Journal of Medical Internet Research最新文献

{"title":"Transformative Impact of the Internet on the Boundaries for the Physician Profession: Why Materiality Matters.","authors":"Lena Petersson","doi":"10.2196/63305","DOIUrl":"10.2196/63305","url":null,"abstract":"<p><strong>Unlabelled: </strong>Over the last 25 years, the health care sector has undergone a digital transformation; health issues and medical conditions are increasingly managed with the support of digital health technology. The internet has transformed the boundaries around physicians' work, which raises questions about how technological artifacts are transforming the boundaries that have traditionally existed between the health care professions and patients regarding information and knowledge. This viewpoint paper analyzes how digital health technologies can transform the boundaries of physicians' work by examining 3 examples of technology aimed at patients or citizens: Open Notes, PatientsLikeMe, and Apple Watch. Traditionally, the physician profession drew the boundaries that separated it from other professions and patients to define and protect its jurisdiction and professional knowledge. However, in the 3 artifacts analyzed, technology changes the boundaries between laypeople and physicians. Therefore, health technologies aimed at citizens impact health care and its professions, and the materiality of artifacts can change the boundaries between physicians and citizens. Thus, the initiators and developers of technology aimed at patients or citizens may have the power to transform the field of knowledge in health care.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e63305"},"PeriodicalIF":6.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145123980","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":"Digital Health Literacy in the General Population: National Cross-Sectional Survey Study.","authors":"Junghee Yoon, Seongwoo Yang, Soo Jin Kang, Mangyeong Lee, Dokyoon Kim, Joungwon Park, Su Jin Kim, Jiyoon Han, Jungin Joo, Juhee Cho","doi":"10.2196/67780","DOIUrl":"10.2196/67780","url":null,"abstract":"<p><strong>Background: </strong>As the rapid advancement of digital health technologies has significantly improved health management, digital health literacy (DHL) has emerged as a crucial determinant of health outcomes.</p><p><strong>Objective: </strong>The aim of this study was to assess DHL among Korean adults using a task-based assessment tool and to examine how sociodemographic and health literacy factors are associated with DHL, with the goal of identifying vulnerable groups and informing equitable digital health strategies.</p><p><strong>Methods: </strong>This cross-sectional survey was conducted from July 20 to July 31, 2022, among adults aged 19 years and older in South Korea. Participants were recruited nationally, with those younger than 55 years completing an online survey and those aged 55 years and older participating in face-to-face interviews to address the digital divide. Participants' DHL was assessed using the 34-item Digital Health Technology Literacy Assessment Questionnaire, a tool designed to evaluate practical task-based competencies.</p><p><strong>Results: </strong>Among 1041 Korean adults, 27.8% (n=289) demonstrated low DHL, with the largest gaps observed in mobile app use and critical evaluation of health information. The mean DHL score (on a 100-point scale) was 73.8 (SD 29.7). The high and low DHL groups scored 90.3 (SD 35.6) and 31.5 (SD 20.0), respectively. Specifically, only 49 (17%) of the low DHL group were able to sign up for an app, compared with 716 (95.2%) in the high DHL group. Similarly, 52 (18%) of the low DHL group could update an app, whereas 712 (94.7%) could in the high DHL group. Multivariate analysis revealed that older age (≥60 years), lower income (≤US $2000/month), unemployment, and inadequate general health literacy were significantly associated with lower DHL, highlighting the need to target modifiable factors beyond age.</p><p><strong>Conclusions: </strong>This study highlights the ongoing digital health disparities, emphasizing the need for tailored strategies in mobile apps and digital health technologies. Addressing modifiable factors such as health literacy is key to ensuring equitable access and the effective use of digital health resources.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e67780"},"PeriodicalIF":6.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124923","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":"Internet Usage, Social Participation, and Depression Symptoms Among Middle-Aged and Older Adult Chinese Individuals Before and During the COVID-19 Pandemic: Evidence From the China Health and Retirement Longitudinal Observational Study.","authors":"Siqian Zhang, Shiju Dong, Zexuan Yu, Shuwen Bi, Wen Wen, Jiajia Li","doi":"10.2196/67039","DOIUrl":"10.2196/67039","url":null,"abstract":"<p><strong>Background: </strong>While the relationship between internet usage and depression, and the mediating role of social participation in this association, has garnered significant attention, the COVID-19 pandemic has disrupted traditional forms of social participation. The extent to which this disruption has altered the association remains underexplored.