JMIR Formative Research

Support from peers has long been considered an alternative support resource than professional healthcare ones. Despite the inconclusive findings of previous studies regarding the effects of peer support, the integration of Peer Support Networks (PSNs) for youth and adolescents appears to offer promising outcomes. However, many existing digital peer support systems operate as proprietary platforms, lacking transparency in monitoring the efficacy of support and in understanding how personality traits influence outcomes. However, many existing digital peer support systems operate as proprietary platforms lacking transparency in monitoring the effect of peer support and understand the influence of personality traits on its outcomes. To address these limitations, we utilized our research platform, Peer2S, a digital PSN designed to facilitate connections based on shared lived experiences while simultaneously monitoring users mental well-being and personality traits. We conducted a four-week within-subjects experiment with 28 Japanese university students to examine the PSN systems impact on anxiety and perceived social support. Following a two-week baseline control period, participants interacted with the system for two weeks. Pre- and post-intervention assessments utilized generalized anxiety and multidimensional social support measures, alongside personality evaluations. The results indicated that participants experienced a significant reduction in anxiety after using the system, whereas no significant changes occurred during the control period. Perceived general social support showed a borderline significant increase, though specific college-context support dimensions remained unchanged. Furthermore, multiple regression analysis revealed that personality traits moderated anxiety outcomes. Contrary to typical protective associations, higher agreeableness significantly predicted increased anxiety during the intervention, which may reflect cultural tendencies toward conflict avoidance and over-accommodation in Japan. Conscientiousness demonstrated a marginally significant protective effect against anxiety, while personality traits did not predict changes in perceived social support. These findings suggest that short-term, algorithmically mediated peer support can yield measurable improvements in mental well-being, particularly in reducing anxiety. Moreover, the varying impacts of personality traits highlight the necessity of considering sociocultural contexts when designing and deploying digital mental health interventions. Authors summaryThe formation of social bonds is often selective, established through shared values, cultural interests, or significant life experiences among "peers." In some populations such as adolescents and young adults, peer support is regarded as a promising source of empathy, understanding, and psychological support. We report a study conducted using our customized digital peer matchmaking system with Japanese university students to examine if this novel approach to peer support impacts mental well-being. We found that after just two weeks of using the system, participants experienced a significant reduction in their anxiety levels. We also dove deeper to look at if individual personality traits influence their use outcomes. Interestingly, our results revealed that highly agreeable individuals actually experienced increased anxiety while using the system. In a Japanese cultural context, this may occur because agreeable users tend to avoid conflict and over-accommodate others at their own expense. Ultimately, our research demonstrates that matchmaking algorithms can effectively facilitate digital peer support to improve mental well-being, provided we carefully consider how different personality traits and cultural backgrounds shape user experiences.

More than one third of adults with diabetes can experience diabetes distress due to the demands of daily self-care. As a cognitive therapy, mindfulness can alleviate diabetes distress but face-to-face programmes can be difficult to access and pay for, and apps lack personalisation and feedback. Virtual reality (VR) may support mindfulness practice, but no VR app tailored to people experiencing diabetes distress exists. We interviewed mindfulness practitioners and conducted co-design workshops (using focus groups, questionnaires, artistic methods, generative artificial intelligence tools and prioritization techniques) with adults with type 2 diabetes to gather perspectives on designing a VR mindfulness app. We analysed data using descriptive statistics and the framework approach. Most participants preferred a simple design and layout to use the virtual environment to practice mindfulness, with customisable design options and interactive features that were culturally appropriate. We identified new design features, functionality, and content that informed a software design specific documentation to build a prototype VR mindfulness app for people experiencing diabetes distress. Further research should include more diverse populations to elicit detailed specifications for software design and include safety features to minimise risk when using VR technologies to practice mindfulness.

