JMIR Human Factors

Barriers to Population Data Use in Overdose Fatality Reviews: Observational and Interview Study of Dashboard Deployment

2026-07-27T14:45:11-04:00

Background: Overdose fatality reviews (OFRs) are an important public health tool for developing local overdose prevention strategies by reviewing individual overdose cases. While this approach offers a rich, contextual understanding of drug overdose factors in communities, it examines a small number of cases, providing limited insight into broader population-level risk patterns. To complement OFRs, we developed a real-time dashboard that visualizes trends about 5 key “touchpoints” (ie, interactions with medical and justice services preceding overdose). We then trained local OFR teams to use this dashboard to identify prevention opportunities. Objective: This study examines the integration of population-level data into OFR practices, as well as the tensions that emerge between OFRs’ traditional case-driven review processes and the statistical, population-level analysis typical in public health. We analyze how and when the dashboard was used in meetings, determine the extent to which the data informed recommendations, and identify barriers that prevented the broad uptake of this intervention. Methods: We observed 26 OFR meetings across 11 counties in Indiana over 10 months, from November 2024 to September 2025, during which teams conducted case reviews and developed recommendations. We documented instances of dashboard use as well as “missed opportunities,” in which relevant population-level data were available but not incorporated into the discussion. We also conducted semistructured interviews with OFR team members (n=7) to understand their perceptions of the dashboard, including its usefulness, usability, and adoption barriers. Results: Despite its intended role, the dashboard was rarely integrated into OFR meetings; it was used only 10 times, compared to 114 missed opportunities in which relevant data could have informed discussions. Interviews revealed that this limited uptake was not solely due to usability barriers but reflected a deeper tension between 2 distinct analytic approaches. OFR teams prioritized narrative-driven case reviews that were grounded in empathy, local knowledge, and lived experience. This approach seemed at odds with the population-level visualizations shown in the dashboard, which required statistical abstraction and interpretation. Other barriers identified included limited time and resources, staff turnover, and varying levels of data fluency, which made it difficult for teams to confidently interpret the dashboard despite training. Conclusions: The results highlight a tension between case-based and data-driven approaches to overdose prevention. These approaches are grounded in different workflows, values, and motivations, making it challenging for OFR teams to maintain their traditional, empathetic review practices while incorporating population-level trends. Our findings indicate the need for data tools that bridge these approaches, such as visualizations that connect aggregate patterns to individual cases. The results also underscore the need for additional support and training for teams, such as dedicated data specialists who interpret population-level trends and provide insights to augment team discussions and inform prevention strategies.

Multicenter Usability Evaluation and Co-Development of a Digital Decision-Support Tool for Labor Triage: Mixed Methods Study

