JMIR Formative Research最新文献

{"title":"Cognitive Fluctuations in a Rare Disease Population: Leveraging Cognitive and Speech Ecological Momentary Assessment in Individuals with Phenylketonuria.","authors":"Shifali Singh, Lisa Kluen, Katelin Curtis, Raquel Norel, Carla Agurto, Elizabeth Grinspoon, Zoe Hawks, Shawn Christ, Susan Waisbren, Guillermo Cecchi, Laura Germine","doi":"10.2196/63644","DOIUrl":"https://doi.org/10.2196/63644","url":null,"abstract":"<p><strong>Background: </strong>Phenylketonuria (PKU) is a rare, hereditary disease that causes disruption in phenylalanine (Phe) metabolism. Despite early intervention, individuals with PKU may have difficulty in several different cognitive domains, including verbal fluency, processing speed, and executive functioning.</p><p><strong>Objective: </strong>The overarching goal of the Evaluating Fluctuations in Cognitive and Speech Characteristics in Phenylketonuria study (CSP Study) is to characterize the relationships among cognition, speech, mood, and blood-based biomarkers (Phe, Tyr) in individuals with early treated PKU. We describe our initial optimization pilot results that are guiding the ongoing CSP Study, while establishing feasibility and reliability of using ecological momentary assessment (EMA) in this clinical population.</p><p><strong>Methods: </strong>Twenty adults with PKU were enrolled in this study between December 2022 and March 2023 through the National PKU Alliance. Eighteen participants completed an extended baseline assessment followed by six EMAs over one month. The EMAs included digital cognitive tests measuring processing speed, sustained attention, executive functioning, as well as speech (semantic fluency) and mood measures. Participants had 60 minutes to complete the assessment; completion rates were around 70% (on average 4.78 out of 6 EMAs).</p><p><strong>Results: </strong>Completion rates of EMAs were above 70%, with stable performances across baseline measures and EMAs. Between person reliability (BPR) of the EMAs, representing the variance due to differences between individuals versus within individuals, is satisfactory with values close to (semantic fluency BPR: 0.7, sustained attention BPR: 0.72) or exceeding (processing speed: 0.93, executive functioning: 0.88) those data collected from a large normative database (N= 5039-10703), as well as slightly below or matching a prior study using a clinical group (N=18). As applicable, within person reliability was also computed; we demonstrated strong reliability for processing speed (0.87). A control analyses ensured that time of day (i.e., morning, afternoon, evening) did not impact performance; performance on tasks did not decrease if tested earlier versus later in the day (all ps>0.09). Similarly, to assess variability in task performance over the course of all EMAs, the coefficient of variability was computed: 28% for the task measuring sustained attention, 37% percent for semantic fluency, 15.8 % for the task measuring executive functioning, and 17.6% for processing speed. Performance appears more stable in tasks measuring processing speed and executive functioning than on tasks of sustained attention and semantic fluency.</p><p><strong>Conclusions: </strong>Preliminary results of this study demonstrate strong reliability of cognitive EMA, indicating that EMA is a promising tool for evaluating fluctuations in cognitive status in this population. Future work should r","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615583","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":"Experiences With an In-Bed Real-Time Motion Monitoring System on a Geriatric Ward: Mixed Methods Study.","authors":"Stefan Walzer, Isabel Schön, Johanna Pfeil, Nicola Merz, Helga Marx, Sven Ziegler, Christophe Kunze","doi":"10.2196/63572","DOIUrl":"10.2196/63572","url":null,"abstract":"<p><strong>Background: </strong>Older adults now make up about two-thirds of hospital admissions, with up to 50% experiencing cognitive impairments such as dementia. These patients often struggle with adherence to care plans and maintaining regular day or night cycles, presenting challenges for nurses. Hospitals are typically unprepared to manage this patient population, resulting in increased nurse workload and challenges like managing motor agitation, which can lead to falls or accidental removal of medical devices.</p><p><strong>Objective: </strong>This study aimed to (1) assess how an in-bed real-time motion monitoring system (IRMS) impacts nurses' perceptions of physical and mental stress, (2) evaluate the IRMS's effect on the care process, (3) explore ethical implications like patient autonomy and privacy, and (4) understand how nurses acquire knowledge about the technology and how this affects their assessment of the IRMS.</p><p><strong>Methods: </strong>The IRMS, which provides real-time motion monitoring and bed edge or exit information, was implemented in the geriatric ward of a university medical center. The study followed a monocentric, explorative evaluation design using a mixed methods approach. It lasted 24 weeks and had two phases. In Phase 0 (6 weeks), patients received standard care. In Phase 1 (18 weeks), the IRMS was introduced. Initial data were gathered through focus groups and participant observations during manufacturer training sessions. At the end of the intervention, a survey, a second focus group, and an interview were conducted to capture nurses' experiences. The study follows the Good Reporting of a Mixed Method Study (GRAMMS) checklist for reporting.