JMIR Formative Research最新文献

{"title":"A Problem-Solving Therapy With Apple Watch Support for College Students With Alcohol Use Disorder Symptoms: Pilot Randomized Controlled Trial.","authors":"Hagar Hallihan, Sangeun Lee, Ruth Adomah, Robert Miranda, Kathleen Rospenda","doi":"10.2196/88846","DOIUrl":"10.2196/88846","url":null,"abstract":"<p><strong>Background: </strong>Alcohol use disorder (AUD) involves an impaired ability to stop or control alcohol use despite adverse consequences and represents a major public health problem. While AUD is most prevalent among college students, integrated evidence-based treatments for this population are lacking.</p><p><strong>Objective: </strong>The objectives of our study were to test the feasibility and acceptability of a newly developed behavioral intervention, problem-solving therapy and Apple Watch (PST-APPLE), and to preliminarily investigate the effectiveness of PST-APPLE among college students with symptoms of AUD.</p><p><strong>Methods: </strong>Participants were recruited through online advertising and on campus at universities in the Chicago area between May and September 2024. They were randomized in a 1:1 ratio using block randomization to the intervention group (PST-APPLE: n=12 individuals) or the control group (education-only: n=14 individuals), with the data analyst blinded to treatment assignment. Participants in the intervention group completed 12 weeks of the PST-APPLE intervention, delivered remotely via Zoom videoconferencing and interactions with the Apple Watch. Participants in the control group were asked to watch a 20-minute abstinence-motivation video and then participate in a 30-minute group discussion via Zoom. All participants completed follow-up assessments at 3 months. Outcomes included alcohol-related problems (Alcohol Use Disorders Identification Test [AUDIT] and Rutgers Alcohol Problem Index [RAPI]) and drinking motivation (Drinking Motives Questionnaire Revised [DMQR]).</p><p><strong>Results: </strong>We enrolled 26 participants aged 18-25 years. The mean age was 22.5 (SD 2.20) years. We found reduced scores between preintervention and postintervention measures in the intervention group using 2-tailed paired <i>t</i> tests and baseline-adjusted analysis of covariance, including reduced alcohol misuse and problems (AUDIT and RAPI scores) and reduced DMQR social and coping motivation scores. Baseline-adjusted mean differences comparing the intervention with the control group showed reductions in alcohol use (AUDIT; mean difference -4.70, 95% CI -8.69 to -0.70) and in DMQR social motivation (mean difference -0.85, 95% CI -1.51 to -0.18) and enhancement motivation scores (mean difference -0.75, 95% CI -1.47 to -0.04).</p><p><strong>Conclusions: </strong>Our study findings indicate that the PST-APPLE intervention is feasible, acceptable, and hypothesis generating among college students with AUD. While findings are promising, this pilot study was not powered for definitive efficacy testing. A fully powered randomized controlled trial is needed to confirm these effects. Future studies could adapt PST-APPLE to other wrist-worn electronic devices/watches that capture physiological data (eg, Fitbit, Samsung Galaxy Watch) to increase reach and scalability, particularly among younger adults and digitally literate populati","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e88846"},"PeriodicalIF":2.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109998","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":"Linking Attainment of Wearable-Derived Sleep and Physical Activity Recommendations with Cardiometabolic Biomarkers and Employer Health Care Claims: A Feasibility Study.","authors":"Gregory J Grosicki, William von Hippel, Finnbarr Fielding, Lucas Holden, Christian P Cheung, Jenna G Cohen, Kristen E Holmes","doi":"10.2196/109259","DOIUrl":"https://doi.org/10.2196/109259","url":null,"abstract":"<p><strong>Unstructured: </strong>Among 80 wearable members stratified into quartiles of attainment of combined physical-activity and sleep recommendations, higher attainment showed age-adjusted associations with lower resting heart rate and BMI and higher heart rate variability. The lowest-attainment quartile incurred approximately 12-fold higher annual per-member health care spending than the other quartiles.