identical pass or 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 or fail classifications. Classification accuracy increased with test length and depended strongly on the distribution of <i>k</i>, with greatest uncertainty near the pass or 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>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e98358"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194107","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":"Acceptability and Feasibility of an Islamic Faith-Based Smoking Cessation Intervention Delivered via WhatsApp for Muslim Smokers in Saudi Arabia: Pilot Randomized Controlled Trial.","authors":"Abdullah Kalantan, Samantha Marsh, Sarah S Monshi, Amer Siddiq Amer Nordin, Chris Bullen","doi":"10.2196/88796","DOIUrl":"10.2196/88796","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Smoking is common in Saudi Arabia, particularly among men. Religion plays a protective role against smoking and serves as a motivator for quitting. Faith-based interventions have shown positive effects in supporting smoking cessation among Muslims who smoke; however, few studies have tested their acceptability when delivered via mobile phone messaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this pilot randomized controlled trial was to evaluate the feasibility and acceptability, as well as the preliminary effectiveness of an Islamic-based smoking cessation intervention delivered via WhatsApp messaging in Saudi Arabia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was a 2-arm randomized controlled trial involving adult Muslim smokers who used cigarettes, waterpipe, or both. Participants were recruited from the Kafa organization antismoking clinic in Saudi Arabia. Participants were randomized in a 1:1 ratio to either the intervention or control group. The intervention messages were codeveloped with religious leaders and informed by formative research with Muslim current and former smokers. The intervention group received both religious and smoking-related health messages, whereas the control group received smoking-related health messages only. The messages were manually delivered daily by trained research assistants. The intervention lasted for 21 days, during which participants received 2 messages per day, one in the morning and one in the evening. The primary outcomes were the feasibility and acceptability of the intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 34 participants were recruited, resulting in a recruitment rate of 68% (34/50). The overall retention rate was 64.7% (22/34). Both groups received 44 WhatsApp messages over 21 days. Message engagement was high, with 88.2% (15/17) of participants in the intervention group and 82.4% (14/17) in the control group, reporting that they read the daily messages. The intervention was acceptable and was perceived as helpful in supporting smoking cessation. Complete abstinence from both cigarettes and waterpipe was slightly higher in the intervention group (4/17, 23.5%) than in the control group (3/17, 17.6%). Cigarette abstinence was also modestly higher in the intervention group than in the control group (5/16, 31.3% vs 3/16, 18.8%). Among 8 waterpipe users at baseline, 2 reported waterpipe abstinence at follow-up, both in the intervention group. No statistical comparisons of smoking cessation outcomes between the groups were conducted because the study focused on feasibility and included a small sample size. These findings were descriptive and should be considered exploratory rather than evidence of intervention effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This Islamic faith-based intervention, delivered via WhatsApp messaging, was acceptable and may be feasible for a full-scale trial, provided that recruitment, participant retention, and follow-up ","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e88796"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194153","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":"Key Decision Points for Personalization and Customization in Self-Guided Digital Suicide Prevention: Qualitative Interview Study.","authors":"Zhiying Quan, Catherine Chen, Sarah A Popowski, Theresa Nguyen, Kevin Rushton, Madhu Reddy, David C Mohr, Kimberly A Van Orden, Jonah Meyerhoff","doi":"10.2196/95930","DOIUrl":"10.2196/95930","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Young adults in the United States experience high rates of suicidal thoughts and behaviors (STB) but low engagement with traditional care, highlighting the need for accessible and scalable digital interventions. Self-guided digital safety planning interventions (SPIs) can expand access to support but introduce important decisions about what content to deliver, when systems should intervene, and how users retain control over system actions. Personalization, defined as system-initiated adaptation, and customization, defined as user-initiated control, may offer complementary approaches to these decisions. However, how they should be coordinated to preserve autonomy and reduce burden during periods of distress remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to identify key decision points in self-guided digital SPIs and characterize what, when, how, and by whom (system or user) safety planning functions should be