Journal of Medical Internet Research最新文献

{"title":"Optimizing Vital Signs in Patients With Traumatic Brain Injury: Reinforcement Learning Algorithm Development and Validation.","authors":"Hongwei Zhang, Mengyuan Diao, Sheng Zhang, Peifeng Ni, Weidong Zhang, Chenxi Wu, Ying Zhu, Wei Hu","doi":"10.2196/63847","DOIUrl":"10.2196/63847","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a critically ill disease with a high mortality rate, and clinical treatment is committed to continuously optimizing treatment strategies to improve survival rates.</p><p><strong>Objective: </strong>This study aims to establish a reinforcement learning algorithm (RL) to optimize the survival prognosis decision-making scheme for patients with TBI in the intensive care unit.</p><p><strong>Methods: </strong>We included a total of 2745 patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database and randomly divided them into a training set and an internal validation set at 8:2. We extracted 34 features for analysis and modeling using a 2-hour time compensation, 2 action features (mean arterial pressure and temperature), and 1 outcome feature (survival status at 28 d). We used an RL algorithm called weighted dueling double deep Q-network with embedded human expertise to maximize cumulative returns and evaluated the model using a doubly robust off-policy evaluation method. Finally, we collected 2463 patients with TBI from MIMIC III as an external validation set to test the model.</p><p><strong>Results: </strong>The action features are divided into 6 intervals, and the expected benefits are estimated using a doubly robust off-policy evaluation method. The results indicate that the survival rate of artificial intelligence (AI) strategies is higher than that of clinical doctors (88.016%, 95% CI 85.191%-90.840% vs 81.094%, 95% CI 80.422%-81.765%), with an expected return of 28.978 (95% CI 28.797-29.160) versus 27.092 (95% CI 24.584-29.600). Compared with clinical doctors, AI algorithms select normal temperatures more frequently (36.56 °C to 36.83 ℃) and recommend mean arterial pressure levels of 87.5-95.0 mm Hg. In external validation, the AI strategy still has a high survival rate of 87.565%, with an expected return of 27.517.</p><p><strong>Conclusions: </strong>This RL algorithm for patients with TBI indicates that a more personalized and targeted optimization of the vital signs is possible. This algorithm will assist clinicians in making decisions on an individualized patient-by-patient basis.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e63847"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Problematic Online Dating: Systematic Review of Definitions, Correlates, and Study Designs.","authors":"Marina F Thomas, Sylvia Dörfler, Gloria Mittmann, Verena Steiner-Hofbauer","doi":"10.2196/72850","DOIUrl":"10.2196/72850","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Users describe mobile dating apps as addictive, and researchers have attempted to formalize compulsive dating app use as a behavioral addiction. However, the concept of online dating addiction remains debated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This systematic literature review synthesized quantitative research on problematized online dating behaviors with a specific focus on (1) definitions and measurement of problematic dating app use, (2) the examined adverse correlates, and (3) study designs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;From 16 databases, we identified 263 reports related to problematic online dating. Twenty-nine papers-published between 2009 and 2024-met inclusion criteria. They covered 32 quantitative studies investigating problematic dating app use. Sample sizes varied between 64 and 4057, and participant ages ranged between 13 and 80 years, while many participants were aged between 18 and 35 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Researchers problematized the following online dating behaviors (in descending order of frequency): use for certain motives (in 10 reports), problematic use in the sense of behavioral addiction (n=9), specific activities or experiences (n=9), compulsive use (n=6), a disbalance between offline and online interactions (too many or too few online interactions, n=4), and mere use or frequency (n=4). Even using dating apps for sexual motivations and relationship-seeking was linked to adverse correlates. Scholars have examined adverse correlates, including (1) mood and emotional issues (n=11), (2) anxieties (n=9), (3) user motives and other media variables (n=9), (4) undesired behaviors (n=8), (5) personality (n=8), (6) self-attitudes (n=7), (7) partner choice (n=5), (8) sexuality (n=5), and (9) interpersonal correlates (n=4). Methodologically, the most common scales (measuring use for certain motives and the 6-component behavioral addiction items) include life problems within their measurement of problematic dating app use (eg, use to forget problems and conflict due to use). Of 32 studies, only 3 were randomized experiments. All surveys measured dating app variables only at a single time point (cross-sectionally) and focused on between-person effects rather than within-person dynamics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Research