2026-07-23T18:00:20-04:00

Background: Digital decision-support tools for labor care remain limited, with few technologies successfully addressing the complex, time-sensitive decisions required during labor triage. Fit4Labour is a clinician-facing, data-driven research tool, currently under development, that combines computerized cardiotocography interpretation with maternal and fetal risk factors to generate individualized risk scores at labor onset. Its primary aim is to support clinicians in identifying fetuses who may require closer monitoring or expedited delivery, while simultaneously providing reassurance in low-risk cases. By promoting consistent communication and timely escalation of care, the Fit4Labour tool seeks to strengthen clinical decision-making. Understanding and addressing usability and implementation barriers will be critical to its adoption in clinical practice. Objective: This study aims to evaluate whether a digitally co-developed labor decision-support tool (Fit4Labour) maintains usability and implementation readiness across NHS hospitals with differing clinical contexts. Methods: We conducted a convergent parallel mixed methods study in 3 United Kingdom hospitals (December 2022 to May 2025). Phase 1 involved iterative co-development with midwives and doctors at Oxford University Hospitals NHS Foundation Trust; Phase 2 validated the locked version at Birmingham Women’s and Children’s NHS Foundation Trust and Buckinghamshire Healthcare NHS Trust. Participants completed scenario-based usability sessions evaluated with the System Usability Scale (SUS) and Single Ease Question (SEQ), and task completion time, followed by focus groups and interviews analyzed thematically. Results: Twenty-six health care professionals participated: 12 in co-development (7 midwives, 5 doctors) and 14 in validation (8 midwives, 6 doctors) phases. During co-development at Oxford, the tool met the “excellent” usability threshold (mean SUS 82.1, SD 12.3), indicating readiness for the validation phase. The locked version (v4.0) independently met the “excellent” threshold at both validation sites (combined mean SUS 85.8, SD 10.2; Birmingham 80.7, SD 10.8; Buckinghamshire 90.8, SD 7.2). Task completion times were comparable across validation sites (Birmingham 10.3, SD 1.6 min; Buckinghamshire 9.2, SD 1.9 min), while SEQ scores were consistently high across all scenarios (mean 6.1/7, SD 0.8). Thematic analysis identified 12 themes within 3 domains: clinical integration and workflow, technology adoption and implementation, and patient safety and decision-making. Participants described the Fit4Labour tool as a supportive tool, “like a co-pilot,” improving confidence in decisions with the potential to aid triage assessment. Perceived limitations included an incomplete risk factor profile and the need for minor technical adjustments or integration with existing hospital systems. Conclusions: Through systematic co-development, the Fit4Labour tool met the established usability benchmark at 2 independent NHS hospitals with markedly different clinical contexts. Clinicians viewed the tool as a supportive aid providing a shared language for risk communication and enhanced decision-making while preserving clinical autonomy. Whether these usability findings translate to improved clinical outcomes in real-world practice requires prospective evaluation.

Process Evaluation of Digital Mental Health Interventions for Psychosis: Scoping Review With Framework Synthesis

2026-07-23T17:00:03-04:00

Background: Implementing digital mental health interventions (DMHI) for those with psychosis is a persistent challenge. A process evaluation, or studies conducted alongside trials, is one research method that may address this issue. However, a synthesis of process evaluation data in this area is missing. Objective: This study aimed to understand what is known about context, implementation, and mechanisms of impact by synthesizing process evaluation data from trials evaluating DMHIs used by people with psychosis. Methods: A scoping review using a 2-phase search strategy underpinned by the Medical Research Council (MRC) process evaluation framework was conducted. Database searches of Cochrane Central Register of Controlled Trials and PsycInfo in 2024 and 2025 first identified an index sample of peer-reviewed trials predominantly conducted in the United Kingdom (≥50% of samples from the United Kingdom in multicountry studies). Next, papers linked to the index sample were retrieved and included if they reported process evaluation data as operationalized in the MRC framework. Two authors independently screened references, extracted summary data, and assessed the quality of index trials. One author qualitatively synthesized process evaluation data using a deductive framework synthesis approach using the MRC framework. Findings were triangulated with senior authors and presented as a narrative synthesis. Results: Searches identified 14 DMHIs and 45 papers reporting process evaluation data, though only 2 were labeled as such. Qualitative syntheses of process evaluation data generated five themes aligned with the MRC framework: (1) enhancing fit and supporting delivery (implementation strategies); (2) DMHI implementation varied across users, staff, and delivery settings (implementation outcomes); (3) helping users to respond in more helpful ways (mechanisms); (4) addressing perceived and actual implementation factors (context); and (5) limited impact of user characteristics on DMHI outcomes (context). Conclusions: There is preliminary evidence that DMHIs can be delivered to people experiencing psychosis within trial settings, although use varied between individuals. Future implementation efforts may benefit from addressing contextual factors influencing DMHI use, including users’ treatment needs and preferences, everyday demands, and staff availability for blended interventions. Future research could evaluate implementation strategies, validate how and for whom DMHIs work, and embed process evaluation in trials. Trial Registration: PROSPERO CRD42024439117; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024439117

Japanese Health Information Technology Usability Evaluation Scale for Sexually Transmitted Infection–Related Chatbots: Development and Psychometric Validation Study

