JMIR Human Factors

User-Centered Virtual Clinic Services for Remote, Rural, and Underserved Sub-Saharan Africa: Development and Usability Study

2026-09-01T15:00:07-04:00

Background: Virtual clinics allow doctors to connect to patients in difficult-to-reach locations. While this can result in improved access to care, implementing existing virtual clinics in these locations is difficult due to their contextual constraints. To address these challenges, a virtual clinic system for remote, rural, and underserved areas was developed based on user-centered design principles. To complete the user-centered design cycle, the developed system was then implemented and evaluated in the target contexts. Objective: This study aimed to conduct a pilot study with the developed user-centered virtual clinic system to evaluate its performance in resource-limited settings. Patient, doctor, and nurse feedback was collected to understand how the virtual clinic system and implementation strategy might be improved before long-term implementation. Methods: A pilot study was conducted at 2 health care facilities in South Africa—1 underserved public primary health clinic in the city of Cape Town, and 1 remote occupational health clinic in the Northern Cape Province. Doctor and nurse dyads participated in using the system to consult with real patients in each clinic. Patients received both virtual and physical examinations by the same doctor, and these 2 consultations were compared with one another. Surveys were conducted to gather patient feedback pre– and post–virtual clinic consult. Observations of system usage were collected, and doctor and nurse participant interviews were conducted at the conclusion of each day. Qualitative data were thematically analyzed to understand barriers and facilitators of virtual consultations, as well as patient satisfaction. Results: A total of 12 patient consultations were conducted using the virtual clinic system across 2 health care facilities. Two doctors and 2 nurses participated in the study as users. Doctor and nurse confidence in using the system increased over time. Doctors were confident that the virtual consultation format could be used to diagnose patients remotely. Key indicators of patient satisfaction were being included in consultation communication and understanding the benefits virtual care could offer. Potential barriers to virtual consultations were infrastructure offered by the implementation environment and medical device limitations. Conclusions: The results from this pilot study indicate that virtual clinic consultation is possible in low-resource settings using the developed virtual clinic system. This system can support patients in remote, rural, and underserved areas to receive certain health care services from a doctor without the doctor having to be physically present in the facility. The results encourage further scaling of the system to support long-term implementation in low-resource health clinics in South Africa and other sub-Saharan African countries.

Effectiveness of Mobile-Delivered Exercise and Yoga Programs on Depressive Symptom Reduction in Employees: Randomized Controlled Trial

2026-09-01T14:30:13-04:00

Background: Mental health challenges such as stress and depression are prevalent among employees. Mobile health platforms that deliver exercise or yoga interventions offer a promising approach to improve mental health outcomes in this population. Objective: This study aimed to assess the effectiveness of 12-session adaptive moderate-intensity exercise and yoga programs delivered via a motion-detecting digital platform in reducing stress and depressive symptoms among employees. Methods: This was an unblinded, 3-arm, parallel-group, randomized controlled trial conducted at Seoul National University Bundang Hospital and Boramae Medical Center between November 2023 and January 2024. Eligible participants were full-time employees. Seventy-five participants were randomly assigned to an exercise, a yoga, or a cognitive behavioral therapy–based self-care control group using computer-generated randomization. The exercise and yoga groups engaged in motion-detecting, adaptive physical activity training, whereas the control group accessed mobile-based, self-directed stress management educational materials. The intervention was largely automated, with no individualized therapeutic guidance provided. Allocation was concealed until trial entry. All recruitment and outcome assessments were conducted in person at the hospitals. The primary outcomes were perceived stress and depressive symptoms, whereas the secondary outcomes included posttraumatic stress, insomnia severity, cognitive stress response, occupational stress, and burnout. Physiological outcomes were assessed using heart rate variability and electroencephalography. Measurements were collected at baseline, immediately after the intervention, and at 4-week follow-up. Data were analyzed using a multivariate linear model to evaluate the main effects of time, group, and time×group interactions. Results: Of the 75 randomized participants (exercise: n=24, 32%; yoga: n=25, 33.3%; and control: n=26, 34.7%), 71 (94.7%) who completed at least 9 of the 12 sessions (≥40 min each) were included in the outcome analysis (exercise: n=21, 29.5%; yoga: n=24, 33.8%; and control: n=26, 36.6%). For the coprimary outcomes, the group×time interaction for depressive symptoms (Patient Health Questionnaire-9) approached but did not reach the Bonferroni-corrected threshold (=2.71; =.03; adjusted α=.025); however, planned pairwise comparisons revealed significantly greater improvement in the yoga group compared to the control group at 4-week follow-up (β=−3.67; adjusted <.001). For the Perceived Stress Scale, the interaction was not significant (=.29), although a significant main effect of time (<.001) indicated overall stress reduction across all groups. For secondary outcomes, a significant group×time interaction was found for the Cognitive Stress Responses Scale (=.003), indicating differential trajectories of improvement. The yoga group showed a consistent linear decrease, whereas the exercise group showed immediate but less sustained gains. Conclusions: Digitally delivered adaptive yoga programs demonstrated superior and sustained improvements in depressive symptoms and Cognitive Stress Responses Scale scores compared with the active cognitive behavioral therapy–based self-care control group. However, the exercise program showed more modest and less sustained effects, warranting further investigation using larger samples. Trial Registration: ClinicalTrials.gov NCT06620783; https://clinicaltrials.gov/ct2/show/NCT06620783

