JMIR Research Protocols

BackgroundCancer survivors experience challenges, that may affect their psychological well-being. Technology-based, mindfulness-based interventions have been offered to cancer survivors; however, contents do not sufficiently cover issues related to cancer and its treatments. This study protocol presents a three-arm randomized controlled trial (RCT) that aims to examine the effectiveness of a digital mindfulness psychoeducation programme (Digital-MindCAN programme) on psychological symptoms among cancer survivors. This program contains knowledge linking to cancer-related matters, mindfulness principles and mindfulness practice, which will be delivered real-time using a videotelephony software. MethodsEligible cancer survivors will include adults who completed curative treatments from two weeks to two years. They will be randomly assigned to one of the three groups: Digital-MindCAN programme with standard care, Palouse Mindfulness programme with standard care, and a wait-list control group. A convenience sample will be recruited from a tertiary hospital in Singapore. A target sample size will be 150 participants, with 50 participants in each group. Primary outcomes encompass objective stress and subjective stress. Secondary outcomes comprise psychological well-being, perceived relaxation, mindfulness, resilience, depression, and anxiety. Self-administered questionnaires and physiological measures will be used to collect participants responses. Focus group interviews will be conducted for intervention groups after the end of the eighth session. Quantitative data will be analyzed by descriptive statistics, analysis of covariance and repeated measures analysis of variance. Qualitative findings will be analyzed using a realist evaluation method. DiscussionThis RCT will be the first to test the effectiveness of the technology-based, mindfulness-based intervention on cancer survivors in Singapore. Positive findings will add knowledge and inform clinical practice. Specifically, the Digital-MindCAN intervention may be offered as part of standard care for cancer survivors. Future research can be implemented and further tested the program in other healthcare institutions. Trial registrationThis study has been registered with ISCTN Clinical Trial Registry (Trial NO. ISRCTN10756933).

ObjectiveThis study aims to review and evaluate the effectiveness of various theoretical frameworks and models used over the past decade to explain the factors influencing BCS. MethodsA scoping review method was used to search the CNKI, Wanfang, VIP, Chinese Biomedical Abstracts, Pubmed, Embase, Web of Science, Ovid, EBSCO, and Cochrane Library databases. After literature screening and data extraction, the research results were summarized. Results55 studies were included and analyzed from the aspects of the application of theoretical models, explanatory effects, existing differences, commonalities and characteristics, and how to improve them. ConclusionThe effectiveness of these models varies by context and population. TPB and HBM are among the most empirically supported models, offering strong predictive power and practical guidance for interventions. Integrated models provide a comprehensive approach, addressing a broader range of influencing factors and demonstrating enhanced predictive capabilities. Future research should focus on refining these models and incorporating digital health tools to improve their applicability and effectiveness.

BackgroundAdolescent pregnancy constitutes a critical public health issue worldwide. Young mothers face substantial physical and psychological changes as they transition to motherhood, while limited knowledge, experience, and maturity may impair parenting and increase stress. The aim of the study was to evaluate the effects of the parental enhancing program with mobile application on parental stress and competence among adolescent postpartum women. MethodsA quasi-experimental study was conducted among sixty adolescent postpartum women, aged 15-19. They were randomly assigned to receive parental enhancing program with mobile application in intervention group (n = 30) and standard postpartum care in control group (n = 30). Adolescent postpartum women in intervention group were received two sessions in the parental enhancing program before discharge with weekly follow-up through the Line Official Account Parent Paplearn. Data was collected using questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS), Parenting Stress Index (PSI-4-SF), and Parenting Sense of Competence Scale (PSOC). Evaluations were conducted during 6-weeks postpartum. Independent t-test was used to compare post-intervention mean scores of parental stress and competence between groups. ResultsAll enrolled participants completed the study (Intervention: 30; Control: 30). At 6-weeks postpartum, adolescent postpartum women in the intervention group who participated in the parental enhancing program with mobile application through Line Official Account Parent Paplearn demonstrated significantly lower parental stress (t = 4.50, p < .001) and higher parental competence (t = -4.16, p < .001) compared to the control group. ConclusionProviding knowledge, skill training, and ongoing support in parenting for adolescent postpartum women through the mobile application significantly reduced parental stress and improved parental competence. Healthcare providers, particularly nurses, are encouraged to integrate such accessible and convenient tools into postpartum care routines. Continuous follow-up post-discharge is recommended to provide ongoing counselling, reduce parental stress, and enhance parental competence in adolescent postpartum women.