2026-07-23T14:30:14-04:00

Background: The rapid expansion of mobile technology has accelerated the integration of health applications and conversational AI into clinical and public health practices. To ensure these tools are effective and sustainable, usability evaluations and early user engagement during development are essential. The Health Information Technology Usability Evaluation Scale (Health-ITUES) is a validated and flexible usability assessment instrument that is available in multiple languages and applicable across diverse contexts. However, a Japanese version of this scale has not yet been developed. Objective: This study aimed to translate and validate a Japanese version of the Health-ITUES, customized for a sexually transmitted infection (STI)–related chatbot, and to support the usability assessment of emerging mobile health tools in Japan. Methods: We developed a Japanese version of the Health-ITUES using a chatbot under development as a consultation tool for young women regarding STIs. First, the original scale was customized to reflect the chatbot’s specific purpose and intended usage context. Following established translation guidelines, we conducted forward translation from English to Japanese, back translation, expert review, and reconciliation. We then evaluated the reliability and validity of the Japanese version in a sample of 301 young women. Results: The Japanese version of the Health-ITUES demonstrated high internal consistency (Cronbach α=0.85‐0.98). Confirmatory factor analysis supported acceptable construct validity (root mean square error of approximation is 0.10, comparative fit index>0.90). Additionally, the Health-ITUES scores showed strong correlations with satisfaction and usage intention for the tool (=0.779 and 0.797, respectively). Conclusions: The Japanese version of the Health-ITUES provides initial evidence of reliability and validity in an STI-related scenario among young women and may facilitate more rigorous usability evaluations of mHealth and conversational AI tools in Japan.

Validation of the Taiwan Chinese Version of the Assistive Technology Usability Questionnaire for People With Neurological Diseases for Wearable Robotic Exoskeletons: Usability Study

2026-07-20T17:30:13-04:00

Background: Assessing usability is important given the increasing use of technology in rehabilitation. While wearable robotic exoskeletons (WREs) are commonly incorporated into neurological rehabilitation in both clinical and community settings, there is a need to examine the applicability of different usability instruments in this context. The Assistive Technology Usability Questionnaire for People with Neurological Diseases (NATU Quest) was developed to evaluate the usability of assistive technology in individuals with neurological conditions. However, its reliability and validity have been established only for assistive devices such as wheelchairs and canes, restricting its generalizability. Objective: This study aimed to cross-culturally adapt a Taiwan Chinese version of the NATU Quest and to preliminarily evaluate its applicability, reliability, and validity for assessing WRE use among patients who had a stroke as an expanding application context. Methods: Cross-cultural adaptation was achieved through a structured translation from Spanish to Taiwan Chinese, followed by content validation by an expert panel of 10 raters. Following the adaptation process, psychometric testing of the NATU Quest was administered to 20 patients who had a stroke following the completion of a comprehensive course of robot-assisted gait training facilitated by a WRE. The internal consistency of the NATU Quest was evaluated using the Cronbach α coefficient. The reliability of the test-retest procedure was evaluated using the intraclass correlation coefficient (ICC). Convergent validity was ascertained by examining the correlation between the NATU Quest scores and the System Usability Scale (SUS). Results: The culturally adapted NATU Quest showed acceptable content validity, with item-level content validity index (CVI) values ranging from 0.80 to 1.00 and scale-level CVI values of 0.93 for clarity and 0.97 for relevance. Cronbach α was 0.943, indicating high internal consistency. Of the 20 participants who completed all 6 rehabilitation sessions, 13 participants completed repeat testing. Preliminary test-retest reliability was acceptable (ICC=0.823; <.001; SE of measurement=0.31). NATU Quest scores were strongly correlated with SUS scores (Spearman ρ=0.818; <.001), providing preliminary support for convergent validity. Conclusions: The adapted NATU Quest demonstrated promising preliminary psychometric properties when applied to WRE use among individuals who had a stroke. Further studies with larger sample sizes are warranted to examine additional psychometric properties such as construct validity and responsiveness.

