Journal of Medical Internet Research最新文献

{"title":"Impact of Social Media Influencers on Amplifying Positive Public Health Messages.","authors":"Gerard Thomas Flaherty, Ryan Michael Mangan","doi":"10.2196/73062","DOIUrl":"https://doi.org/10.2196/73062","url":null,"abstract":"","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e73062"},"PeriodicalIF":5.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674184","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":"Profiling Generalized Anxiety Disorder on Social Networks: Content and Behavior Analysis.","authors":"Linah Alhazzaa, Vasa Curcin","doi":"10.2196/53399","DOIUrl":"https://doi.org/10.2196/53399","url":null,"abstract":"<p><strong>Background: </strong>Despite a dramatic increase in the number of people with generalized anxiety disorder (GAD), a substantial number still do not seek help from health professionals, resulting in reduced quality of life. With the growth in popularity of social media platforms, individuals have become more willing to express their emotions through these channels. Therefore, social media data have become valuable for identifying mental health status.</p><p><strong>Objective: </strong>This study investigated the social media posts and behavioral patterns of people with GAD, focusing on language use, emotional expression, topics discussed, and engagement to identify digital markers of GAD, such as anxious patterns and behaviors. These insights could help reveal mental health indicators, aiding in digital intervention development.</p><p><strong>Methods: </strong>Data were first collected from Twitter (subsequently rebranded as X) for the GAD and control groups. Several preprocessing steps were performed. Three measurements were defined based on Linguistic Inquiry and Word Count for linguistic analysis. GuidedLDA was also used to identify the themes present in the tweets. Additionally, users' behaviors were analyzed using Twitter metadata. Finally, we studied the correlation between the GuidedLDA-based themes and users' behaviors.</p><p><strong>Results: </strong>The linguistic analysis indicated differences in cognitive style, personal needs, and emotional expressiveness between people with and without GAD. Regarding cognitive style, there were significant differences (P<.001) for all features, such as insight (Cohen d=1.13), causation (Cohen d=1.03), and discrepancy (Cohen d=1.16). Regarding personal needs, there were significant differences (P<.001) in most personal needs categories, such as curiosity (Cohen d=1.05) and communication (Cohen d=0.64). Regarding emotional expressiveness, there were significant differences (P<.001) for most features, including anxiety (Cohen d=0.62), anger (Cohen d=0.72), sadness (Cohen d=0.48), and swear words (Cohen d=2.61). Additionally, topic modeling identified 4 primary themes (ie, symptoms, relationships, life problems, and feelings). We found that all themes were significantly more prevalent for people with GAD than for those without GAD (P<.001), along with significant effect sizes (Cohen d>0.50; P<.001) for most themes. Moreover, studying users' behaviors, including hashtag participation, volume, interaction pattern, social engagement, and reactive behaviors, revealed some digital markers of GAD, with most behavior-based features, such as the hashtag (Cohen d=0.49) and retweet (Cohen d=0.69) ratios, being statistically significant (P<.001). Furthermore, correlations between the GuidedLDA-based themes and users' behaviors were also identified.</p><p><strong>Conclusions: </strong>Our findings revealed several digital markers of GAD on social media. These findings are significant and could contribute ","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e53399"},"PeriodicalIF":5.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670124","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":"Spatiotemporal and Behavioral Patterns of Men Who Have Sex With Men Using Geosocial Networking Apps in Shenzhen From Mobile Big Data Perspective: Longitudinal Observational Study.","authors":"Lan Wei, Yongsheng Wu, Lin Chen, Jinquan Cheng, Jin Zhao","doi":"10.2196/69569","DOIUrl":"https://doi.org/10.2196/69569","url":null,"abstract":"<p><strong>Background: </strong>The use of geosocial networking apps is linked to increased risky sexual behaviors among men who have sex with men, but their relationship with HIV and other sexually transmitted infections remains inconclusive. Since 2015, the prevalence of app use among men who have sex with men in Shenzhen has surged, highlighting the need for research on their spatiotemporal and behavioral patterns to inform targeted prevention and intervention strategies.