JMIR Human Factors

Exploring Patients’ Experiences in a Blended Transdiagnostic Group Treatment: Qualitative Study

2026-07-06T14:30:15-04:00

Background: Emotional disorders (EDs) are the most prevalent mental disorders worldwide. Health services face significant difficulties in attending to the high demand and applying evidence-based psychological treatments. Combining the transdiagnostic approach with the group and blended formats could help the accessibility of treatment for ED. It is important to assess the feasibility and acceptability of new interventions from a qualitative perspective. Objective: This study aimed to explore the experiences and opinions of patients with ED who have received transdiagnostic cognitive behavioral therapy treatment in a group and blended format. Methods: Two subsamples of participants were included: those who completed the intervention (n=18) and those who did not (n=4). The completers’ subsample participated in focus groups, which were transcribed verbatim and subsequently analyzed using a consensus qualitative research methodology. The noncompleters subsample completed a brief online questionnaire. Key themes identified by 2 independent researchers were described and used as complementary to focus group findings. Results were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Results: After analyzing the focus group interviews using the consensus qualitative research method, 8 domains (or topic areas) were identified, namely experience with the online platform, configuration of the blended intervention, therapeutic content, experience with the group sessions via videoconference, role of the therapists, overall assessment of the blended treatment, elements that help maintain adherence, and suggestions for improvement. Overall, participants reported benefits from this type of intervention, expressed satisfaction with the treatment, and highlighted the perceived improvement and usefulness of what they learned. They also noted the good usability of the platform and the possibility of establishing a good therapeutic alliance in this format. Participants also pointed out unfavorable aspects and offered suggestions on possible areas for improvement. For noncompleters, various reasons for dropping out were identified: lack of treatment efficacy, intervention-related stress, difficulty in applying learned strategies, low involvement, lack of motivation, time constraints, or need for different types of help. Strategies to enhance adherence to treatment were also identified, such as changes in the format and configuration of the sessions, allowing more time to discuss individual problems or reducing the number of homework assignments. Conclusions: These qualitative results support the feasibility, acceptability, and clinical utility of a blended group transdiagnostic intervention for the treatment of ED. This novel format could be a scalable and well-valued option within mental health services, although it can still be further optimized based on the results of this study. Trial Registration: ClinicalTrials.gov NCT04008576; https://clinicaltrials.gov/study/NCT04008576

A Mobile App (Tpro) for Symptom Management in Patients With Deep Vein Thrombosis Based on Patient-Reported Outcomes: Design and Development Using an Iterative Convergent Mixed Methods Approach

2026-07-03T16:30:20-04:00

Background: Deep vein thrombosis (DVT) is a significant global health issue, often associated with a high symptom burden and reduced quality of life, especially after discharge. Traditional symptom management models are typically passive, clinician-centered, and lack real-time monitoring and feedback, which can lead to delayed interventions and poor patient engagement. While mobile health (mHealth) interventions offer a promising alternative, they require rigorous usability testing to ensure both efficacy and adoption. Objective: This study aimed to design and develop Tpro (developed by the Department of Vascular Surgery, Peking Union Medical College Hospital), a patient-reported outcome (PRO)–based mobile app for patients with DVT. Using an iterative convergent mixed methods design, the app seeks to enable proactive symptom monitoring, health education, clinician-patient interaction, and peer support, thereby optimizing its usability, functionality, and alignment with patient needs. Methods: The development followed an iterative convergent mixed methods design, comprising predevelopment and iterative optimization phases. Initial functions were informed by qualitative interviews with 14 patients with DVT. Over 4 iterative cycles, qualitative feedback and quantitative usability data (including task completion rates and User Interface Usability Questionnaire [UIUQ] scores) were concurrently collected, analyzed, and integrated via joint displays to guide refinements in content, interface, and system architecture until usability benchmarks were met. Results: The final Tpro app encompasses 4 core modules, including gamified symptom reporting, multimodal health education, clinician-patient communication, and a peer support community. Iterative testing identified and resolved key usability issues. The final prototype demonstrated high usability, achieving an excellent UIUQ score (mean 89, SD 13) and a task completion rate of 92% (12/13), indicating high user acceptance and operational reliability. Conclusions: Applying the iterative convergent mixed methods approach enabled the systematic and user-centered development of Tpro. This methodology effectively integrated diverse stakeholder feedback into a functional and engaging patient-reported outcome–based app, ready for subsequent efficacy trials. This approach offers a replicable model for developing digital health tools in complex clinical contexts.