</p><p><strong>Results: </strong>Initial training sessions with 12 participants (10 nurses and 2 physiotherapists) showed varying levels of engagement, with the second session demonstrating more optimism and interprofessional collaboration. A total of 10 questionnaires were completed (10/21, 48%). Survey results showed that 80% (8/10) of nurses found the IRMS valuable for assessing the quality of work, and 90% (9/10) were willing to continue using it. The system was regarded as reliable for monitoring bed edge and exit events. Usability was positively rated, with minimal concerns about documentation burden. Focus group discussions (n=3 per session) indicated that nurses viewed the system as reliable and appreciated its role in reducing anxiety related to fall prevention. However, concerns about patient privacy and monitoring were raised. Nurses expressed a willingness to continue using the IRMS but reaffirmed their ability to care for patients without it.</p><p><strong>Conclusions: </strong>Nurses had a generally positive attitude toward the IRMS, recognizing its benefits, particularly for nighttime monitoring. Although its effectiveness in preventing falls remains inconclusive, the system helps reduce nurses' fear of falls and enhances their responsiveness. The study hi","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e63572"},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575830","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":"Daily Treatment Monitoring for Patients Receiving Home-Based Peritoneal Dialysis and Prediction of Heart Failure Risk: mHealth Tool Development and Modeling Study.","authors":"Jia Wu, Youjia Zeng, Jun Yang, Yutong Yao, Xiuling Xu, Gaofeng Song, Wuyong Yi, Taifen Wang, Yihou Zheng, Zhongwei Jia, Xiangyu Yan","doi":"10.2196/56254","DOIUrl":"10.2196/56254","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis is one of the major renal replacement modalities for patients with end-stage renal disease. Heart failure is a common adverse event among patients who undergo peritoneal dialysis treatment, especially for those who undergo continuous ambulatory peritoneal dialysis at home, because of the lack of professional input-output volume monitoring and management during treatment.</p><p><strong>Objective: </strong>This study aims to develop novel mobile health (mHealth) tools to improve the quality of home-based continuous ambulatory peritoneal dialysis treatment and to build a prediction model of heart failure based on the system's daily treatment monitoring data.</p><p><strong>Methods: </strong>The mHealth tools with a 4-layer system were designed and developed using Spring Boot, MyBatis Plus, MySQL, and Redis as backend technology stack, and Vue, Element User Interface, and WeChat Mini Program as front-end technology stack. Patients were recruited to use the tool during daily peritoneal dialysis treatment from January 1, 2017, to April 20, 2023. Logistic regression models based on real-time treatment monitoring data were used for heart failure prediction. The sensitivity, specificity, accuracy, and Youden index were calculated to evaluate the performance of the prediction model. In the sensitivity analysis, the ratio of patients with and without heart failure was set to 1:4 and 1:10, respectively, to better evaluate the stability of the prediction model.</p><p><strong>Results: </strong>A WeChat Mini Program named Futou Bao for patients and a patient data management platform for doctors was developed. Futou Bao included an intelligent data upload function module and an auxiliary function module. The doctor's data management platform consisted of 4 function modules, that is, patient management, data visualization and marking, data statistics, and system management. During the study period, the records of 6635 patients who received peritoneal dialysis treatment were uploaded in Futou Bao, with 0.71% (47/6635) of them experiencing heart failure. The prediction model that included sex, age, and diastolic blood pressure was considered as the optimal model, wherein the sensitivity, specificity, accuracy, and Youden index were 0.75, 0.91, 0.89, and 0.66, respectively, with an area under the curve value of 0.879 (95% CI 0.772-0.986) using the validation dataset. The sensitivity analysis showed stable results.</p><p><strong>Conclusions: </strong>This study provides a new home-based peritoneal dialysis management paradigm that enables the daily monitoring and early warning of heart failure risk. This novel paradigm is of great value for improving the efficiency, security, and personalization of peritoneal dialysis.