</p><p><strong>Objective: </strong>This study aims to investigate the population size, spatiotemporal and behavioral patterns, and mobility of app-using men who have sex with men in Shenzhen using mobile big data. The goal is to inform enhanced and innovative intervention strategies and guide health resource allocation.</p><p><strong>Methods: </strong>By leveraging mobile big data application technology, we collected demographic and geographic location data from 3 target apps-Blued (Blued Inc), Jack'd (Online Buddies Inc), and Zank (Zank Group)-over continuous time periods. Spatial autocorrelation (Global Moran I) and hot spot analysis (Getis-Ord Gi) were used to identify the geographic clusters. The Geodetector tool (Chinese Academy of Sciences) was adopted to measure spatially stratified heterogeneity features.</p><p><strong>Results: </strong>From September 2017 to August 2018, a total of 158,387 males aged 15-69 years in Shenzhen used one of the 3 apps, with the majority (71,318, 45.03%) aged 25-34 years. The app user-to-male ratio was approximately 2.6% among all males aged 15-69 years. The estimated population of app-using men who have sex with men in Shenzhen during this period was 268,817. The geographic distribution of app-using men who have sex with men in Shenzhen was clustered, with hot spots primarily located in central and western Shenzhen, while the distribution of HIV testing and counseling was more concentrated in central-eastern Shenzhen. Approximately 60,202 (38%) app-using men who have sex with men left Shenzhen during the Spring Festival, and 37,756 (62.7%) of them returned after the holiday. The destination distribution showed a relatively centralized flow throughout the country, with the largest mobility within Guangdong province (67.7%), followed by lower mobility to Hunan province (7.9%) and other neighboring provinces (3%-5%), such as Jiangxi, Guangxi, and Hubei Provinces.</p><p><strong>Conclusions: </strong>Shenzhen has a large population of men who have sex with men. The variation and inconsistent spatiotemporal distribution of app use and HIV testing and counseling emphasize the need to adapt traditional venue-based prevention and intervention to identified hot spots and to launch outreach initiatives that extend beyond traditional healthcare settings. Given the relatively high internal and interprovincial mobility of app-using men who have sex with men, further smartphone-based behavioral monitoring could provide valuable insights for developing en","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e69569"},"PeriodicalIF":5.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670126","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":"Contextualizing Changes in e-Cigarette Use During the Early COVID-19 Pandemic and Accompanying Infodemic (\"So Much Contradictory Evidence\"): Qualitative Document Analysis of Reddit Forums.","authors":"Shannon Lea Watkins, Katherine Snodgrass, Lexi Fahrion, Emily Shaw","doi":"10.2196/66010","DOIUrl":"https://doi.org/10.2196/66010","url":null,"abstract":"<p><strong>Background: </strong>Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health responses during times of uncertainty. While some risk factors for COVID-19 susceptibility and severity (eg, old age) were clear, whether e-cigarette use increased risk was not clear. People who used e-cigarettes had to navigate both the COVID-19 infodemic and a conflicting, politicized, and changing information environment about the interaction between COVID-19 and e-cigarette use.</p><p><strong>Objective: </strong>This study aims to characterize and contextualize e-cigarette-related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision-making.</p><p><strong>Methods: </strong>We conducted a qualitative analysis of COVID-19-related e-cigarette discussions on 3 Reddit forums about e-cigarettes. We collected 189 relevant discussion threads made in the first 6 months of the pandemic (collected from June 27, 2020, to July 3, 2020). Threads included 3155 total comments (mean 17 comments) from approximately 1200 unique Redditors. We developed and applied emergent codes related to e-cigarette perceptions and behaviors (eg, the role of nicotine in COVID-19 and do-it-yourself narratives) and web-based community interactions (eg, advice), identified thematic patterns across codes, and developed a model to synthesize the socioecological context of e-cigarette behaviors.