BackgroundThe management of Type 2 Diabetes Mellitus (T2DM) heavily relies on lifestyle choices and adherence. Opting for a high-risk lifestyle can exacerbate the impact on individuals with T2DM, worsening their condition. These approaches encompass self-care practices, cognitive behavioral strategies, training for family support, and educational initiatives focusing on lifestyle changes. Motivational interviewing is one strategy to changes behavior of T2DM patients. MethodThis study reviewed the literature following the PRISMA guidelines (2019- 2023). The exploration involved keyword searches for "motivational interviewing," "T2DM," "lifestyle," and "glycemic index" across databases such as Scopus, Science Direct, and ProQuest. Inclusion criteria encompassed quantitative research design, English language publications, research involving patients with T2DM, motivational interviewing, lifestyle modifications, and glycemic index. This resulted in the identification of 286 papers. A PICO synthesis and grouping method was used to analyze the data, aligned with the Cochrane Handbook for Systematic Reviews. The methodological quality assessment, carried out using the Joanna Briggs Institute Critical Appraisal methodology, indicated that adopting a multidisciplinary approach involving ontological, epistemological, and axiological inquiry is a robust foundation for enhancing health information systems and clinical practice. ResultsThis study reviewed ten articles focusing on using motivational interviewing techniques to improve T2DM patients so that they can change their lifestyle and manage their glycemic index in the long term. Motivational interviewing can be conducted face to face for an average of 10-12 sessions, approximately3-6 months, both online and through intensive intervention. ConclusionThis study can demonstrate how motivational interviews can improve the behavior of T2DM patients by changing lifestyle and reducing the glycemic index in T2DM patients.

BackgroundPost-traumatic stress symptoms (PTSS) are prevalent among children with cancer and their families. Although family-based interventions such as the Surviving Cancer Competently Intervention Program (SCCIP) are effective, their reliance on mental health specialists limits scalability, highlighting the need for nurse-led approaches. Methods and analysisThis multicenter randomized controlled trial will enroll 110 families of children with cancer to evaluate the efficacy of a nurse-led adaptation, the SCCIP-N. Participants from Hunan and Xinjiang will be randomly assigned (1:1) to the intervention or an active control group. The study employs a hybrid outcome assessment strategy, integrating validated psychosocial measures with objective physiological monitoring. Assessments occur at baseline (T0), 1 week (T1), 4 weeks (T2), and 8 weeks (T3) post-intervention. The primary outcome is PTSS in children and caregivers. Secondary outcomes include posttraumatic growth, cognitions, anxiety, depression, family management, resilience, quality of life, and sleep quality. Objective physiological data (e.g., sleep, heart rate) from primary caregivers will be continuously collected using the Huawei Band 9. A process evaluation will follow the RE-AIM framework. Data will be analyzed according to intention-to-treat principles using linear mixed-effects models. DiscussionThis trial will evaluate the efficacy of a novel, nurse-led family intervention (SCCIP-N) for pediatric oncology families. By combining psychosocial and physiological assessment, it aims to provide a comprehensive, multidimensional evaluation of intervention effects. If effective, SCCIP-N could be integrated into routine care to improve family psychological outcomes and inform future implementation strategies. Trial registrationChiCTR, ChiCTR2500114338. Registered on Dec 10, 2025.