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e56254"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575811","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":"App- and Wearable-Based Remote Monitoring for Patients With Myasthenia Gravis and Its Specialists: Feasibility and Usability Study.","authors":"Maike Stein, Regina Stegherr, Pushpa Narayanaswami, David Legg, Meret Herdick, Andreas Meisel, Lea Gerischer, Sophie Lehnerer","doi":"10.2196/58266","DOIUrl":"10.2196/58266","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Myasthenia gravis (MG) is rare, chronic autoimmune disorder of the neuromuscular junction that requires specialized care and often lifelong treatment, facing challenges due to its rarity and the limited availability of specialists. Telemedical solutions in specialized centers hold considerable promise in bridging this gap by increasing access to this care to a broader patient population in a timely manner. However, there is no research regarding interventional remote care solutions in the field of MG to date.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to assess the feasibility and usability among patients with MG and specialists of a telemedicine platform, tailored to patients with MG and designed to facilitate remote monitoring, treated in a specialized center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The telemedicine platform consisted of an app for patients and a web-based portal for physicians. Over a period of 3 months, 30 patients continuously monitored their vital parameters through external devices, including a digital spirometer and a wearable (activity tracker). Furthermore, patients completed 7 different patient-reported outcome measures (PROMs) through the app at predefined intervals. Specialists could review this monitoring data and adjust therapy as necessary. In addition, communication between patients and physicians was facilitated through a chat module. Feasibility was evaluated by total adherence rates for completing PROMs within the app, alongside the collection of spirometry and wearable data. Furthermore, user satisfaction was assessed among both patients with MG and physicians at the end of study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Total adherence rates ranged from 74.3% (1830/2464) to 97.9% (327/334) across all data types, with the highest adherence observed for PROMs (1139/1179, 96.6%), followed by spirometry (293/334, 87.7%) and wearables (1830/2261, 80.9%). Notably, patients wore the wearable longer than required by protocol and conducted a higher number of spirometry measurements during the study than required per protocol (median 20 h/d [IQR 15-24] vs 14 h/d and median 49 [IQR 15-59] measurements vs 11 measurements, respectively). Technical issues and discomfort with wearables were factors affecting lower adherence in some patients. The System Usability Scale yielded a median score of 85 indicating \"excellent usability.\" In addition, results from a more detailed user evaluation questionnaire showed high levels of user satisfaction among both patients and health care professionals across diverse categories, including their experience of the care program, communication, and evaluation of the program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Remote monitoring of patients with MG through the telemedical platform demonstrated good feasibility and acceptability, as evidenced by above-average adherence rates and user satisfaction for both patients and physicians. The majority of patients wanted to conti","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e58266"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596997","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":"Assessment of the Sensitivity of a Smartphone App to Assist Patients in the Identification of Stroke and Myocardial Infarction: Cross-Sectional Study.","authors":"Amar Dhand, Rama Mangipudi, Anubodh S Varshney, Jonathan R Crowe, Andria L Ford, Nancy K Sweitzer, Min Shin, Samuel Tate, Haissam Haddad, Michael E Kelly, James Muller, Jay S Shavadia","doi":"10.2196/60465","DOIUrl":"10.2196/60465","url":null,"abstract":"<p><strong>Background: </strong>Most people do not recognize symptoms of neurological and cardiac emergencies in a timely manner. This leads to delays in hospital arrival and reduced access to therapies that can open arteries. We created a smartphone app to help patients and families evaluate if symptoms may be high risk for stroke or heart attack (myocardial infarction, MI). The ECHAS (Emergency Call for Heart Attack and Stroke) app guides users to assess their risk through evidence-based questions and a test of weakness in one arm by evaluating finger-tapping on the smartphone.</p><p><strong>Objective: </strong>This study is an initial step in the accuracy evaluation of the app focused on sensitivity. We evaluated whether the app provides appropriate triage advice for patients with known stroke or MI symptoms in the Emergency Department. We designed this study to evaluate the sensitivity of the app, since the most dangerous output of the app would be failure to recognize the need for emergency evaluation. Specificity is also important, but the consequences of low specificity are less dangerous than those of low sensitivity.</p><p><strong>Methods: </strong>In this single-center cross-sectional study, we enrolled patients presenting with symptoms of possible stroke or MI. The ECHAS app assessment consisted of a series of evidence-based questions regarding symptoms and a test of finger-tapping speed and accuracy on the phone's screen to detect unilateral arm weakness. The primary outcome was the sensitivity of the ECHAS app in detecting the need for ED evaluation. The secondary outcome was the sensitivity of the ECHAS app in detecting the need for hospital admission. Two independent and blinded board-certified physicians reviewed the medical record and adjudicated the appropriateness of the ED visit based on a 5-point score (ground truth). Finally, we asked patients semistructured questions about the app's ease of use, drawbacks, and benefits.