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109460","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":"Feasibility and Preliminary Effects of AI-Generated Personalized Sleep Feedback in High School Female Soccer Players: Pilot Randomized Controlled Trial.","authors":"Hayato Kedoin, Yuzuru Itoh, Takumi Nirengi, Yuji Sato, Shun Sugisawa, Yusuke Nishio, Ryo Akitsu","doi":"10.2196/101615","DOIUrl":"10.2196/101615","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adequate sleep supports mood regulation and injury prevention in high school female athletes; however, insufficient sleep is common in this population. Wearable devices enable continuous assessment of objective sleep metrics, but personalized feedback based on daily sleep data remains underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study evaluated the technical and operational feasibility of a multicomponent AI-supported mobile health (mHealth) intervention that delivered personalized sleep feedback to high school female soccer players. Sleep efficiency was the primary preliminary efficacy outcome; other sleep-related measures were secondary or exploratory outcomes, and mood state and sports injury severity were exploratory outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a pilot randomized controlled trial among 25 high school female soccer players from a single team. The study briefing and system setup began on August 18, 2025, and the trial was retrospectively registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry on April 7, 2026 (UMIN000061189). Weeks 1 to 4 constituted the baseline period. After the week 5 baseline questionnaires, participants were stratified by median baseline total sleep time (TST) and Pittsburgh Sleep Quality Index score and randomly allocated 1:1 to the intervention (n=12) or control (n=13) group. During weeks 6 to 9, the intervention group received GPT-4o-generated personalized feedback via LINE on days with valid prior-night Fitbit data, whereas the control group received daily nonpersonalized sleep information. Technical and operational feasibility outcomes included message delivery success, valid Fitbit wear nights, questionnaire completion, technical problems, adverse events, and privacy breaches. Secondary outcomes included TST, wake after sleep onset (WASO), subjective sleep quality, sleep difficulty, and daytime sleepiness. Deep, light, and rapid eye movement (REM) sleep durations, mood state, and sports injury severity were exploratory outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 25 participants completed the trial. Message delivery success and questionnaire completion were 100% in both groups. Median valid Fitbit wear nights were 26 (IQR 24-28) in the intervention group and 22 (IQR 15-26) in the control group. No major technical problems, adverse events, or privacy breaches occurred. Change in sleep efficiency, the primary preliminary efficacy outcome, favored the intervention group (Hodges-Lehmann between-group difference 2%, 95% CI 0.50%-4%; P=.046; r=0.35). Nominal between-group differences were also observed for the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) total score and sleep difficulty score and, among exploratory outcomes, REM sleep duration and total mood disturbance. No between-group differences were observed in TST, WASO, deep or light sleep duration, daytime sleepiness, or sports injury ","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e101615"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110100","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":"Digital Phenotyping and Noninvasive Quality-of-Life Monitoring in Glioblastoma: Feasibility and Usability Study of the Lalaby-Glio App.","authors":"Sabina Asensio-Cuesta, Elies Fuster-García, Juan M García-Gómez, Carlos Sáez, Daniel Sánchez-García, Ángel Sánchez-García, Jorge Soler, Inmaculada Maestu, Teresa Soria-Comes, Maria De Julian Campayo","doi":"10.2196/89765","DOIUrl":"10.2196/89765","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults, with a poor prognosis despite Stupp protocol treatment. Given the substantial burden of the disease and its therapies, monitoring health-related quality of life (HRQoL) is essential. Smartphone-based approaches may enable continuous, low-burden monitoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to evaluate the feasibility and usability of the Lalaby-Glio app for monitoring HRQoL in patients with GBM and to explore preliminary hypothesis-generating associations between subjective global quality of life (QoL) and passive smartphone sensor data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study comprised four phases: (1) adaptation of Lalaby for GBM-specific monitoring by combining passive smartphone sensors (movement, step count, location, sound, light exposure, internet use, and call activity) with a clinician-designed daily 5-item questionnaire and weekly