Monitoring Health Status: Development and Preliminary Validation of a Personal Health Index Using the International Classification of Functioning, Disability and Health

2026-07-02T17:15:05-04:00

Background: Effective health monitoring is essential for personalized care and comprehensive health assessment. Personal health indices and profiles offer a concise summary of an individual’s overall health, supporting both clinical decision-making and self-management. However, global standardization remains challenging due to diverse practices and data formats across countries. Objective: This study aimed to present a novel model for computing a personal health index and health profile using the International Classification of Functioning, Disability and Health (ICF) framework. The model was designed to handle incomplete and heterogeneous datasets and aimed to provide standardized, interpretable health metrics. Methods: We developed a recursive algorithm that calculates the health index based on the hierarchical structure of the ICF, using all available measurements. The model incorporates time decay and linkage reliability to weight input data. Preliminary validation was conducted on data from 505 individuals, using statistical correlation analyses with self-assessed health measures (EuroQol Visual Analogue Scale and pain ratings), and a sensitivity analysis was performed to assess model robustness. Results: The computed health index showed moderate positive correlations with EuroQol Visual Analogue Scale scores (all <.001) and negative correlations with maximum pain trajectories, supporting its validity. Sensitivity analysis confirmed predictable behavior in response to input changes, and the model demonstrated resilience to missing data. Conclusions: The proposed model offers a flexible and scientifically grounded approach to computing personal health indices and profiles within the ICF framework. It enables the integration of diverse health data sources and supports the visual representation for clinical and personal use. This model has potential applications in health monitoring, rehabilitation planning, and machine learning–based health informatics.

Using Intervention Mapping to Codevelop Orchid, a Digital Tool for Reproductive Life Planning: Development and Feasibility Study

2026-07-02T15:45:16-04:00

Background: Most people make no health or lifestyle changes before pregnancy, missing a key opportunity to improve outcomes. Consequently, nearly half of UK pregnancies are unplanned, disproportionately affecting underserved groups and widening health inequalities. Digital health interventions (DHIs) offer promise but require systematic, theory-driven development to ensure effectiveness and real-world applicability. Objective: This study aimed to use Intervention Mapping to codevelop and pilot Orchid, a novel DHI designed to support people of reproductive age to understand their pregnancy preferences and develop a reproductive life plan (RLP). Methods: We used Intervention Mapping steps 1‐4 to guide the systematic, theory-informed codevelopment of Orchid. A multidisciplinary planning group and codevelopment group of 21 members of the public contributed throughout. At step 1, previous research and a scoping review of existing RLPs informed the program goals and logic model of the problem. During step 2, we identified performance objectives and behavioral determinants to specify practical strategies for each target behavior. At step 3, we applied the Capability, Opportunity, Motivation–Behavior (COM-B) model and relevant behavior change techniques to guide intervention design. Finally, at step 4, Orchid was co-designed as a website and mobile app providing users with a pregnancy preference group and prediction of pregnancy, a dynamic RLP, tailored evidence-based information, and optional goal-setting features to support behavior change. Orchid was piloted between January and May 2025 to explore its feasibility and acceptability in health care settings. Interviews with users, nonusers, and health care professionals were conducted and quantitative data from users were collected. Results: These findings indicate that implementation was feasible, and health care professionals found it acceptable to recommend Orchid to patients, though noted barriers including time constraints and competing priorities. Overall, 153 people signed up to Orchid; 68% (72/106) of eligible users received a pregnancy preference group and 27% (32/119) of eligible users completed a full RLP. Users were positive about Orchid, appreciating its content and design, noting that Orchid contained a wealth of information about reproductive health presented in an easy-to-understand manner. They valued the autonomy, convenience, and privacy afforded by the digital format, and found it acceptable to be recommended Orchid within a health care setting. Orchid uptake was lower than anticipated, and use was limited; this was partly expected given the short pilot period, but feedback also suggested targeted recruitment and navigation improvements could enhance uptake and engagement. Conclusions: Orchid is the first co-designed DHI to support reproductive health across the life course. Its systematic development, theoretical foundation, strong user involvement, and positive pilot testing position it as a promising, scalable innovation to support reproductive health, deliver credible information in accessible formats, and promote preventative, community-based care across the National Health Service.