controlled. We further examined how personalization and customization can jointly support autonomy, reduce burden, and promote safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Nine young adults (ages 18-24) with lived experience of suicidal thoughts and behaviors were recruited from an asynchronous remote community comprising individuals who had engaged with the Mental Health America (MHA) website. Participants completed semistructured individual interviews via Zoom. Three coders analyzed interview transcripts using codebook thematic analysis. One coder open-coded all transcripts to develop a preliminary codebook. Two additional coders then applied the codebook to overlapping transcripts, after which all coders revised the codebook and resolved discrepancies by consensus before coding the remaining transcripts. Themes were interpreted using the 5W1H (Who, What, Where, When, Why, and How) framework as an organizing lens for identifying and structuring decision points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants identified 3 classes of decision points for self-guided digital SPIs: (1) system-level decisions about what content and actions are automatically provided; (2) user-level decisions about when and at what pace safety planning unfolds; and (3) shared decisions requiring coordination between users and the system. Participants favored system personalization of decision aids, coping suggestions, brainstorming prompts, example messages for contacting trusted others, affirmations, and relevant resources. In contrast, participants wanted control over the timing and pacing of safety planning and the representation and organization of their safety plans. Participants also emphasized that systems should obtain explicit permission before taking safety-relevant actions, such as contacting trusted others or connecting users with crisis counselors in response to increases in detected risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Personalization and customization can function as complementary mechanisms for alloc","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e95930"},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182023","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":"Quality Assessment of Physician Discharge Summaries: Instrument Development and Reliability Study.","authors":"Leopold Bentheim, Leonard Fehring, Hendrik Friederichs, Samer Zawy Alsofy, Markus Unnewehr","doi":"10.2196/105705","DOIUrl":"https://doi.org/10.2196/105705","url":null,"abstract":"<p><strong>Background: </strong>Discharge summaries (DSs) are key clinical documents at the interface between inpatient and outpatient care. Their quality affects continuity of care, coordination, and patient safety, yet information transfer at discharge is often incomplete, delayed, or unclear. Standardized instruments for assessing DS quality remain scarce.</p><p><strong>Objective: </strong>This study aimed to develop a structured, recipient-oriented quality assessment instrument (QAI) for physician DS as a pragmatic measure of discharge communication quality and to conduct an initial evaluation of its applicability and interrater reliability.</p><p><strong>Methods: </strong>We conducted a formative instrument development study using a structured, iterative author panel consensus process informed by Delphi principles, condensing 43 recipient-oriented DS criteria into 12 items across 3 domains: medical content, structure and organization, and language and clarity. It was applied in a pragmatic pilot reliability evaluation to 20 anonymized internal medicine DSs, independently assessed by 5 physician raters with heterogeneous clinical backgrounds who were not involved in QAI development. Interrater reliability was evaluated using Krippendorff alpha and quadratically weighted Gwet agreement coefficient 2 (AC2). Reporting followed the Guidelines for Reporting Reliability and Agreement Studies.</p><p><strong>Results: </strong>The median overall quality score was 78.5% (IQR 75.3%-82.5%), and the mean was 79.1% (SD 5.0%). Scores were highest for language and clarity and lowest for medical content. Overall interrater reliability differed by coefficient: Krippendorff α was 0.45 (95% CI 0.34-0.55) whereas Gwet AC2 was 0.76 (95% CI 0.70-0.80). The largest discrepancy was observed for language and clarity, with an α of 0.02 (95% CI -0.06 to 0.10) and an AC2 of 0.88 (95% CI 0.84-0.91).</p><p><strong>Conclusions: </strong>The QAI provides preliminary evidence for a clinically applicable approach to assessing key quality dimensions of physician DS. Interrater reliability varied across domains and reliability coefficients, with a marked discrepancy between AC2 and Krippendorff alpha for language and clarity. These findings support its use for exploratory quality improvement and future validation.