Cervical cancer is a leading cause of cancer-related deaths among Mexican women [75]. Women with type 2 diabetes mellitus are more prone to HPV infections, raising their cervical cancer risk [23]. Despite global guidance for Pap smear screening, coverage is low in this group [30]. This study will assess Pap smear use among women aged 21 to 64 with type 2 diabetes at the HGZC/MF No. 21 clinic in Leon, Guanajuato, in late 2024. Using random sampling and a cross-sectional design, the study will evaluate sociodemographic and clinical factors through structured interviews, aiming to identify screening coverage gaps and guide early prevention strategies for women with chronic illnesses [33].

Low literacy is on the rise in the USA and is one of the independent predictors of poor health outcomes. While much written health information is now adapted to lower reading levels, more needs to be done to address the gap between material content and target consumers comprehension ability which often is more complex than simple reading level adjustments. This paper describes the process of developing a culturally, context and literacy-aligned intervention that promotes and supports preventive lifestyle behaviors among low-income Latino women (Latinas). Focus group discussions and key-informant interviews were conducted to identify needs, barriers and beliefs of low-income Latinas regarding obesity, healthy eating and physical activity. A simple literacy-aligned, culturally-appropriate and socio-economically acceptable (LACASA) framework and intervention were then created through an academic-community partnership: medical professionals and students, community health workers and researchers. The curriculum - which included minimal and easy-to-read written material and power point presentations - was piloted and revised before being launched. The resulting lifestyle curriculum for high-risk low-income Latinas was well-received and was a good fit for the priority population. Creating a program using the LACASA approach requires an interdisciplinary team to invest time working with key members of the priority population and a commitment to adjusting materials to the groups literacy level and its cultural and economic realities. Programs created to serve low-income individuals with limited literacy cannot rely on pre-created curricula. Instead, these must be re-evaluated and adjusted to address both content core principles and specific contexts of the priority population.

The number of bariatric surgery rises as the prevalence of obesity and metabolic comorbidities consistently increases[1]. Although bariatric surgery was originally developed for glycemic control and weight reduction, increasing evidence suggested extra-metabolic health outcomes are followed by bariatric surgery; incidences on diverse types of cancer[2], perinatal outcomes[3], sexual function[4], and even degree of physical activity[5] are known to be altered after bariatric surgery. We aim to conduct umbrella review for metabolic and other multiple health outcomes following bariatric surgery, and systematically appraise the context and quality of the relevant evidence. Contactminseolike@naver.com; crossing96@yonsei.ac.kr

BackgroundProfessional association recommendations call for integrating preconception health promotion with primary care, yet there are scarce tools and implementation research to support practices in doing so. PurposeTo evaluate the feasibility of integrating a preconception health digital risk assessment and virtual coaching into womens primary care encounters. MethodsIn the Emory Family Medicine Clinic (Atlanta, Georgia), female patients 21-40 years of age with a well-woman or chronic condition encounter scheduled between 9/1/2022 and 5/1/2023 were invited to participate. Consenting patients were provided the Frame Your Future weblink to complete the digital risk assessment followed by virtual counseling, and their family physicians were provided with a pdf summary to discuss during the primary care encounter. Demographic and clinical information was collected via medical record abstraction and patient and physician experiences via survey. ResultsOf 46 enrolled patients, 44 (96%) made a Frame account, 38 (86%) completed the risk assessment, 34 (89%) completed virtual coaching, and 24 (71%) had a physician discuss their preconception health assessment during the primary care encounter. Nearly 80% of patients reported an increase in confidence in discussing fertility with their physician, and 50% reported they would not otherwise have brought up fertility and preconception health during the encounter. Both patients and physicians were satisfied with the process and viewed it as helping motivate positive changes in patient health and health behaviors. ConclusionThe completion of preconception digital risk assessment and virtual counseling facilitates discussion of preconception health during primary care encounters and shows promise for improving womens health.

