JMIR Formative Research最新文献

{"title":"The Validation and Accuracy of Wearable Heart Rate Trackers in Children With Heart Disease: Prospective Cohort Study.","authors":"Hidde J Hardon, Yara N Van Kerkhof, Beatrijs Bartelds, Janneke A E Kammeraad, Arend W Van Deutekom","doi":"10.2196/70835","DOIUrl":"10.2196/70835","url":null,"abstract":"<p><strong>Background: </strong>Wearables are increasingly used in pediatric cardiology for heart rate (HR) monitoring due to advantages over traditional HR monitoring, such as prolonged monitoring time, increased patient comfort, and ease of use. However, their validation in this population is limited.</p><p><strong>Objective: </strong>The objective of this paper was to assess HR accuracy and validity from 2 wearables, the Corsano CardioWatch bracelet and the Hexoskin smart shirt, in children attending the pediatric cardiology outpatient clinic, exploring factors that influence accuracy, the Hexoskin shirt's arrhythmia detection efficacy, and patient satisfaction.</p><p><strong>Methods: </strong>Children with an indication for 24-hour Holter monitoring were equipped with a 24-hour Holter electrocardiogram (ECG; gold standard), together with both wearables. HR accuracy was defined as the percentage of HRs within 10% of Holter values, and agreement was assessed using Bland-Altman analysis. Subgroup analyses were conducted based on BMI, age, and time of wearing, among other factors. The association between accelerometry (expressed in gravitational units, g) and HR accuracy was analyzed to assess the impact of bodily movement on measurement accuracy. A blinded pediatric cardiologist analyzed Hexoskin shirt data for rhythm classification. Patient satisfaction was measured using a 5-point Likert scale questionnaire.</p><p><strong>Results: </strong>A total of 31 participants (mean age 13.2, SD 3.6 y; n=14, 45% female) and 36 participants (mean age 13.3, SD 3.9 y) were included for the CardioWatch and Hexoskin measurements, respectively. Mean accuracy was 84.8% (SD 8.7%) for the CardioWatch and 87.4% (SD 11%) for the Hexoskin shirt. Hexoskin shirt accuracy was notably higher in the first 12 hours (94.9%, SD 7.4%) compared to the latter 12 (80%, SD 16.7%; P<.001). Higher accuracy was observed at lower HRs (low vs high HR: CardioWatch: 90.9%, SD 9.3% vs 79%, SD 10.6%; P<.001 and Hexoskin shirt: 90.6%, SD 14% vs 84.5, SD 11.8%; P<.001). Both wearables demonstrated good agreement in their HR measurement with Holter readings (CardioWatch bias: -1.4 beats per minute [BPM]; 95% limits of agreement [LoA] -18.8 to 16.0. Hexoskin shirt bias: -1.1 BPM; 95% LoA -19.5 to 17.4). HR measurement accuracy declined during more intense bodily movements. Correct classification of the Hexoskin's shirt rhythm recordings was achieved in 86% (31/36) of cases. Patient satisfaction scores were significantly higher for both the CardioWatch (median 3.8, range 3.5-4.3; P<.001) and Hexoskin shirt (median 3.7, range 3.0-4.0; P<.001) compared to the Holter (median 2.6, range 2.1-3.2).</p><p><strong>Conclusions: </strong>The Corsano CardioWatch and Hexoskin shirt demonstrate good accuracy in pediatric HR monitoring and provide higher patient comfort than conventional monitoring. Both wearables show good agreement in relation to the gold standard device. However, measurement accuracy de","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e70835"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199431","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":"Bactericidal Efficacy of Ultraviolet-C Light on Virtual Reality Devices: In Vitro Assessment of Bacterial Killing.","authors":"Scott C Roberts, Jayson Wright, Mahnoor Mustafa, Richard S Feinn, Asher Marks, Kimberly Hieftje, Pamela H Huang, Richard A Martinello, Thomas S Murray","doi":"10.2196/70326","DOIUrl":"10.2196/70326","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) headsets are increasingly used in health care settings for a variety of clinical indications, yet processes to ensure safe use between patients are not well-established. Centers vary in how these processes are performed. Most use disinfection wipes that require manual contact with VR devices for a specified dwell time to allow for sufficient pathogen killing, which may introduce manual error and device degradation over time. Ultraviolet-C light (UV-C) devices offer a no-touch, low-cost, and passive method to achieve pathogen killing without the harms of chemical contact-based disinfectants. The use of UV-C for disinfection has been studied for some medical devices but its efficacy for microbe killing on VR headsets is not well-established.</p><p><strong>Objective: </strong>This study aims to determine the bactericidal efficacy of UV-C on VR headsets through quantifying UV-C irradiance and bacterial killing of 3 commercially available UV-C devices.