European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Brain Neoplasm 20 (QLQ-BN20); (2) a 6-week feasibility study in 4 adults (aged ≥18 years) initiating Stupp treatment; (3) usability testing in patients with GBM and a complementary nonpatient sample of 103 healthy adults using either screenshot mock-ups or the installed app; and (4) exploratory Spearman correlation analyses of associations between passive sensor data and subjective global QoL using patient-level bootstrap, with no causal or predictive claims inferred due to the small sample size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We enrolled 4 patients (3 men, 1 woman; mean age 54.3, SD 8 years), of whom 3 completed all 6 weeks, and 1 died after 2 weeks. Engagement was high, with 168 questionnaires completed (22 QLQ-C30, 19 QLQ-BN20, and 127 daily status entries). Mean app use was 1.8 (SD 2.7) minutes per day, and mean completion time for the weekly questionnaires was 7.2 (SD 3.3) minutes. Weekly patient-reported outcome measures (PROMs) revealed substantial interindividual and intraindividual variability in functioning, symptoms, and global QoL during treatment. Usability among patients with GBM was favorable (overall mean 3.7/5). Among healthy participants (mean age 20.9, SD 1.4 years; 72/103, 69.9% women), those who installed the app (n=46) achieved a mean System Usability Scale score of 72.9 (SD 10.2), above the standard benchmark, and 91.3% (94/103) judged the nature-inspired design appropriate for oncology. Passive sensing yielded 91.7 MB of data; global QoL correlated negatively with calls (ρ=-0.598; P=.01) and movement (ρ=-0.604; P&lt;.001), while steps showed a positive but nonsignificant association (ρ=0.392; P=.63). These correlations should be interpreted as preliminary signals rather than robust evidence of digital biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Lalaby-Glio appears feasible and usable for monitoring HRQoL","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e89765"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109969","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":"Psychological and Contextual Factors of AI Acceptance Among Informal Caregivers of People Living With Dementia: Cross-Sectional Pilot Study.","authors":"Louis Fisher, Minh-Nguyet Hoang, Logan DuBose, Qiping Fan","doi":"10.2196/104072","DOIUrl":"https://doi.org/10.2196/104072","url":null,"abstract":"<p><strong>Background: </strong>Informal caregivers make up a large share of the care provided to people living with dementia, and experience an elevated risk for anxiety, depression, and caregiving burden. Technology-based interventions, such as mobile apps, aim to support informal caregivers by providing information, training, and mental or social support. Considering the diverse nature of the caregiver experience, AI is being incorporated into such interventions to create more tailored and specific support; however, AI hesitancy may serve as a significant barrier to usage.</p><p><strong>Objective: </strong>The study aimed to preliminarily assess the levels of AI acceptance in adult informal caregivers of people living with dementia, and generate hypotheses regarding the psychological and contextual factors of AI acceptance.</p><p><strong>Methods: </strong>Adult, unpaid caregivers were recruited through social media and community partners. A cross-sectional, web-based survey was administered through Qualtrics (Qualtrics, LLC) to evaluate AI acceptance and psychological flexibility (PF). AI acceptance was measured using the Attitude Towards Artificial Intelligence (ATTARI-12) scale, while PF was measured using the Personalized Psychological Flexibility Index (PPFI). Social needs were assessed by the 'Accountable Health Communities Health Related Social Needs (AHC-HRSN) tool (Centers for Medicare and Medicaid Services). Descriptive, correlational, and regression analyses were performed to examine the associations between these factors and AI acceptance.</p><p><strong>Results: </strong>Overall, 31 informal caregivers of people living with dementia completed the survey. With an average age of 60 (SD 10.6) years old, the majority of caregivers were women (29/31, 94%), Caucasian (25/31, 81%), highly educated (24/31, 77% completed some form of higher education), and currently serving in a caregiver role (21/31, 68%). Mean PPFI and ATTARI-12 scores were moderate (66.4, SD 10.3, and 3.01, SD 0.55, respectively), demonstrating a neutral attitude regarding AI use. In bivariate analyses, ATTARI-12 differed by the caregiver-perceived illness severity (<i>P</i><.001). Linear regression suggested trends that the PPFI acceptance subscale (β=.05, 95% CI 0.002-0.097; <i>P</i>=.04) was associated with ATTARI-12 scores.