IntroductionCardiovascular diseases (CVDs) are the leading causes of death in the U.S. Having a healthy dietary pattern and engaging in regular physical activity (PA) reduces the risk of developing CVDs. The U.S. Preventative Services Task Force and the American College of Sports Medicines Exercise is Medicine (EIM) initiatives recommend patients at risk for CVDs receive behavioral counseling interventions (BCIs). However, few patients are screened for lifestyle behaviors and connected with evidence-based BCIs. PurposeTo describe (1) our approaches for identifying insufficiently active patients and connecting them to evidence-based BCIs and (2) the methods of our 12-week, theory-based BCI for insufficiently active patients. MethodsA novel clinical workflow was implemented in six Family Medicine clinics to screen and refer insufficiently active patients to a 12-week BCI. The BCI is theoretically grounded in the Multi-Process Action Control (M-PAC) framework and includes health education, health coaching, and self-monitoring. The implementation and preliminary efficacy of the workflow and BCI will be evaluated with the RE-AIM framework. Implementation outcomes include clinical workflow metrics and BCI acceptability and fidelity. Preliminary efficacy includes changes in psychosocial mechanisms of action, device-based and self-reported health behaviors, and health outcomes. Efficacy outcomes are assessed at baseline, post-intervention, with a subset of outcomes assessed after 12 weeks of post-intervention follow-up. ConclusionThis clinical workflow and BCI will inform the future implementation of primary care-based BCIs to reduce the risk of developing CVD in insufficiently active patients.

BackgroundAlcohol use is one of the largest worldwide contributors to morbidity and mortality, and a major risk factor for esophageal cancer. Reducing or stopping alcohol use results in a significant esophageal cancer risk reduction. A causal factor in alcohol-related esophageal cancer is exposure to acetaldehyde, an alcohol metabolite and established carcinogen. Japanese people have a high proportion of the aldehyde dehydrogenase 2*2 (ALDH2*2) allele, which causes a deficiency in ALDH2 enzyme activity and increases exposure to acetaldehyde, elevating their risks of esophageal cancer. Personalized health information about such risks can be important in developing motivation to moderate alcohol consumption. Fortunately, brief intervention (BI) for unhealthy alcohol use is an effective behavioral intervention that can capitalize on this motivation source but is underused in Japan. ObjectivesThe proposed project will test the efficacy of an unguided web-based BI using genetic cancer risk education to reduce alcohol consumption in a randomized controlled trial. MethodsParticipants will be recruited online and screened for moderate alcohol use and probable ALDH2*2 allele. Included participants will be randomized to an experimental BI condition or sham educational control. The experimental condition will receive an unguided web-based brief video intervention. The intervention will educate participants about their probable genetic risk, how consuming alcohol significantly increases risk of esophageal cancers, and the benefits of reducing or stopping alcohol use. The primary outcome is mean endpoint past 4-week alcohol quantity at 3-months post-randomization. Additionally, secondary main effects will be investigated with alcohol use in grams, severity, motivation to change, health knowledge retention, participant satisfaction, and quality of life. Assessments will be collected at baseline, 1- , 2-, and 3-months post-randomization through a web portal. ResultsThe present study was funded in April 2024. Data collection is projected to occur August 2025 - August 2026 through a Japanese research panel company. Currently, no data has been collected. ConclusionsThis intervention is expected to reduce unhealthy alcohol use at a low cost of implementation by using personalized health information as a motivational factor in a general population. Additional group differences are expected to be observed in secondary alcohol use outcomes. Trial RegistrationThis trial has been registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000058012).