on user motives dominates the field. To understand harmful media effects, researchers should measure media use and harmful consequences separately. However, motives are often worded as coping with an undesired state (eg, use to forget problems) or enhancing a desired state (eg, use for self-esteem enhancement). Similarly, behavioral addiction scales include life problems (eg, conflict due to use). These scales thus conflate predictor and outcome. Future literature reviews or meta-analyses that examine associations should include only results of scales that validly distinguish media use from its adverse outcomes. Overall, research on internet dating addictio","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e72850"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Inflammatory Bowel Disease Discourse on Reddit Throughout the COVID-19 Pandemic Using OpenAI's GPT-3.5 Turbo Model: Classification Model Validation and Case Study.","authors":"Tyler Babinski, Sara Karley, Marita Cooper, Salma Shaik, Y Ken Wang","doi":"10.2196/53332","DOIUrl":"10.2196/53332","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) is a chronic autoimmune disorder with an increasing prevalence in the general population. Internet-based communities have become vital for communication among patients with IBD, especially throughout the COVID-19 pandemic. However, these internet-based patient-to-patient communications remain largely underexplored.</p><p><strong>Objective: </strong>This study aims to analyze community posts from 3 of the largest IBD support groups on Reddit between March 1, 2020, and December 31, 2022, using a pretrained transformer model, and to validate the classification system's results via comparison to human scoring.</p><p><strong>Methods: </strong>We collected posts (N=53,333) from subreddits r/CrohnsDisease, r/UlcerativeColitis, and r/IBD and classified them using OpenAI's GPT-3.5 Turbo model to determine sentiment, categorize topics, and identify demographic information and mentions of the COVID-19 pandemic. A subset of posts (n=397) was manually scored to measure interrater agreement between human raters and the GPT-3.5 Turbo model.</p><p><strong>Results: </strong>Fleiss κ and Gwet AC1 coefficients indicated a high level of agreement between raters, with values ranging from 0.53 to 0.91. The raters demonstrated almost perfect agreement on the classification of gender, with a Fleiss κ of 0.91 (P<.001). Medications (14,909/53,333) and symptoms (14,939/53,333) emerged as the most discussed topics, and most posts conveyed a neutral sentiment. While most users did not disclose their age, those who did primarily belonged to the 20-29 years (2392/4828) and 30-39 years (859/4828) age groups. Based on self-reported gender, we identified 1509 men and 1502 women among our IBD Reddit users. When comparing the users on the IBD subreddits to the general IBD population, there was a significant difference in gender distribution (N=3,090,011; χ²₂=69.53; P<.001; φ<0.001). After an initial spike in posts within the first month, most posts did not reference the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>Our study showcases the potential of generative pretrained transformer models in processing and extracting insights from medical social media data. Future research can benefit from further subanalyses of our validated dataset or use OpenAI's model to analyze social media data for other conditions, particularly those for which patient experiences are challenging to collect.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e53332"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recruiting Asian Americans for Online Studies: Methodological Systematic Review.","authors":"Fang Lei, Fei-Fei Huang, Ying Jiang","doi":"10.2196/71765","DOIUrl":"10.2196/71765","url":null,"abstract":"<p><strong>Background: </strong>Engaging Asian American participants in research studies helps to understand their health needs and health disparities better. However, recruiting Asian Americans for online studies remains challenging.</p><p><strong>Objective: </strong>This study aims to synthesize strategies for recruiting Asian Americans to research studies that collected data online and to further explore the characteristics of the recruited participants.</p><p><strong>Methods: </strong>A systematic review method was used. Data were searched in the PubMed, CINAHL, and OVID databases using Medical Subject Headings (MeSH) terms and title search strategies. A narrative synthesis was conducted to summarize strategies for recruiting Asian Americans to online research studies. An independent Student t test (2-tailed and unpaired) was performed to compare the characteristics of recruited Asian Americans, using SPSS 29.0 software. The study was reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist.</p><p><strong>Results: </strong>After data extraction, 18 studies were included in this review. Results showed that strategies for recruiting Asian Americans to research studies that collected data online included both online and offline methods. Online recruitment methods included online survey market services, social media groups, online advertisements, and email lists. Offline recruitment methods included churches, community organizations, local clinics, health care centers, American Cancer Society local chapters, and cancer registries. Among the online and offline recruitment methods, social media groups and community recruitment were the most frequently used, respectively. The most commonly used online study platform was self-designed project websites. Participants engaged in the online studies tended to be in their middle adulthood and have a high level of education beyond high school. Compared with those recruited offline, participants recruited online tended to be younger and more highly educated.</p><p><strong>Conclusions: </strong>This study suggests that researchers may use mixed recruitment methods, combining both online and offline approaches, to recruit Asian Americans to online studies. When selecting the recruitment venue, researchers should consider project budget, data security, data quality, and credibility. They should also be aware of the distinct characteristics of participants recruited online versus offline.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e71765"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone Usage Patterns and Sleep Behavior in Demographic Groups: Retrospective Observational Study.","authors":"Ting Wang, Anja Seiger, Alexander Markowetz, Ionut Andone, Konrad Błaszkiewicz, Thomas Penzel","doi":"10.2196/60423","DOIUrl":"10.2196/60423","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although previous studies have examined the relationship between smartphone usage and sleep disorders, research on demographic differences in smartphone usage and nocturnal smartphone inactivity patterns remains limited. This study introduces \"nocturnal smartphone inactivity duration\" as a proxy indicator to address the limitation of lacking direct sleep data and to further investigate the association between smartphone usage patterns and sleep characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate demographic differences and relationships between daily smartphone usage and nocturnal smartphone inactivity patterns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective analysis of data collected from the Murmuras app from January 1, 2022, to December 31, 2022. A total of 1074 participants were included, categorized by gender, age, highest degree, employment status, and smartphone usage purpose. All participants consented to participate in the study through the app. To explore the relationship between smartphone usage and nocturnal smartphone inactivity, we first calculated each participant's daily smartphone usage duration (including app usage) and duration of nocturnal smartphone inactivity; then, we assessed the normality and homogeneity of variance tests within each demographic category. Based on the results, the Kruskal-Wallis tests were applied to potentially identify differences between groups. Finally, correlation and regression analyses were conducted to explore associations between smartphone usage and nocturnal smartphone inactivity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The findings revealed distinct patterns of smartphone use across demographics. Participants predominantly used smartphones for social contact (average daily usage duration=1.52 h) and recreational activities (average daily usage duration=1.08 h) through apps like Facebook and YouTube. Frequent users, especially of social media and entertainment, often increased their phone usage at night. Female participants used their phones more frequently, mainly for digital shopping and social interactions, whereas male participants used phones more at nighttime (P&lt;.001). Both younger users and non-full-time employees engaged more in activities such as gaming and chatting (P&lt;.01 for those comparisons). Higher education was correlated with lower use (P&lt;.001). Those using smartphones for work-related purposes generally decreased their phone usage after work (P&lt;.05 for those comparisons). Correlation and regression analyses of smartphone usage duration and nighttime inactivity across groups indicated that only a small subset of groups exhibited significant positive correlations, a moderate number displayed significant negative correlations, and the majority showed no significant correlation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study underscores the significant association between demographic factors and smartphone usage p","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e60423"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Quality of Primary Care Electronic Health Record Data in Australia and Canada: Case Study in Osteoarthritis.","authors":"Sharmala Thuraisingam, D Himasara Marasinghe, Kendra Barrick, Fariba Aghajafari, Jo-Anne Manski-Nankervis, Michelle M Dowsey, Hude Quan, Tyler Williamson, Stephanie Garies","doi":"10.2196/69631","DOIUrl":"10.2196/69631","url":null,"abstract":"<p><strong>Background: </strong>General practice electronic health records (EHRs) contain a wealth of patient information. However, these data are collected for clinical purposes. Hence, questions remain around the suitability of using these data for other purposes, including epidemiological research, developing and validating clinical prediction models, conducting audits, and informing policy.