BackgroundPerinatal mood and anxiety disorders are the most common complications of pregnancy. Given the limited mental health resources, there is a need for novel treatment approaches. Though smartphone applications can increase access to evidence-based care, recent research highlights notable limitations, including varying quality and unclear effectiveness. Blended hybrid care models, which integrate synchronous telehealth services with asynchronous modalities (such as mobile apps), have emerged as an alternative. This pilot study evaluates one such model, the Digital Clinic, to determine its potential to bridge this critical treatment gap and compare outcomes to that of non-peripartum patients in the clinic. MethodsPregnant and postpartum women referred for anxiety and depression received 8 weeks of synchronous, virtual, evidence-based CBT from a trained clinician. This treatment was complemented by the asynchronous use of the mindLAMP app, providing digital phenotyping, psychoeducation, and CBT skills, with the support of a Digital Navigator. The efficacy of the intervention was evaluated by comparing GAD-7 and PHQ-9 scores from intake to the end of treatment. ResultsThis secondary analysis included 13 peripartum women from a larger sample of 224 clinic patients. At intake, they reported a mean PHQ-9 score of 9.4 (SD=3.9) and a mean GAD-7 score of 11.69 (SD=6.0). After 8 weeks, participants reported statistically significant decreases of 4.14 points on the GAD-7 (p<.01) and 3.92 points on the PHQ-9 (p<.01). Effect sizes for these reductions were 0.74 (95% CI: 0.20, 1.28) for GAD-7 and 1.10 (95% CI: 0.29, 1.90) for PHQ-9. ConclusionA novel blended hybrid care model, the Digital Clinic, was successful in reducing depression and anxiety among pregnant and postpartum women. This novel approach to maternal mental health shows promise for delivering accessible, effective, evidence-based care to peripartum patients in real-world settings. Future work should further validate its effectiveness with larger, more diverse patient populations with moderate to severe disease.

Abstract Background People with disabilities use technology, like search engines, to seek health information online. This health information includes information on coronavirus disease, or COVID-19. COVID-19 remains a public health concern. Research shows that people with disabilities encounter frustrations, or "pain points," when seeking online information, but little is known about these specific pain points and who encounters them. Objective The goals of this study are to determine pain points for people with disabilities who seek health information online, and to assess how pain points impact the experience of technology use and information seeking. Methods Ten participants recruited from a prior quantitative survey completed the concurrent think-aloud study over a month-long period. Participants completed four online search tasks and narrated their experiences in real-time while doing so. Transcripts were stored in Taguette; thematic analysis was performed on these transcripts. Findings Participants were predominantly white, with three identifying as Asian. All ten participants reported having disabilities. Participants with attention deficit hyperactivity disorder (ADHD) reported distracting webpage layout, whereas participants with physical disabilities reported physical fatigue while navigating online information. All participants encountered AI-generated information; only one participant indicated trust in the AI-generated information. Other common sources of information included hospital and governmental webpages, peer-reviewed articles, and news and advertising results. News and advertising results were especially common with respect to search results for "COVID-19 vaccine." Themes identified included the following: accessibility/usability, AI-generated information, government/hospital and related sources of information, peer-reviewed articles, news and advertising, and sentiment and trust. Conclusions Information can be fatiguing, distracting, or otherwise difficult to navigate for people with diverse disabilities searching for COVID-19 related information online. Further work should incorporate user feedback from people with disabilities when designing online content.

Background: Continuous adhesive patch electrocardiographic (ECG) wearables are increasingly prescribed. Patient experience with these devices can influence adherence, but research in this area is limited. This study aimed to explore the perceptions and experiences of patients receiving wearable cardiac monitoring technology as part of their routine care through the lens of treatment burden. Methods: This was a qualitative study with semi-structured phone interviews conducted between February and May 2024. We recruited participants from primary care and outpatient clinics using maximum variation sampling to ensure diversity in sex, ethnicity, and education levels. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Results: Sixteen participants (mean age 51 years, 63% female) were interviewed (average duration: 33 minutes). Three themes were developed: 1) ?Experience using the device: Burden vs Ease of Use?, which captured participants? perceptions of how easily they could integrate the device in their daily lives; 2) ?Individual variability in responses to ECG self-monitoring? covered participants? emotional and cognitive response to knowing their heart rhythm was monitored; and 3) ?The care process shapes patient experiences? reflected support preferences during the set-up and monitoring period and the uncertainty regarding timely clinical and device feedback. Conclusions: Patients valued cardiac wearables for facilitating diagnosis and felt reassured knowing they were clinically monitored. However, gaps in information provided to patients seemed to cause anxiety for some participants. These concerns could be mitigated through clearer clinician communication and patient education at the time of prescription.