BackgroundA healthy lifestyle, including sufficient physical activity, limited sedentary behavior, and adequate sleep (24-hour physical behaviors) can mitigate late effect risks for childhood cancer survivors (CCS). Most research on 24-hour physical behaviors has been questionnaire-based, while device-based assessment is lacking. Here, we assess the feasibility of 24-hour physical behavior monitoring using thigh-worn accelerometers in an age-diverse CCS population. MethodsSCCSS-Activity is nested in the Swiss Childhood Cancer Survivor Study (SCCSS), a nation-wide questionnaire-based cohort study. As part of the 2024/2025 mailing, we asked participants if they are willing to participate in an accelerometer-based sub-study. Participants wore an activPAL4(R) accelerometer continuously for eight days. We investigated feasibility using the following indicators: recruitment rate, acceptability and suitability of contact procedures and measurement scheduling, accelerometer return and adherence, summary reports, and overall impression. We analyzed quantitative data descriptively and conducted semi-structured interviews with nine participants. ResultsOf 367 CCS returning the baseline questionnaire (median: 14 years [IQR: 10-21]; 50% female), 157 (43%) expressed interest in the accelerometer study, 100 were enrolled as of June 2025, and 90 wore and returned the accelerometer, with all except two containing valid data. Participants wore the device for a median of seven days (IQR 7-8). Interview results indicated high acceptability and minimal burden. ConclusionTwenty-four-hour physical behavior assessment using thigh-worn accelerometers is feasible and well accepted among pediatric, adolescent, and adult CCS. This holds promise for future research to better understand and intervene on physical behaviors and to understand their compositional impact on CCS health. HighlightsO_LIThigh-worn accelerometry is feasible to assess 24-hour physical behaviors in survivors C_LIO_LI43% of eligible survivors expressed interest in accelerometer participation C_LIO_LI98% of participants provided valid accelerometry data C_LIO_LIMailing-based recruitment and return procedures were effective and acceptable C_LIO_LISurvivors reported low burden and high acceptability of study participation C_LI

BackgroundVirtual reality technology has emerged as a transformative educational tool in nursing education, offering immersive learning experiences that bridge theoretical knowledge and clinical practice. While quantitative studies have examined learning outcomes and skill acquisition, the subjective experiences of nursing students regarding engagement, satisfaction, and self-efficacy development through virtual reality remain inadequately synthesized. Understanding these experiential dimensions is crucial for optimizing virtual reality integration in nursing curricula and supporting student learning in increasingly technology-enhanced educational environments. ObjectivesThis systematic review protocol aims to synthesize qualitative evidence on nursing students experiences of engagement, satisfaction, and self-efficacy when participating in virtual reality-based educational interventions, exploring facilitators, barriers, and contextual factors influencing these psychological outcomes. MethodsFollowing PRISMA-P guidelines, we will search seven databases (MEDLINE, CINAHL, Education Source, ERIC, PsycINFO, Scopus, and Web of Science) from 2014 to December 2025. The PICo framework guides eligibility criteria focusing on nursing students experiencing virtual reality education, with qualitative exploration of engagement, satisfaction, and self-efficacy. Covidence will facilitate study screening and selection. Quality assessment will employ the Critical Appraisal Skills Programme qualitative checklist. Thematic synthesis following Thomas and Hardens approach will integrate findings across studies. Confidence in synthesized findings will be assessed using GRADE-CERQual methodology. DiscussionThis protocol establishes systematic methodology for understanding nursing students psychological experiences with virtual reality education. Synthesis findings will inform evidence-based implementation of virtual reality in nursing programs, curriculum design strategies, and support mechanisms for technology-enhanced learning. Results will guide educators in creating engaging virtual reality experiences that enhance satisfaction and build clinical self-efficacy among nursing students.

The Healthy Family Program trial aims to evaluate the effectiveness of a community-based, health instructor led, multifaceted family intervention, as compared with usual care, on blood pressure (BP) management among Chinese rural residents, with or without hypertension. It is designed as a two-arm, parallel, cluster randomized trial of 80 villages for 12 months. This statistical analysis plan pre-specifies the method of analysis for every outcome and key variables conducted in the trial. The primary outcome is change in systolic BP from baseline to 6 months in all participants, reported as the absolute difference between intervention and control groups. The primary outcome will be modelled using a linear mixed effect model based on a participant-level analysis. The model will include random effects at the village and family level to account for the clustering of participants within village and within family, respectively. Revision SummaryThis version contains this updated information. O_LIWe modified the primary analysis to account for potential correlation of outcomes within families. A mixed effect model was extended with the same set of fixed effects, village random effect, and family random effect (nested within village). However, since the number of participants within a family is relatively small, the estimation of family random effect could be numerically unstable. When the variance of the family random effect could not be estimated, a mixed effect model with village random effect will be conducted instead. C_LIO_LIAdditional sensitivity analysis is planned at the family level, where family-level mean change in systolic blood pressure will be analyzed using a linear mixed effect model. C_LIO_LIAdditional subgroup analyses is included by stratifying participants based on family size and township socio-economic level. C_LIO_LIIn the subgroup analysis, the categorization of the Mini-EAT dietary scale was modified from the original cutoffs of <60 and [&ge;]60 points to new thresholds based on the sample medium (i.e., below the median vs. equal to or above the median). C_LI