Change Adaptation Resilience Evaluation Questionnaire for Industry 5.0 Among Workers in High-Tech Manufacturing Companies: Questionnaire Development and Pilot Evaluation Study

2026-08-28T16:15:11-04:00

Background: Despite increasing recognition of human factors in technologically advanced manufacturing, psychological resilience remains an underexplored dimension. Existing studies often rely on generic instruments that fail to capture the specific adaptive challenges faced by workers in high-tech environments. There is a growing need for context-sensitive tools capable of assessing resilience in line with the human-centric vision of Industry 5.0. Objective: This study aimed to develop and conduct a preliminary evaluation of the Change Adaptation Resilience Evaluation Questionnaire for Industry 5.0 (CARE-QI 5.0), a multidimensional instrument designed to assess individual and contextual factors contributing to psychological resilience among workers in high-tech manufacturing settings. Methods: The questionnaire was developed through a 4-phase process: literature review, expert evaluation, focus groups with operators, and pilot testing within 2 manufacturing companies. CARE-QI 5.0 conceptualizes resilience as a higher-order construct comprising 2 second-order dimensions—individual resilience and contextual resilience—further articulated into 18 first-order subscales. Internal consistency and intersubscale correlations were assessed using data from a sample of workers employed in the mechanical and packaging industries in Northeastern Italy. Results: Findings on the 84 items showed good internal consistency across all subscales and meaningful patterns of intercorrelation. External validity showed that problem-solving self-efficacy, cognitive flexibility, and problem-oriented coping were positively associated with both individual-based resilience and a wide range of contextual resources, including support given by organizations, colleagues, and family, as well as openness to change. In contrast, perseverance in the face of difficulties was linked to cognitive inflexibility, avoidance, and seeking change, suggesting the presence of rigid or less adaptive coping functioning. Conclusions: CARE-QI 5.0 provides a theoretically grounded and context-sensitive tool for assessing psychological resilience as a multidimensional construct in technologically evolving manufacturing environments. By integrating both individual and contextual protective resources, this instrument captures key adaptive processes relevant to Industry 5.0 scenarios, where human-technology interaction plays a central role. While further psychometric validation is needed, including confirmatory factor analysis and measurement invariance testing, CARE-QI 5.0 shows promise for both theoretical and research use. It can support organizations in monitoring workers’ adaptability and well-being, guiding targeted interventions and training strategies that align with workers’ resilience profiles and their technological experience.

Understanding the Limits of Patient Safety Classification Systems for Health Information Technology–Related Incidents

