JMIR Formative Research最新文献

{"title":"Feasibility and Acceptability of Oura Ring Sleep Monitoring in Older Adults Admitted From the Emergency Department: Prospective Cohort Study.","authors":"Adrian D Haimovich, Annie Lacourciere, Kerry Palihnich, Sydney Mulqueen, Natalie Jansen, Suzanne M Bertisch, Mara A Schonberg, Aanand D Naik, Sarah D Berry, Edward R Marcantonio, Nathan I Shapiro, Janet M Mullington","doi":"10.2196/92359","DOIUrl":"https://doi.org/10.2196/92359","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) boarding exposes admitted older adults to a high-disruption environment. Sleep loss during acute hospitalization is associated with adverse outcomes and may contribute to delirium, yet objective sleep measurement in this setting is difficult. Consumer multisensor wearables may permit low-burden, longitudinal measurement, but the feasibility and acceptability of ring-based monitoring among acutely ill older adults is unknown.</p><p><strong>Objective: </strong>This study aimed to estimate the feasibility and acceptability of Oura Ring Gen 3 sleep monitoring in older adults admitted to the hospital from the ED, and to describe exploratory device-measured and patient-reported sleep outcomes.</p><p><strong>Methods: </strong>We conducted a single-site prospective cohort study from February through March 2025. Patients aged 65 years or older with an inpatient medical bed request were recruited in the ED and asked to wear the ring continuously for up to 4 days or until discharge; monitoring continued after transfer to an inpatient unit from the ED. Participants underwent daily 3-Minute Diagnostic Interview for Confusion Assessment Method-Defined Delirium (3D-CAM) assessments, cognitive testing when not delirious, daily sleep surveys, and an exit survey. Feasibility outcomes were the approached-to-enrolled proportion and the proportion of study completers with wear for more than 75% of the analyzed period. Acceptability was the proportion of exit respondents who disagreed or strongly disagreed that the ring bothered them. Device-estimated sleep duration was normalized to hours per 24 hours, and its association with mean patient-reported sleep quality was assessed using Kendall τ.</p><p><strong>Results: </strong>Of 29 patients approached for consent, 15 enrolled (51.7%, 95% CI 32.5%-70.6%); 1 withdrew immediately, leaving 14 who completed study procedures. Of these 14 patients, 13 wore the ring for ≥75% of their enrollment period (92.9%, 95% CI 66.1%-99.8%). Eleven participants completed the exit survey, and 9 reported that the ring was not bothersome (81.8%, 95% CI 48.2%-97.7%). Among the 13 participants who wore the ring for ≥75% of the analyzed period, median device-estimated sleep was 4.3 (IQR 2.6-7.0) hours per 24 hours. Participants reported good or very good sleep on 9 of 19 surveyed nights (47.4%). Mean sleep quality and device-estimated sleep duration were positively associated among 10 participants with complete paired data (Kendall τ=0.54; <i>P</i>=.04).</p><p><strong>Conclusions: </strong>In this pilot study, we found that sleep monitoring with the Oura Ring Gen 3 was feasible and acceptable to older adults admitted from the ED. These findings support larger studies validating the Oura Ring against polysomnography in hospitalized older adults.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e92359"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109977","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":"Remote Glucose Monitoring Engagement and Glycemic Control in Type 2 Diabetes and Prediabetes: Retrospective Cohort Study.","authors":"Yong Huang, Nitish Nagesh, Ajan Subramanian, Li Wang, Zhiyu Liu, Yichen Sun, Weiyi Hou, Iman Azimi, Amir M Rahmani, Randall S Stafford","doi":"10.2196/95679","DOIUrl":"https://doi.org/10.2196/95679","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Suboptimal glycemic control remains a significant public health challenge among adults with type 2 diabetes and prediabetes, with 47.4% of US adults with diagnosed diabetes having hemoglobin A&lt;sub&gt;1c&lt;/sub&gt; (HbA&lt;sub&gt;1c&lt;/sub&gt;) ≥7%. Remote glucose monitoring programs have shown promise for supporting self-management, but real-world evidence on the causal impact of varying patient engagement levels on glycemic outcomes remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to estimate the causal dose-response relationship between patient engagement, operationalized as weekly glucose monitoring frequency, and glycemic control measured by HbA&lt;sub&gt;1c&lt;/sub&gt; among adults enrolled in a comprehensive primary care-integrated remote monitoring