Patient-generated streaming data from wearable and digital technologies is increasingly promoted as a means of supporting mental health monitoring and clinical decision-making. While patient acceptance of these technologies has been reported, clinician perspectives remain underexplored despite their central role in determining whether streaming data are meaningfully integrated into routine care. This study explored clinicians experiences, as well as perceived facilitators and barriers, related to integrating patient-generated streaming data into routine mental health practice. A qualitative, exploratory interview study was conducted to examine clinicians experiences and perspectives on integrating patient-generated streaming data into mental health care. Semi-structured interviews were conducted with 33 clinicians, including family physicians (n=11), psychiatrists (n=12), and psychologists (n=10). Data were analyzed using reflexive thematic analysis guided by Braun and Clarkes six-step approach. Six themes were identified. Clinicians described variable use of digital and streaming technologies, ranging from routine engagement to deliberate non-use. Streaming data were viewed as clinically valuable when they provided longitudinal and objective insights, identified physiological and behavioural pattern changes, and supported patient engagement. However, clinicians emphasized that clinical usefulness was contingent on interpretability, contextual information, and relevance to decision-making. Major barriers included poor integration with electronic medical records, time constraints, data volume, limited organizational support, and uncertainty regarding data reliability and validity. Clinicians also expressed persistent concerns about privacy, governance, and regulatory oversight, highlighting the need for clear safeguards and accountability structures. Clinicians view patient-generated streaming data as a promising adjunct to mental health care, particularly for capturing longitudinal change between visits. However, meaningful clinical integration remains constrained by usability, workflow, organizational, and regulatory challenges, as well as limited confidence in data interpretation. Addressing these barriers through improved system integration, interpretive support, validation, and governance will be essential for translating the potential of streaming data into routine clinical practice.

Anxiety symptoms among adults in the U.S. have increased significantly in recent years, with higher prevalence among younger adults in rural areas. Using an experimental design, this industry-academia collaborative study evaluates the impact of a telehealth-enabled multi-sensory environment on anxiety levels among young adults. A sample of 30 participants aged 18-25 was recruited from a university population in the U.S. Anxiety levels were assessed during three five-minute episodes: baseline, exposure to Trier Social Stress Test (TSST), and physical sensory environment with telehealth (pre-recorded guided meditation). Physiological data-- electrodermal activity (EDA), number and duration of eye fixations and saccades-- were collected continuously using sensors (EmbracePlus) and eye-tracking (Tobii Pro Glasses). Subjective data were measured using the State-Trait Anxiety Inventory (STAI) and semi-structured exit interviews. Pairwise comparisons based on complete datasets from 25 participants revealed a significant decrease in EDA (P < .001), mean frequency of saccades (P = .011) and eye fixations (P < .001), and mean state anxiety scores (P < .001) among participants following TSST, indicating the effectiveness of the telehealth-enabled multi-sensory environment in anxiety reduction. Semi-structured interviews also highlighted participants preferences regarding key sensory environment features, including tactile, form, lighting, furniture types, and configurations. Findings from this study will inform the design and implementation of telehealth-enabled multi-sensory environments in the future educational settings to improve anxiety symptoms among young adults.

Purpose: To understand how the Philips PAP device recall affected patient experiences, clinical practice, and health system responses. Methods: From November 2022 to August 2023, we interviewed individuals with OSA, physicians, respiratory therapists and health system leaders. We also received emailed responses from Health Canada. Interviews explored participants' experiences with the recall announcement and communication, their own responses and perceptions of actions taken by others, the overall impact of the recall and suggestions for improving future recall processes. Interviews were analyzed using an inductive thematic approach. Results: We interviewed 47 participants (16 individuals with OSA, 10 physicians, 17 public or private respiratory therapists, five health system leaders). Themes were organized into four domains: recall communication, execution, participant experiences, and the policy and regulatory context. Participants were confused due to inadequate information from Philips throughout the process. The burden of notifying patients and tracing devices mostly fell to healthcare providers and vendors, while replacement efforts were disorganized and frustrating. Individuals with OSA experienced emotional distress over therapy decisions and difficulties navigating the recall. Healthcare providers described moral distress from being unable to support patients adequately, and vendors faced additional logistical and financial strain. While regulatory authorities reported that Philips followed standard procedures, participants expressed a loss of trust in both the manufacturer and oversight systems. Conclusions: Interviews revealed that poor communication and execution of the Philips recall caused confusion, frustration and significant emotional and financial burden. Collaborative, context-specific strategies are required to improve future recalls.