</p><p><strong>Methods: </strong>Three commercially available, low-cost UV-C devices were tested for UV-C energy output at multiple positions, angles, and times across the devices' zone of disinfection. The top and lens of a VR headset, the Meta Oculus Quest 2, were artificially inoculated with high quantities of 3 different strains of bacteria (Staphylococcus aureus, Pseudomonas aeruginosa, and Staphylococcus epidermidis) and subjected to UV-C light according to each device's manufacturer's instructions for use. The primary outcome was the amount of bacterial killing after exposure to UV-C light.</p><p><strong>Results: </strong>All 3 UV-C devices produced a UV-C dose that ranged from 3.57 to 195.37 mJ/cm2, depending on proximity, angle, irradiance, and time the sensor received. At least 3-log10 killing of all 3 strains of bacteria was achieved for each of the tested UV-C devices; however, there was variability by organism with respect to UV-C device and VR headset location within the device, notably with the proximity of the bacteria to the bulb. S aureus and P aeruginosa were more readily killed than S epidermidis, with increased bacterial killing occurring with increased UV-C exposure doses. There was no experiment in which all bacteria were killed.</p><p><strong>Conclusions: </strong>UV-C dosage increased with exposure irradiance, time, proximity, and angle to the bulb for all 3 UV-C devices. Bacterial killing on the top and lens of a VR headset occurred in all 3 UV-C devices when run according to their manufacturer's instructions for use, although full bacterial killing did not occur in any experiment. UV-C may be an effective method for microbial killing on VR equipment with low-level contamination.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e70326"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212342","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 Therapeutic Alliance and Clinical Outcomes in Virtual Telepsychiatry: A Retrospective Analysis of Data from Talkiatry.","authors":"Cheryl Person, Nathaniel David Phillips, Kartik Venkatachalam, Georgia Gaveras","doi":"10.2196/77243","DOIUrl":"https://doi.org/10.2196/77243","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Given the increasing demand for accessible mental health services, fully virtual telepsychiatry has become a vital component of modern health care delivery. Therapeutic alliance, the collaborative and affective bond between patients and therapists, is a well-established predictor of clinical outcomes in traditional face-to-face and teletherapy. However, the relationship between therapeutic alliance and clinical outcomes in an outpatient telepsychiatry setting remains less understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our primary objective was to evaluate the relationship between therapeutic alliance and clinical outcomes for depression and anxiety in an outpatient telepsychiatry practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study analyzed data from treatment-seeking adults receiving services from Talkiatry, a single commercial telepsychiatry practice. Treatments included a comprehensive psychiatric evaluation, supportive psychotherapy, and medication management conducted by a psychiatrist utilizing a fully virtual platform. Assessment of anxiety and depressive symptoms using the Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire scale (PHQ-8), respectively, allowed us to identify patients with at least moderate baseline symptoms (PHQ-8 and/or GAD-7≥10). Patients completed a baseline clinical assessment within 1 week of their first visit. Therapeutic alliance ratings from the patients' perspective were collected using the Working Alliance Inventory-Short Revised (WAI-SR). Follow-up clinical assessments were conducted between 8 and 16 weeks after their first visit. We used regression models to assess whether therapeutic alliance was associated with clinically significant improvement, which was defined as having ≥50% improvement in depression and/or anxiety symptoms at follow-up after adjusting for demographic (age, region, sex, insurance type, urban/rural), baseline clinical score (PHQ-8 or GAD-7), time from baseline to follow-up, and baseline prescription status covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After application of the inclusion criteria (PHQ-8 and/or GAD-7≥10), we identified 170 patients for depression analyses and 157 for anxiety analyses. Mean baseline symptom severity scores for PHQ-8 and GAD-7 were 14.90 (SD 3.81) and 14.64 (SD 3.39), respectively. In response to telepsychiatry treatment, patients showed a 41.1% reduction in anxiety symptoms from baseline (d=1.16, P&lt;.001) and a 38.8% reduction in depressive symptoms (d = 1.07, P&lt;.001). After controlling for other covariates, higher WAI-SR scores were significantly associated with greater likelihood of