program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study of 1436 adults with type 2 diabetes or prediabetes enrolled in the Unika Health program between 2019 and 2024. The program integrated Bluetooth-connected glucose meters, a mobile app, structured lifestyle coaching, and primary care coordination across 74 physician practices. Engagement was defined as mean weekly glucose monitoring frequency during the first 6 months. The causal effect of monitoring frequency on 6-month HbA&lt;sub&gt;1c&lt;/sub&gt; was estimated using marginal structural models (MSMs) with inverse probability weighting to address time-varying confounding. Covariates included age, sex, BMI, baseline HbA&lt;sub&gt;1c&lt;/sub&gt;, comorbidities, medication status, and physical activity level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cohort was predominantly older (95.4%, 1370/1436 aged ≥46 years), with 82.6% (1186/1436) having hypertension and 45.9% (659/1436) classified as obese. Overall, HbA&lt;sub&gt;1c&lt;/sub&gt; decreased by a mean of 0.54 (SD 1.47; 95% CI 0.47-0.62) percentage points (&lt;i&gt;P&lt;/i&gt;&lt;.001) over 6 months. Cluster analysis identified 3 engagement tiers: low (n=835; mean 2.55, SD 1.35 measurements/week), medium (n=493; mean 6.19, SD 1.46 measurements/week), and high (n=108; mean 12.59, SD 3.03 measurements/week). A monotonic dose-response was observed, with mean HbA&lt;sub&gt;1c&lt;/sub&gt; reductions of 0.38 (SD 1.40; 95% CI 0.29-0.48), 0.71 (SD 1.50; 95% CI 0.58-0.85), and 1.01 (SD 1.67; 95% CI 0.69-1.32) percentage points for the low, medium, and high tiers, respectively (all &lt;i&gt;P&lt;/i&gt;&lt;.001 by 2-tailed paired &lt;i&gt;t&lt;/i&gt; test). In weighted MSMs, each additional weekly measurement was associated with a 0.05 (95% CI 0.03-0.07) percentage point greater HbA&lt;sub&gt;1c&lt;/sub&gt; reduction (&lt;i&gt;P&lt;/i&gt;&lt;.001). Among patients with high baseline HbA&lt;sub&gt;1c&lt;/sub&gt; (≥9%), the high-engagement group achieved a mean reduction of 3.12 (SD 1.97; 95% CI 2.29-3.94) percentage points. Findings were consistent in sensitivity analyses at 3 months (β=-0.04; &lt;i&gt;P&lt;/i&gt;&lt;.001) and 12 months (β=-0.03; &lt;i&gt;P&lt;/i&gt;=.003) and across alternative weighting specifications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Higher engagement with a digitally enabled, primary care-inte","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e95679"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110062","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 Transferable Evaluation Framework for Mobile Health Data Collection in Shift-Work Nurses: Development and Feasibility Study.","authors":"Kyulhee Park, Kihye Han","doi":"10.2196/103689","DOIUrl":"https://doi.org/10.2196/103689","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Shift-work nurses experience substantial variability in work schedules, health behaviors, and recovery patterns, which traditional retrospective surveys fail to capture due to recall bias. Although mobile health (mHealth) tools offer ecological momentary data capture, existing off-the-shelf survey platforms lack shift-synchronized notification logic and impose excessive cognitive friction on fatigued clinicians, limiting their applicability in nursing research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to propose and demonstrate a transferable, dual-perspective evaluation framework for mHealth data collection tools in high-burden occupational settings, using the newly developed \"Nurses' Work-Life and Health\" app as a tailored exemplar.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 3-phase, user-centered iterative design was used: (1) needs assessment, (2) app development with alpha testing (n=5) and beta testing (n=16), and (3) a 14-day feasibility and process evaluation. The feasibility study evaluated 5 shift-work nurses who completed daily near-real-time journal entries over 14 consecutive days, capturing shift characteristics, sleep, nutrition/hydration, physical activity, and acute fatigue/stress. To complement end-user evaluation (n=5), an expert nurse researcher participated in a follow-up semistructured interview assessing methodological rigor. Evaluation was guided by the technology acceptance model and system usability scale. Objective system logs and subjective surveys were integrated to analyze adherence, completion, and user burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Phase 1 needs assessment identified key functional requirements, including shift-synchronized notifications, low cognitive burden timeline entries for postshift fatigue, and automated