BackgroundHwa-byung (HB) is a Korean culture-bound syndrome characterised by prolonged suppression of anger and somatic complaints. No evidence-based digital therapeutic (DTx) has been developed for HB. We evaluated the feasibility, user experience (UX), and preliminary clinical effect of an acceptance and commitment therapy (ACT)-based DTx application, Hwa-free, for HB. MethodsAdults aged 19-80 years diagnosed with HB were enrolled in a four-week app-based intervention with assessment at baseline (Week 0), Week 2, Week 4, and Week 8 follow-up. The primary outcome was UX assessed via a 22-item survey at Week 4. Secondary outcomes included HB-related symptom and personality scales, depression, anxiety, anger expression, psychological flexibility, health-related quality of life, and heart rate variability. ResultsOf 45 screened, 30 were enrolled and 28 constituted the modified intention-to-treat population. Mean app use was 19.9 {+/-} 7.9 days (71.2% adherence over 28 days). Adverse events were infrequent and unrelated to the intervention. Positive response rates exceeded 80% for video content (items 2-4: 82.8-89.7%), HB self-assessment (86.2%), meditation therapy (86.2%), and in-app guidance (85.7%). Pre-post improvements from baseline to Week 4 were observed in 11 of 18 clinical scales, including HB Symptom Scale ({Delta} = -9.8, Cohens d = -0.92), Beck Depression Inventory-II ({Delta} = -13.3, d = -1.11), and state anger ({Delta} = -7.8, d = -0.96). The HB screening-positive rate declined from 100% at baseline to 55.6% at Week 8. ConclusionsHwa-free demonstrated adequate feasibility, acceptable UX, and preliminary evidence of clinically meaningful improvement in HB-related symptoms. Future randomised controlled trial is warranted. Trial registrationCRIS, KCT0011105

Background Comprehensive sexuality education (CSE) is essential to the health and well-being of young people. In the Democratic Republic of Congo (DRC), where more than 65% of the population is under the age of 25, access to interpersonal CSE remains limited owing to sociocultural and structural barriers. This exposes young people to persistent socio-sanitary vulnerabilities. In this context, mobile health apps (MHAs) constitute a promising solution, supported by the growing use of smartphones among young Congolese. However, this group's intention to use MHAs for CSE has been the subject of little research to date. Objective The aim of this study was to identify predictors of intention to use MHAs among young Congolese, based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2). Methods A predictive correlational study was conducted in eight public secondary schools in Bukavu (DRC) with a stratified random sample of 859 students. Predictors of intention to use--performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), and perceived risk (PR)--and moderators--age, gender, and past MHA experience--were measured from data collected through a self-administered UTAUT questionnaire. Descriptive and multivariate analyses were run on SPSS version 28. Results Mean age of participants was 16.3 years (SD = 1.5). Boys made up 55.1% of the sample. Overall, 51.0% of the sample owned a smartphone, of which 62.3% reported having easy access to mobile data and 16.2% were already using MHAs to learn about sexual health. Intention to use MHAs was positively influenced by PE ({beta} = 0.523, p < 0.001), EE ({beta} = 0.115, p < 0.001), and SI ({beta} = 0.113, p < 0.001). FC (p = 0.260) and PR (p = 0.631), however, had no significant influence. Age moderated all of the relationships tested (F (1, 849-854) = 9.97-20.82; p [&le;] 0.002), with more marked effects observed among younger participants 14-15 years old. The final model explained 44% of the variance, indicating good predictive power. Conclusion Intention to use digital CSE was explained primarily by PE, EE, and SI and moderated by age. To strengthen this intention, stakeholders will need to promote e-interventions that are pertinent, easy to use, socially valorized, and tailored to young people's needs and to the local context.

Somatic symptoms, such as bodily pain, fatigue, or signs of bodily dissociation, are frequent in the general population, impair mental wellbeing, and form early signs of developing mental disorders, such as depression. Managing somatic symptoms effectively in daily life is a crucial step towards establishing early intervention strategies that prevent the occurrence of mental disorders. Yet, somatic symptoms that occur in daily life have received little scientific attention so far. Here, we ask if mentalizing abilities, specifically the ability to reflect on ones own or others emotion, cognitive, or bodily states, explain somatic symptom burden in daily life. Reflective functioning was assessed in N = 96 healthy individuals via a standardized questionnaire, RFQ-8, in addition to a novel questionnaire focusing on the ability to understand ones own and others bodily reactions, BRFQ-9. Subsequently, over the period of 8 weeks, somatic symptoms were sampled in daily life via a novel Mobile Application that combines standardized questionnaire items of the FFSS, SCL-90, SDQ and SSD-12 with an interactive 3D avatar. 91.7% of participants reported somatic symptoms in the assessment period, and BRFQ scores show a significant negative relationship to overall somatic symptom burden. Such a relationship could not be evidenced for RFQ scores. Body reflective functioning abilities are also a significantly stronger predictor of somatic symptoms and explain more variance than standard reflective functioning abilities. This study introduces a new mobile Application that monitors somatic symptoms in daily life and suggests that body reflective functioning is a novel target for prevention and early intervention techniques with the aim to reduce the negative influence of aberrant bodily feelings on daily life.