2026-08-28T16:00:53-04:00

Patient safety classification systems are fundamental to surveillance, organizational learning, research, and governance because they enable adverse events and near misses to be organized into standardized categories for comparison and analysis. However, the increasing complexity of health information technology (HIT)–related patient safety incidents challenges the assumptions underpinning conventional classification approaches, as these incidents often emerge from dynamic, distributed, and evolving sociotechnical interactions rather than discrete, time-bounded events. In this Viewpoint, I argue that many of the challenges associated with classifying HIT-related patient safety incidents arise not simply from limitations of individual classification systems but from the inherent representational logic of classification itself. By viewing classification as a knowledge practice rather than merely a technical tool for organizing incident data, I contend that abstraction, boundary-setting, and standardization inevitably simplify complex sociotechnical processes and constrain how safety problems are represented, interpreted, and acted upon. I discuss 4 recurring representational limitations that characterize the application of patient safety classification systems to HIT-related incidents: fragmentation of sociotechnical interactions, loss of temporality and evolving processes, inadequate representation of scale and propagation across systems, and normalization of “use error” through simplified attribution of responsibility. These limitations can contribute to incomplete organizational learning, misaligned safety interventions, and challenges in interpreting and comparing classified patient safety data across health care settings. Rather than arguing against the continued use of patient safety classification systems, I propose that their strengths and limitations should be recognized simultaneously. Classification remains indispensable for surveillance, learning, and governance, but it should be interpreted as one component of a broader sociotechnical understanding of patient safety. Recognizing the representational limits of classification can support more reflexive interpretation of classification-based evidence and encourage complementary approaches that better capture the complexity of HIT-related patient safety.

Patient Experiences of Digital Technology Use in Interstitial Lung Disease (PRODIGY-ILD Study): Qualitative Study Using Reflexive Thematic Analysis

2026-08-25T15:00:18-04:00

Background: Digital health technology enables collection of continuous physiological and behavioral data from participants in clinical trials. This supports hybrid trial designs, potentially reducing clinic visits and participant burden for patient monitoring. Interstitial lung disease (ILD) is characterized by an unpredictable clinical course, creating a need for new treatments and more sensitive approaches to assessing treatment effectiveness, disease progression, and clinically meaningful trial end points. Objective: This study aimed to explore the experiences of individuals with ILD using digital tools in a clinical study to inform digital health–enabled clinical research. Methods: This qualitative study was conducted within the PRODIGY-ILD (Predicting Outcomes using Digital Technology in Interstitial Lung Disease) cohort, a prospective observational study using wearable devices and electronic patient-reported outcome measures for a planned 3 years of longitudinal monitoring. Participants were recruited from a specialist outpatient ILD clinic. A topic guide was developed iteratively, and individual semistructured interviews were conducted remotely via Zoom (Zoom Video Communications, Inc) and/or telephone, audio-recorded, and transcribed. Data were analyzed using reflexive thematic analysis with NVivo software (Lumivero). Results: Fifteen of the final 20 participants recruited to the PRODIGY-ILD study consented and completed interviews. Four key themes were identified, highlighting how trust, digital literacy, participant-initiated engagement with data, and illness burden shape sustained participation in digital health–enabled clinical research: (1) trust and altruism override data concerns: confidence in researchers’ data handling and a desire to contribute enabled data sharing; (2) navigating digital tools: friction and flexibility: digital literacy, usability, and device compatibility varied, but participants were able to use workarounds to maintain engagement; (3) participant-initiated engagement with wearable data: participants moved from passive to active engagement, in many cases integrating devices into daily routines; and (4) life-limiting illness as a constraint on digital trial participation: managing symptoms and severe comorbidities reduces motivation and engagement with study technology. Conclusions: Despite participants’ motivations to contribute data to research, engagement was shaped by usability, participant-initiated engagement, and the constraints of living with chronic illness. There is a need for patient-centered design, tailored support, and flexible trial procedures to optimize adherence in digital health–enabled clinical research.

Personalized Intelligent Chatbot Based on AI-Generated Content Assists Memoir Writing for Older Adults With Cognitive Impairment: Mixed Methods Study