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e105705"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181261","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":"Associations Between Daily EMA of Emotional Exhaustion and Monthly Burnout Symptoms During Work Reintegration: Longitudinal Multilevel Study.","authors":"Lea Berkemeier, Wim Kamphuis, Hilbrand Oldenhuis, Rudolf Verdaasdonk, Lisette van Gemert-Pijnen","doi":"10.2196/92458","DOIUrl":"https://doi.org/10.2196/92458","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Burnout is increasingly conceptualized as comprising both stable, slowly changing features and more dynamic, fluctuating features, with emotional exhaustion widely regarded as one of burnout's core components. Traditionally, burnout has been assessed using retrospective self-report questionnaires, such as the Burnout Assessment Tool (BAT), administered at sporadic intervals. In contrast, ecological momentary assessment (EMA) enables high-frequency assessment of daily experiences while reducing recall bias. However, it is not well understood how EMA-based measures fluctuate and develop longitudinally within individuals or how they relate to retrospective burnout measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This paper examined the relationship between 30-day aggregates of daily EMA-assessed emotional exhaustion, specifically the within-person mean level and variability (SD), and monthly burnout symptoms measured with the BAT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Eighteen participants undergoing work reintegration after stress- or burnout-related sick leave completed daily EMAs of emotional exhaustion (N=3157) and monthly BAT questionnaires over 6 months (N=94). For each monthly BAT assessment, EMA data from the preceding 30 days were aggregated into within-person mean and SD values. Linear mixed-effects models with random intercepts and time effects were fitted separately for each BAT subscale. Additionally, intraclass correlation coefficients (ICCs) were calculated to quantify the proportion of variance attributable to between-person differences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;ICCs indicated that a large proportion of variance in the BAT subscales was attributable to between-person differences, whereas daily EMA emotional exhaustion showed relatively greater within-person variability. Significant time-related changes were observed for the BAT subscales of Cognitive Impairment, Mental Distance, and Emotional Impairment. Within-person increases in the EMA mean of emotional exhaustion were significantly associated with higher scores on BAT Exhaustion (&lt;i&gt;β&lt;/i&gt;=0.073; &lt;i&gt;P&lt;/i&gt;=.001) and BAT Cognitive Impairment (&lt;i&gt;β&lt;/i&gt;=0.041; &lt;i&gt;P&lt;/i&gt;=.04). EMA-based variability (SD) and between-person mean levels were not significantly associated with any BAT subscale. Conditional &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; values were high (0.667-0.777), whereas marginal &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; values were modest (0.056-0.121). Consistent with the ICC findings, these results suggest that most explained variance in BAT scores reflects between-person differences and time-related changes, with EMA-derived predictors accounting for only a limited additional proportion of explained variance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;EMA-based aggregates showed partial correspondence with monthly burnout scores. Within-person increases in mean daily emotional exhaustion were associated with higher subsequent scores on the BAT Exhaustion and Cognitive Impairment subscales, bu","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e92458"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182085","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":"Synthetic Content Validation of Pediatric Trust Instruments Using Persona-Driven Large Language Models: Development and Evaluation Study.","authors":"Ella Boone, Katya Loban, Carmel Daskalo, Suganthi Rajasegaran, Elena Guadagno, Jeannie Haggerty, Sylvie Lambert, Dan Poenaru","doi":"10.2196/96901","DOIUrl":"https://doi.org/10.2196/96901","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Large language models (LLMs) could assist in streamlining health care instrument validation. This is particularly relevant as traditional instrument development is time-intensive and resource-intensive. Currently, there is a significant gap in specifically developed and validated trust instruments for pediatric emergency and surgical contexts. Such tools are key because trust is foundational to the patient family-physician relationship and is associated with improved care-seeking and treatment adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed (1) to develop new trust instruments and conduct their preliminary content validation confirming item relevance through a Synthetic Instrument Validation approach integrating human and LLM capabilities and (2) to evaluate appropriate use cases for LLMs in psychometric assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two trust instruments were developed (patient family and physician versions). In phase 1, instruments underwent a 2-stage content validation process using parallel synthetic and human expert panels (5 patient family members, 3 physician synthetic experts, and 7 unique human experts). Synthetic panels consisted of 3 persona-prompted LLMs (Claude Sonnet 4, GPT-5, and Grok 4), with human panels serving as comparators. The scale-content validity index (S-CVI) threshold was set at ≥0.80, percent agreement on item relevancy was used to compare panels. In phase 2, LLM performance in quantitative research tasks was evaluated. The patient family instrument underwent Flesch-Kincaid