Journal of Medical Internet Research最新文献

{"title":"Consumer Engagement With Risk Information on Prescription Drug Social Media Pages: Findings From In-Depth Interviews.","authors":"Jacqueline B Amoozegar, Peyton Williams, Kristen C Giombi, Courtney Richardson, Ella Shenkar, Rebecca L Watkins, Amie C O'Donoghue, Helen W Sullivan","doi":"10.2196/67361","DOIUrl":"https://doi.org/10.2196/67361","url":null,"abstract":"<p><strong>Background: </strong>The volume of digital drug promotion has grown over time, and social media has become a source of information about prescription drugs for many consumers. Pharmaceutical companies currently present risk information about prescription drugs they promote in a variety of ways within and across social media platforms. There is scarce research on consumers' interactions with prescription drug promotion on social media, particularly on which features may facilitate or inhibit consumers' ability to find, review, and comprehend drug information. This is concerning because it is critical for consumers to know and weigh drug benefits and risks to be able to make informed decisions regarding medical treatment.</p><p><strong>Objective: </strong>We aimed to develop an understanding of the user interface (UI) and user experience (UX) of social media pages and posts created by pharmaceutical companies to promote drugs and how UI or UX design features impact consumers' interactions with drug information.</p><p><strong>Methods: </strong>We conducted in-person interviews with 54 consumers segmented into groups by device type (laptop or mobile phone), social media platform (Facebook or Instagram), and age. Interviewers asked participants to navigate to and review a series of 4 pages and 3 posts on their assigned device and platform. Interviewers encouraged participants to \"think aloud,\" as they interacted with the stimuli during a brief observation period. Following each observation period, participants were asked probing questions. An analyst reviewed video recordings of the observation periods to abstract quantitative interaction data on whether a participant clicked on or viewed risk information at each location it appeared on each page. Participants' responses were organized in a metamatrix, which we used to conduct thematic analysis.</p><p><strong>Results: </strong>Observational data revealed that 59% of participants using Facebook and 70% of participants using Instagram viewed risk information in at least 1 possible location on average across all pages tested during the observation period. There was not a single location across the Facebook pages that participants commonly clicked on to view risk information. However, a video with scrolling risk information attracted more views than other features. On Instagram, at least half of the participants consistently clicked on the highlighted story with risk information across the pages. Although thematic analysis showed that most participants were able to identify the official pages and risk information for each drug, auto-scrolling text and text size posed barriers to identification and comprehensive review for some participants. Participants generally found it more difficult to identify the drugs' indications than risks. Participants using Instagram more frequently reported challenges identifying risks and indications compared to those using Facebook.</p><p><strong>Conclusions: </st","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e67361"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach.","authors":"Si Chen, Omid V Ebrahimi, Cecilia Cheng","doi":"10.2196/70483","DOIUrl":"https://doi.org/10.2196/70483","url":null,"abstract":"<p><strong>Background: </strong>In the digital age, there is an emerging area of research focusing on digital well-being (DWB), yet conceptual frameworks of this novel construct are lacking. The current conceptualization either approaches the concept as the absence of digital ill-being, running the risk of pathologizing individual digital use, or follows the general subjective well-being framework, failing to highlight the complex digital nature at play.</p><p><strong>Objective: </strong>This preregistered study aimed to address this gap by using a network analysis, which examined the strength of the relationships among affective (digital stress and web-based hedonic well-being), cognitive (online intrinsic needs satisfaction), and social (online social connectedness and state empathy) dimensions of DWB and their associations with some major DWB protective and risk factors (ie, emotional regulation, nomophobia, digital literacy, self-control, problematic internet use, coping styles, and online risk exposure).</p><p><strong>Methods: </strong>The participants were 578 adults (mean age 38.7, SD 13.14 y; 277/578, 47.9% women) recruited from the United Kingdom and the United States who completed an online survey. Two network models were estimated. The first one assessed the relationships among multiple dimensions of DWB, and the second examined the relationships between DWB dimensions and related protective and risk factors.