time-stamping to verify contemporaneous logging. In phase 2, the app demonstrated high usability and acceptance, with total mean scores of 3.47 (SD 0.53) in alpha testing and 3.48 (SD 0.55) in beta testing (range 1-4). In the phase 3 feasibility study, the app demonstrated 100% retention and 94.3% adherence (mean 13.2, SD 1.1 d). The data entry completion rate was 88.5%, with an average entry time of 3.4 minutes. Participants reported high overall satisfaction and low user burden, reflected by mean scores of 3.82 and 3.65, respectively. Time-stamped logs supported the feasibility of near-real-time data capture without disrupting clinical workflows. Qualitative feedback from the expert nurse researcher highlighted the app's methodological strengths, including its potential to reduce recall bias and support for self-monitoring, while also identifying areas for refinement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;By integrating subjective end-user perceptions, objective usage logs, and qualitative scrutiny from an expert researcher, this study established a transferable evaluation framework for mHealth research instruments. The findings indicate that shift-tailored mobile ","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e103689"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109942","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 and Functional Breadth of Publicly Available Mobile Apps Supporting Self-Management After Kidney Transplantation: Cross-Sectional App Store Evaluation.","authors":"Hyejin Lee, Chan Mi Kang","doi":"10.2196/92472","DOIUrl":"10.2196/92472","url":null,"abstract":"<p><strong>Background: </strong>Nonadherence to immunosuppressants and other self-management behaviors remains a major challenge after kidney transplantation. Publicly available mobile apps may support long-term self-management, but their quality and functional breadth remain unclear.</p><p><strong>Objective: </strong>This study aimed to identify publicly available mobile apps accessible in South Korea that support self-management after kidney transplantation, evaluate their quality and functional breadth using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality score, and describe gaps in transplant-specific self-management support.</p><p><strong>Methods: </strong>From January 13 to 21, 2026, we searched the Apple App Store and the Google Play Store using 6 keywords, including \"kidney transplant\" and \"kidney graft,\" and selected apps that met the inclusion criteria (n=6). Two trained nursing faculty raters independently evaluated each app using the MARS and IMS functionality score. Interrater reliability was good for the MARS (intraclass correlation coefficient=0.71, 95% CI 0.62-0.78) and the IMS functionality score (Cohen κ=0.88).</p><p><strong>Results: </strong>The mean MARS score across the 6 apps was 4.06 (SD 0.96). Subscale scores were highest for aesthetics (mean 4.22, SD 0.81), followed by functionality (mean 4.13, SD 0.80), information (mean 4.11, SD 0.75), and engagement (mean 3.80, SD 1.32). The mean IMS functionality score was 5.67 (SD 4.27) out of 11 functions, and the \"evaluate data\" function was included in only 1 (16.7%) app.</p><p><strong>Conclusions: </strong>Few publicly available apps met the eligibility criteria. Although trained-rater MARS assessments were generally favorable, functions involving data evaluation and individualized guidance or intervention were less frequently implemented. Because the apps differed in their intended purposes and the study did not assess end-user usability or clinical outcomes, the findings should be interpreted as a descriptive baseline rather than evidence of usability or effectiveness. Future studies should involve kidney transplant recipients in patient-centered usability and outcome evaluations.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e92472"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110020","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":"Enhancing a Behavioral Intervention Using Rest-Activity Rhythm Monitoring via a Consumer Wearable in Older Dementia Caregivers and People With Dementia: Feasibility and Acceptability Study.","authors":"Sarah T Stahl, Juleen Rodakowski, Riddhi Patira, Stephen F Smagula","doi":"10.2196/88773","DOIUrl":"https://doi.org/10.2196/88773","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite being established risk factors for poor mental or brain health outcomes in aging, rest-activity rhythm (RAR) disturbances are not routinely monitored or treated. This is, in part, due to a lack of clinician-friendly RAR monitoring systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We