assessment; both instruments underwent cosine similarity analyses using algorithmic and LLM-based methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In phase 1, percent agreement between panels for the patient family and physician instruments was 90.9% and 88.9% for dimensional validation and 90.9% and 100% for contextual validation. Fleiss κ for within-panel agreement ranged from poor to almost perfect; 0.20 (95% CI -0.23 to 0.63) to 1.00 (95% CI 1.00-1.00). All instrument subsections met or exceeded S-CVI thresholds across both rounds and panels. Phase 2 Flesch-Kincaid metrics converged across all 3 methods to target benchmark (mean Grade Level 8.1, SD 1.1; mean Reading Ease 60.1, SD 5.6), while reference readability was near target, showing convergence across implementations of the same formula. In contrast, cosine similarity analyses revealed significant LLM performance limitations; cosine similarity analyses were, therefore, abandoned in favor of the algorithmic method alone, which achieved a maximum cosine similarity of 0.83, indicating acceptable item distinctiveness overall.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Persona-prompted LLMs effectively assisted preliminary content validation and may help reduce timelines from months to weeks, but showed limitations in quantitative computations. This suggests that, in this study, persona-prompted LLMs performed better in subjective rating tasks than in","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e96901"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181238","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":"Feasibility of Online and On-Site Physical Activity Delivery Among Older Adults: Mixed Methods Pilot Randomized Controlled Trial.","authors":"Anna Nilstomt, Johanna Gustavsson, Charlotte Bäccman, Linda Beckman, Finn Nilson, Erik Wästlund","doi":"10.2196/97824","DOIUrl":"https://doi.org/10.2196/97824","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Physical activity (PA) is central to healthy aging, yet interventions targeting older adults often report substantial attrition and variable adherence. Although digital and internet-based exercise programs broaden accessibility and flexibility, their ability to sustain engagement compared with traditional on-site formats remains unclear. Understanding how delivery mode influences attrition and adherence-and why participants persist or withdraw-is essential for designing inclusive and sustainable PA interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This pilot study evaluates the feasibility of delivering a 26-week PA intervention to older adults through 2 modes: online or on-site. Feasibility was assessed primarily by attrition, adherence, and participants' experiences of factors influencing continued participation or withdrawal. Additionally, the study explores preliminary patterns in PA levels and physical and mental health outcomes to inform the design of a future definitive trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This 26-week pragmatic pilot trial used an embedded convergent mixed methods design. Community-dwelling adults aged 60 years or older (N=35) from 3 residential areas in Sweden were cluster-randomized, without blinding, by site to an online (prerecorded video-based Otago exercises; n=12) or on-site (group-based, in-person Otago exercises; n=23) delivery mode. Feasibility outcomes included attrition and adherence. Exploratory outcomes included PA level (Godin-Shephard Leisure-Time Exercise Questionnaire), lower-body strength (Chair Stand Test), depressive symptoms (Geriatric Depression Scale), and health-related quality of life (EQ-5D-3L), assessed at baseline, midintervention (14 weeks), and postintervention (26 weeks). Exploratory quantitative analyses included t tests, chi-square tests, analysis of covariance, and mixed-design ANOVAs. We analyzed semistructured interviews with completers (n=17) and dropouts (n=7) using qualitative content analysis. Findings were integrated using the COM-B (Capability, Opportunity, Motivation-Behavior) framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall attrition rate was 37% (13/35), with no significant difference between delivery modes (P=.29). Most dropouts occurred within the first 2 weeks. Mean adherence appeared higher in the online delivery mode (mean 17.0, SD 6.7) than in the on-site delivery mode (mean 12.1, SD 10.1) but did not differ significantly (P=.15). Qualitative findings indicated that attrition was primarily driven by physical health issues and a perceived lack of fit, whereas adherence was supported by appeal and reward, routine and commitment, flexibility, feedback and PA overview, and (often) social presence. Mixed methods findings suggest that capability, opportunity, and motivation supported participation across both delivery modes. No intervention-related adverse events were reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both online and on-site d","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e97824"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182048","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":"Impact of Migraine and Its Management in 5 Gulf Countries: Results of a Social Media Platforms Listening Study.","authors":"Taoufik Alsaadi, Abubaker Almadani, Suhail Al-Rukn, Alessandro Terruzzi, Ali Mohamed Hassan, Osama Robin El-Alamy, Ali Al Balushi, Fatema Abdullah, Nadine Tarcha, Haytham Mohamed Ahmed, Mohamed Hegab","doi":"10.2196/82843","DOIUrl":"10.2196/82843","url":null,"abstract":"<p><strong>Background: </strong>Migraine is a common neurological disorder that affects a significant proportion of the global population but remains largely underdiagnosed and undertreated. This study analyzed discussions related to migraines in English and Arabic across Kuwait, Bahrain, the United Arab Emirates (UAE), Oman, and Qatar.