</p><p><strong>Objective: </strong>This study aims to examine the impact of internet usage on depressive symptoms among middle-aged and older adults and to assess how the mediating role of social participation differs before and during the COVID-19 pandemic.</p><p><strong>Methods: </strong>Data for this study were sourced from the fourth wave (2018: 15,326 observations) and the fifth wave (2020: 15,758 observations) of the China Health and Retirement Longitudinal Study. A 2-way fixed-effects model incorporating an instrumental variable was employed to investigate the relationship between internet usage and depressive symptoms among middle-aged and older adults. Furthermore, a mediation effect model was applied following propensity score matching to assess changes in the mediating role of social participation on the relationship between internet usage and depressive symptoms before and during the pandemic, as well as to explore changes in 3 internet usage functions. Subgroup analyses based on age and urban-rural residence were performed to assess heterogeneity in this association.</p><p><strong>Results: </strong>The average Center for Epidemiological Studies Depression Scale (CESD-10) score among middle-aged and older Chinese people increased from 1.94 in 2018 to 1.98 in 2020. Internet usage was negatively associated with depressive symptoms (β=-.041; P<.01), with social participation serving as a partial mediator. The proportion of the mediating effect of social participation on the relationship between distinct internet usage functions and depression shifted during the pandemic: the social function declined from 12.55% in 2018 to 9.30% in 2020, while the informational and recreational function increased from 7.53% and 11.29% in 2018 to 8.85% and 16.37% in 2020, respectively. Both the total and indirect effects were statistically significant across subgroups, with a higher mediation proportion observed among rural residents and women than among urban residents and men.</p><p><strong>Conclusions: </strong>Internet usage was negatively associated with depressive symptoms among middle-aged and older adults. Despite a noticeable increase in depression scores in 2020 compared with 2018, the mediating effect of social participation diminished, while the direct effect of internet usage became more pronounced during the pandemic. These findings underscore the need to prioritize mental health recovery in this population, promote diverse forms of social participation, and leverage the internet's potential to enhance social participation and mental well-being.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e67039"},"PeriodicalIF":6.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191162","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":"Reflections on the Optimal Use of eDiaries for Data Collection in Vaccine Clinical Trials.","authors":"Ujwani Nukala, Sylvia Cho, Aneesha Suresh Sahu, Jessica Zhou, Whitney R Steele, Barbee I Whitaker, Hussein Ezzeldin","doi":"10.2196/66971","DOIUrl":"10.2196/66971","url":null,"abstract":"<p><strong>Unlabelled: </strong>Recent years have witnessed a transformative shift in the way patient-reported outcomes are captured. The increasing adoption of digital health technologies offers exciting possibilities for more efficient, engaging, and insightful data collection electronically. Regulators recommend that the source data captured electronically should adhere to Attributable, Legible, Contemporaneous, Original, and Accurate principles to ensure data quality and integrity and be compliant with regulatory requirements. Traditionally, paper diaries are used to collect safety data in clinical trials; however, electronic forms of these paper diaries represent a paramount resource that could improve data quality, reduce costs, and limit the burden on clinical staff and trial participants. Electronic diaries (eDiaries) offer significant advantages, but specific measures must be taken to ensure their optimal use. In this paper, we provide our reflections on key measures, such as programming the eDiary platform, training the trial staff and participants, and real-time monitoring of participant compliance, to leverage eDiaries for optimal data collection. By implementing the measures discussed in this paper, eDiaries can offer significant advantages for both trial participants and clinical investigators by ensuring the quality and integrity of the data collected.