IntroductionUndertaking physical activity, pre- and post-operatively, can benefit recovery time and improve post-surgical outcomes. One cohort of patients that have reported these benefits are those undergoing surgery for breast cancer. Yet, what remains unclear is the level to which physical activity interventions are implemented into standard surgical care for patients with breast cancer. AimsThis systematic review aimed to examine existing qualitative evidence focusing on pre- and post-operative physical activity interventions to better understand the benefits and shortcomings of physical activity within the surgical journey. MethodsA systematic literature search was undertaken in November 2022, across five databases: MEDLINE, PsycINFO, Embase, CINAHL and Scopus. Qualitative studies involving people with breast cancer who had undertaken a physical activity intervention, either pre- and/or post-operatively, were included for analysis. The review was registered on PROSPERO: CRD42022372466 and performed according to PRISMA guidelines. The Critical Appraisal Skills Programme qualitative study checklist was used to assess study quality. ResultsFourteen studies were included, comprising the perspectives of 418 people receiving surgery for breast cancer. One study implemented pre-operative physical activity interventions; the remaining studies focused on post-operative interventions. A narrative systematic review was undertaken due to heterogeneity in reported results. Four themes were developed by thematic analysis, centring on: (i) factors promoting engagement with physical activity interventions; (ii) factors preventing engagement with physical activity interventions; (iii) the impact of pre- and post-operative interventions on physical and psychological health; and (iii) participant recommendations for pre- and post-operative interventions. Conclusionpre- and post-operative physical activity interventions were well-accepted. Patients recognised factors which promoted or prevented engagement with interventions, as well as pre- and post-operative physical and psychological benefits that arose as a result. Evidence based co-design studies may further inform successful implementation of physical activity into standard care for surgical breast cancer patients.

BackgroundSafewards is a multi-intervention mental health nursing model evidence-based practice, aimed at preventing and reducing conflict and containment. ObjectiveTo evaluate the effectiveness of the implementation of Safewards model in an open-door acute mental health unit. This analysis examines the impact of the Safewards model on conflict levels and restrictive therapeutic measures. DesignA prospective quasi-experimental study was conducted between August 2019 and January 2022, with patients admitted to an acute mental health unit from Spain. MethodsDescriptive and inferential analysis will be conducted. Multivariate regression models will be used to investigate the relationship between coercive measures, conflict levels, and clinical and demographic variables, adjusting for covariates if necessary. ResultsThe results indicated statistically significant differences in several variables such as rule violations (F=6.11, df= 1, p < .014), verbal aggression (F=14.9, df = 1, p < .001), and physical aggression towards objects (F = 7.2, df= 1, p < .008). The results indicated a statistically significant differences in restrictive therapeutic measures: intramuscular forced medication (F=8.5, df= 1, p < .004), environmental seclusion (F=14.6, df = 1, p < .001), and verbal/behavioural containment (F=75.0, df = 1, p < .001). ConclusionThis is the first study to evaluate the implementation of the Safewards model in an open-door acute inpatient unit in Spain with respect to restrictive therapeutic measures. Social media abstractSafewards Model in an Open-Door Acute Inpatient Unit in Barcelona @annabcn_24, @SafewardsBCN, @jcuevasesteban What is already known?O_LISafewards reduces conflict and restrictive interventions in mental health inpatient units. C_LIO_LISafewards uses 10 interventions based on mental health nursing theory. C_LIO_LISafewards is a mental health model for practice improvement implemented internationally. C_LI What this paper addsO_LIThis study is the first evaluation of Safewards implementation in Spain. C_LIO_LIThe research team translated Safewards into Spanish for staff training. C_LIO_LITranslating Safewards aids its use in Spanish-speaking mental health units. C_LIO_LIRestrictive measures reduced significantly, except for mechanical restraint. C_LI Reporting MethodThis study adheres to the relevant EQUATOR guidelines and follows the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting method. Patient or Public ContributionThe implementation of the Safewards model relies on the active participation of both healthcare professionals and patients to promote a safer and more therapeutic environment. Through structured interventions, staff facilitate communication strategies, de-escalation techniques, and conflict resolution, while patients actively contribute to fostering a climate of mutual respect and support. This bidirectional approach not only reduces coercion and incidents but also strengthens the therapeutic relationship and enhances the sense of community within the unit