2026-08-25T11:00:20-04:00

Background: Older adults with cognitive impairment often face significant challenges in memoir writing, including memory fragmentation, emotional loneliness, and speech and language disorders. Although AI-generated content (AIGC) technologies such as GPT-3.5 show potential in creative tasks, they often lack the personalization and adaptability required for users with dementia. Generic AIGC tools often fail to address the heterogeneous cognitive and emotional needs of this population. Objective: This study aimed to design and evaluate, as a proof-of-concept, a personalized AIGC-powered chatbot to assist older adults with cognitive impairment in memoir writing and emotional support. Methods: We developed a multimethod collaborative design framework integrating Kansei Engineering, Quality Function Deployment, Axiomatic Design, and the Technique for Order of Preference by Similarity to Ideal Solution decision model. The system dynamically adapts interaction strategies based on users’ Mini-Mental State Examination (MMSE) scores, using a clinical threshold of 20 to distinguish mild (20-26) from moderate-to-severe (<20) impairment. In a single-session, nonrandomized, matched-pair evaluation using minimization-based allocation with an active control condition, performance was assessed via usability testing (System Usability Scale), affect assessment (Positive and Negative Affect Schedule), and blinded psychiatrist-rated memoir quality among 20 participants (10 per arm). Results: The experimental group showed significantly greater improvement than the active control group in positive affect, negative affect, and psychiatrist-rated memoir quality (all ≤.03 by matched-pair analysis; all comparisons remained significant after Benjamini-Hochberg correction), with moderate-to-large effect sizes (Cohen =0.85‐1.03 for affect outcomes; rank-biserial =1.00 for memoir quality). Within the sample (MMSE range 11‐23), participants in the lower MMSE tier (<20; n=12) appeared to benefit more from AI-driven narrative generation, while those in the higher tier (20-23; n=8) responded better to keyword-based prompting; these subgroup observations are descriptive, given the small cell sizes. The mean System Usability Scale total score of 92.2 (SD 5.1) exceeded the acceptability threshold and fell in the excellent range, though single-session exposure and potential acquiescence bias warrant cautious interpretation. Conclusions: These findings provide preliminary, hypothesis-generating evidence that a personalized AIGC-based chatbot may support short-term affective and narrative outcomes among older adults with cognitive impairment. The adaptive, multimodal design shows promise for human-AI collaboration in memoir writing and older adult care contexts, but larger, adequately powered randomized controlled trials with verified active control fidelity, multisession follow-up, and content source–differentiated outcome scoring are needed before clinical conclusions can be drawn.

Factors Associated With Health Perception and Psychological Well-Being Among Third-Age University Students: Cross-Sectional Study on the Role of Cyberchondria

2026-08-21T16:15:11-04:00

Background: With Türkiye’s aging population and widespread internet usage, the excessive seeking of health information through online platforms, formally identified as cyberchondria, has emerged as a concern affecting older individuals’ health perception and psychological well-being. Objective: This study aimed to evaluate the association of cyberchondria with health perceptions and psychological well-being among older participants in a third-age university program. Methods: This cross-sectional study included 352 participants aged ≥60 (mean 67.4, SD 4.7) years from Tazelenme University, Antalya, Türkiye, and was conducted between November and December 2024. Data were collected using the Cyberchondria Severity Scale Short Form (CSS-12), Individual Health Perception Scale, and Psychological Well-Being Scale for Older People (PWBS-OP). Statistical analyses included correlation and multiple regression analyses. Results: The mean age of the 352 participants was 67.4 (SD 4.7, range 60-87) years, 38.6% (n=136) were first-year students, 69.6% (n=245) were men, 58.8% (n=207) were married, 48.9% (n=172) were university graduates or above, and 65.1% (n=229) had chronic diseases. Significant negative correlations were found between CSS-12 distress, compulsion, and total scores with both Individual Health Perception Scale and PWBS-OP scores (<.05). According to the multiple linear regression analysis, the presence of chronic disease was the only significant positive predictor of higher health perception levels (=2.16, 95% CI 1.721-3.593; =.003), whereas factors such as age, gender, education level, and CSS-12 total scores did not demonstrate a statistically significant impact (>.05). Psychological well-being (PWBS-OP) was significantly and positively predicted by age (=0.22, 95% CI 0.037-0.399; =.02), marital status (=1.67, 95% CI 1.064-2.716; =.002), economic status (=2.10, 95% CI 1.729-3.464; =.003), and the thought of having an undiagnosed disease (=3.38, 95% CI 1.038-5.830; =.007), whereas it was significantly and negatively predicted by medical examinations in the past year (=−1.29, 95% CI −2.093 to 0.485; =.002), undergoing examinations without a physician’s recommendation (=−2.04, 95% CI −3.794 to −0.290; =.02), searching for health-related topics on the internet (=−1.26, 95% CI −2.152 to −0.360; =.006), and CSS-12 total scores (=−0.13, 95% CI −0.261 to −0.060; =.04). Conclusions: High cyberchondria levels significantly impair older adults’ psychological well-being and health perception. While demographic factors positively influence health perception, excessive internet-based health seeking deteriorates psychological well-being. Digital health literacy programs, professional online health counseling, and psychological support should be recommended to target cyberchondria risks in older populations.