</p><p><strong>Objective: </strong>This study aimed to compare the quality of osteoarthritis-related data in Australian and Canadian general practice EHRs for externally validating a clinical prediction model for total knee replacement surgery.</p><p><strong>Methods: </strong>A data quality assessment was conducted on 201,462 patient general practice EHRs from Australia provided by National Prescribing Service MedicineWise, and 92,425 from Canada provided by the Canadian Primary Care Sentinel Surveillance Network. Completeness, plausibility, and external validity of data elements relevant to osteoarthritis were assessed. Completeness and plausibility were evaluated using counts and proportions. For external validity, prevalence was estimated using proportions, and knee replacement summarized as a rate per 100,000 population.</p><p><strong>Results: </strong>There were minimal incomplete and implausible data fields for age and sex (<1%), geographic location (<5%), and commonly cooccurring comorbidities (<10%) in both datasets. However, weight, height, BMI, and Canadian Index of Multiple Deprivation contained >50% missing data. The recording of osteoarthritis by age and sex in both datasets were similar to national estimates, except for patients aged >80 years (Australia: 16.6%, 95% CI 16%-17.3% vs 13.1%, 95% CI 11.2%-15.4%; Canada: 36.7%, 95% CI 36.1%-37.2% vs 50.8%, 95% CI 50.7%-50.9%). Total knee replacement rates were substantially lower in both EHR datasets compared with national estimates (Australia: 72 vs 218 per 100,000; Canada: 0.84 vs 200 per 100,000).</p><p><strong>Conclusions: </strong>Age, sex, geographic location, commonly cooccurring comorbidities, and prescribing of osteoarthritis medications in Australian and Canadian general practice EHRs are suitable for use in clinical prediction model validation studies. However, BMI and the Canadian Index of Multiple Deprivation are unfit for such use due to large proportions of missing data. Rates of total knee replacement surgery were substantially underreported and should not be used for prediction model validation. Better harmonization of patient data across primary and tertiary care is required to improve the suitability of these data. In the meantime, data linkage with national registries and other health datasets may overcome some of the data quality challenges in general practice EHRs.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e69631"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Smart Health Care Service Using Metaverse and Chatbot Technologies for Adolescents, Parents, and School Health Teachers: User-Centered Design Approach.","authors":"Hana Kim, Jae-Heon Kang, Yeeun Kwon, Che Eun Kim, Jung Han Yu, Hyo Seung Nam, Jisan Lee","doi":"10.2196/69190","DOIUrl":"10.2196/69190","url":null,"abstract":"<p><strong>Background: </strong>Adolescent health issues, particularly obesity, have become increasingly serious, highlighting the need for health management strategies tailored to the unique life cycle characteristics of adolescents.</p><p><strong>Objective: </strong>This study aimed to develop a smart health care service for adolescents, their parents, and school health teachers to enhance their health.</p><p><strong>Methods: </strong>The service leverages a mobile app, a web platform, wearable devices, the metaverse, and chatbots. The development process included a needs assessment, core user interface (UI) design, and service model creation. The needs assessment involved a literature review of 65 studies, a web survey of 96 participants, and 30 interviews. A usability evaluation of the core UI, shaped by the insights from the needs assessment, was conducted with 76 participants.</p><p><strong>Results: </strong>The service was conceptualized emphasizing school settings to cater to school-aged users, ensuring that the design is closely aligned with user needs. In addition, it incorporates features to deliver personalized services based on individual health information and uses gamification elements to enhance user engagement. The core UI was developed in response to the needs assessment findings, supported by a user flowchart. Furthermore, we created a use case diagram illustrating the interaction between various users and the services, a flowchart outlining the service algorithm, and a lifelog data collection system. The core UI usability evaluation results revealed that both students and parents considered sleep management important, while school health teachers deemed the measurement of physical activity essential. Students and parents prioritized physical activity measurement, and students particularly favored rewards for activities as the most promising solutions for health management challenges. The outcomes of the core UI usability evaluation indicated that school health teachers rated effectiveness (mean 4.26, SD 0.41), usefulness (mean 4.18, SD 0.54), usability (mean 4.29, SD 0.55), and user control (mean 4.08, SD 0.60) highly, reflecting the highest expectations across all categories.