clinically significant improvement for both anxiety (OR=1.07, P&lt;.001, 95% CI: [1.03, 1.11]) and depression (OR=1.04, P=.03, 95% CI: [1.01, 1.09]). In addition, receipt of prescription within the seven days of the first visit was significantly associated with a greater likelihood of clinical improvement for depress","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149035","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":"Health Care Content and Engagement in Chronic Illness Instagram Posts: Content Analysis.","authors":"Lindsey D Daon, Fu-Shiuan Whitney Lee, Olga Saynina, C Jason Wang","doi":"10.2196/57523","DOIUrl":"10.2196/57523","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Instagram and other social media platforms provide a unique environment for people with chronic illnesses to share experiences, but posts with higher engagement may also shape behavior. The hashtag #ChronicIllness appears in over 5 million posts, reflecting the large digital community where users seek validation, connection, and support. Frameworks such as social cognitive theory, self-presentation theory, and illness identity theory suggest that highly engaging content can shift social norms and drive behavior change via observational learning. Despite the strong theoretical basis for this behavioral impact, little is known about what chronic illness-related content is the most engaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study is to identify the content of Instagram posts related to chronic illness and determine if health care content is associated with higher engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study is a mixed methods content analysis of 279 publicly available Instagram posts tagged with #chronicillness, #chronicallyill, or #spoonie. Posts were selected via convenience sampling and included if they featured original, nonvideo content. Photos, hashtags, and captions were coded for themes including location, medical equipment, health care experience, and illness identity. Quantitative metrics, such as likes, comments, and overperforming scores (a normalized metric of engagement), were extracted using CrowdTangle. Multivariate analyses assessed if health care content (posts featuring health care experiences or photos in a medical setting or with medical equipment) was associated with a higher odds of overperforming.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Posts had a median of 25 (IQR 0-14,936) likes, 3 (IQR 0-525) comments, and 20 (IQR 1-31) hashtags. A total of 222 (80%) posts were created by women, and 110 (40%) were overperforming. Photo analysis (260 posts with 406 photos) showed 27 (10%) in health care settings, and 49 (19%) included medical equipment, with 10 (4%) featuring invasive devices (eg, intravenous lines and feeding tubes), which were strongly associated with higher engagement. Hashtag analysis revealed that 243 (87%) posts referenced a medical condition, most commonly chronic pain (n=101, 36%), fibromyalgia (n=56, 20%), and Ehlers-Danlos syndrome (n=38, 14%), while 57 (20%) included medical interventions. Captions reflected 4 main themes: medical experience, illness journey, connection, and nonillness experiences. In multivariate regression analysis, longer captions (odds ratio [OR] 2.44, 95% CI 1.05-5.67), health care content (OR 1.85, 95% CI 1.00-3.42), and invasive medical equipment (OR 6.19, 95% CI 1.16-32.99) were independently associated with overperforming.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Posts featuring health care content and invasive medical equipment were associated with significantly more engagement, suggesting that medicalized portrayals of illness may be ampli","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e57523"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175614","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 Series of Personalized Melatonin Supplement Interventions for Poor Sleep: Feasibility Randomized Crossover Trial for Personalized N-of-1 Treatment.","authors":"Mark J Butler, Thevaa Chandereng, Heejoon Ahn, Stefani Slotnick, Danielle Miller, Alexandra Perrin, Jordyn Rodillas, Ciaran P Friel, Ashley M Goodwin, Ying Kuen Cheung, Karina W Davidson","doi":"10.2196/58192","DOIUrl":"10.2196/58192","url":null,"abstract":"<p><strong>Background: </strong>Poor sleep (defined by short sleep duration or poor quality) is a common condition with potential serious health consequences. Exogenous melatonin supplements have been found to effectively improve poor sleep but have also been shown to have heterogeneity of treatment effects (HTEs) between individuals. Personalized N-of-1 trials, in which each participant is the unit of analysis, are ideal for identifying whether a treatment with high HTE is beneficial for each individual patient.