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e66971"},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092169","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":"Research Implications of Increased Political Oversight in the United States.","authors":"Kayleigh-Ann Clegg","doi":"10.2196/83499","DOIUrl":"10.2196/83499","url":null,"abstract":"","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e83499"},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113410","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":"Reality Check: The Aspirations of the European Health Data Space Amidst Challenges in Decentralized Data Analysis.","authors":"Holger Fröhlich, Anne Funck Hansen, Mika Hilvo, Gunther Jansen, Sumit Madan, Sobhan Moazemi, Sanziana Negreanu, Venkata Satagopam, Phil Gribbon, Christian Muehlendyck","doi":"10.2196/76491","DOIUrl":"10.2196/76491","url":null,"abstract":"<p><strong>Unlabelled: </strong>The European Health Data Space (EHDS) aspires to enable secure, interoperable, and decentralized health data usage across Europe. This paper explores legal and technical challenges in implementing EHDS goals, particularly for secondary data use. It highlights federated and swarm learning as promising yet complex solutions, requiring robust infrastructure, standardization, and regulatory clarity. We emphasize the need for coordinated legislative and technological advances to realize EHDS ambitions.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e76491"},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092120","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":"Implementation of a Virtual Hospital in the Home Service for Patients With COVID-19 in Queensland, Australia: Mixed Methods Evaluation Using the RE-AIM Framework.","authors":"Linh Khanh Vo, Hannah E Carter, Steven M McPhail, Kelly McGowan, Shannon Wallis, Kate Atkinson, Michelle J Allen","doi":"10.2196/73749","DOIUrl":"10.2196/73749","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hospital in the home (HITH) provides home-based care as an alternative to traditional hospitalization. In response to the COVID-19 Omicron wave, a public hospital in the rural Western portion of Southeast Queensland implemented a virtual HITH service to support adults, maternity patients, and children with moderate COVID-19 symptoms and additional health concerns. Although the pandemic accelerated the uptake of virtual care within HITH models, existing literature has focused on clinical outcomes, with limited evidence on key implementation outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, this study evaluated the implementation of the virtual COVID-19 HITH service and identified factors influencing its implementation, to inform ongoing service development and support potential scaling of this model of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The RE-AIM implementation science framework was selected to guide the evaluation, capturing both clinical and contextual dimensions of implementation at both individual and organizational levels. Quantitative data on service usage and costs were retrospectively extracted from electronic medical records and finance records, while patient experience data were drawn from patient-reported experience measures surveys. Qualitative data were collected through one-on-one interviews with patients and staff. All data sources were analyzed separately and then triangulated within the RE-AIM framework to understand what occurred, how, and why.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The service admitted 3192 patients, most of whom were female (2027/3192, 63.5%), English-speaking (3140/3192, 98.4%), and residing in socioeconomically disadvantaged areas (1879/3192, 58.9%) (reach). The model was feasible and safe to implement, managing 3240 admissions with no reported deaths. Patients valued continuous access to care and described better recovery experiences at home (effectiveness). Staff viewed the model as appropriate for identifying and managing high-risk patients in the community, easing pressure on hospital beds (adoption). The service cost Aus $ 5.4 million (US $3.5 million) over 11 months. Implementation barriers included the urgency of the pandemic scenario, limited infrastructure and human resources, and changing requirements in relation to COVID-19. These were mitigated by several people factors that were critical to its successful implementation, including a consultant-led structure, staff commitment, and adaptability (implementation). The service saved 16,651 inpatient bed days before being integrated into core HITH operations. The experience strengthened staff capabilities in emergency response, virtual care delivery, and strategic planning. The model shows promise for broader application into pediatric care, though further work is needed to enhance interdepartmental collaboration and staff recognition (m","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e73749"},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092138","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":"Maturity