Evaluating the Viability of Virtual Reality for Children’s Food Choice Research: Comparative Mixed Methods Study

2026-07-02T10:00:24-04:00

Background: Virtual reality (VR) systems offer promising potential as a controlled platform to investigate human behaviors specifically related to food choices. Yet, little is known about its viability for conducting food choice studies with children, thus limiting the development of public health research. Objective: This study aimed to investigate the viability of VR technology for understanding children’s food choices, focusing specifically on perceptual differences between VR and real-life (RL) settings. We examined how children perceive and interact with food portion sizes and container sizes in VR as compared with an equivalent RL scenario. Methods: A within-subject, mixed methods study was conducted with 437 children aged 5‐12 years at a science museum. Participants engaged in a standardized food selection task for a simulated breakfast scenario, choosing portions of cereal and milk in 2 conditions: a head-mounted VR environment and a corresponding RL physical setup. Children’s food selection behaviors were quantitatively compared across 3 independent variables: condition (VR vs RL), food healthiness (healthy vs unhealthy options), and container size (small, medium, and large). Qualitative and quantitative data were collected via postsession questionnaires assessing presence, embodiment, and simulator sickness, alongside detailed interaction logs from the VR environment. Data analysis used statistical comparisons and thematic analysis. Results: The findings revealed both behavioral consistency and significant perceptual differences between the VR and RL conditions. A behavioral similarity was identified, as children served significantly larger portions of unhealthy food compared with healthy food in both conditions. Crucially, a difference was observed in size perception: children struggled to accurately match the size of bowls and glasses between the VR and RL conditions. Furthermore, while children reported low feelings of presence and embodiment within the VR scenario, they demonstrated a high degree of control and engagement in the virtual task. Conclusions: Our findings suggest that current state-of-the-art VR technology presents limitations in its viability for conducting food choice studies with children, particularly concerning accurate size and volume perception. Based on the findings, we provide 4 practical recommendations to guide the future development of immersive food environments, thereby supporting more reliable and ecologically valid food choice research with young populations.

Risk Factors for Noninitiation and Dropout in Blended Therapy in Inpatient Psychiatric Patients: Retrospective Cohort Study