Video-Algorithmic Patient Monitoring in Mental Health Inpatient Settings: Qualitative Study of Patient or Consumer, Clinician, and Vendor Perspectives

2026-07-20T17:30:13-04:00

Background: Video-algorithmic patient monitoring (VAPM) combines remote, noncontact sensors and algorithmic analysis and is increasingly trialed in acute psychiatric and other care settings. While promoted for improving safety and reducing risk, it raises ethical concerns regarding safety, privacy and surveillance. Little is known about how those encountering VAPM in mental health care contexts anticipate its use and potential impacts, including where it has not yet been implemented. Objective: This study aimed to explore the views of patients or mental health consumers, specialized mental health nurses and nurse academics, hospital managers, and technology vendors regarding the appropriateness and anticipated implications of VAPM in mental health inpatient care. Methods: This qualitative study identified key stakeholders in Australia via networking techniques for participation in a deliberative workshop. A deliberative workshop was held, and the workshop discussion was audio-recorded, transcribed, and thematically analyzed, consistent with methods in health technology research, which enable exploration of different viewpoints, including convergences and divergences across stakeholder groups. Results: In total, 16 stakeholders participated, exploring themes concerning (1) contestation over the rationale for VAPM in mental health settings, (2) VAPM reshaping care and relationships, (3) perceived harms of VAPM, (4) perceived observational support for safety and reduced disruption, (5) serious privacy implications of VAPM, (6) the need for appropriate governance, and (7) the potential for VAPM to transform, not augment, service delivery. General views differed across groups. Patients or service users expressed concerns about privacy, coercion, and the potential to intensify stigma. Mental health nurses were cautious but interested in possible benefits for safety and suicide prevention. Hospital managers and technology vendors largely emphasized safety gains. Conclusions: The findings suggest that the anticipated risks of VAPM are primarily experienced subjectively, as infringements on privacy, dignity, and trust, while purported benefits remain largely untested and unquantified. From a utilitarian perspective, direct comparison is therefore difficult—the risks are set out in the anticipated experiences of those with lived experience, and the benefits remain hypothetical. From this view, robust, independent evidence of real-world outcomes is required. Yet, for some participants, the very premise of such calculation was rejected, with privacy, dignity, and trust regarded as nonnegotiable, rather than items for trade-off. If VAPM is to be pursued at all, it should proceed only with extreme caution, with transparent evidence of outcomes, and with meaningful participation from those whose lives and care are most directly impacted.

Body Image and Eating Disorder Education Chatbot, JEM, in Australia and Canada: First 6-Month Real-World Survey Evaluation

2026-07-20T16:30:12-04:00

Background: Body image dissatisfaction, disordered eating, and eating disorders represent significant public health concerns; however, many affected individuals never access evidence-based support. We co-designed and developed a rule-based chatbot, JEM, which conducts conversations addressing evidence-based psychoeducation and psychotherapeutic microinterventions. We previously demonstrated the feasibility, acceptability, and preliminary satisfaction of the JEM chatbot in a research setting. However, broader satisfaction, experiences, and user-reported outcomes in real-world settings have not yet been investigated. Objective: This study aims to conduct a real-world evaluation of the JEM chatbot in Australia and Canada, the two countries that have hosted a deployment of the chatbot to date. Specifically, we aim to explore user satisfaction and experiences with the chatbot and within-session differences in user mood and body image satisfaction when completing the chatbot’s microinterventions. Methods: Respondents were users of the JEM chatbot aged 13 to 64 years who self-selected to complete a web-based overall evaluation survey (N=230; n=122 in Australia and n=108 in Canada) over a 6-month period. This evaluation survey included user demographic characteristics, satisfaction measures, and the System Usability Scale. Respondents for the within-session pre-post analyses were JEM chatbot users who chose to complete brief web-based surveys immediately before and after completing one of the chatbot’s microinterventions during the same 6-month period. Sample sizes varied across microinterventions, ranging from 75 to 276 respondents overall (Australia: n=34‐146; Canada: n=39‐130). These surveys included validated visual analog scales (VAS) measuring mood (anxiety, depression, happiness, confidence) and body image satisfaction (body size satisfaction, body shape satisfaction, physical attractiveness). Results: Demographic characteristics showed that survey respondents were commonly young adult cisgender women and nonbinary individuals across Australia and Canada. Respondent satisfaction with the chatbot was high in both countries (Australia: mean 76.1, SD 22.7; Canada: mean 78.8, SD 14.3), and the usability of the chatbot was rated as “excellent” in both countries (Australia: mean 86.5, SD 16.9; Canada: mean 89.5, SD 11.6) according to the System Usability Scale. Across completed microintervention surveys, patterns of within-session pre-post ratings were broadly similar in Australia and Canada, with effect sizes generally ranging from very small to large across VAS-measured mood and body image outcomes. Conclusions: The JEM chatbot achieved high satisfaction and usability ratings. Among respondents who completed pre-post surveys, immediate within-session differences in mood and body image ratings were observed following the completion of chatbot microinterventions. The study findings were broadly similar across Australia and Canada. These results provide evidence of user experience and within-session differences following engagement with JEM and support continued evaluation in future studies.