</p><p><strong>Objective: </strong>This study aimed to identify the feasibility, acceptability, and effectiveness of a series of personalized N-of-1 trials of melatonin for poor sleep.</p><p><strong>Methods: </strong>This study consisted of 60 digital, personalized N-of-1 crossover trials comparing the effects of 3.0 mg and 0.5 mg of melatonin versus placebo for poor sleep with randomization to 1 of 2 orders. The trial comprised a 2-week baseline period and a 12-week intervention period. The primary outcomes were usability of the personalized trial system (measured using the System Usability Scale [SUS]) and participant satisfaction with the trial. Effectiveness outcomes included sleep duration (measured using a Fitbit activity tracker [Google]) and sleep quality (measured using the consensus sleep diary).</p><p><strong>Results: </strong>Participants rated the usability of the personalized trial as acceptable (average SUS score 76.3, SD 17.1), and 96% (55/57) of those who completed satisfaction surveys stated that they would recommend the trial to others. Importantly, indices of HTE were low for 3.0 mg and 0.5 mg doses of melatonin, indicating that the effect of these treatments on sleep duration and sleep quality did not substantially vary between participants and that averaged treatment responses are appropriate. Averaged participant sleep duration did not significantly differ between the 3.0 mg (P=.70) and 0.5 mg (P=.90) melatonin intervention periods and the baseline period. In addition, regression models did not show differences between different levels of melatonin and placebo periods for sleep duration or quality.</p><p><strong>Conclusions: </strong>Participant ratings of the usability of and satisfaction with this series of personalized N-of-1 trials of melatonin for sleep suggest these trials are both feasible and acceptable. However, our results show that melatonin supplements did not significantly improve sleep duration or sleep quality. Furthermore, the treatment effects' lack of heterogeneity among participants suggests that future use of N-of-1 trials of melatonin for poor sleep is not needed.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e58192"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175604","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":"eHealth Applications Improve Glycemic Control in Patients With Diabetes: Randomized Controlled Trial.","authors":"Junjie Huang, Claire Chenwen Zhong, Siu Hin Wong, Chung Yi Lo, Man Kin Yim, Martin C S Wong","doi":"10.2196/67761","DOIUrl":"10.2196/67761","url":null,"abstract":"<p><strong>Background: </strong>The eHealth app introduced a chronic disease management module to enhance the efficiency of clinical consultations and facilitate self-health management. However, there was limited information on health outcomes after using the module.</p><p><strong>Objective: </strong>This study aimed to examine the health outcomes of individuals who used the health management module of an individualized electronic application compared to those who did not.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted with 165 participants, with 82 participants assigned to the control group and 83 participants assigned to the intervention group. Randomization was done via a computer randomizer to evaluate the impact of the eHealth chronic disease management module installation on clinical outcomes such as blood pressure, hemoglobin A1c (HbA1c), renal function tests, estimated glomerular filtration rate, and urine albumin/creatinine ratio. Data were collected at baseline and at follow-up visits at 4 and 8 months. Student t tests and chi-square tests were performed to analyze the difference between the intervention and control groups and examined the potential impact of the use of the eHealth chronic disease management module on various health outcomes.</p><p><strong>Results: </strong>In total, 161 participants were included in the analysis, with an average age of 66.58 (SD 9.75) and 66.49 (SD 8.45) years in control and intervention group respectively. After 4 months, the intervention group showed better glycemic control, with significantly lower mean HbA1c levels (mean 6.76%, SD 0.64%) compared to the control group (mean 7.09%, SD 0.82%, P=.007). Also, more participants in intervention group achieved optimal HbA1c levels (n=58, 73.4%; P=.004) compared to the control group (n=36, 49.3%) in month 4. App usage had significantly decreased when comparing the usage after 4 months (mean 1.88 points, SD 0.81 points) and month 8 (mean 1.39 points, SD 0.72 points; P<.001). The results indicated better glycemic control for participants using the module in a relatively shorter period of time, and app adherence was the key for the continuous optimal glycemic control.</p><p><strong>Conclusions: </strong>These findings support the potential of the module for clinical application in patients with suboptimal glycemic control. The long-term benefit of the module may be affected by the compliance of participants to the module.