</p><p><strong>Results: </strong>e-Cigarette subreddits provided a platform for Redditors to discuss perceptions and experiences with e-cigarettes, make sense of information, and provide emotional support. Discussions reflected an array of e-cigarette-related behavioral responses, including increases and decreases in use intensity, changes in purchasing practices (eg, stockpiling), and changes in vaping practices (eg, reusing disposable pods). This study presented a theoretically and empirically informed model of how circumstances created by the pandemic (eg, changes in activity space and product shortages) compelled behavior changes. Redditors drew from their existing perceptions, intentions, and experiences with nicotine and tobacco products; their personal pandemic experiences; and their participation on Reddit to decide whether and how to change their e-cigarette behaviors during the early pandemic. Forums reflected uncertainty, stress, and debate about the rapidly evolving and complicated public health information. Consumption and discussion of media (eg, news articles and peer-reviewed publications) on Reddit informed e-cigarette perceptions and behaviors. Decisions were complicated by distrust of the media.</p><p><strong>Conclusions: </strong>Variations in individual traits and environmental circumstances during the early COVID-19 pandemic provide context for why there was no unified direction of e-cigarette behavior change during this period. Information ","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e66010"},"PeriodicalIF":5.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670121","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":"Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis.","authors":"Jacinta Brinsley, Edward J O'Connor, Ben Singh, Grace McKeon, Rachel Curtis, Ty Ferguson, Georgia Gosse, Iris Willems, Pieter-Jan Marent, Kimberley Szeto, Joseph Firth, Carol Maher","doi":"10.2196/56975","DOIUrl":"https://doi.org/10.2196/56975","url":null,"abstract":"<p><strong>Background: </strong>There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior.</p><p><strong>Objective: </strong>The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes.</p><p><strong>Methods: </strong>A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics.</p><p><strong>Results: </strong>Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] -0.37; P<.001), a small effect on anxiety (SMD -0.29; P<.001) and stress (SMD -0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted.</p><p><strong>Conclusions: </strong>Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity.</p><p><strong>Trial","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e56975"},"PeriodicalIF":5.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670123","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":"Effect of a Telemedicine Model on Patients With Heart Failure With Reduced Ejection Fraction in a Resource-Limited Setting in Vietnam: Cohort Study.","authors":"Hoai Thi Thu Nguyen, Hieu Ba Tran, Phuong Minh Tran, Hung Manh Pham, Co Xuan Dao, Thanh Ngoc Le, Loi Doan Do, Ha Quoc Nguyen, Thom Thi Vu, James Kirkpatrick, Christopher Reid, Dung Viet Nguyen","doi":"10.2196/67228","DOIUrl":"https://doi.org/10.2196/67228","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a complex, life-threatening condition marked by high morbidity, mortality, reduced functional capacity, poor quality of life, and substantial health care costs. HF with reduced ejection fraction (HFrEF) represents the subgroup of HF with the highest risks of mortality and hospitalization, necessitating the prioritization of care and management models to optimize treatment outcomes in these patients. Currently, data on the effectiveness of telemedicine models in resource-limited settings, such as low- and middle-income countries, are scarce.</p><p><strong>Objective: </strong>This study aimed to evaluate the impact of telemedicine on improving prognosis in patients with HFrEF in Vietnam.</p><p><strong>Methods: </strong>In this prospective cohort study, we recruited patients who received either remote monitoring and management (telemedicine) or standard monitoring and management (usual care) in the outpatient department of the Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam. Eligible patients were ≥18 years old, had a diagnosis of HFrEF defined as left ventricular ejection fraction (LVEF) ≤40%, had a history of HF hospitalization within the past 12 months, and presented with clinical symptoms classified as New York Heart Association (NYHA) II or III. The primary composite outcome was defined as the time to the first unplanned HF hospitalization or all-cause mortality. The follow-up period for all outcomes extended to 12 months.