</p><p><strong>Results: </strong>We enrolled 202 patients (57 with stroke and 145 with MI). The ECHAS score was strongly correlated with the ground truth appropriateness score (Spearman correlation 0.41, P<.001). The ECHAS app had a sensitivity of 0.98 for identifying patients in whom ED evaluation was appropriate. The app had a sensitivity of 1.0 for identifying patients who were admitted to the hospital because of their ED evaluation. Patients completed an app session in an average of 111 (SD 60) seconds for the stroke pathway and 60 (SD 33) seconds for the MI pathway. Patients reported that the app was easy to use and valuable for personal emergency situations at home.</p><p><strong>Conclusions: </strong>The ECHAS app demonstrated a high sensitivity for the detection of patients who required emergency evaluation for symptoms of stroke or MI. This study supports the need for a study of specificity of the app, and then a prospective trial of the app in patients at increased risk of MI and stroke.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e60465"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541693","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":"Patients' Experience With Evaluation by Both a Musculoskeletal Physician and Physical Therapist in the Same Digital Visit: Survey Study.","authors":"Mary I O'Connor, Carolyn Chudy, Kaitlyn C Peters, Megan Ribaudo, Carrie McCulloch, Jared Aguilar, Trista Taylor, Ryan A Grant","doi":"10.2196/66744","DOIUrl":"10.2196/66744","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing evaluation for musculoskeletal concerns are often seen by a physician and physical therapist in the in-person setting in a sequential manner. This process typically delays the onset of nonoperative care, inclusive of physical therapy, and creates the risk of inadequate clinical collaboration between physician and physical therapist. To address these issues, we designed a novel initial patient evaluation to a group visit in which both a specialty-trained musculoskeletal physician and physical therapist simultaneously evaluate a patient together in the digital encounter.</p><p><strong>Objective: </strong>The aim of the study is to gain insights from patients on their experience with this innovative digital simultaneous musculoskeletal medical doctor and physical therapist (MD+PT) visit format for the initial evaluation of musculoskeletal concerns.</p><p><strong>Methods: </strong>An electronic 7-question survey was sent to 750 patients who completed an MD+PT visit asking them to comment on prior musculoskeletal evaluations and their experience with the MD+PT format.</p><p><strong>Results: </strong>In total, 195 (26%) patients responded to the survey with the frequent body regions of diagnosis being lumbar spine (n=65), knee (n=32), shoulder (n=21), cervical spine (n=20), hip (n=14), and hand (n=11). Most patients had prior musculoskeletal experience with a physician or nurse practitioner (171/195, 87.7%) or physical therapist (148/195, 75.9%) with nearly all such encounters in the in-person setting (161/171,94.2% for physician or nurse practitioner and 144/148, 97.3% for physical therapy). Only 3.1% (6/193) of patients reported seeing both a physician and physical therapist during the same in-person visit. Patients rated the simultaneous MD+PT visit very favorably: this type of digital evaluation saved them time (179/192, 93.2%) and permitted them to promptly start their treatment plan (174/192, 90.6%). Overall, 87.5% (168/192) rated the MD+PT visit as enjoyable, and 92.2% (177/192) responded that it increased their confidence with understanding their medical condition and how to start treating it.</p><p><strong>Conclusions: </strong>Our early experience with the evaluation of patients with musculoskeletal conditions by both a specialty-trained musculoskeletal physician and physical therapist simultaneously in the same digital visit resulted in patients reporting a very positive experience with high satisfaction, engagement, and confidence in understanding their diagnosis and how to start treating it.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e66744"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597007","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":"Text Messaging Interventions for Unhealthy Alcohol Use in Emergency Departments: Mixed Methods Assessment of Implementation Barriers and Facilitators.","authors":"Megan O'Grady, Laura Harrison, Adekemi Suleiman, Morica Hutchison, Nancy Kwon, Frederick Muench, Sandeep Kapoor","doi":"10.2196/65187","DOIUrl":"10.2196/65187","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many patients with unhealthy alcohol use (UAU) access health care in emergency departments (EDs). Scalable supports, such as SMS text messaging interventions, are acceptable and feasible to enhance care delivery for many health issues, including substance use. Further, SMS text messaging