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Register ChiCTR2500108895; https://www.chictr.org.cn/showprojEN.html?proj=214865.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e67761"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148761","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":"Health Care Providers' Perspectives of Clinical Decision Support Tools for Pediatric Sepsis in Bangladesh: Qualitative Study.","authors":"Shamsun N Shaima, Alicia E Genisca, Md Tanveer Faruk, Md Fakhar Uddin, Akash Saha, Nadia Sultana, Nidhi Kadakia, Monique Gainey, Elleen Kim, Kikuyo Shaw, Farzana Afroze, Joan Chepngeno, Atin Jindal, Sifat A Chowdhury, Md Jobayer Chisti, Adam C Levine, Stephanie C Garbern","doi":"10.2196/73451","DOIUrl":"10.2196/73451","url":null,"abstract":"<p><strong>Background: </strong>Sepsis, a life-threatening condition resulting from a dysregulated immune response to infection, disproportionately affects children in low- and middle-income countries (LMICs). Children with sepsis in LMICs face high mortality rates, with early detection and clinical monitoring posing significant challenges to effective management. There is great potential for digital technologies, such as wearable biosensor devices and mobile health (mHealth) clinical decision support (CDS) tools, together referred to as clinical decision support systems (CDSSs), to enable closer monitoring and more prompt recognition of children at risk of advanced sepsis and death. However, little is known about the perceptions of health care providers (HCPs) regarding the introduction of new digital health tools for pediatric sepsis care in LMICs.</p><p><strong>Objective: </strong>The objective of this study was to assess HCPs' understanding, perceptions, and recommendations regarding the design and implementation of digital CDSSs for pediatric sepsis care in Bangladesh.</p><p><strong>Methods: </strong>Between February and May 2024, 18 individual semistructured in-depth interviews were conducted with HCPs (nurses and physicians) at 3 urban hospitals in Bangladesh. The data were transcribed, translated from Bangla to English, and analyzed using a framework matrix analysis approach. Participants were asked about familiarity with digital health tools, feedback on CDSS design, perceptions of the system's utility, and barriers and facilitators to use of similar tools in clinical settings in Bangladesh.</p><p><strong>Results: </strong>Participants reported overall positive perceptions toward the potential implementation of a CDSS for pediatric sepsis care in Bangladesh. Some key priorities for the design of a CDSS were durability, reusability, cost considerations, reliability, and accuracy. Clinicians desired the CDS tool to also have customizable alarm parameters and include additional functions such as glucose monitoring. Many favored audio (ringtone) or visual (light) alarms to alert about changes in captured vital signs. HCPs believed that a CDSS could enhance patient care by allowing greater staff capacity to monitor patients, reducing management time, and aiding in faster clinical decision-making, with some suggesting it could lower mortality rates. Concerns regarding implementation included internet availability, affordability of the wearable devices, and trust in the CDSS outputs compared to expert clinician judgement.</p><p><strong>Conclusions: </strong>The findings of this study highlight HCPs' perceptions toward the potential of wearable biosensor devices and CDS tools (CDSSs) for improving pediatric sepsis outcomes in LMICs and highlight the need to address implementation challenges to ensure the effective integration of CDSSs into health care systems.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e73451"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148828","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":"Evaluating a Website on Learning Disorders for Parents and Learning Therapists: Observational Mixed Methods Study.","authors":"Olga Hermansson, Paula Dümig, Björn Witzel, Lior Weinreich, Susanne Volkmer, Gerd Schulte-Körne, Kristina Moll","doi":"10.2196/68365","DOIUrl":"10.2196/68365","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Between 5% and 15% of children worldwide have a specific learning disorder. This creates a substantial demand for information among both parents and professionals. LONDI (londi.de) is a German-language website that (1) provides evidence-based information on learning disorders and (2) offers a tool to search for relevant diagnostics and intervention measures for professionals (Help System). This paper reports the results of an evaluation study of the website.