</p><p><strong>Results: </strong>In total, 426 patients (298/426, 70% male; 128/426, 30% female) with a mean age of 61.3 (SD 14.6) years and a mean LVEF of 32.1% (SD 6.0%) were included in our study. Of these patients, 121 received telemedicine care, while 305 received usual care. The primary outcome occurred in 23 (23/121, 19%) patients in the telemedicine group and 82 (82/305, 26.9%) patients in the usual care group during the follow-up period, indicating a significant reduction in risk (adjusted hazard ratio [aHR] 0.57, 95% CI 0.35-0.94; P=.03). However, this effect was primarily driven by a significant reduction in unplanned HF hospital admissions (aHR 0.57, 95% CI 0.33-0.98; P=.04) rather than in all-cause mortality (aHR 0.77, 95% CI 0.36-1.63; P=.49).</p><p><strong>Conclusions: </strong>This study demonstrates that a simplified telemedicine model, even in resource-limited settings such as Vietnam, can effectively facilitate the remote monitoring and management of patients with HFrEF, resulting in significant reductions in HF-related hospitalizations and all-cause mortality.</p><p><strong>Trial registration: </strong>National Agency for Science and Technology Information (NASATI), Vietnam CT07/01-2022-3; https://nsti.vista.gov.vn/projects/dth/xay-dung-mo-hinh-theo-doi-va-tu-van-suc-khoe-tim-mach-tu-xa-tai-thanh-pho-ha-noi-109276.html.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e67228"},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663774","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":"Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama \"Secure Voucher\" Study Cluster Randomized Controlled Trial.","authors":"Trinity Vey, Eleonora Kinnicutt, Andrew G Day, Nicola West, Jessica Sleeth, Kenneth Bernard Nchimbi, Karen Yeates","doi":"10.2196/51524","DOIUrl":"https://doi.org/10.2196/51524","url":null,"abstract":"<p><strong>Background: </strong>Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention.</p><p><strong>Objective: </strong>This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania.</p><p><strong>Methods: </strong>This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data.</p><p><strong>Results: </strong>The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers.</p><p><strong>Conclusions: </strong>The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e51524"},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663781","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 Perceptions of the CANreduce 2.0 eHealth Intervention for Cannabis Use: Focus Group Study.","authors":"Daniel Folch-Sanchez, Maria Pellicer-Roca, María Agustina Sestelo, Paola Zuluaga, Francisco Arias, Pablo Guzmán Cortez, Salma Amechat, Gustavo Gil-Berrozpe, Estefania Lopez Montes, Clara Mercadé, Francina Fonseca, Laia Miquel, Joan I Mestre-Pintó","doi":"10.2196/65025","DOIUrl":"https://doi.org/10.2196/65025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cannabis is the most widely used illicit drug, and admissions for cannabis use disorders (CUDs) are increasing globally, posing a significant public health challenge. Despite its negative consequences, a substantial proportion of individuals with problematic use do not seek treatment. In recent years, digital health interventions (DHIs) have emerged as accessible and cost-effective solutions, empowering users to manage their health care. CANreduce is one such eHealth intervention that has demonstrated effectiveness in reducing cannabis use (CU); however, its suboptimal adherence rates underscore the need for strategies to enhance user engagement and motivation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to improve the effectiveness, adherence, and user experience of the Spanish version of CANreduce 2.0 by employing focus groups (FGs) within a user-centered design approach that actively involves both users and professionals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Separate FGs were conducted for users and professionals, involving a total of 10 participants. Users were recruited from individuals registered on the CANreduce 2.0 platform and active cannabis users, while professionals comprised addiction specialists familiar with the platform. Each session was held remotely and moderated by 2 interviewers following a semistructured script. Qualitative analysis of the transcripts was performed using MAXQDA software and content analysis methodology to identify key themes related to the acceptability, usability, and utility of CANreduce 2.0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The qualitative analysis identified 3 main themes, encompassing 15 subcodes. Within the \"motivation and awareness\" theme, both users (n=6, mean age 31.8 years, SD 4.1 years) and professionals (n=4, mean age 37.25 years, SD 1.71 years) frequently discussed the importance of \"motivation\" and \"problem awareness\" as crucial for the success of CANreduce 2.0. In the \"guidance and use\" theme, the subcode \"complement to face-to-face therapy\" was the most emphasized. Professionals supported CANreduce 2.0 as a valuable adjunct to in-person therapy, serving as both an educational and monitoring tool, with no objections raised by either group. Lastly, within the \"content and design\" theme, \"information,\" \"small achievements,\" and \"personalized content\" emerged as key areas for improvement, highlighting the need to enhance motivation and adherence through gamification and tailored content.