</p><p><strong>Conclusions: </strong>This study demonstrated that a school-based smart health care service can effectively support adolescent health management by integrating personalized health data, gamification, and interactive tools. The usability evaluation revealed that students and parents prioritized sleep and physical activity tracking, while school health teachers emphasized the importance of monitoring physical activity. In addition, reward-based engagement strategies were identified as a promising approach to improve adolescent health behaviors. These findings suggest that leveraging digital health solutions tailored to adolescents' needs can contribute to establishing sustainable health habits from an early age.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e69190"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality and Privacy Policy Compliance of Mental Health Care Apps in China: Cross-Sectional Evaluation Study.","authors":"Xinying Lin, Xingxing Wu, Ziping Zhu, Danting Chen, Hong Li, Rong Lin","doi":"10.2196/66762","DOIUrl":"10.2196/66762","url":null,"abstract":"<p><strong>Background: </strong>The global prevalence of mental health issues such as depression and anxiety is escalating, yet access to high-quality care remains severely limited. Although mental health care apps can enhance outcomes, their handling of highly sensitive personal data poses significant privacy risks.</p><p><strong>Objective: </strong>This study systematically investigated Chinese mental health care apps, assessing their quality and privacy policy compliance through an integrated framework of the Information Security Technology-Personal Information Security Specification (GB/t 35273-2020) and the Mobile App Rating Scale (MARS).</p><p><strong>Methods: </strong>A comprehensive search on the Chinese iOS and Android platforms identified apps for evaluation by 2 independent reviewers. Each app was assessed for general characteristics, professional context, functionality, quality, and privacy policy compliance using a previously published privacy policy compliance scale and the MARS.</p><p><strong>Results: </strong>A comprehensive analysis of the 115 identified apps revealed that all provided privacy policy links on their marketplace interfaces. Of these 115 apps, 104 (90.4%) displayed policy reminders during log-in, but only 85 (73.9%) implemented policy pop-ups or required active user confirmation. The average privacy policy compliance score across the 115 apps was 60.83% (SD 21.75%), with the highest average compliance in general characteristics (80.58%, SD 19.01%) and the lowest in information destruction (49.57%, SD 28.67%). Only 2 (1.7%) of the 115 apps notified third parties to promptly delete personal information. The mean MARS score was 3.41 (SD 0.26), indicating generally good app quality. A significantly positive correlation was found between MARS total scores and overall privacy policy compliance (r=0.354; P<.01), with the strongest associations observed for information destruction (r=0.405; P<.01) and data sharing or transfer (r=0.324; P<.01).</p><p><strong>Conclusions: </strong>Although privacy policy compliance in Chinese mental health care apps is at a moderate level, superficial personal information protections, inadequate implementation, and poor transparency in information destruction persist. The findings indicate that enhancing privacy policy compliance can significantly improve app quality and user engagement. Therefore, China's internet content regulators should establish robust enforcement and oversight systems to strengthen the supervision of mental health care apps, elevating their privacy policy compliance to ensure the sustainable development of high-quality apps with enhanced privacy protection standards.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e66762"},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ecological Momentary Assessment of the Quality of Life and Self-Efficacy Among People With a Stoma: Longitudinal Study.","authors":"William Goodman, Matthew Allsop, Amy Downing, Julie Munro, Gill Hubbard, Rebecca J Beeken","doi":"10.2196/57427","DOIUrl":"10.2196/57427","url":null,"abstract":"<p><strong>Background: </strong>When a stoma is formed, people with a stoma have to adjust to managing this on a daily basis. There are a number of factors that can impact their self-efficacy to self-manage and their quality of life, including complications with their stoma, body image concerns, stigma, and the changes to their daily routine. Ecological momentary assessment studies in other populations have suggested that these constructs may vary over short periods of time and could be influenced by contextual factors. We, however, do not currently understand how context-specific factors such as what an individual is doing, who they are with, or where they are could impact upon quality of life and self-efficacy in people with a stoma.</p><p><strong>Objective: </strong>This study aimed to understand whether quality of life and self-efficacy fluctuated over time and whether contextual factors (eg, activity, location, or company) and time of day were associated with quality of life and self-efficacy over the course of a week.