tested the feasibility and acceptability of personalizing a 6-week behavioral intervention using RAR monitoring from a consumer wearable device (Apple Watch). We selected a target population study of people with dementia and their family caregivers, given that rest-activity pattern disturbances are common in these groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-arm trial enhanced a behavioral activation rhythm treatment with the Apple Watch-based app myRhythmWatch, providing users and their therapists with objective RAR monitoring for customizing therapy. Therapists used information from the myRhythmWatch app to visualize the participants' behavioral patterns, identify treatment targets, and track progress. Participants included 21 older adults (15 dementia caregivers: mean age 61.8, SD 8.4 years; 6 people with dementia: mean age 81.45, SD 8.5 years). Feasibility outcomes were as follows: (1) proportion adherent enough to assess RARs (defined as ≥3 consecutive valid days with ≥20 hours per day) and (2) the total number of valid days. Acceptability was measured via the Likert scale to gauge participants' satisfaction with the intervention. We secondarily examined preintervention and postintervention changes in depression (9-item Patient Health Questionnaire scores) and insomnia (Insomnia Severity Index) scores among a smaller group of 11 caregivers who completed these measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 21 participants obtained the minimum data requirement for characterizing an RAR snapshot. Caregivers averaged 35 valid RAR monitoring days, and all 15 caregivers were still using the app at week 6 of the trial. In contrast, people with dementia averaged 30 valid days, and of the 6 people with dementia, only 6 were active users at the end of the trial. On average, caregivers completed 5.7 (SD 0.46) of the 6 therapy sessions offered, and participant satisfaction with program components was \"high.\" Depression symptoms improved with medium preintervention and postintervention effect sizes (&lt;i&gt;t&lt;/i&gt;&lt;sub&gt;10&lt;/sub&gt;=2.417; &lt;i&gt;P&lt;/i&gt;=.02; Hedges &lt;i&gt;g&lt;/i&gt;=0.67, 95% CI 0.04-1.28), and there were large effect size improvements in insomnia symptoms (&lt;i&gt;t&lt;/i&gt;&lt;sub&gt;10&lt;/sub&gt;=3.377; &lt;i&gt;P&lt;/i&gt;=.004; Hedges &lt;i&gt;g&lt;/i&gt;=0.94, 95% CI 0.25-1.61).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;These findings show that older adults without dementia were highly engaged with RAR monitoring. This supports the feasibility of personalizing interventions for older adults with objective RAR monitoring. Randomized controlled trials are warranted to determine whether adding RAR monitoring improves intervention efficiency, efficacy, or durability. While feasible in a subset ","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e88773"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109926","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":"Physical Activity Determinants Among Adolescents With Mild Intellectual Disability in Dutch Practical Education: Exploratory Sequential Mixed Methods Study.","authors":"Maria Inês Ribeiro, Monique Simons, Daniëlla van Uden, Laura Genga, Pieter Van Gorp","doi":"10.2196/89518","DOIUrl":"https://doi.org/10.2196/89518","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A sedentary lifestyle is a global health crisis that contributes to chronic disease and premature mortality. Adolescents with mild intellectual disability attending Dutch practical education (PrO) schools face elevated health risks due to low levels of physical activity (PA) and limited conceptual, social, and practical skills. Digital health interventions offer scalable solutions, but require contextual adaptation informed by formative research. However, understanding of PA behavior in this population and context remains limited because existing research relies on partial lenses and lacks integration of theory, participatory methods, and multistakeholder insights.