</p><p><strong>Results: </strong>The 2 resulting network structures demonstrated high stability, with the correlation stability coefficients being 0.67 for the first and 0.75 for the second regularized Gaussian graphical network models. The first network indicated that all DWB variables were positively related, except for digital stress, which was negatively correlated with the most central node-online intrinsic needs satisfaction. The second network revealed 2 distinct communities: digital competency and digital dependency. Emotional regulation emerged as the most central node with the highest bridge expected influence, positively associated with emotion-focused coping in the digital competency cluster and negatively associated with avoidant coping in the digital dependency cluster. In addition, some demographic differences were observed. Women scored higher on nomophobia (χ<sup>2</sup><sub>4</sub>=10.7; P=.03) and emotion-focused coping (χ<sup>2</sup><sub>4</sub>=14.9; P=.01), while men scored higher on digital literacy (χ<sup>2</sup><sub>4</sub>=15.2; P=.01). Compared with their older counterparts, younger individuals scored lower on both emotional regulation (Spearman ρ=0.27; P<.001) and digital self-control (Spearman ρ=0.35; P<.001) and higher on both digital stress (Spearman ρ=-0.14; P<.001) and problematic internet use (Spearman ρ=-0.25; P<.001).</p><p><strong>Conclusions: </strong>The network analysis revealed how different aspects of DWB were interconnected, with the cognitive component being the most influential. Emotiona","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e70483"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Competence of Arabic-Speaking Immigrant and Refugee Older Adults Enacting Agency and Navigating Barriers: Qualitative Descriptive Study.","authors":"Jordana Salma, Alesia Au, Ghada Sayadi, Manal Kleib","doi":"10.2196/60547","DOIUrl":"https://doi.org/10.2196/60547","url":null,"abstract":"<p><strong>Background: </strong>Canada's immigrant and refugee older adult population is projected to grow substantially, making equitable access to information and communications technologies (ICTs) vital for enhancing quality of life in older age. Strengthening the digital competence of immigrant and refugee older adults can improve their social connectedness and access to local information.</p><p><strong>Objective: </strong>This study explored the digital competence of Arabic-speaking immigrant and refugee older adults, focusing on how they engage with ICTs to meet their information and communication needs and the strategies they use to navigate digital barriers.</p><p><strong>Methods: </strong>A qualitative descriptive methodology within a social constructivist paradigm was adopted, incorporating triangulated data collection and iterative co-design cycles. The qualitative approach facilitated an in-depth exploration of participants' experiences, skills, and emotions and the contextual factors influencing their digital competence. Data were collected through storytelling approaches, qualitative interviews, and focus group discussions, which were effective in capturing the experiential aspects of aging and technology use. Co-design cycles informed 6 digital learning sessions tailored to participants' immediate learning needs, fostering motivation and engagement and allowing for observation of ICT use. Digital competence was mapped across the learning domains of the Digital Competence Framework for Citizens 2.2.</p><p><strong>Results: </strong>This study engaged 31 Arabic-speaking immigrant and refugee older adults residing in Canada. Most participants had limited formal education (19/31, 61%), lived with family (22/31, 70%), and reported a low income (21/31, 68%). All participants (31/31, 100%) used smartphones as their primary ICT device, whereas few (3/31, 10%) had access to a computer. In total, 3 themes were identified from the analysis, grounded in Digital Competence Framework for Citizens 2.2 competencies on information and data literacy, communication and collaboration, and safety and problem-solving. The themes focused on agency, which is enhanced or constrained using ICTs, impacting older adults' desire and ability to use these technologies to independently meet their daily needs.</p><p><strong>Conclusions: </strong>Immigrant and refugee older adults require support to navigate digital barriers and gain digital competence. Smartphones serve as a critical tool for enhancing digital agency, which can lead to greater social connectedness and improved access to local resources in older age. The findings will inform the design of future digital competence programs for older migrants, emphasizing community partnership and reciprocal learning.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e60547"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing Risks and Opportunities: Data-Empowered-Health Ecosystems.","authors":"Lan Li, Emma Back, Suna Lee, Rebecca Shipley, Néo Mapitse, Stefan Elbe, Melanie Smallman, James Wilson, Ifat Yasin, Geraint Rees, Ben Gordon, Virginia Murray, Stephen L Roberts, Anna Cupani, Patty Kostkova","doi":"10.2196/57237","DOIUrl":"https://doi.org/10.2196/57237","url":null,"abstract":"<p><p>This viewpoint paper addresses the ongoing challenges and opportunities within the data-for-health ecosystem, drawing insights from a multistakeholder workshop. Despite notable progress in the digitization of health care systems, data sharing and interoperability remain limited, so the full potential of health care data is not realized. There is a critical need for data ecosystems that can enable the timely, safe, efficient, and sustainable collection and sharing of health care data. However, efforts to meet this need face risks related to privacy, data protection, security, democratic governance, and exclusion. Key challenges include poor interoperability, inconsistent approaches to data governance, and concerns about the commodification of data. While emerging platforms such as social media play a growing role in