</p><p><strong>Conclusions: </strong>This study suggests that caregivers' acceptance of such technology may vary according to their care recipient's disease severity and the acceptance subscale of the PPFI. Additionally, the study provides justification for using the ATTARI-12 and PPFI scales to assess AI acceptance and PF in informal caregivers of people living with dementia, respectively. Future research should explore these factors across a larger and more diversified cohort to further generalize and confirm our findings.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e104072"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110040","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":"The STORY MINE Digital Recovery Narrative Intervention for Personal Recovery in Mental Health Care: Pilot Randomized Controlled Trial.","authors":"Mitch N Lases, Jojanneke Bruins, Ingrid Dc van Balkom, Stynke Castelein","doi":"10.2196/83948","DOIUrl":"https://doi.org/10.2196/83948","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hope and confidence support personal recovery by helping individuals with mental illness to rediscover meaning, enhance social connections, and build fulfilling lives. Digital recovery narrative interventions may help stimulate these recovery processes by providing access to hopeful lived-experience stories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This pilot feasibility randomized controlled trial evaluated the feasibility, acceptability, and exploratory outcome signals of STORY MINE, a novel digital intervention based on hopeful recovery narratives, to support personal recovery among adult service users receiving specialized mental health care at a Dutch psychiatric institute.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Adult service users receiving outpatient specialized mental health care were recruited through clinician referral and self-enrollment. Participants (N=28) were randomized (1:1) to either intervention (STORY MINE access for 12 wk alongside care as usual) or control (care as usual only). Feasibility and acceptability were assessed via platform usage data, evaluation questions embedded within the intervention, and postintervention feedback. Quantitative outcomes were assessed at baseline and postintervention using validated self-report questionnaires on mental health confidence, hope, self-stigma, and personal recovery. Descriptive statistics and exploratory effect sizes with 95% CIs were calculated. Qualitative feedback was analyzed thematically to explore user experiences and perceived impact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All participants (N=28) completed self-report questionnaires, while 13 of 14 participants in the intervention group provided evaluation feedback. Feasibility and acceptability were rated positively (mean 7.7, SD 2.52). Engagement was low, with a mean of 2.77 (SD 1.49) active login days per participant over 12 weeks, with some participants reporting minor technical barriers to use. Participants reported mixed perceived recognition (identification with narratives) and relevance (perceived applicability), but qualitative findings indicated perceived benefits including increased meaning-making, inspiration, and connectedness to recovery narratives. Some reported STORY MINE contributed to their recovery process (eg, narratives provided practical tips and evoked meaning-making and more positive self-evaluation). However, mixed emotional responses were reported; one participant reported narratives triggered distressing memories. Exploratory analyses showed small negative effect sizes for mental health confidence (Cohen &lt;i&gt;d&lt;/i&gt;=-0.32, 95% CI -1.07 to 0.42), hope (Cohen &lt;i&gt;d&lt;/i&gt;=-0.45, 95% CI -1.20 to 0.30), and self-stigma (Cohen &lt;i&gt;d&lt;/i&gt;=-0.33, 95% CI -1.08 to 0.42), and a medium negative effect size for personal recovery (Cohen &lt;i&gt;d&lt;/i&gt;=-0.53, 95% CI -1.28 to 0.22). These effect estimates decreased after excluding 2 participants experiencing an acute mental health crisis during the study period.