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of the study was to (1) evaluate the website and (2) inform existing theories on technology acceptance and user satisfaction. The study was conducted using the RE-AIM framework for evaluating public health impact and the information system continuance intention framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This mixed methods observational study was conducted online from February 2023 to August 2023 in Germany. Parents of children with learning difficulties and learning therapists participated in a 1.5-hour online session in which they were guided through the website. A pre-post design was used to assess changes in participants' knowledge, attitudes, and self-efficacy. Additionally, two path models assessing the predicting factors of the intention to further use (ie, continuance intention) and the intention to recommend the website were tested. The first model was based on the widely used information system continuance intention framework and tested expectations confirmation, perceived usefulness, and website satisfaction as predictors of the continuance intention and the intention to recommend the website. The second model focused on usability, content perception, visual aesthetics, and satisfaction as predictors of the same outcome variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 77 parents and 73 learning therapists participated in the study. In the sample of learning therapists, age correlated negatively with usability opinion and website satisfaction. A 2-tailed t test revealed a significant increase in knowledge about learning disorders in both groups (parents: t&lt;sub&gt;76&lt;/sub&gt;=12.02, P&lt;.001; learning therapists: t&lt;sub&gt;71&lt;/sub&gt;=7.03, P&lt;.001). There was no change in attitudes and self-efficacy in parents (F&lt;sub&gt;1,76&lt;/sub&gt;=2.04, P=.14; Wilks lambda=0.95), but there was a significant change for learning therapists (F&lt;sub&gt;1,68&lt;/sub&gt;=15.83, P&lt;.001; Wilks lambda=0.68) after using the website. A path analysis revealed that the intention to recommend the website can be included as an additional variable in the information system continuance intention framework. For the informational pages, content perception and visual aesthetics significantly predicted website satisfaction (R&lt;sup&gt;2&lt;/sup&gt;=0.59, F&lt;sub&gt;3,143&lt;/sub&gt;=69.06, P&lt;.001), and content perception significantly predicted continuance intention (R&lt;sup&gt;2&lt;/sup&gt;=0.45, F&lt;sub&gt;3,143&lt;/sub&gt;=39.74, P&lt;.001). For the Help System, usability was the only significant predictor of websi","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e68365"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175659","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":"User-Reported Mechanisms of Change on a Suicide Prevention Website: Single-Arm Pragmatic Trial.","authors":"Martina Fruhbauerova, David Huh, Ursula Whiteside","doi":"10.2196/71136","DOIUrl":"10.2196/71136","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital platforms can serve as effective interventions for individuals in crisis, those with limited access to mental health resources, or those who prefer web-based support over in-person care. NowMattersNow.org, a web-based platform grounded in dialectical behavior therapy, has been shown to reduce suicidal thoughts and negative emotions. However, little is known about the specific mechanisms that drive these improvements. Identifying the active ingredients that contribute to its effectiveness will help optimize its impact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study examined the reasons users reported behind reductions in suicidal thoughts and negative emotions after visiting NowMattersNow.org. Specifically, this study sought to determine which reported reasons were associated with greater versus lesser improvements and whether these changes differed across specific subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this single-arm pragmatic trial, data were collected from 3185 respondents who completed a 6-item retrospective survey while visiting NowMattersNow.org. The survey assessed changes in suicidal ideation and emotional distress (ie, intensity upon entering the site vs at the time of survey completion), reasons the website was helpful, and basic nonexclusive demographic information. Cross-tabulations were used to examine the most commonly endorsed reasons for finding the website helpful, while longitudinal regression analyses assessed the statistical significance of changes in suicidal ideation and emotional distress.