</p><p><strong>Objective: </strong>Social media listening may help to identify gaps in migraine management and guide the development of strategies to address them. This study aims to analyze discussions related to migraines in both English and Arabic across various social media platforms. By applying social analytics to the bilingual discourse on migraines in the Gulf region, a region that is often underrepresented, we seek to integrate clinical perspectives with regional digital conversations and identify potential gaps in awareness and care pathways.</p><p><strong>Methods: </strong>The study was conducted using a retrospective and descriptive approach to social analytics. The study analyzed discussions about migraines from over 100 million websites in English and Arabic across Kuwait, Bahrain, the UAE, Oman, and Qatar between January 1, 2018, and June 30, 2022. Vendor-implemented, rule-based processes, including keyword matching, language identification, and structured data extraction, were used to evaluate publicly available content in English and Arabic.</p><p><strong>Results: </strong>Out of 53,000 mentions, 33,920 (64%) occurred on X (formerly Twitter), and men were 1.1 times more likely to discuss migraines than women. Among patient conversations, the impact of migraines on overall health was often discussed, including mentions of pregnancy 1060 (2%), vision problems 1325 (2.5%), and sleep disruption 1590 (3%). Medications like paracetamol, aspirin, ibuprofen, and triptans were frequently mentioned, alongside self-management treatments such as cannabidiol softgels, cupping, and aroma oils. Patients often used TikTok to share experiences and seek advice. Many patients actively sought to connect and engage with other migraine sufferers for support and to share experiences. Social media served as a valuable source of information for patients, with health care professionals (HCPs) actively sharing insights and resources through these platforms.</p><p><strong>Conclusions: </strong>The study finds that analysis of migraine discourse across the 5 Gulf countries reveals active engagement by patients and HCPs in migraine-related discussions on various social media platforms. However, many rely on self-management and alternative medicine instead of seeking professional medical help, which leads to improper management of symptoms. The findings should be regarded as compelling descriptive signals in discourse rather than predictive or inferential outcomes. Social media listening may help to identify possible gaps in management and suggest areas for improvement, but these findings need further validation.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e82843"},"PeriodicalIF":2.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147746","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":"Association Between Wrist-Worn Device-Estimated Sleep Efficiency and Hand Grip Strength in Older Outpatients With Cardiometabolic Diseases: Cross-Sectional Study.","authors":"Yoshiaki Tamura, Rui Gong, Yuji Murao, Fumino Kobayashi, Satomi Kobayashi, Remi Kodera, Kazuhito Oba, Maki Shirobe, Kenji Toyoshima, Kanae Kubo, Yuko Chiba, Hisashi Kawai, Joji Ishikawa, Hiroyuki Sasai, Yoshinori Fujiwara, Shunei Kyo, Kenji Toba, Masahiro Akishita, Shuichi Obuchi, Atsushi Araki","doi":"10.2196/95303","DOIUrl":"10.2196/95303","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Older outpatients with chronic diseases are susceptible to muscle weakness and functional disabilities. Recently, various wearable devices have been developed to generate health lifelogs in daily life; however, data from patients with chronic diseases remain scarce. Previous studies have shown that subjective sleep efficiency assessed by self-questionnaires is associated with grip strength, but whether objective sleep efficiency detected by wearable devices is associated with physical function and body composition remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study is to clarify the association between sleep duration, sleep efficiency estimated by wearable watch, grip strength, frailty, and sarcopenia in outpatients with predominantly cardiometabolic diseases and the influence of diabetes as part of the Smart Watch Innovation for Geriatrics and Gerontology (SWING-Japan) project.