2026-06-29T16:30:18-04:00

Background: Blended therapy (BT) combines digital applications with face-to-face treatment and has become an increasingly important component of psychiatric care. Evidence indicates that BT can achieve outcomes comparable to or even superior to those of traditional face-to-face therapy. Despite certain advantages, routine implementation of BT remains challenging, and clinical practice suggests that while some inpatients engage with BT, many either discontinue early or do not initiate its use at all. To better understand these patterns, this multicentric, retrospective observational study investigates factors associated with noninitiation and dropout among inpatients who are offered BT. Objective: In this study, data from 278 inpatients were analyzed to examine the influence of sociodemographic variables, comorbidities, and symptom severity on the uptake and continued use of BT. The objective was to identify predictors of noninitiation and dropout. Methods: Multivariable logistic regression models were conducted to identify significant predictors of noninitiation and dropout among inpatients using the transdiagnostic, cognitive behavioral therapy–based electronic mental health platform Minddistrict, which offers modules targeting psychoeducation, cognitive restructuring, and behavioral activation. Data were collected from 2 psychiatric hospitals between January 2020 and May 2024. The sample consisted predominantly of patients diagnosed with depression (182/278, 65.7%) and posttraumatic stress disorder (61/278, 21.9%), alongside various comorbid conditions. Results: The findings indicate distinct patterns of association for noninitiation and dropout. Of the 278 patients, only 5 (1.8%) completed all the assigned modules, and one-third of the patients never initiated the platform at all. Specifically, increasing age was linked to a lower risk of noninitiation (odds ratio [per year age difference] 0.98, 95% CI 0.96-1.00; P=.01), while the presence of a comorbid anxiety disorder was associated with a reduced risk of dropout (odds ratio 0.23, 95% CI 0.08-0.66; P=.007). Several variables showed no association with either noninitiation or dropout across all analyses, including sex, overall symptom severity, and certain comorbidities such as personality disorders and depression. Conclusions: In this preselected inpatient sample, uptake of BT was very limited. Older age was associated with lower noninitiation, and comorbid anxiety disorders were associated with a lower likelihood of dropout. These findings may help inform future prospective studies on how BT can be introduced and supported more effectively in inpatient psychiatric care. As access to BT was granted selectively by therapists, the results should be interpreted as predictors of engagement within a selected sample rather than general predictors of BT uptake among all psychiatric inpatients. Trial Registration:

Smartphone-Based Ecological Momentary Assessment to Monitor Opioid Use and Overdose Among People Who Use Opioids: Prospective Observational Feasibility Study

2026-06-29T16:00:20-04:00

Background: Opioids account for 76% of drug overdose deaths in the United States, with nearly 80,000 opioid overdose deaths annually. The risk of overdose is dynamic and influenced by rapidly changing behaviors and contexts that are not well captured by retrospective or infrequent assessments. Ecological momentary assessment (EMA) allows repeated near real-time reporting of behaviors and experiences in natural settings. Objective: This study evaluated the feasibility and acceptability of smartphone-based EMA among people who use opioids to monitor opioid use, overdose experiences, and naloxone access. Methods: Participants were recruited through the New Haven Syringe Services Program in New Haven, Connecticut, and completed fixed-time, twice-daily EMA prompts for 30 days using a smartphone app. EMA measures assessed behaviors and experiences occurring within the previous 12 hours, including opioid craving, plans to use drugs, opioid use, overdose experiences, and naloxone access. Feasibility was assessed through recruitment, retention, and EMA completion rates, as well as the reporting of drug use-related behaviors. Acceptability was evaluated using exit surveys assessing ease of use, burden, and privacy, as well as qualitative interviews. Results: Of the 13 screened individuals, 10 were enrolled and completed the baseline assessment. A total of 9 (90%) participants completed EMA and responded to 411 prompts, with an overall compliance rate of a mean of 85.0% (SD 8.7%). Compliance was similar across morning (84.2%, SD 13.1%) and evening (85.8%, SD 11.2%) prompts. Participants reported opioid cravings (274 reports), plans to use illicit drugs (252 reports), and opioid use (411 reports) during the study period. Two participants reported overdose events (5 reports) and were carrying naloxone during each overdose event. Acceptability ratings were high: all participants reported that EMA prompts were easy to understand and private, and most did not find them burdensome. Qualitative feedback further highlighted the ease of use, integration into daily routines, and increased self-awareness, although some participants reported emotional discomfort when reflecting on their substance use. Conclusions: Smartphone-based EMA was feasible and acceptable among people who use opioids recruited through a syringe service program. EMA may support the monitoring of opioid use, overdose experiences, and naloxone access, and it may inform future digital health interventions aimed at reducing harm, including overdose risk, among people who use opioids.