gathering and sharing health information, their integration into formal data systems remains limited. A robust and secure data-for-health ecosystem requires stronger frameworks for data governance, interoperability, and citizen engagement to build public trust. This paper argues that reframing health care data as a common good, improving the transparency of data acquisition and processing, and promoting the use of application programming interfaces (APIs) for real-time data access are essential to overcoming these challenges. In addition, it highlights the need for international norms and standards guided by multisector leadership, given the multinational nature of data sharing. Ultimately, this paper emphasizes the need to balance risks and opportunities to create a socially acceptable, secure, and effective data-sharing ecosystem in health care.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e57237"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Clinically Significant Drug-Drug Interactions in Fatal Torsades de Pointes: Disproportionality Analysis of the Food and Drug Administration Adverse Event Reporting System.","authors":"Huanhuan Ji, Meiling Gong, Li Gong, Ni Zhang, Ruiou Zhou, Dongmei Deng, Ya Yang, Lin Song, Yuntao Jia","doi":"10.2196/65872","DOIUrl":"https://doi.org/10.2196/65872","url":null,"abstract":"<p><strong>Background: </strong>Torsades de pointes (TdP) is a rare yet potentially fatal cardiac arrhythmia that is often drug-induced. Drug-drug interactions (DDIs) are a major risk factor for TdP development, but the specific drug combinations that increase this risk have not been extensively studied.</p><p><strong>Objective: </strong>This study aims to identify clinically significant, high-priority DDIs to provide a foundation to minimize the risk of TdP and effectively manage DDI risks in the future.</p><p><strong>Methods: </strong>We used the following 4 frequency statistical models to detect DDI signals using the Food and Drug Administration Adverse Event Reporting System (FAERS) database: Ω shrinkage measure, combination risk ratio, chi-square statistic, and additive model. The adverse event of interest was TdP, and the drugs targeted were all registered and classified as \"suspect,\" \"interacting,\" or \"concomitant drugs\" in FAERS. The DDI signals were identified and evaluated using the Lexicomp and Drugs.com databases, supplemented with real-world data from the literature.</p><p><strong>Results: </strong>As of September 2023, this study included 4313 TdP cases, with 721 drugs and 4230 drug combinations that were reported for at least 3 cases. The Ω shrinkage measure model demonstrated the most conservative signal detection, whereas the chi-square statistic model exhibited the closest similarity in signal detection tendency to the Ω shrinkage measure model. The κ value was 0.972 (95% CI 0.942-1.002), and the P_positive and P_negative values were 0.987 and 0.985, respectively. We detected 2158 combinations using the 4 frequency statistical models, of which 241 combinations were indexed by Drugs.com or Lexicomp and 105 were indexed by both. The most commonly interacting drugs were amiodarone, citalopram, quetiapine, ondansetron, ciprofloxacin, methadone, escitalopram, sotalol, and voriconazole. The most common combinations were citalopram and quetiapine, amiodarone and ciprofloxacin, amiodarone and escitalopram, amiodarone and fluoxetine, ciprofloxacin and sotalol, and amiodarone and citalopram. Although 38 DDIs were indexed by Drugs.com and Lexicomp, they were not detected by any of the 4 models.</p><p><strong>Conclusions: </strong>Clinical evidence on DDIs is limited, and not all combinations of heart rate-corrected QT interval (QTc)-prolonging drugs result in TdP, even when involving high-risk drugs or those with known risk of TdP. This study provides a comprehensive real-world overview of drug-induced TdP, delimiting both clinically significant DDIs and negative DDIs, providing valuable insights into the safety profiles of various drugs, and informing the optimization of clinical practice.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e65872"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Digital Intelligent Interventions on Self-Management of Patients With Diabetic Foot: Systematic Review.","authors":"Jinyan Zhou, Shanni Ding, Yihong Xu, Hongying Pan","doi":"10.2196/64400","DOIUrl":"https://doi.org/10.2196/64400","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diabetic foot (DF) is one of the most common and serious complications of diabetes. Effective self-management by patients can delay disease progression and improve quality of life. Digital intelligent technologies have emerged as advantageous in assisting patients with chronic diseases in self-management. However, the impact of digital intelligent technologies on self-management of patients with DF remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This systematic review aimed to determine the effects of digital intelligent interventions on self-management in patients with DF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature search was conducted across PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trial, ProQuest, China National Knowledge Internet, WanFang, China Science and Technology Journal Database, and SinoMed up to February 6, 2025, to identify eligible articles. Randomized controlled trials (RCTs) that assessed the effects of digital intelligent interventions on self-management of patients with DF were included. In total, 2 researchers independently conducted literature