Framework for Operationalizing Machine Learning Applications in Health Care: Scoping Review.","authors":"Yutong Li, Julie Tian, Ariana Xu, Russell Greiner, Jake Hayward, Andrew James Greenshaw, Bo Cao","doi":"10.2196/66559","DOIUrl":"10.2196/66559","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The exponential growth of publications regarding the application of machine learning (ML) tools in medicine highlights the significant potential for ML to revolutionize the field. Despite the multitude of literature surrounding this topic, there are limited publications addressing the implementation and feasibility of ML models in clinical practice. Currently, Machine Learning Operations (MLOps), a set of practices designed to deploy and maintain ML models in production, is used in various information technology and industrial settings. However, the MLOps pipeline is not well researched in medical settings, where multiple barriers exist to implementing ML pipelines into practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to detail how MLOps is implemented in health care and propose a maturity framework for the health care implementations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A scoping review search was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. Results were synthesized using the 3-stage basic qualitative content analysis. We searched 4 databases (eg, MEDLINE, Embase, Web of Science, and Scopus) to include any studies that involved proof of concept or real-world implementation of MLOps in health care. Studies not reported in English were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 19 studies were included in this scoping review. The MLOps workflow identified within the studies included (1) data extraction (19/19 studies), (2) data preparation and engineering (18/19 studies), (3) model training (19/19 studies), (4) measured ML metrics and model evaluation (17/19 studies), (5) model validation and test in production (14/19 studies), (6) model serving and deployment (15/19 studies), (7) continuous monitoring (14/19 studies), and (8) continual learning (13/19 studies). We proposed a 3-stage MLOps maturity framework for health care based on existing studies in the field, that is, low (5/19 studies), partial (1/19 studies), and full maturity (13/19 studies). There were 8/19 studies that discussed ethical, legislative, and stakeholder considerations for MLOps implementations in health care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We investigated the implementation of MLOps in health care with a corresponding maturity framework. It is evident that only a limited number of studies reported the implementation of ML in health care contexts. Hence, it is imperative that we shift our focus toward creating an environment that supports the development of ML health care applications, such as improving existing data infrastructure, and engaging partners to support the development of MLOps applications. Specifically, we can include patients, policymakers, and health care professionals in the creation and implementation of ML applications. One of the main limitations includes the varying quality of each extracted study in terms of how the MLOps implementation was presented. Hence","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e66559"},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092145","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":"The Development and Growth of the English National Real-Time Syndromic Surveillance Program: Key Developments and Lessons Learned From the First Two Decades.","authors":"Gillian E Smith, Natalia R Jones, Sally E Harcourt, Sue Smith, Paul Loveridge, Roger A Morbey, Helen E Hughes, Obaghe Edeghere, Daniel Todkill, Sue Ibbotson, Duncan Cooper, Brian McCloskey, Alex J Elliot","doi":"10.2196/73373","DOIUrl":"10.2196/73373","url":null,"abstract":"<p><strong>Unlabelled: </strong>Syndromic surveillance now forms an integral part of the surveillance for a wide range of hazards in many countries. Establishing syndromic surveillance systems can be difficult due to the many different sources of data that can be used, cost pressures, the importance of data security, and the presence of different (and rapidly evolving) technologies. Here we describe major points in the development of the UK Health Security Agency English real-time syndromic surveillance service over its first 2 decades (1998 to 2018). We identify the key wider themes that we believe are important in ensuring a sustainable and useful syndromic surveillance service. We conducted semistructured interviews with current members of the UK Health Security Agency syndromic surveillance team who were involved from the earliest stages and previous senior colleagues who were supportive of the syndromic surveillance work during the early phases. For this viewpoint, we partitioned the development of syndromic surveillance in England into 3 time periods: 