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to identify and prioritize PA determinants among adolescents with mild intellectual disability in Dutch PrO schools, using a theory-driven, participatory, and multistakeholder approach to inform the contextual adaptation of digital health interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used an exploratory sequential mixed methods study design integrating context mapping and concept mapping. Inclusive participatory methods were co-designed with PrO schools for adolescents. In the first qualitative phase, PA determinants were identified through data collected from experts (n=13), teachers (n=8), and adolescents (n=83-90). Qualitative data from all stakeholder groups were integrated and analyzed using a framework approach grounded in the Theoretical Domains Framework and the Capability, Opportunity, Motivation-Behavior model. In the subsequent quantitative phase, the PA determinants identified across all data sources were translated into inclusive pictorial rating instruments and prioritized from the adolescents' perspectives using a 7-point Likert scale ranging from barriers to facilitators. Quantitative analyses included descriptive statistics and hierarchical clustering to examine perceived importance and consensus across determinants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Qualitatively, 29 PA determinants were identified and mapped to Capability, Opportunity, Motivation-Behavior components: opportunity (n=15), motivation (n=8), and capability (n=6). Experts and teachers focused on capability and opportunity barriers (eg, impaired skills and cognitive fatigue), while adolescents emphasized motivation and social opportunity facilitators (eg, fun activities, enjoyment, and peer or family support). Quantitatively, adolescents' ratings showed a positive bias toward facilitators (mean 5.09/7, SD 1.72), and facilitators showed greater consensus than barriers (&lt;i&gt;ρ&lt;/i&gt;=0.74). Adolescents rated several determinants as facilitators that experts and teachers emphasized as barriers (eg, those related to impaired skills and self-efficacy).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Three meta-inferences informing future intervention adaptation were derived: (1) substantial individual variation exists in adolescents' perceptions of PA ","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e89518"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110056","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":"Factors Associated With Engagement When Using Social Media to Teach Physicians Point-of-Care Ultrasound During Off-Hours: Observational Study.","authors":"Katelyn A Seward, Gagandeep Kaur, Paul J Han, Michelle C Higginson, Samantha R Spierling Bagsic, Bruce J Kimura","doi":"10.2196/94540","DOIUrl":"10.2196/94540","url":null,"abstract":"<p><strong>Background: </strong>Although social media is often viewed by residents and could be used to reinforce teaching points, there is little data on methods that improve engagement in learning medical topics while socially perusing this medium.</p><p><strong>Objective: </strong>We observed how the timing of posted questions, correctly answering questions, and providing supportive comments affected resident engagement with point-of-care ultrasound clips viewed electively on a private social media account.</p><p><strong>Methods: </strong>Of 60 medical residents, 35 followed an Instagram account that posted ultrasound video clips with questions during the academic year. Engagement was defined as the percentage of questions answered among the total number of clips viewed, calculated for each posted story (story engagement, E(s)) and each resident (resident engagement, E(r)). E(s) was tested for an association with (1) weekend vs weekday posts, (2) answering questions correctly vs incorrectly, and (3) supportive responses from faculty vs no feedback.</p><p><strong>Results: </strong>Of 16 posts, 120 questions were answered from 428 clips viewed by 35 residents, resulting in an E(s) of 28% (range 15%-59%) across posts and a median E(r) of 19% (IQR 0%-39%) across residents; 71% (n=25) of residents engaged with at least 1 post. E(s) was higher during weekdays vs weekends (30% vs 21%; P=.007) and correlated to answering correctly vs incorrectly (r=0.6; P<.001). A supportive comment resulted in a lower percentage of answering the next post, compared to no feedback (30% vs 71%; P=.02).</p><p><strong>Conclusions: </strong>Social media engagement was higher when questions were answered correctly but, surprisingly, lower when posts were made on weekends and immediately after receiving a supportive comment.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e94540"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080936","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 a Virtual Family-Based Single-Session Intervention for Young Teens at High Risk for Substance Use Disorder: Single-Arm Pilot Trial.","authors":"Chelsea K Pike, Catherine Stanger, Inbal Nahum-Shani, Susan A Murphy, Vanessa Ramirez, Madison Siegel, Lucia Berglund, Amy Hughes Lansing","doi":"10.2196/93263","DOIUrl":"10.2196/93263","url":null,"abstract":"<p><strong>Background: </strong>Preventive interventions to delay substance use disorder (SUD) are ideally delivered during early adolescence, a critical period for exposure to substance use (SU) risk factors. Young teens (aged 12-14 years) engaging in occasional use of alcohol, cannabis, or tobacco use, or with a family history of SUD, are at increased risk for SUD. Although behavioral-ecological family therapy is effective for prevention, many families face access barriers. Single-session interventions (SSIs) may offer an accessible, low-intensity alternative.