&lt;/p&gt;&lt;p","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e83948"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110085","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":"Perioperative Body-Composition and Phase-Angle Measures in Women Undergoing Breast Cancer Surgery After Neoadjuvant Chemotherapy or Treated Through a Surgery-First Pathway (BC-NUTRITION): Exploratory 2-Cohort Pilot Analysis.","authors":"Yu Liu, Congyi Ma, Guanfeng Chen, WangJing Hu, Lu Li, Jingxia Pan, Huan Li","doi":"10.2196/102885","DOIUrl":"10.2196/102885","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer survivorship requires attention to treatment-related changes in body composition, nutritional status, and quality of life. Bioelectrical impedance phase angle is influenced by tissue electrical properties and fluid distribution and may provide complementary whole-body and segmental information.</p><p><strong>Objective: </strong>This study described perioperative body-composition and phase-angle measures in women undergoing breast cancer surgery after neoadjuvant chemotherapy or treated through a surgery-first pathway. It also estimated T0-to-T2 changes and documented the availability of selected longitudinal variables.</p><p><strong>Methods: </strong>BC-NUTRITION (Body Composition and Nutrition Trajectories in Breast Cancer) is a prospective 2-cohort observational study with 5 planned assessments from admission to 6 months after discharge. The present exploratory pilot analysis included 30 women in cohort A, assessed after neoadjuvant chemotherapy, and 65 women in cohort B, who were treated through a surgery-first pathway. T1 measurements were displayed descriptively; inferential analyses used T0 values and participant-level T0-to-T2 changes. T0 between-cohort comparisons used Welch 2-sample <i>t</i> tests, within-cohort changes used paired <i>t</i> tests, and between-cohort differences in change used Welch tests. Benjamini-Hochberg <i>q</i> values were calculated across the 13 between-cohort change comparisons.</p><p><strong>Results: </strong>All 95 participants had complete data for the 13 selected longitudinal variables at T0, T1, and T2. At T0, cohort A had lower albumin, absolute lymphocyte count, prognostic nutritional index, and whole-body 50-kHz phase angle. The whole-body phase-angle means were 4.64° (SD 0.66) and 5.23° (SD 0.62), with a difference of -0.59° (95% CI -0.88° to -0.31°; <i>P</i><.001). Cohort A had a higher whole-body extracellular water to total body water ratio (ECW/TBW) than cohort B (0.3890 vs 0.3815; <i>P</i><.001). Ipsilateral upper-limb 50-kHz phase angle changed by -0.50° in cohort A and -0.51° in cohort B between T0 and T2. The between-cohort difference was 0.01° (95% CI -0.17° to 0.19°; <i>P</i>=.93). The corresponding difference in whole-body phase-angle change was 0.14° (95% CI -0.02° to 0.30°; <i>P</i>=.09). No <i>q</i> value for the 13 between-cohort change comparisons was below 0.05.</p><p><strong>Conclusions: </strong>The treatment pathways differed in selected laboratory and whole-body bioelectrical measures at T0. The mean upper-limb phase angle ipsilateral to the recorded tumor side decreased in both cohorts between T0 and T2. All five prespecified perioperative feasibility thresholds were met in the available T0-to-T2 data. Assessment acceptability and T3/T4 follow-up were not evaluated. Definitive interpretation requires standardized acquisition, a prechemotherapy baseline, relevant clinical covariates, and outpatient follow-up.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e102885"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081012","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":"Defensive Medicine Attitudes and Associated Factors Among Physicians Working in Obstetrics and Gynecology Clinics in Istanbul, Türkiye: Cross-Sectional Analytical Study.","authors":"Cüneyt Destan Cenger, Giray Kolcu, Mehmet Ali Malkoç, Birgül Tüzün, Meral Çevik Doğan, Tuğba Saraç Sivrikoz","doi":"10.2196/105255","DOIUrl":"https://doi.org/10.2196/105255","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Defensive medicine (DM) is particularly relevant in obstetrics and gynecology (OB/GYN), where physicians face substantial medicolegal risks and malpractice-related pressures. Defensive practices may involve cost-increasing diagnostic or therapeutic behaviors and avoidance of high-risk patients or procedures. Identifying factors independently associated with DM may help inform organizational and medicolegal interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate DM attitudes among physicians working in OB/GYN clinics in Istanbul, Türkiye, and to identify professional, organizational, and medicolegal factors independently associated with these attitudes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional analytical study was conducted among resident physicians, specialists, and faculty members working in OB/GYN departments in Istanbul between June 2023 and February 2024. Participants were recruited using nonprobability convenience