A Geospatially Customizable Culturally Tailored Just-in-Time Adaptive Intervention for Violence-Affected People Living With HIV: Mixed Methods Acceptability, Feasibility, and User Experience Study

2026-06-26T13:15:13-04:00

Background: Posttraumatic stress, along with comorbid mental health challenges and hazardous alcohol use, disproportionately affects people living with HIV. The drivers of these stressors are both intraindividual, rooted in early life adversity and firsthand violence exposures, and contextual, often place-based. Imparting effective coping skills and distinguishing between changeable and unchangeable stressors can improve stress management in the short term, with cascading effects on key HIV continuum of care end points, such as antiretroviral therapy adherence. However, problem- and emotion-based coping skills, delivered via traditional linear in-person group modalities, may falter in the moment. To address this, we adapted the evidence-based Living in the Face of Trauma intervention into an iOS- and Android-native app, featuring daily diary–triggered coping skills recommendations, self-guided Living in the Face of Trauma psychoeducational sessions, and a customizable geofencing function. Objective: This mixed methods study aimed to examine the acceptability, feasibility, and user experiences of NOLA (New Orleans, Louisiana) Gem, focusing on user interaction costs relative to geographic ecological momentary assessment (GEMA) alone and refining future optimization options. Methods: People living with HIV (N=32) were recruited across New Orleans and initially randomized 1:1 to treatment (NOLA Gem + GEMA) versus control (GEMA) for 21 days. Feasibility was assessed via enrollment and attrition rates. At the immediate postassessment, participants completed acceptability and usability measures and a brief structured usability interview. Analyses included descriptive statistics, bivariate logit modeling, and synergistic human–large language model deductive coding. Results: In total, 30 participants (n=22 in the GEMA + NOLA Gem treatment arm) completed the pilot, representing 94% (n=29) of baseline enrollees. Acceptability was very high across the board: 100% (n=30) of users considered NOLA Gem “very” or “somewhat” successful in addressing their daily lives, with 91% (n=28) endorsing increased calm and emotional well-being. In addition, 50% (n=11) of NOLA Gem users were “extremely likely” (Net Promoter Score=10/10) to recommend the app to friends. Eight (27%) GEMA and GEMA + NOLA Gem users reported privacy concerns. Eleven (50%) NOLA Gem users received geofencing alerts; perceptions of this feature’s helpfulness were mixed. No statistically significant sociodemographic or clinical predictors of disparate acceptability or increased privacy concerns were found. No additional frictions were evidenced by GEMA + NOLA Gem versus GEMA users. Qualitatively, NOLA Gem users praised the just-in-time mindfulness, breathing, problem-solving skills delivery, and broader stress control and self-insight benefits. A subset of users pointed out the burdensome length and sometimes inconvenient timing of the daily diaries. Recommendations for next-generation personalization included user-specific dynamic daily diary and geofencing prompt tailoring. Conclusions: Our small pilot study demonstrated high NOLA Gem acceptability and feasibility, as well as a rich and beneficial user experience among people living with HIV, with clear and actionable opportunities for improvement. Trial Registration: ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/study/NCT05784714 International Registered Report Identifier (IRRID): PRR2-10.2196/47151

Evaluating a Dual Digital Cognitive Behavioral Therapy and Health and Wellness Coaching Intervention for Anxiety and Depression: Single-Arm Pilot Study