A Smartphone App to Improve Intuitive Eating and Diet Quality: Design and Usability Study

2026-07-17T16:30:02-04:00

Background: Web-based and mobile phone–based apps have become widely available for dietary self-monitoring; however, their use may increase the risk of disordered eating. College students frequently demonstrate poor nutrient intake despite consumption of sufficient calories. One way to improve diet quality may be via the use of a smartphone app that encourages intuitive eating. Objective: The purpose of this study was to improve diet quality among college students through the use of a novel smartphone app that promotes intuitive eating rather than calorie counting and weight loss. Methods: The In2Eat iOS mobile app was developed in SwiftUI and stored user data in a Firebase database. A total of 45 college students completed assessments of intuitive eating, diet quality, and disordered eating before and after 4 weeks of using the In2Eat app. Users evaluated the usability of the app with the System Usability Scale (SUS). Engagement with the app was recorded as the total number of days a meal was logged, the total number of meals logged, and the average number of meals logged per day. Results: After our 4-week intervention, dietary qualities that protect against chronic disease increased by 28%, fruit consumption increased by 63%, and skin antioxidant levels increased by 6.1% (Hedges g=0.16; mean difference 0.33, 95% bias corrected and accelerated [BCa] CI 0.04-0.61; P=.03). Global intuitive eating did not change during the user study; however, the unconditional permission to eat subscale increased (Hedges g=−0.28; mean difference 0.28, 95% BCa CI 0.07-0.49; P=.01, adjusted P=.07). Overall, disordered eating also did not change with app use, although dietary restraint decreased (Hedges g=−0.23; mean difference 0.30, 95% BCa CI −0.61 to −0.04; P=.04, adjusted P=.22). The average SUS score for the In2Eat app was 67.2 (SD 15.5). The number of days a meal was logged was positively correlated with SUS scores (r=0.28; P=.06), and the total number of meals logged had a monotonic association with app usability (ρ=0.31; P=.04). When divided according to the low (mean 10.2, SD 5.3), medium (mean 26.3, SD 2.8), and high (mean 33.6, SD 3.8) number of days logging meals, participants with higher days of logging reported the app as more usable (H=6.75; P=.03). A regression analysis showed that 8% of the variance in system usability (R²=0.080; P=.31) was explained by app use; however, none of the individual predictors contributed substantially to the variance. Conclusions: An intuitive eating smartphone app can improve diet quality without increasing disordered eating. Results suggest that participants who logged more meals tended to rate the app as more usable. Further research is needed with a greater sample size after incorporating features to improve the app’s usability.

Engaging Older Adults With Neurocognitive Disorders in Digital Health Technologies: Scoping Review