interventions have been shown to improve patient outcomes related to alcohol consumption (eg, reduced consumption compared to no intervention, basic health information, or drink tracking), but they are rarely offered in clinical settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This paper describes a mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The goal of this study was to use a stakeholder-engaged mixed methods design to assess barriers and facilitators to the implementation of SMS text messaging interventions for UAU in EDs with a focus on the recipient's characteristics, the innovation's degree of fit within the existing practice, and the unique nature of the inner and outer context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was conducted in a large health system in the northeastern United States. We examined electronic health record data on alcohol screening in 17 EDs; surveyed 26 ED physician chairpersons on implementation feasibility, acceptability, and appropriateness; and interviewed 18 ED staff and 21 patients to understand barriers and facilitators to implementation. Interviews were analyzed according to the i-PARIHS framework to assess recipient characteristics, innovation degree of fit, and inner and outer context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Electronic health record data revealed high variability in alcohol screening completion (mean 73%, range 35%-93%), indicating potential issues in identifying patients eligible to offer the intervention. The 26 ED chair surveys revealed a relatively high level of implementation confidence (mean 4, SD 0.81), acceptability (mean 4, SD 0.71), and appropriateness (mean 3.75, SD 0.69) regarding the UAU SMS text messaging intervention; feasibility (mean 3.5, SD 0.55) had the lowest mean, indicating concerns about integrating the text intervention in the busy ED workflow. Staff were concerned about staff buy-in and adding additional discussion points to already overwhelmed patients during their ED visit but saw the need for additional low-threshold services for UAU. Patients were interested in the intervention to address drinking and health-related goals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;ED visits involving UAU have increased in the United States. The results of this formative study on barriers and facilitators to the implementation of UAU SMS text messaging interventions in EDs indicate both promise and caution. In general, we found that staff viewed offering such interventions as appropriate and acceptable; however, there were concerns with feasibility (eg, low alcohol risk screening rates). Patients also","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e65187"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541886","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":"Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre- and Post-Follow-Up Study.","authors":"Chiara Samele, Norman Urquia, Rachel Edwards, Katie Donnell, Nihara Krause","doi":"10.2196/55603","DOIUrl":"10.2196/55603","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, particularly with rising rates of anxiety and depression in young people.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to assess the usability, acceptability, safety, and effectiveness of a new app, Clear Fear, developed to help young people manage symptoms of anxiety using the principles of cognitive behavioral therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Clear Fear app was developed to provide cognitive behavioral strategies to suit anxiety disorders. An uncontrolled pre- and post-follow-up design over a 9-week period was used to assess the app and its effects. This study comprised 3 phases: baseline (stage 1), post-app familiarization phase (stage 2), and follow-up (stage 3). Eligible participants were aged between 16 and 25 years with mild to moderate anxiety but not currently receiving treatment or in contact with specialist mental health services or using other interventions or apps to help monitor or manage their mental health. A community sample was recruited via advertisements, relevant websites, and social media networks. Eligible participants completed standardized self-report tools and questionnaires at each study stage. These measured probable symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (Mood and Feelings Questionnaire); emotional and behavioral difficulties (Strengths and Difficulties Questionnaire); and feedback on the usability, accessibility, and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon signed rank tests. Qualitative data derived from open-ended questions were coded and entered into NVivo (version 10) for analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 48 young people entered the study at baseline, with 37 (77%) completing all outcome measures at follow-up. The sample was mostly female (37/48, 77%). The mean age was 20.1 (SD 2.1) years. In total, 48% (23/48) of the participants reached the threshold for probable anxiety disorder, 56% (27/48) had positive scores for probable depression, and 75% (36/48) obtained a total score of \"very high\" on the Strengths and Difficulties Questionnaire for emotional and behavioral difficulties. The app was well received, offering reassurance, practical and