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Personalization, robust motivational strategies, and an engaging, interactive design are essential for the success of DHIs, particularly in addiction treatment. Collaboration among technology developers, health care professionals, and users should be central to the development process, fostering the cocreation of practical and effective solutions that are responsive to the needs of those seeking treatment. This approach ensures that DHIs are not o","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e65025"},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663775","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":"Machine Learning-Based Explainable Automated Nonlinear Computation Scoring System for Health Score and an Application for Prediction of Perioperative Stroke: Retrospective Study.","authors":"Mi-Young Oh, Hee-Soo Kim, Young Mi Jung, Hyung-Chul Lee, Seung-Bo Lee, Seung Mi Lee","doi":"10.2196/58021","DOIUrl":"https://doi.org/10.2196/58021","url":null,"abstract":"<p><strong>Background: </strong>Machine learning (ML) has the potential to enhance performance by capturing nonlinear interactions. However, ML-based models have some limitations in terms of interpretability.</p><p><strong>Objective: </strong>This study aimed to develop and validate a more comprehensible and efficient ML-based scoring system using SHapley Additive exPlanations (SHAP) values.</p><p><strong>Methods: </strong>We developed and validated the Explainable Automated nonlinear Computation scoring system for Health (EACH) framework score. We developed a CatBoost-based prediction model, identified key features, and automatically detected the top 5 steepest slope change points based on SHAP plots. Subsequently, we developed a scoring system (EACH) and normalized the score. Finally, the EACH score was used to predict perioperative stroke. We developed the EACH score using data from the Seoul National University Hospital cohort and validated it using data from the Boramae Medical Center, which was geographically and temporally different from the development set.</p><p><strong>Results: </strong>When applied for perioperative stroke prediction among 38,737 patients undergoing noncardiac surgery, the EACH score achieved an area under the curve (AUC) of 0.829 (95% CI 0.753-0.892). In the external validation, the EACH score demonstrated superior predictive performance with an AUC of 0.784 (95% CI 0.694-0.871) compared with a traditional score (AUC=0.528, 95% CI 0.457-0.619) and another ML-based scoring generator (AUC=0.564, 95% CI 0.516-0.612).</p><p><strong>Conclusions: </strong>The EACH score is a more precise, explainable ML-based risk tool, proven effective in real-world data. The EACH score outperformed traditional scoring system and other prediction models based on different ML techniques in predicting perioperative stroke.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e58021"},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663778","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":"Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study.","authors":"Gabriele Kerr, Geva Greenfield, Edmond Li, Thomas Beaney, Benedict W J Hayhoe, Josip Car, Ana Clavería, Claire Collins, Gustavo Gusso, Robert D Hoffman, Geronimo Jimenez, Tuomas H Koskela, Liliana Laranjo, Heidrun Lingner, Ensieh Memarian, Katarzyna Nessler, Davorina Petek, Rosy Tsopra, Azeem Majeed, Ana Luisa Neves","doi":"10.2196/65147","DOIUrl":"10.2196/65147","url":null,"abstract":"<p><strong>Background: </strong>Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis.</p><p><strong>Objective: </strong>This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability.</p><p><strong>Methods: </strong>Primary care physicians (PCPs) from 20 upper-middle- and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V.</p><p><strong>Results: </strong>A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001).</p><p><strong>Conclusions: </strong>Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.2196/30099.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e65147"},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656817","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}