1998 to 2005 (\"the beginnings\"); 2006 to 2011 (\"the growth phase\"); and 2012 to 2018 (\"mainstream\"). We asked the interviewees for their views about the development of syndromic surveillance, and in particular the main drivers and events, the team and system, and outputs and uses. The results from the interviews highlighted some key themes including the integration of syndromic surveillance into the public health system, creativity, good collaboration and teamwork, leadership and determination to persevere, and agility and the ability to adapt to new threats. Using the results of the discussions and our personal experience of running the syndromic surveillance service from inception and over decades, we constructed a set of recommendations for establishing and running sustainable syndromic surveillance systems. In this age of increased automation, with the ability to transfer data in real-time and to use machine learning and artificial intelligence, we are approaching a \"new age of syndromic surveillance.\" We consider that the focus on the public health questions, relationships, collaboration, leadership, and true teamwork should not be underestimated in the success of and usefulness of real-time syndromic surveillance systems.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e73373"},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092182","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":"Parental Internet-Specific Rules and the Onset of Adolescents' Problematic Social Media Use: Prospective Study Testing Potential Moderators.","authors":"Suzanne Geurts, Ina Koning, Regina Van den Eijnden, Helen Vossen","doi":"10.2196/64252","DOIUrl":"10.2196/64252","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many parents are concerned about their adolescents' (problematic) social media use. Therefore, parents may apply restrictive mediation practices to prevent problematic social media use. However, their effectiveness remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to provide insights into the specific groups and conditions under which restrictive mediation may effectively prevent adolescents' problematic social media use. Specifically, we investigated the prospective relationship between rules about the amount, location, and timing of internet use and the onset of adolescents' at-risk or problematic social media use. In addition, we examined the moderating role of demographic and parenting factors, including adolescents' age, adolescents' gender, adolescent involvement in rule-setting, positive parenting, parental phubbing, and quality of coparenting (2-way interactions). Furthermore, we explored whether the moderation effects of the parenting factors varied by adolescents' age and gender (3-way interactions).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Four-wave survey data of 315 adolescents (T1: mean age 13.44, SD 2.26 years; n=146, 46.3% girls, n=169, 53.7% boys) and their parents (T1: mean age 46.4, SD 5.05 years; n=292, 55.4% mothers) were used. Data were collected between April 2020 and January 2022, with a 6-month interval between each wave.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;No significant main effect was found of internet-specific rule-setting at T1 on the onset of adolescents' at-risk or problematic social media use throughout the study period (odds ratio [OR] 0.959, 95% CI 0.60-1.54, d=0.02). Yet, 2-way interaction analyses revealed that the effect of internet-specific rule-setting varied by adolescents' age (OR 2.171, 95% CI [1.35-3.49], d=0.43). Specifically, for adolescents aged &lt;12.31 years (-0.5 SD), stricter rules were associated with a lower likelihood of developing at-risk or problematic social media use (unstandardized beta (B)=-0.568, SE=0.280, 95% CI [-1.12 to -0.02], P=.042). In contrast, for adolescents aged &gt;15.70 years (+1 SD), stricter rules were associated with a higher likelihood of developing at-risk or problematic social media use (B=0.594, SE=0.294, 95% CI 0.02-1.17, P=.043). Two-way interaction effects of rule-setting with adolescents' gender (OR 0.945, 95% CI 0.54-1.64, d=0.03), adolescent involvement in rule-setting (OR 1.02, 95% CI 0.77-1.36, d=0.01), positive parenting (OR 1.044, 95% CI 0.69-1.59, d=0.02), parental phubbing (OR 0.977, 95% CI [0.72-1.33], d=0.01), and quality of coparenting (OR 0.877, 95% CI 0.64-1.21, d=0.07) were not significant, nor were any of the 3-way interaction effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Setting internet-specific rules seems to have a preventive effect on the development of problematic social media use symptoms in pre- and early adolescence, but may be counterproductive from the age of 15.7 years onward. These findings highlight the ","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e64252"},"PeriodicalIF":6.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086364","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}