immediate help to manage symptoms, and encouragement to seek help, and was generally found easy to use. A small minority (3/48, 6%) found the app difficult to navigate. The Clear Fear app resulted in statistically significant reductions in probable symptoms of anxiety (t&lt;sub&gt;36&lt;/sub&gt;=2.6, 95% CI 0.41-3.53; P=.01) and depression (z=2.3; P=.02) and behavioral and emotional difficulties (t&lt;sub&gt;47&lt;/sub&gt;=4.5, 95% CI 3.67-9.65; P&lt;.001), representing mostly medium to large standardized effect sizes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The Clear Fear app was found to be usable, acceptable, safe, and e","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e55603"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575755","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":"Development and Implementation of Strong Foundations, a Digitally Delivered Fall Prevention Program: Usability and Feasibility Pilot Exercise Cohort Study.","authors":"Ryan Moran, David Wing, Hope Davey, Hava Barkai, Jeanne Nichols","doi":"10.2196/67406","DOIUrl":"10.2196/67406","url":null,"abstract":"<p><strong>Background: </strong>Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility.</p><p><strong>Objective: </strong>This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance.</p><p><strong>Methods: </strong>The \"Strong Foundations\" program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention's (CDC's) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021.</p><p><strong>Results: </strong>A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9% and 24%, respectively; by week 12, 64% (23/36) of participants improved in the timed up and go and 91% (32/35) improved the chair stands.</p><p><strong>Conclusions: </strong>There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e67406"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523382","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 Distress Tolerance Skills in Adolescents With Anorexia Nervosa Through the BALANCE Mobile App: Feasibility and Acceptability Study.","authors":"Christina Miranda, Brittany Matheson, Nandini Datta, Aileen Whyte, Hyun-Joon Yang, Paul Schmiedmayer, Vishnu Ravi, Oliver Aalami, James Lock","doi":"10.2196/70278","DOIUrl":"10.2196/70278","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent anorexia nervosa, involving parents in renourishment and behavior interruption. Despite its effectiveness, challenges in distress tolerance and emotion regulation during high-stress situations, such as mealtimes, contribute to suboptimal treatment outcomes, with only 35% to 50% of adolescents achieving full recovery. Enhancing distress tolerance skills during FBT may improve treatment responses and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, dialectical behavior therapy (DBT)-based distress tolerance skills to support adolescents and families during mealtimes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our aim was to explore the feasibility and acceptability of a mobile app designed to deliver distress tolerance skills to adolescents with and adolescents without anorexia nervosa. When fully programmed and optimized, we plan to use the mobile app to improve distress tolerance during mealtimes for adolescents with anorexia nervosa undergoing FBT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;BALANCE was developed collaboratively with Stanford University's Center for Biodesign, leveraging the expertise of clinical psychologists and using biodesign student input and the Stanford Spezi ecosystem. The app underwent an iterative development process, with feedback from adolescent users. The initial feasibility and acceptability of the app were assessed through self-reported questionnaires and structured interviews with 24 adolescents aged 12 to 18 years, including 4 diagnosed with anorexia nervosa and 20 healthy controls. Adolescents with anorexia nervosa specifically used the app during mealtimes, and healthy controls used it as needed. Participants assessed the app's usability, perceived effectiveness, and its impact on their distress tolerance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The app demonstrated high usability and acceptability. Of 24 participants, 83% (n=20) reported enjoying the app, 88% (n=21) would recommend it to peers, and 100% (n=24) found it user-friendly. Adolescents with anorexia nervosa reported that BALANCE helped them manage stressful mealtimes more effectively, highlighting features such as guided meditation, breathing exercises, and gamification elements as particularly effective. Healthy controls provided additional feedback, confirming the app's broad appeal to the target audience and potential scalability. Preliminary findings suggest that BALANCE may enhance distress tolerance in adolescents with and adolescents without anorexia nervosa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;BALANCE shows promise as an innovative mobile health intervention for enhancing distress tolerance in adolescents with anorexia nervosa. Its user-friendly design and tailored DBT-based skills make it a f","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"9 ","pages":"e70278"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527778","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}