</p><p><strong>Methods: </strong>A smartphone-based ecological momentary assessment study was conducted over a 7-day period with measurements taken 3 times a day (morning, afternoon, and evening). Measures included demographic and clinical characteristics of age, gender, and time with a stoma, and self-reported self-efficacy and quality of life in the moment rated from 0 to 100 (with 100 being the best). Multilevel modeling was conducted due to the clustering of responses within individuals, with models run for both self-efficacy and quality of life.</p><p><strong>Results: </strong>In total, 62 participants completed the ecological momentary assessment protocol. Null multilevel models indicated that both self-efficacy and the quality of life varied over time, with around 35% of total variance explained by within-person variability, which suggests that there are intraindividual fluctuations over time. Results indicated that, for the self-efficacy model, people reporting from home had higher levels of self-efficacy than those outside the home (β=-3.8, 95% CI -6.4 to -1.3). In the quality of life model, there was increasing levels of quality of life throughout the day (afternoon: β=2.0, 95% CI 0.8-3.2, evening: β=3.9, 95% CI 2.6-5.2).</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is the first study to use ecological momentary assessment in this population. These findings indicate that, among people with a stoma, self-efficacy and quality of life do vary from moment to moment. Furthermore, contextual factors such as location and time of day are associated with self-efficacy and quality of life. There is a need to explore how future self-management interventions could enhance self-efficacy to self-manage outside of the home environment, with the potential for more dynamic and tailored interventions.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e57427"},"PeriodicalIF":5.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Women Discuss Heavy Menstrual Bleeding in Online Forums (\"It's Like Revenge of the Uterus\"): Template Approach to Thematic Analysis.","authors":"Emily Jade Young, Heather Mary Kirk","doi":"10.2196/73532","DOIUrl":"10.2196/73532","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Heavy menstrual bleeding (HMB) is a common condition that affects approximately 20% to 30% of women globally. However, despite significant physical, mental, and social impacts on the quality of life of women who experience HMB, they face barriers to both diagnosis and treatment. With current challenges to female reproductive autonomy growing on a global scale and with the stigma that surrounds menstruation, women with HMB may turn to online communities to access peer support and information. Online forums such as Reddit, which support the use of anonymous posting, may offer a space where those affected by HMB can share their experiences, seek support, and offer advice to others.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore how those experiencing HMB use Reddit to share experiential knowledge, provide support, and share experiences of HMB within an online community space.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were collected from discussion threads on the TwoXChromosomes subreddit on Reddit. Publicly accessible posts were identified through a systematic search conducted on August 13 and 14, 2024, using keywords related to HMB. A template approach to thematic analysis was used to analyze the data. A priori codes were developed from existing literature on HMB and the research objective. The template was refined after further examination of the transcripts, with all transcripts being analyzed using the final template.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search initially identified 434 discussion threads. Threads were screened for relevance and user engagement, resulting in a final 13 (2.99%) threads being analyzed for this research. These comprised 1505 individual comments from 1115 unique users. Four central themes were identified: validation and camaraderie, life impacts of HMB, practical support, and medical treatment and management. In the validation and camaraderie theme, users frequently shared personal experiences and validated the experiences of others, challenging the normalization of debilitating symptoms and creating a shared sense of solidarity. When discussing the life impacts of HMB, users emphasized how it disrupts daily functioning, including work, relationships, and mental well-being, and poses serious physical health risks. In the theme of practical support, Reddit users exchanged strategies for managing symptoms, including recommending specific menstrual products, home and workplace adaptations and adjustments, and self-advocacy. The final theme of medical treatment and management explored Reddit users' frustration with health care experiences, particularly around the prioritization of fertility over quality of life. Hormonal contraception, intrauterine devices, and surgical interventions were discussed with varying degrees of satisfaction and concern. Overall, Reddit users reported a general dismissal of HMB within medical and social contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Reddi","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e73532"},"PeriodicalIF":5.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}