Digital therapeutics for mental health often face low patient engagement, which limits their clinical impact. Interventions that deliver treatment using a video game medium may improve engagement and therapeutic efficacy, but the putative emergence of gaming-related problems remains a concern among clinical stakeholders. We examined whether long-term engagement with Meliora, a video game therapeutic for adult major depressive disorder, was associated with changes in gaming-related problems in a three-arm randomized controlled trial. The intention-to-treat cohort (n = 1,001) had a mean age of 33.4 years (SD 9.3) and 64% were female. The Gaming Addiction Scale (GAS-7) scores decreased from baseline (week 0) to post-intervention (week 12) in the Meliora arm (p = 8.1x10-4) and in the treatment-as-usual arm (p = 6.0x10-6), with no significant change observed in the Sham arm (p = 0.39). Changes in GAS-7 scores were not associated with intervention use hours (Meliora: p = 0.17; Sham: p = 0.28) or with experienced immersion (Meliora: p = 0.93; Sham: p = 0.19). Deterioration analysis found worsening rates from baseline to post-intervention low and comparable across study arms. Analyses in the per-protocol completer cohort ([&ge;]24 h use) corroborated these findings, indicating that even higher use did not lead to increases in gaming-related problems. These results provide evidence that long-term use of a video game therapeutic does not increase gaming-related problems when risks are properly mitigated, suggesting that video games may provide a safe medium for digital therapeutics. Author summaryMany patients use digital therapeutics insufficiently or drop out early, which limits their effectiveness and applicability in healthcare. Video game therapeutics deliver the treatment using an interactive video game as a medium to improve both engagement and therapeutic efficacy. However, extended use of video game therapeutics could inadvertently increase gaming-related problems. We examined whether long-term use of Meliora, a video game therapeutic for adults living with depression, was associated with increased gaming-related problems. We found that using Meliora or a highly similar Sham device did not increase gaming-related problems. Changes in gaming-related problems were not associated with the amount of time participants used the interventions, suggesting that typical use patterns are safe. We also found no relationship between experienced immersion and changes in gaming-related problems, suggesting that subjective immersion is distinct from problematic gaming. This study provides the first clinical evidence that extended engagement with a video game therapeutic does not increase gaming-related problems. These findings suggest that video games can be a safe medium for digital therapeutics in healthcare.

BackgroundAs digital communication becomes central to daily life, psychotherapy increasingly has access to patients electronic media data. While digital phenotyping has been widely studied, less is known about whether incorporating personal communication data, such as text messages, improves clinical outcomes in psychotherapy. ObjectiveTo determine whether integrating personalized text message data into psychotherapy improves depression, anxiety, health related quality of life, and therapeutic alliance, and to examine whether increased access to collateral information influences clinical decision making. MethodsThe Electronic Media and its Impact on Psychotherapy EMAP study was a randomized controlled trial conducted in adult and geriatric outpatient and partial hospitalization settings at an academic psychiatric hospital. Participants receiving psychotherapy for primary depression or anxiety N = 101 were randomized to Electronic Media Enhanced Therapy EME n = 52 or Treatment as Usual TAU n = 49. In EME, research staff reviewed participants text messages prior to sessions using personalized mood related key terms and presented aggregated findings on a HIPAA compliant clinician dashboard. TAU participants received standard care without message review. Outcomes included change scores for PHQ 9, GAD 7, SF 36, and Working Alliance Inventory Short Revised WAI SR. Linear regression and nonparametric tests compared groups. Moderation analyses assessed whether frequency of information access influenced treatment changes. ResultsNo significant between group differences were observed in anxiety or working alliance. Among participants with SF 36 follow up data n = 65 EME participants demonstrated greater improvement in the pain subscale. Greater frequency of information access was associated with increased treatment related changes in the EME group. Access to additional collateral information was associated with more clinical actions but not improved distal outcomes. ConclusionsIntegrating personalized text message data into short term psychotherapy did not significantly improve depression or anxiety, and neither improved nor worsened therapeutic alliance. However, access to greater amounts of collateral information including electronic media influenced clinical decision making, suggesting nuanced and context dependent effects.