2026-06-25T10:00:24-04:00

Background: Anxiety and depressive disorders remain highly prevalent and insufficiently treated, with many individuals experiencing persistent or untreated symptoms, limited access to evidence-based care, or insufficient support between clinical encounters. Adults with disabilities represent a particularly underserved subpopulation, often facing compounded barriers to mental health care and higher rates of anxiety and depression. Digital therapeutics offer a scalable opportunity to address these gaps by extending structured, evidence-based interventions beyond traditional care settings. Objective: This pilot study evaluated Rauha, a novel digital therapeutic created by Toivoa Inc, that integrates cognitive behavioral therapy (CBT)–based modules with live weekly sessions led by a National Board-Certified Health and Wellness Coach (NBC-HWC), delivering structured, smartphone-based psychoeducation and interactive therapeutic exercises combined with personalized mental health coaching to support behavior change. Methods: Thirteen adults with mobility and/or hearing disabilities and clinically elevated anxiety and/or depression were enrolled in a single-arm, within-participants design. Participants completed 8 weeks of CBT modules delivered via smartphone, accompanied by synchronous virtual mental health coaching. Anxiety and depression were assessed using the Hamilton Anxiety and Hamilton Depression Rating Scales, respectively, at baseline, post treatment, and at the 4-week follow-up. Results: Mean reductions were significant for both anxiety (−13.05, SD 2.51; <.001) and depression (−12.83, SD 1.55; <.001), exceeding thresholds for clinical significance and sustained through follow-up. Post treatment, 84.6% (11/13) of participants showed clinically significant improvement in both anxiety and depression. At follow-up, 76.9% (10/13) and 92.3% (12/13) of participants showed clinically significant improvement in anxiety and depression, respectively. Between baseline and follow-up time points, these reductions corresponded to mean shifts from moderate to mild anxiety on the Hamilton Anxiety Rating Scale and from moderate to mild/nondepressed on the Hamilton Depression Rating Scale. Participants reported strongly favorable acceptability, experience, and usability ratings for the Rauha treatment program, demonstrating 100% treatment retention and an average replay rate of 5.5 for personalized smartphone content. Conclusions: The findings suggest that a combined digital CBT and NBC-HWC approach can yield clinically meaningful and durable symptom reductions in depression and anxiety, coupled with high user acceptability and engagement, for adults with disabilities. These findings provide preliminary evidence supporting Rauha as a scalable, evidence-informed mental health intervention with the strong potential to improve access and address key barriers to care.

Effect of a Personalized Mobile App on Glucose Control in Adults With Prediabetes and Type 2 Diabetes: Exploratory Pilot Randomized Controlled Trial

2026-06-24T17:00:03-04:00

Background: The incidence of type 2 diabetes (T2D) continues to increase, and the lack of individualized therapy strategies hinders patient engagement with and commitment to a healthy lifestyle. The PROTEIN project aimed to facilitate users in choosing healthy living, thereby improving their metabolism and T2D management. Objective: This study aims to assess the efficacy of a personalized mobile app to achieve a 5% time in range (TIR) improvement over a 12-week intervention in adults with prediabetes or T2D. Methods: We conducted an exploratory pilot randomized controlled trial with 21 individuals with T2D or prediabetes who used a continuous glucose monitoring system and the PROTEIN mobile app for personalized meals and exercise recommendations based on their glucose levels and physical activity. Results: The TIR of the participants increased (P<.05; from 71.8%, SD 27.3% to 76%, SD 28.1%) with individual use of the PROTEIN app but did not achieve a 5% improvement overall; however, given the exploratory design and small sample size, this finding should be interpreted with caution. Glycated hemoglobin, fasting blood glucose, and body weight did not fluctuate throughout the 12-week intervention. The dropout rate was high, and the average duration of use of the PROTEIN app was 42 (range 5-84) days. Conclusions: Our results showed a modest increase in TIR with the use of the PROTEIN app; however, considering the exploratory design and small sample size, this finding should be interpreted as preliminary. Integrating wearables and automated personalization for well-being is an innovative approach that must keep pace with the accelerated development of ever-evolving technologies. The COVID-19 pandemic was a major obstacle to recruitment in our clinical trial. Clinical Trial: ClinicalTrials.gov NCT05951140; https://clinicaltrials.gov/study/NCT05951140