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The majority of participants reported experiencing suicidal thoughts (n=2309, 72.5%) and negative emotions (n=2745, 86.2%) upon arriving at the website, with 52.4% (n=1211) and 55.6% (n=1527) of these individuals, respectively, experiencing reductions in suicidal thoughts and negative emotions after engaging with the site. Regarding the primary aims of the study, the most frequently cited reason for finding NowMattersNow.org helpful was \"I learned something\" (n=668, 21%), followed by \"It distracted me\" (n=544, 17.1%) and \"I felt less alone\" (n=414, 13%). These were also the top 3 reasons reported by LGBTQI individuals, those endorsing alcohol or opioid problems, and those experiencing unusual experiences, though the order varied across groups. Among participants who experienced the largest reduction in suicidal ideation (a 4-point decrease), the most common reasons cited were \"It distracted me\" (n=5, 29.4%), \"I felt less alone\" (n=3, 17.6%), and \"I felt cared for\" (n=3, 17.6%). Similarly, for those with the largest reduction in negative emotions (a 4-point decrease), the most frequently endorsed reasons were \"It distracted me\" (n=3, 23.1%), \"I felt less alone\" (n=3, 23.1%), and \"I felt cared for\" (n=2, 15.4%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The findings suggest that NowMattersNow.org is an accessible, scalable digital intervention that shows promise for redu","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e71136"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149085","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":"Assessing Work-Related Stressors in Online Counseling: Cross-Sectional Questionnaire Development Study.","authors":"Wiebke Schlenger, Marlies Joellenbeck, Elke Ochsmann","doi":"10.2196/65766","DOIUrl":"10.2196/65766","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The rapid digitalization of health and social services, particularly accelerated by the COVID-19 pandemic, has led to a widespread adoption of online counseling. While offering flexibility and improved access for clients, online counseling presents new challenges for counselors, including technical issues, difficulties in building therapeutic relationships, and changes in work organization. Despite growing reliance on digital counseling platforms, there is a lack of validated tools to assess specific occupational stressors associated with online counseling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to develop and evaluate the \"QueStrOn\" (Questionnaire to Assess Stressors in Online Counseling), an instrument designed to identify stressors and resources specific to online counseling and to explore its ability to predict perceived stress levels in counselors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Item development was guided by the Job Demands-Resources model, qualitative interviews with 22 counselors, expert input, and a literature review. A preliminary version of the questionnaire was pretested and then distributed via email and social media to counselors offering both online and face-to-face services. A total of 219 counselors completed the survey, and after applying inclusion criteria, 174 responses were analyzed. Exploratory factor analysis was conducted using principal axis factoring and varimax rotation. Internal consistency was assessed via Cronbach alpha (α). A linear regression model was used to initially test the predictive power of the identified factors with perceived digital stress as the dependent variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The exploratory factor analysis resulted in a four-factor solution with 16 items, capturing (1) Online Work Organization, (2) Online Framework, (3) Online Work Content, and (4) Online Communication. The overall instrument demonstrated high internal consistency (α=0.870), with acceptable values for factors (1), (3), and (4) (α=0.754, 0.745, and 0.826, respectively), although the factor \"Online Framework\" showed limited reliability (α=0.502). The regression model, adjusted for age and gender, significantly predicted perceived stress in online counseling (F5=13.335, P&lt;.001), explaining 27.1% of the variance. Online Work Organization, Online Communication, and Online Framework were associated with lower perceived stress when rated positively, whereas Online Work Content showed an inverse relationship, potentially reflecting emotional distancing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The QueStrOn instrument provides a valid first step toward systematically assessing occupational stressors in online counseling. Its 4-factor structure aligns with theoretical and empirical findings and offers practical utility for workplace risk assessments. Incorporating these dimensions into routine evaluations may support counselor well-being and inform digital health policy. Further valida","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e65766"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12466792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148754","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}