Objectives: Heart failure is a leading cause of mortality, necessitating identification of patients at increased risk needing intervention. In this study, we investigated if Fitbit data can reveal physiological trends associated with hospital visit risk. Materials and methods: Individuals with heart failure (n=249) were randomized into three arms for prospective 180-day monitoring. All arms received a Fitbit and wireless weight scale. Arm 1 received devices only; Arm 2 received a mobile app with surveys; Arm 3 received the app plus financial incentives. Results: 51 participants had hospital visits during the study period. These individuals took fewer steps (p=.002) and reported increased symptom severity (p=.044). Resting heart rate increased three days prior to a visit (p=.022). Baseline steps revealed a higher visit probability for less active participants (p=.003). Discussion and conclusion: Passive physiological monitoring can effectively identify individuals at risk of health exacerbation, demonstrating the potential of wearable devices for timely clinical intervention.

Background/Objectives: This study aimed to evaluate the efficacy and outcomes of operative hysteroscopy for the removal of endometrial polyps and assess the procedure's impact on pain experienced by patients. The research was conducted to determine whether the minimally invasive nature of operative hysteroscopy compromises patient comfort when compared with diagnostic hysteroscopy. Methods: The study was conducted at the Gynecology and Obstetrics Clinic of Ba[g]clar Training and Research Hospital over a period of four months. It included 200 women over 18 years of age who were indicated for hysteroscopy. Operative hysteroscopy procedures were performed without the use of a speculum, cervical dilation, anesthesia, or analgesic agents, emphasizing the procedure's minimally invasive approach. Pain assessment utilized the Visual Analog Scale (VAS). Patients were stratified into two groups--those undergoing operative and those undergoing diagnostic hysteroscopy--to compare outcomes and pain scores. Results: The study found that operative hysteroscopy successfully removed 85.1% of the lesions, primarily polyps. There was no significant difference in pain scores between the operative and diagnostic hysteroscopy groups, indicating that the minimally invasive procedure does not increase patient discomfort. Conclusions: Operative hysteroscopy is an effective and tolerable procedure for the removal of endometrial polyps, with high success in complete lesion removal and without significantly impacting the pain experienced by patients. The findings support the use of operative hysteroscopy as a first-line treatment option for endometrial polyps, underscoring the importance of patient selection and the need for further studies on long-term outcomes related to fertility and recurrence.

BackgroundCognitive deficits in anxiety disorders (ADs) contribute to clinical and socio-occupational dysfunction, necessitating targeted interventions. NoveltyIntegrated Cognitive Control Training (ICCT), a novel intervention, has demonstrated benefits in other disorders, however, remains unexplored in ADs. With its process-specific training and multi-pronged exercises for stimulation, metacognitive training and generalization, it has potential for enhancing cognitive functions in ADs. ObjectivesThis paper describes the study protocol for a multi-site randomized controlled trial (RCT) to test efficacy of ICCT in individuals with ADs. MethodsAdults diagnosed with ADs (n=100) will be recruited across two sites. Following baseline assessments, they will be randomized to either ICCT (8 weekly sessions) or Treatment As Usual (TAU). ICCT will be delivered through once-weekly therapist-guided, and smartphone app-based ( Cogtrain) homework (20-30 mins, 4-6 times per week). Multimodal assessments will be carried out at baseline, mid-intervention (4 weeks), post-intervention (8 weeks) and follow-up (20-24 weeks). The primary measure comprises Hamilton Anxiety Rating Scale, with secondary measures of Work and Social Adjustment Scale (socio-occupational functioning), neuropsychological tests (attention, memory and executive functions) and functional Magnetic Resonance Imaging of the cognitive control circuits. Intervention feasibility and acceptance metrics (response rate, intervention relevance) will also be recorded. Quality assurance and ethical procedures will be documented. Expected outcomeThe ICCT is expected to enhance cognitive functioning in adults with ADs, in addition to symptom reduction, changes in underlying neural circuits of cognitive control and improve overall functioning. Digital delivery through a smartphone app may provide a cost-effective and scalable intervention, useful in resource-constrained settings. Key MessagesThis multi-site randomized controlled trial evaluates a novel, smartphone-delivered Integrated Cognitive Control Training (ICCT) program for adults with anxiety disorders, targeting core cognitive deficits that contribute to functional impairment. By combining therapist-guided sessions with app-based training and multimodal assessments, the study examines both clinical and neural outcomes. Findings are expected to inform the scalability and feasibility of process-based digital cognitive interventions for anxiety disorders, particularly in resource-limited settings. Protocol RegistrationTrial registry name: Clinical Trial Registry of India URL: https://ctri.nic.in/Clinicaltrials/************** Registration number: CTRI/202*/**/******