screening, quality assessment, and data extraction. The Cochrane Risk of Bias 2.0 tool (revised version 2019) for RCTs was used to assess the quality of the studies. A qualitative synthesis was conducted on the extracted data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 1079 articles were retrieved, and 18 RCTs were included. All studies were rated as having a high risk of bias. The digital intelligent interventions in the included studies varied in forms, components, and durations. The intervention forms included WeChat (Tencent Holdings Limited; 7/18, 39%), apps (4/18, 22%), electronic platforms (3/18, 17%), mixed interventions (3/18, 17%), and smartphone thermography (1/18, 6%). The intervention components included self-management education (17/18, 94%), blood glucose and foot condition monitoring (8/18, 44%), self-management supervision and follow-up (6/18, 33%), and other components like foot risk assessment, foot care reminders, visit reminders, and remote consultations. Intervention durations ranged from 5 weeks to 12 months, with the majority (10/18, 56%) lasting 6 months. Among the 18 included studies, 17 studies (17/18, 94%) indicated that, compared with routine care, digital intelligent interventions significantly improved the self-management behaviors of patients with DF, including diabetes control, foot care behaviors, and blood glucose monitoring. Only 1 study (1/18, 6%) showed that the effects of digital intelligent interventions were not significantly different from those of routine care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this systematic review, evidence suggests that digital intelligent interventions can improve self-management behaviors and capabilities in patients with DF. However, due to the overall low quality of the in","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e64400"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of the Digital Health Literacy Questionnaire for Stroke Survivors: Exploratory Sequential Mixed Methods Study.","authors":"Qin Ye, Wei Wang, Xuan Zeng, Yuxian Kuang, Bingbing Geng, Song Zhou, Ning Liu","doi":"10.2196/64591","DOIUrl":"https://doi.org/10.2196/64591","url":null,"abstract":"<p><strong>Background: </strong>In China, there is limited research on digital health literacy (DHL) among patients with stroke. This is mainly due to the lack of validated tools, which hinders the precision and sustainability of our country's digital transformation.</p><p><strong>Objective: </strong>This study aimed to develop and validate a DHL scale specifically for stroke survivors in China.</p><p><strong>Methods: </strong>We used a sequential, exploratory, mixed methods approach to develop a DHL questionnaire for stroke survivors. This study comprised 418 patients with stroke aged 18 years and older. To evaluate the questionnaire's psychometric qualities, we randomly assigned individuals to 2 groups (subsample 1: n=118, subsample 2: n=300). Construct validity was evaluated through internal consistency analysis, exploratory and confirmatory factor analyses, hypothesis testing for structural validity, measurement invariance assessments using the eHealth Literacy Scale, and Rasch analyses to determine the questionnaire's validity and reliability.</p><p><strong>Results: </strong>This study underwent 4 stages of systematic development. The initial pool of items contained 25 items, 5 of which were eliminated after content validity testing; 19 items were subsequently retained through cognitive interviews. After an interitem correlation analysis, 2 more items were excluded, leaving 17 items for exploratory factor analysis. Finally, 2 items were excluded by Rasch analysis, resulting in a final version of the questionnaire containing 15 items. The total score range of the scale was 15-75, with higher scores indicating greater DHL competence. Results showed that principal component analysis confirmed the theoretical structure of the questionnaire (69.212% explained variance). The factor model fit was good with χ²₄=1.669; root mean square error of approximation=0.047; Tucker-Lewis Index=0.973; and Comparative Fit Index=0.977. In addition, hypothesis-testing construct validity with the eHealth Literacy Scale revealed a strong correlation (r=0.853). The internal consistency (Cronbach α) coefficient was 0.937. The retest reliability coefficient was 0.941. Rasch analysis demonstrated the item separation index was 3.81 (reliability 0.94) and the individual separation index was 2.91 (reliability 0.89).</p><p><strong>Conclusions: </strong>The DHL Questionnaire for Stroke Survivors is a reliable and valid measure to assess DHL among stroke survivors in China.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e64591"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating a Digital Health Tool Designed to Improve Low Sexual Desire in Women: Mixed-Methods Implementation Science Study.","authors":"Lori A Brotto, Kyle R Stephenson, Nisha Marshall, Mariia Balvan, Yaroslava Okara, Elizabeth A Mahar","doi":"10.2196/69828","DOIUrl":"https://doi.org/10.2196/69828","url":null,"abstract":"<p><strong>Background: </strong>Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While cognitive behavioral therapy and mindfulness-based therapy are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers cognitive behavioral therapy and mindfulness-based therapy skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious.</p><p><strong>Objective: </strong>The goal of the present implementation science study was to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance of Implementation) framework to assess the integration of eSense into several sexual health clinics. We chose the RE-AIM framework because it addresses both dissemination (eg, reach) and implementation of an intervention.</p><p><strong>Methods: </strong>A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on waitlists to receive sex therapy or sexual medicine care.</p><p><strong>Results: </strong>Per clinic outcomes, all aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics, reporting that offering eSense helped them overcome negative feelings associated with their long clinic waitlists. The majority expressed a need for eSense and could see how it overcame the limitations of traditional therapy. Nearly all expressed a wish to continue offering eSense to patients after the implementation study was complete. One caveat was that half of the clinics noted cost as a key issue for future implementation, and one-third noted that the administrative burden of implementing eSense as a standard of care may be challenging. For individual users, the majority expressed an interest in knowing more about eSense and a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related distress with no clinically meaningful change in other outcomes and a high level of satisfaction with eSense. Most also reported doing things differently in their sexual lives after participating in eSense.</p><p><strong>Conclusions: </strong>We found that eSense demonstrates potential as a digital intervention for sexual difficulties for women, particularly concerning its moderate implementation outcomes and also because of its ability to reduce sexual distress. Future studies should address the barriers identified for broader adoption of eSense in clinical settings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05168371; https://clinicaltrials.gov/study/NCT05168371.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e69828"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial.","authors":"Puneeta Tandon, Kathleen P Ismond, Graeme Purdy, Christofer Cruz, Evelyn Etruw, Kirsten Suderman, Ashley Hyde, Michael Stickland, John C Spence, Dale C Lien, Rahima Bhanji, Carla M Prado, Antonio Miguel-Cruz, Anil A Joy, Maryna Yaskina, Margaret L McNeely","doi":"10.2196/57537","DOIUrl":"10.2196/57537","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist-led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 216 participants, 202 (93.5%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4%; cancer: 126/202, 62.4%). Adherence exceeded a priori targets, with 82% (105/128) attending &gt;75% of the program elements including postintervention tests. Participants rated the program as \"quite a bit\" or \"very\" useful, with similar ratings between Heal-Me Light (56/64, 88%) and Heal-Me Intensive (51/58, 88%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The demonstrated satisfaction, adherence, and ef","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e57537"},"PeriodicalIF":5.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the Innovation Ecosystem: Overcoming Challenges to Introducing Information-Driven Technologies in Health Care.","authors":"Julie Reed, Petra Svedberg, Jens Nygren","doi":"10.2196/56836","DOIUrl":"https://doi.org/10.2196/56836","url":null,"abstract":"<p><p>As health care demands rise and resources remain constrained, optimizing health care systems has become critical. Information-driven technologies, such as data analytics and artificial intelligence (AI), offer significant potential to inform and enhance health care delivery at various levels. However, a persistent gap exists between the promise of these technologies and their implementation in routine practice. In this paper, we propose that fragmentation of the innovation ecosystem is behind the failure of new information-driven technologies to be taken up into practice and that these goals can be achieved by increasing the cohesion of the ecosystem. Drawing on our experiences and published literature, we explore five challenges that underlie current ecosystem fragmentation: (1) technology developers often focus narrowly on perfecting the technical specifications of products without sufficiently considering the broader ecosystem in which these innovations will operate; (2) lessons from academic studies on technology implementation are underused, and existing knowledge is not being built upon; (3) the perspectives of healthcare professionals and organizations are frequently overlooked, resulting in misalignment between technology developments and health care needs; (4) ecosystem members lack incentives to collaborate, leading to strong individual efforts but collective ecosystem failure; and (5) investment in enhancing cohesion between ecosystem members is insufficient, with limited recognition of the time and effort required to build effective collaborations. To address these challenges, we propose a series of recommendations: adopting a wide-lens perspective on the ecosystem; developing a shared-value proposition; fostering ecosystem leadership; and promoting local ownership of ecosystem investigation and enhancement. We conclude by proposing practical steps for ecosystem members to self-assess, diagnose, and improve collaboration and knowledge sharing. The recommendations presented in this paper are intended to be broadly applicable across various types of innovation and improvement efforts in diverse ecosystems.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e56836"},"PeriodicalIF":5.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}