sampling through on-site visits and an online survey. DM attitudes were assessed using the 14-item Turkish Defensive Medical Practice Attitude Scale (TDMPAS). Multivariable linear regression models with heteroscedasticity-consistent HC3 SEs were used to identify factors independently associated with the total and subscale scores. Sensitivity analyses were used to assess the potential influence of the data collection modality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1069 physicians participated in the study. The mean total TDMPAS score was 48.12 (SD 10.59), with mean scores of 15.65 (SD 5.21) for cost-increasing behavior, 16.07 (SD 3.24) for defensive behavior, and 16.40 (SD 5.22) for avoidance behavior. Internal consistency was good for the total TDMPAS (Cronbach α=0.880), cost-increasing behavior (α=0.879), and avoidance behavior (α=0.879) and acceptable for defensive behavior (α=0.780). In the multivariable model, dissatisfaction with working conditions (B=6.62, 95% CI 4.19 to 9.05; &lt;i&gt;P&lt;/i&gt;&lt;.001), partial satisfaction (B=3.90, 95% CI 1.60 to 6.20; &lt;i&gt;P&lt;/i&gt;&lt;.001), and a history of administrative investigation (B=3.44, 95% CI 1.37 to 5.50; &lt;i&gt;P&lt;/i&gt;=.001) were independently associated with higher total DM scores. Malpractice training (B=-2.18, 95% CI -3.54 to -0.82; &lt;i&gt;P&lt;/i&gt;=.002), professor status compared with resident physician status (B=-7.53, 95% CI -12.22 to -2.83; &lt;i&gt;P&lt;/i&gt;=.002), and longer experience in OB/GYN (B=-0.15 per y, 95% CI -0.29 to -0.01; &lt;i&gt;P&lt;/i&gt;=.03) were associated with lower mean scores. The total-score model explained 17.6% of the variance (&lt;i&gt;R&lt;/i&gt;²=0.176; adjusted &lt;i&gt;R&lt;/i&gt;²=0.154). The data collection modality was not independently associated with the total TDMPAS score or any subscale score and did not materially alter the primary findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;DM attitudes were prominent among physicians working in OB/GYN and were independently associated with professional and organizational factors. Dissatisfaction with work","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e105255"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109994","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":"Youth-Centered Intervention to Lower the Threshold to Municipal Support and Help Youth Come to Terms with the Dutch Childcare Benefits Scandal: Case Report.","authors":"Roel Otto Lutkenhaus, Caspar van Ette","doi":"10.2196/94223","DOIUrl":"https://doi.org/10.2196/94223","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Dutch childcare benefits scandal (toeslagenschandaal) involved the wrongful labeling of thousands of parents as fraudsters in the childcare allowance system. This led to long-term harm for families and a profound trust crisis in governmental institutions. While the national recovery operation provided financial compensation, municipalities were tasked with offering broader support across life domains to youth who grew up in affected families. Central to this effort was helping them \"come to terms\" with the scandal by acknowledging, processing, and moving forward from its practical and emotional consequences. Yet, many youths remain hard to reach due to distrust and avoidance of institutional contact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This paper describes the development and pretest of a Theory of Change (ToC), grounded in Entertainment-Education (EE) principles, designed to address the municipality of Rotterdam's challenge of reaching and supporting youth affected by the scandal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used a 2-stage formative approach. First, semistructured interviews with 10 affected youth informed the ToC, segmenting youth by their readiness to come to terms with the benefits scandal, ranging from avoidance to active peer support, and aligning messages to each stage. Second, affected youth and a professional producer-artist cocreated a rap track and music video (\"Excuses/Tegenwind\" [Apologies/Headwind]) to tell their story and provide inspiration. The video was pretested at a peer-network event, where we evaluated how well it advanced the ToC's goals through a question-and-answer (Q&A) and moderated group discussion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The interviews revealed that affected youth experienced the benefits scandal as a disruptive family event, marked by chronic stress, shame, and distrust in governmental institutions. Many described coping through avoidance, ignoring official communication, withdrawing