Structured Abstract (for clinical articles and laboratory investigations)O_ST_ABSObjectiveC_ST_ABSEvaluating and monitoring patients with cervical spondylotic myelopathy (CSM) remains a challenge due to limited tools for assessing objective neurological disability longitudinally and in the home environment. Given their prevalence and low cost, mobile health (mHealth), and specifically smartphone technologies offer a promising approach to fill this gap. This study explored stakeholder perspectives on the role of mHealth in CSM monitoring to inform development of a smartphone-based assessment application. MethodsWe conducted semi-structured interviews with 15 patients with CSM and 14 healthcare providers (spine surgeons, physical therapists, and occupational therapists). Interviews explored current assessment practices, perceived limitations, and attitudes toward mHealth integration. Data were analyzed using thematic analysis. ResultsTwo major themes emerged from provider interviews: (1) diagnosing and monitoring CSM is challenging due to limitations in current tools, and (2) mHealth presents significant opportunities but requires thoughtful integration. Providers described current methods and technologies, clinical signs and symptoms, and challenges evaluating patients. Current tools were viewed as inadequate for precision medicine, with inter-rater variability and inability to capture real-world function. Within the second theme, providers identified ways mHealth could improve care, challenges for integration, and practical implementation considerations. Patients expressed strong interest in objective, longitudinal monitoring of gait, dexterity, and daily function. ConclusionsStakeholders recognized substantial potential for mHealth to address unmet needs in CSM assessment. Successful implementation will require intuitive design, electronic medical record integration, and attention to accessibility. These findings provide a foundation for user-centered development of digital health tools in CSM care.

Limited research has examined the use of physical mock-ups and artificial intelligence (AI) to evaluate design features in adolescent mental and behavioral health environments, such as the Crisis Stabilization Unit (CSU). This mixed-methods study investigated caregiver workflows and environmental features in adolescent CSUs (e.g., furniture and open vs. enclosed nursing station designs) through physical mock-up simulations with expert and novice clinicians/designers (N = 17). Participants feedback was obtained using questionnaires and focus groups. Simulations were video-recorded, manually coded, and an AI-driven tool was developed for automatic analysis of videos. Findings revealed that experts rated the enclosed nursing station higher in visibility, whereas novice designers reported significantly higher perceived privacy in the open nursing station (P = 0.036). AI-driven video analyses demonstrated promising, high-accuracy performance in automatic detecting, tracking, and localizing individuals (>80%) when compared with manual data. This study proposed an innovative methodology to enhance safety in future adolescent CSUs.