2026-07-17T15:00:19-04:00

Background: Population aging is associated with a growing prevalence of neurocognitive disorders among adults aged 65 years and older. Digital health technologies offer promising opportunities to support cognitive health and well-being in this population. However, their effectiveness largely depends on users’ level of engagement. Despite the recognized importance of engagement in digital health, limited evidence exists on how engagement is conceptualized, measured, and related to intervention outcomes among older adults living with neurocognitive disorders. Objective: This scoping review aimed to describe how engagement with digital health technologies among older adults with neurocognitive disorders is conceptualized and measured, examine the relationship between engagement and the effectiveness of digital health interventions, and identify factors that facilitate or hinder engagement. Methods: A scoping review was conducted following the Joanna Briggs Institute methodological guidance and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. A comprehensive search strategy, developed in collaboration with an information specialist, was applied to MEDLINE, Embase, CINAHL, Web of Science, and Google Scholar, without date restrictions. Empirical studies involving adults aged 65 years and older living with neurocognitive disorders and using digital health technologies were included. Study selection and data extraction were performed independently by at least 2 reviewers, and the results were synthesized narratively. Results: Of the 1665 records identified after duplicate removal, 2 studies met the inclusion criteria. One study examined computerized cognitive stimulation and cognitive engagement programs among community-dwelling older adults with mild neurocognitive disorders, whereas the other explored the use of a personalized digital reminiscence application in long-term care settings among individuals with major neurocognitive disorders. No study used a validated instrument to directly measure engagement. However, observable indicators and markers related to the behavioral, cognitive, and affective components of engagement were reported. Both studies also documented concurrent cognitive or psychosocial outcomes. Factors facilitating engagement included professional support, content personalization, and involvement of informal caregivers, whereas limiting factors included cognitive fluctuations, fatigue, technical complexity, and reliance on external support. Conclusions: This scoping review highlights a significant gap in the literature regarding the explicit conceptualization and standardized measurement of engagement with digital health technologies among older adults living with neurocognitive disorders. The findings underscore the need to develop and apply multidimensional, context-sensitive engagement measurement tools tailored to this population to better understand and optimize digital health interventions.

Feasibility of the “OA Coach” Mobile App to Support Individuals with Osteoarthritis: Development and Usability Testing

2026-07-15T17:00:16-04:00

Background: The OA Coach mobile app was developed to support individuals with knee osteoarthritis in self-managing their condition. The app aims to fill a current gap in the osteoarthritis mobile app field by combining key features such as symptom tracking, objective activity tracking, educational modules, and encouragement notifications underpinned by behavior change theory. Objective: The aim of this study was to describe the development of the OA Coach mobile app and assess its usability in a 6-week feasibility study. Methods: The app was designed in consultation with consumers, rheumatologists, physiotherapists, and osteoarthritis researchers. The app prototype contained four screens: (1) a home screen to track goals and activities, (2) a progress page, (3) a learning page with self-directed modules, and (4) an inbox for communication with the study team. For the feasibility study, 30 participants were recruited between March and April 2024 from a database of osteoarthritis trial participants or through the Osteoarthritis Chronic Care Program at Royal North Shore Hospital, Sydney, Australia. Participants were eligible if they were aged 45 years or older, had knee pain ≥4 on an 11-point numerical pain rating scale and knee stiffness lasting <30 minutes in duration, or stiffness >30 minutes and diagnosed with knee osteoarthritis through a health care provider or radiographs. Participants were provided access to the app and asked to interact with it daily for 6 weeks. Outcomes were assessed through online questionnaires or through mobile app data. The primary outcome was usability, assessed using the mHealth App Usability Questionnaire (MAUQ). Secondary outcomes included computer self-efficacy and osteoarthritis knowledge. The quantitative data were summarized descriptively. Qualitative feedback was collected through open-ended survey responses and discussed within the research team to improve the app. Results: A total of 30 participants completed the study. There was a 1:1 ratio of male to female participants, with an average age of 66.9 (SD 9.1) years and a mean pain level of 6.0 (IQR 5.0-6.8) on an 11-point numerical pain rating scale. Twenty-nine responses from the MAUQ were available for analysis. Most statements scored >5 out of 7 (“somewhat agree”), indicating that the app was easy to use. The mean satisfaction score for the app on the MAUQ was 4.7 (SD 2.0) out of 7. Qualitative feedback from participants indicated the need for clear instructions on how to use and navigate the app, improved structure and integration of the exercise program, and improved tailoring of osteoarthritis education and support. Conclusions: Overall, the OA Coach app was well accepted by participants. Based on participant feedback, the app will be revised to improve aspects of clarity, ease of use, and personalization. The updated app will be tested against other methods of care delivery in a randomized controlled trial. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623001223628; https://tinyurl.com/2rzk7ftk