emotionally, and/or relying on self-sufficiency. The ToC prioritized recognition of these experiences, inspiration through peer narratives, and gradual connection to (peer) support. The pretest showed that the cocreated music video aligned with this: youth described the music video as confronting yet validating, noting that it reduced shame and sharing their experiences in their own language. Participants stressed the need for peer-to-peer, low-threshold pathways (eg, WhatsApp [Meta Inc] groups) to sustain engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;When governmental institutions face trust issues, formative research is critical to designing effective communication strategies. In this paper, formative research informed a ToC grounded in EE principles, leading to the cocreation of a music video that served as a stepping stone to municipal support by fostering recognition, inspiration, and peer connection. This approach demonstrates how formative research can contribute to interventions","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e94223"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110053","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":"Use of mHealth Apps by General and Family Medicine Physicians in Portugal: Observational Cross-Sectional Quantitative Study.","authors":"Érica Taveira, Inês Dutra, Sílvia Rêgo","doi":"10.2196/88760","DOIUrl":"https://doi.org/10.2196/88760","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The digitalization of health care has accelerated the adoption of mobile health (mHealth) apps in general and family medicine in Portugal. These tools may support chronic disease management and clinical decision-making. However, limited high-quality scientific evidence and the absence of a national framework for certification and quality standards create uncertainty about their safe integration into clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to characterize mHealth app use among general and family medicine residents and physicians in Portugal. It also examined factors influencing app selection, barriers to adoption, and clinicians' perceptions regarding the integration of AI into clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An observational, cross-sectional, quantitative study was conducted using an online survey developed with LimeSurvey. The survey was distributed to residents and physicians registered with the &lt;i&gt;Ordem dos Médicos&lt;/i&gt; (Portuguese Medical Association) who were in active clinical practice. Data were analyzed using descriptive statistics, with absolute and relative frequencies reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final sample included 141 participants (n=104, 73.8% female; n=37, 26.2% male). Most clinicians were aware of mHealth apps (138/141, 97.9%), and 85.1% (120/141) reported using them in clinical practice. Among 120 users, 87.5% (n=105) regularly used 2 to 5 apps. A total of 69 unique apps were identified; the 13 most cited accounted for 77.4% (246/318) of all mentions, including Tonic, UpToDate, Cardio4all, and PEM Móvel. Apps were mainly used during clinical consultations (111/120, 92.5%). The most frequent factors influencing app choice were ease of use (114/120, 95.0%) and evidence-based clinical effectiveness (79/120, 65.8%). Reported barriers included lack of knowledge about available apps (117/139, 84.2%) and the absence of national evaluation standards (66/139, 47.5%). Among nonusers (n=21), the main structural barrier was poor integration with clinical information systems (n=15, 71.4%). Regarding AI, 56.0% (79/141) reported awareness of AI-integrated apps, mainly Tonic and ChatGPT. The same proportion considered AI use beneficial, especially for clinical decision support (114/141, 80.9%) and administrative automation (88/141, 62.4%). Key concerns included ethics, data security, and privacy (105/141, 74.5%) and limited interoperability (94/141, 66.7%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;mHealth app adoption in Portugal is high but fragmented and largely driven by personal initiative (98/218, 45.0%) and informal recommendations, with limited institutional guidance. Tonic was the only app identified by respondents as reporting compliance with ISO 13485 (medical software quality), ISO/IEC 42001 (AI management systems), and UEMS-EACCME clinical accreditation. Most clinicians perceive national regulatory guidance as insufficient (73/139, 52.5%). F","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e88760"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110025","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}