BackgroundThe internet highly used worldwide triggers addiction to technology at various age stages. Digital addiction has various negative impacts on health, social, economic, and educational aspects. Various recent studies explained the influence of technology-based interventions to prevent and overcome digital addiction, which indirectly reduced the negative impact of addiction. The purpose of this study was to analyze the use of e-health in various age ranges, the type of e-health used and the type of intervention that uses e-health as a media for fighting digital addiction. MethodThis study is a literature review related to e-health intervention in digital addiction obtained from data bases: SpringerLink, ScienceDirect, ProQues, Ebsco CINAHL, and Google scholar with keywords and booleans: "internet addiction" OR "smartphone addiction" OR "game addiction" AND therapy OR intervention AND "e-health" OR "digital health" OR "digital intervention" OR "digital education. Articles in this review are limited to English articles from 2020-2023. The PRISMA guidline is used as a reference protocol and evaluation of literature review. ResultBased on the 11 articles included in this review, e-health interventions are used as strategy to prevent and treat digital addiction in children, adolescents and adults. The majority of the population who use e-health are adolescents. The type of e-health used as the main intervention was smartphone apps, while game was used as additional intervention. The majority of interventions that can be delivered through e-health are CBT based, while other interventions are behavior monitoring and nudge based. ConclusionE-health intervention can be used as the main and additional intervention to prevent and overcome digital addiction in various ages, especially adolescents, tend to have a high success rate. The development of e-health can be seen as a promising intervention to facilitate healthy digital behavior change.

IntroductionCompared to other high-income countries, the United States continues to have the highest rates of pregnancy-related and associated mortality and morbidity (PRAMM), particularly in rural areas and among non-Hispanic Black pregnancies. Over 80% of pregnancy- related deaths are preventable; however, the intensity of existing interventions has proven difficult to broadly disseminate. Technology offers the potential to address such barriers. This study will develop a multi-level digital intervention to reduce PRAMM and evaluate its effects using a site-randomized trial. Methods and analysisThe Michigan Healthy Mom (MI MOM) intervention will be developed using a community-partnered approach and will seek to address PRAMM risks at four distinct levels: individual, support system, provider, and community. Pregnant participants and up to three members of their personal support system will receive an initial brief interactive session through a mobile web app and will thereafter receive a series of text messages with links to extended content. Healthcare providers will receive biweekly text messages and/or flyers distributed in clinic staff areas, and community health workers (CHWs)-- who can facilitate access to local services--will be available via secure live chat text access. MI MOM effects will be evaluated using a cluster randomized trial in 10 antenatal care clinics throughout Michigan (N = 500 pregnant participants age 18+ receiving Medicaid). We will compare intervention and control arms on two co-primary outcomes: total PRAMM through 1 year postpartum as measured using a universally collected linked dataset of Medicaid claims and vital records and an index of PRAMM risk factors directly targeted by MI MOM. Ethics and disseminationThe Michigan State University (MSU) Institutional Review Board (IRB) has provided ethical approval (STUDY00011005). Results will be disseminated via presentations at academic conferences and community forums, as well as publications in peer-reviewed journals. Trial registration numberClinicalTrials.gov Registry (NCT07213284). STRENGTHS AND LIMITATIONS OF THIS STUDYO_LI* Community co-creation of the intervention content ensures MI MOM reflects the best available evidence-based practices while also being deeply rooted in the preferences and needs of the intended users. C_LIO_LI* The technology-driven approach provides a unique level of scalability for the developed intervention, enabling MI MOM to be readily implemented in practice with high fidelity and minimal training across contexts. C_LIO_LI* Integrating technology-delivered services with CHW live chat text access allows on-demand connection to helping professionals to facilitate warm handoffs to locally available services. C_LIO_LI* Digital approaches can elicit concerns around offering a minimally intensive approach to addressing the complexity of PRAMM; the ideal public health response would include person-delivered approaches used in concert with highly scalable, low-barrier technology- driven programs. C_LI