</p><p><strong>Objective: </strong>This open pilot trial aimed to evaluate the acceptability, feasibility, and potential usefulness of a family-based SSI targeting improvements in family practices that prevent SUD.</p><p><strong>Methods: </strong>Participants were 9 young teens engaging in occasional SU or with a family history of SUD and their parent. The SSI involved a virtual 2-hour family consultation with a trained family coach. Acceptability was measured via Program Feedback Scale, feasibility via SSI completion rate, and potential usefulness via pre-post changes in parenting self-efficacy.</p><p><strong>Results: </strong>The SSI was acceptable to parents and teens (mean Program Feedback Scale scores ≥3) and feasible (8/9, 88.89% of parent-teen dyads completed the SSI). Among the 8 completing dyads, most participants (13/16, 81.25%) selected Communication and Problem Solving as their primary target for change. Parents reported increases in parenting self-efficacy from pre- to post-SSI.</p><p><strong>Conclusions: </strong>Findings support the SSI's acceptability and feasibility for young teens at high risk for SUD. A randomized clinical trial is needed to confirm the SSI's acceptability, feasibility, and efficacy, as well as to address potential for delivery by a lay workforce.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06538922; https://clinicaltrials.gov/study/NCT06538922.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e93263"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081006","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":"Using Student-Reported Digital Daily Logs and Human-Verified AI-Assisted Reflection Coding to Describe Clinical Experiences in Community-Based Clerkships: Exploratory Observational Mixed Methods Study.","authors":"Naoto Ozaki, Kiyoshi Shikino, Nobuyuki Araki, Hiroshi Tajima, Hajime Kasai, Ikuo Shimizu, Kazuyo Yamauchi, Shoichi Ito","doi":"10.2196/102390","DOIUrl":"10.2196/102390","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In Japan, the 2021 revision to the Medical Practitioners Act formally supported students' participation in supervised clinical practice. However, monitoring day-to-day clinical experiences across community-based clerkship sites remains challenging. Student-reported digital daily logs and reflection sheets provide complementary descriptive information across such sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate whether a digital educational data workflow, combining student-reported daily clinical activity logs with human-verified artificial intelligence (AI)-assisted reflection coding, can be used to describe clinical learning experiences across distributed community-based clerkship sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this exploratory observational study, we explored variations across placement contexts, including whether sites included community-based attending physicians (CAPs) trained in the university faculty development (FD) program. Data from 112 fifth-year medical students who had completed 3-week community-based clinical clerkships at sites with trained CAPs (n=34) or at sites without trained CAPs (n=78) were analyzed. Students recorded daily experiences of 50 Model Core Curriculum (MCC)-based clinical activities using a Google Spreadsheet-based digital daily log. The primary outcome was the number of student-reported examination-based, lower-risk clinical activity types recorded as performed at least once. Log completion, defined as the presence of any substantive daily log entry, was assessed across eligible student-days, and a classification-independent sensitivity analysis examined all 50 activity items. Reflection sheets were deductively coded according to MCC learning objectives using a human-verified AI-assisted preliminary sorting and candidate-coding workflow. Furthermore, exploratory sensitivity analyses examined the role of the placement context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Daily log entries were available for 1491 (99.6%) of 1497 eligible student-days. Students at sites with trained CAPs had more