Background: The urgent care departments in Europe face a structural paradox: accelerating digitalisation is accompanied by a patient population that is disproportionately unable to engage with standard digital tools. An internal analysis at the Emergency Department (Akutafdelingen) of Nordsjaellands Hospital in Hilleroed, Denmark found that 43% of emergency patients struggle with digital solutions - a figure that reflects the predictable composition of acute care populations rather than any individual failing. Objective: This paper presents the design, iterative development, and secondary validation of the ED Adaptive Interface (v5): a prototype adaptive patient terminal developed in response to this challenge. The system operationalises what the author terms impairment-first design - a methodology that treats the most constrained patient experience as the primary design problem and derives the standard experience as a subset. The interface configures itself in under ten seconds via nurse-led setup, adapting across four axes of impairment: visual, motor, speech, and cognitive. System: Version 4 supports five accessibility modes, a heatmap pain assessment grid, a Privacy and Dignity panel, a live workflow tracker with care notifications, structured dual-category help requests, and plain-language medical term definitions across four languages. Version 5, reported here for the first time, introduces a Condition Worsening Escalation button, a Referral Pathway Display, a "Why Am I Waiting?" triage explainer, a Symptom Progression Log, MinSP/Yellow Card Scan simulation, expanded language support (seven languages: English, Danish, Arabic with full RTL layout, Turkish, Romanian, Polish, and Somali), and an expanded ten-item Communication Board. The entire system runs as a single 79-kilobyte HTML file with zero infrastructure requirements. Methods: To base the design on patient-generated evidence, two independent social media threads were subjected to an inductive thematic analysis (Braun and Clarke, 2006): a primary corpus of 83 entries in the Facebook group Foreigners in Denmark (collected March 2026) and a corroborating corpus in an international community group in the Aarhus region (collected April 2026). All identifiers in both datasets were fully anonymised under GDPR Article 89 research provisions prior to analysis. No participants were contacted. Generative AI tools were used to assist with drafting, writing, and prototype code development; all scientific content, data collection, analysis, and conclusions are the sole responsibility of the authors. Results: The first discourse corpus produced five major themes corresponding to the five problem areas the prototype was designed to address: system navigation and triage literacy gaps (31 entries); language and cultural barriers (6 entries); communication failures during care (5 entries); staff overload and capacity constraints (8 entries); and pain and severity assessment failures (14 entries). The corroborating dataset supported all five themes and introduced two additional themes: differential treatment of international patients and medical gaslighting as a long-term pattern of patient advocacy failure. One structural finding - the five most-liked comments incorrectly criticised the original poster for self-referring when she had received explicit 1813 telephone triage approval - directly inspired the Referral Pathway Display and "Why Am I Waiting?" features in v5. Conclusions: The convergence of design rationale and independent social evidence across all five problem categories suggests that impairment-first design is not a niche accessibility concern but a structural approach to healthcare interface quality. The prototype is ready for a structured clinical pilot using the System Usability Scale (SUS) and semi-structured staff interviews. The long-term roadmap includes full MinSP integration, hospital PMS connectivity, and clinical validation.

Artificial intelligence (AI) is increasingly integrated into healthcare delivery, yet patient acceptance in resource constrained settings remains incompletely characterized. This study assessed attitudes toward AI supported care among patients attending hospitals in three Jordanian governorates (Amman, Balqa, Irbid) and examined demographic and digital literacy correlates of acceptance. In a cross sectional survey (n = 500 complete questionnaires), participants rated exposure to AI in healthcare and five attitudinal domains, namely perceived usefulness or performance expectancy, trust and transparency, privacy and perceived risks, empathy and human interaction, and readiness or behavioral intention, using 25 items on 5 point Likert scales. Patients expressed conditional optimism: empathy and human interaction was most strongly endorsed (M = 4.33, SD = 0.58), alongside relatively high perceived usefulness (M = 3.97, SD = 0.68), while trust and transparency (M = 3.57, SD = 0.74) and readiness (M = 3.66, SD = 0.90) were moderate to high; privacy and risk concerns were moderate (M = 3.51, SD = 0.77) and self reported exposure was lowest (M = 2.57, SD = 1.07). The highest agreement item indicated preference for AI to work alongside physicians rather than be relied on alone (M = 4.47, SD = 0.81). Trust and transparency and perceived usefulness were positively associated with readiness (r = 0.48 and r = 0.44, respectively; p <.001), while privacy and perceived risks were negatively correlated with trust and usefulness. In multivariable regression adjusting for gender, age group, education, prior AI health app or device use, and self rated digital skill, lower educational attainment (less than high school and high school) predicted reduced readiness, whereas higher digital skill predicted increased readiness (R2 = 0.101). These findings suggest that implementation strategies in Jordan should emphasize human involvement alongside AI, transparent communication and governance, and interventions that build digital confidence and reduce readiness gaps linked to education. Author summaryAI is increasingly used in healthcare, for example to support diagnosis, triage, and treatment decisions. Whether these tools are accepted by patients depends not only on how well they work, but also on whether patients trust them, understand how they are used, and feel their privacy is protected. Evidence on patient views in middle income and resource constrained settings is still limited. We surveyed 500 patients attending hospitals in three Jordanian governorates to understand how they view AI supported care. Patients generally expected AI to be useful, but they strongly preferred that clinicians remain actively involved and that AI supports rather than replaces physicians. Trust and perceived usefulness were closely linked to willingness to accept AI enabled care, while privacy concerns were present and shaped trust. Readiness to accept AI was lower among participants with lower educational attainment and higher among those with greater self rated digital skill. These findings suggest that successful implementation in Jordan should prioritize transparent communication, strong privacy safeguards, and human centered workflows, while also strengthening digital confidence to avoid widening gaps in acceptance.