This protocol describes a research and development (R&D) project aimed at optimizing a targeted, preventive, efficacious, and tailored intervention called Supportive Parents - Coping Kids (SPARCK). Combining recent developments in basic and intervention research, the goal of this project is to develop, test and optimize a unified parent training intervention targeting children who display externalizing and internalizing symptoms and parents who are at risk of exhibiting maladaptive or neglectful parenting behaviors. We plan to utilize various design-based research methodologies to investigate what works for whom in which context, points which are essential to the innovation process, by employing a mixed methods research design and an iterative optimization process of testing and refinement. Furthermore, we introduce a cocreation process for SPARCK to involve relevant stakeholders working in Norwegian frontline services for children and their families to ensure that the intervention adheres to the needs and constraints encountered by these stakeholders and thereby promote the scalability and sustainable implementation of SPARCK. In this paper, we present the theoretical and methodological background of this approach to R&D in the field of mental health prevention as well as the operationalization of innovative methodology in the current project. This R&D approach aims to produce new knowledge concerning individual change mechanisms in parent training interventions and stakeholder feedback pertaining to intervention components and implementation strategies, all of which are imperative for the iterative SPARCK design process.

IntroductionBreast cancer remains a leading cause of cancer deaths; however, recent improvements in treatment have improved survivorship. As a result of this improvement, more individuals are living with the long-term side effects of cancer treatment. Therefore, methods that incorporate lifestyle and mind-body approaches are becoming increasingly used in the patient treatment pathway. MethodsIn this study, PranaScience Institute will develop and test a group video mobile application for Yogic Breathing (YB). YB is shown to reduce symptomatic conditions associated with several conditions including breast cancer. For this initial feasibility study, PranaScience will collaborate with the Medical University of South Carolina to implement the study app-based program in breast cancer survivors. This research is aimed to understand if the YB could be delivered via an app, if participants are able to practice it satisfactorily, and if there is any symptom relief by the YB practice. In the control group, participants will be directed to the Attention Control (AC) feature of the app, which guides users to focus on a mindfulness activity not involving YB. Participants will be randomly assigned to the YB or AC study plan (N=20 per group). Breast cancer survivors who have completed radiation therapy within last 6 months will be recruited for this study and provided access to the app for a 12-week program. The study app will record total practice times. Virtual visits by a study yoga instructor during group video sessions will measure participant compliance with proper technique. Feasibility will be examined by evaluating intervention delivery factors and resource needs. Acceptability of using the mobile study app to support symptom management will be evaluated using a satisfaction and system usability scale. Behavioral survey measures will help guide effect sizes and power calculations for the next larger-scale study. Biomarkers in the saliva (tumor suppressors, cytokines), and fingernails (cortisol, differential proteomics) will be measured at baseline and end of study at 12 weeks. DiscussionAll findings from this pilot study will be synthesized to refine the mobile study app in preparation for large-scale evaluation in Phase II involving all-study site participants with cancer. ClinicalTrials.gov Identifier NCT05161260.