student-reported examination-based, lower-risk clinical activity types recorded as performed at least once than those at sites without trained CAPs. No statistically significant difference was observed for basic clinical and emergency procedures. The classification-independent analysis across all 50 items showed a similar pattern. Reflection sheet analysis yielded 4097 textual units. Placement category was closely associated with medically underserved placement, home visit exposure, and baseline rural self-efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The digital workflow yielded nearly complete student-reported daily data and described variation in clinical experiences across clerkship sites. These differences should be interpreted as variation across placement contexts rather than evidence of an independent effect of supervision by trained CAPs. Reflection sheets provi","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e102390"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080999","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":"Harnessing Data Warehousing for Precision in Off-Label Prescription Detection in Psychiatry (PSYHAMM): Retrospective Proof-of-Concept Evaluation Study.","authors":"Emmanuel Chevallier, Catherine Letord, Jean Charlet, Marie-Odile Krebs, Emmanuelle Advenier-Iakovlev, Stefan J Darmoni, Julien Grosjean, Romain Leguillon","doi":"10.2196/71516","DOIUrl":"10.2196/71516","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Off-label drug prescribing is prevalent across medicine, including psychiatry, often due to unmet therapeutic needs and inadequate responses to standard treatments. The PSYHAMM (Psychotropes Hors Autorisation de Mise sur le Marché) project, funded by the French Research Agency, investigates these practices. To support this research, a clinical data warehouse (CDW) with advanced data analysis tools was developed and deployed. This system integrates both structured and unstructured data from electronic health records, facilitating comprehensive data analysis. The goal is to improve understanding, regulation, and safety of off-label drug use in psychiatry by providing insights into prescribing patterns and their impacts, ultimately contributing to better clinical guidelines and patient care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the precision (positive predictive value) of a CDW in identifying candidate off-label prescriptions in psychiatry among the cases automatically flagged by the system, rather than its overall accuracy, sensitivity, or specificity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The PSYHAMM data analysis involved a retrospective study of pathology-medication pairs to evaluate the precision of a computerized system among system-flagged cases. This system was compared with manual checks performed by a psychiatrist. The evaluation process included verifying if the condition identified by PSYHAMM was documented in the medical record, assessing diagnostic agreement with tolerance for schizoaffective disorders, and ensuring the identified treatment was current or prescribed in the past. Precision was measured as the number of relevant documents retrieved divided by the total number of documents proposed and was computed for the precise diagnosis, the broad diagnosis, and the identified treatment among the flagged cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study analyzed 197 records, identifying 14 unique drug-pathology combinations. Bipolar disorder treated with sodium valproate represented the most cases (108/197, 54.8%), followed by schizophrenia treated with sodium valproate (37/197, 18.8%). The overall precision for detecting off-label situations was 51.3% (101/197). The precise diagnosis achieved a precision of 75.6% (149/197), while the broad diagnosis showed a higher precision of 84.8% (167/197). The identified treatment had a precision of 61.4% (121/197). The primary challenge was temporal discrepancies, such as distinguishing between acute and chronic conditions, which accounted for most of the 48.7% (96/197) of cases that were incorrectly classified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;As a single-center, proof-of-concept evaluation, the PSYHAMM project demonstrates the potential of automated systems to support the identification of off-label prescriptions in psychiatry as a sensitive prescreening step requiring expert validation. The relatively high false-positive rate was driven m","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e71516"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080941","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}