Development of a Data-Enabled Mixed Method for Designing for Patients From a Human-Centered Design Perspective: Explorative Case Study

2026-08-19T14:30:16-04:00

Background: In the early stage of human-centered design (HCD), qualitative and generative methods are commonly used to explore patients’ contexts and needs, emphasizing active patient involvement to ensure that design insights accurately reflect real experiences and enhance both design effectiveness and patient empowerment. However, certain challenges arise in the early stage of the HCD process, including (1) high vulnerability of patient participants, (2) less diverse and representative patient groups due to recruitment challenges, and (3) insufficient problem framing across diverse patient experiences. Objective: To address these challenges while embracing the system-level HCD perspective, we propose a data-enabled mixed method combining large-scale patient digital research (module A) and in-depth patient engagement research (module B). This paper explores the feasibility and potential value of this mixed method in addressing the identified challenges through a case study. Methods: In module A, we analyzed a large-scale dataset of online forum posts and validated the extracted topics with medical experts to create a patient community journey map through cocreation sessions. Guided by these findings, module B involved a diary study using a sensitizing paper prototype and semistructured follow-up interviews with 4 patients. Results: In module A, 37 topics and 10 upper clusters were summarized from 212,107 online posts, revealing that topics associated with the home context exhibited a higher density of emotional content than those related to the hospital context. Patients placed more emphasis on social and mental health during the follow-up stage than in the diagnosis and treatment phases. This shift reveals a gap in current remote monitoring systems, which focus mainly on physical health. Addressing this identified gap, we developed a prototype for use in the module B diary study involving 4 patients. Patients responded positively to the prototype, noting that remote monitoring incorporating social and mental well-being could help them better understand themselves, enhance self-awareness, and improve communication with their physicians. Overall, this study explores the preliminary value of this mixed method in effectively reframing design problems and deeply contextualizing patient needs. Conclusions: This study provides preliminary evidence supporting the potential of integrating large-scale digital patient research (module A) with in-depth patient engagement (module B) during the early stages of human-centered health care design. The core strength of this mixed method approach lies in its ability to facilitate problem reframing and cultivate a deeper sense of empathy and understanding of patient vulnerability prior to direct engagement. Simultaneously, it captures both the breadth and depth of patient perspectives, offering evidence-based insights that enhance the overall efficacy of user research. Further research across diverse medical contexts is essential to establish the generalizability of these findings.

Exploring Response Patterns to Motivational Messages Supporting Physical Activity: Latent Class Analysis

2026-08-19T09:00:15-04:00

Background: In mobile health care, text messages play an important role in improving physical activity. Recent studies have developed message banks based on theories, including the behavior change technique (BCT) taxonomy. However, little evidence is available for individual differences (ie, who responds to which BCTs presented in messages), which is crucial for optimizing message delivery. Objective: We investigated how individuals perceive messages supporting physical activity and what clusters of individuals are identified by their responses. Methods: Japanese-speaking adults (n=2859; mean age 54.5, SD 17.5 years; 1486 women) were presented with messages conveying different BCTs and rated how motivational each message was. The motivation ratings were subjected to latent class analysis to identify clusters of individuals per motivation rating. Results: A total of 7 clusters were identified. Two clusters gave consistently high ratings across BCT types; one showed a general receptivity to all messages, while the other showed a clearer preference for information-based BCTs. Two clusters showed moderate ratings, both preferring information about consequences but differing in their additional preferences for goal setting vs rewards. Two clusters gave overall low ratings and typically included less active individuals in the preaction stages, both showing a preference for information-based BCTs. The remaining cluster showed the greatest variability in BCT preferences, with the strongest preference for salience of consequences. Conclusions: These results highlight individual differences in perceived motivations across BCTs, informing what BCTs should be prioritized in delivery. The practical implications for message tailoring are also discussed. Trial Registration:

Correction: Acceptability of a Digital Care App in Patients Undergoing Hip and Knee Arthroplasty: Prospective Cohort Study

2026-08-14T16:00:19-04:00