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this cross-sectional study, the wrist-worn device Silmee 22 was used in an outpatient clinic of an acute care facility for 7-90 nights for the analyses, and individual average sleep duration and efficiency (wearable-estimated sleep efficiency: total sleep duration/time spent in bed) were calculated. Low grip strength was defined as &lt;28 kg for men and &lt;18 kg for women. Sarcopenia was defined based on the Asian criteria and frailty based on the Japanese version of Cardiovascular Health Study and Kihon Checklist criteria. Sleep indices were compared between individuals with and without these conditions. Next, logistic regression analysis was performed, with lower grip strength as the dependent variable and wearable-estimated sleep efficiency as the independent variable, adjusted for age, sex, BMI, glycohemoglobin, cognitive function (Mini-Mental State Examination), Geriatric Depression Scale-15 score, and daily step count measured using the ankle-worn device WalkX. Subgroup analyses were performed and stratified according to the status of diabetes mellitus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Data from 165 patients (median age: 77 y; duration of device use: 65 d; diabetes prevalence: 55%) were used for analyses. Wearable-estimated sleep efficiency and sleep duration were significantly lower in patients with low grip strength than in those without (58.0% vs 62.7%, &lt;i&gt;P&lt;/i&gt;=.006, 245 vs 276 min, &lt;i&gt;P&lt;/i&gt;=.04). Wearable-estimated sleep efficiency was not associated with frailty, low muscle mass, or slow walking speed. After adjusting for the above variables, low wearable-estimated sleep efficiency, but not low sleep duration, was associated with a risk of lower grip strength (odds ratio 1.04, 95% CI 1.01-1.08; &lt;i&gt;P&lt;/i&gt;=.02) by 1 percentage point decrease in wearable-estimated sleep efficiency. This association was observed in patients with diabetes (odds ratio 1.05, 95% CI 1.002-1.093; &lt;i&gt;P&lt;/i&gt;=.04). However, no significant interaction was observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In older p","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e95303"},"PeriodicalIF":2.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148205","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":"Experts' Needs Assessment and Evaluation of Mobile Apps for Children of Parents With Mental Illness: Mixed Methods Study.","authors":"Victoria Lönnfjord, Leonardo Horn Iwaya, Charlotte Bäccman, Gisela Priebe","doi":"10.2196/102905","DOIUrl":"https://doi.org/10.2196/102905","url":null,"abstract":"<p><strong>Background: </strong>Children of parents with mental health illness (COPMI) have the right to receive preventive interventions to avoid developing their own mental health and socioeconomic problems. However, access to interventions varies widely within health care and social services depending on their geographical location in Sweden. In this regard, mobile health (mHealth) interventions for COPMI provide a pathway for more equitable and sustainable preventive support.</p><p><strong>Objective: </strong>This project aims to (1) map and assess the quality of available mHealth apps relevant to COPMI; (2) investigate experts' perceptions of COPMI needs for digital health solutions (particularly mHealth) by consulting and collaborating with an interdisciplinary reference group (scholars, child rights organizations, and IT professionals); and (3) explore the prerequisites for development, implementation, and sustainable access to future digital solutions for COPMI.</p><p><strong>Methods: </strong>We collaborated with a reference group through a series of meetings and workshops, identifying and assessing the quality of 9 free, highly ranked apps (ie, using the well-known Mobile App Rating Scale [MARS]). All the workshop sessions were recorded and transcribed for further qualitative analysis, allowing us to document and derive our main findings.</p><p><strong>Results: </strong>Three out of 9 apps received high scores across the MARS dimensions of aesthetics, perceived functionality, information, and engagement in the expert heuristic evaluation using recorded demonstrations of the apps, indicating a significant lack of high-quality apps relevant to COPMI. Further findings were derived, such as the experts' preference for more general apps that are not specifically targeted to COPMI, as these could promote self-identification and reduce stigmatization. Regarding the third aim, the results showed that it was important to find an app that protected users' privacy by allowing anonymous access to digital support and that mobile apps should be complemented (or replaced) by web-based applications to improve accessibility for children who may not be allowed to download apps without parental permission.</p><p><strong>Conclusions: </strong>The sustainability of digital solutions (web applications or mobile apps) for COPMI is the biggest challenge for future developments. Long-term impact requires stable funding, continuous maintenance, and partnering with established organizations that already possess the infrastructure, expertise, and reach necessary to provide ongoing support. To address the limitations in the study design and deployment issues, it is important to actively involve children through participatory and co-creational approaches when designing and developing mHealth solutions. Also, future evaluations should include privacy and data security assessments such as app permissions, privacy-policy presence, and third-party sharing.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e102905"},"PeriodicalIF":2.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148295","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}