JMIR Human Factors

Development, Implementation, and Preliminary Results of a Novel Social Network for Rare Disease Communities: Mixed Methods Study

2026-05-15T17:00:24-04:00

Background: Rare diseases affect approximately 20 million Europeans, presenting unique challenges such as delayed diagnoses, limited therapies, and significant personal and financial burden. While resilience-supporting factors such as peer support are available and artificial intelligence–based diagnostic tools are being developed further, there is a lack of a dedicated online social network connecting patients, caregivers, relatives, and experts. This study presents the development and preliminary findings of Unrare.me, a novel social network designed to provide a secure space for experts and individuals affected by rare and chronic diseases (diagnosed and undiagnosed). Objective: This study aimed to design, develop, and evaluate a social networking platform tailored to the needs of different stakeholders of the rare disease community, facilitating interaction, knowledge exchange, and emotional support while prioritizing data security. Methods: This multidisciplinary, multicenter initiative brought together patient groups, health care professionals, psychologists, and web design experts. A literature review assessed existing networking approaches in the rare disease community. Structured interviews and user journey mapping defined user needs and essential app features. Iterative prototyping and stakeholder discussions informed the final design, which was developed into a functional app launched in December 2023 on major platforms. A survey conducted four months post-launch evaluated user feedback. Data security was prioritized throughout development. Results: A total of 270 users (approximately 1 in 7 users at the time) participated in the evaluation. Most of them (n=221, 81.9%) registered to connect with others in similar situations, whereas 56.7% (n=153) sought expert input and 44.4% (n=120) looked for disease-related information. The app received positive ratings for usability (mean 6.12, SD 1.03; out of 7), accessibility (mean 5.59, SD 1.22), and design (mean 5.84, SD 1.12), as well as overall impression (mean grade of 2.24, SD 0.90 on a scale from 1-6, with 1 being the best score). Data security was highly rated (mean 5.58, SD 1.15). The app’s ontology was suitable for 77% (n=208) of the participants, enabling them to find their diagnosis, and 60.7% (n=164) of users found at least one match. Matching preferences centered on shared diagnosis (mean 82.5, SD 25.1 on a visual analog scale from 0 to 100), symptoms (mean 74.2, SD 25.8), and everyday experiences (mean 69.6, SD 29.5). Overall, users welcomed the opportunity to network with each other securely and highlighted areas for further improvement, such as enhanced matching features and group chat options. Conclusions: Unrare.me has generated significant interest and engagement within the German rare disease community, serving as a valuable tool for peer support, knowledge sharing, and expert identification. Current challenges include optimizing user acquisition and refining matching algorithms. Planned features include group chats, expert interaction, and gamification elements. Unrare.me illustrates the potential of tailored digital solutions to address unmet needs in the rare disease community.

A Chronic Pain Self-Management Mobile App (Dolodoc): Cross-Sectional Acceptability Study

2026-05-14T17:00:28-04:00

Background: Approximately 19% of adults in Europe are affected by chronic pain, which reduces the quality of life. Pain-management mobile health (mHealth) apps offer a promising solution for self-management, but user engagement and adherence can limit their clinical impact. User experience design and research play a crucial role in optimizing usability and long-term adoption of digital health interventions. Objective: This study aims to evaluate the user experience of Dolodoc, a mobile app for chronic pain self-management, using a mixed methods approach that assesses acceptability through a content quality survey and examines use by analyzing overall use patterns. Methods: A cross-sectional acceptability study of the main content of Dolodoc was conducted among patients with chronic pain recruited from the Geneva University Hospitals pain center and through snowball sampling. Participants rated 84 evidence-based self-management strategies by using a 5-point Likert scale based on 5 acceptability criteria: understandability, motivation, feasibility, relevance, and alignment with the related quality-of-life dimension. To reduce participant fatigue and avoid random responses, the 84 strategies were randomly divided across survey versions. Use was assessed through metrics collected over 6 months with Piwik PRO Analytics to observe real-world use behaviors among Dolodoc users. Results: In the acceptability study, 33 participants rated the self-management strategies positively across all dimensions. On a scale from –2 to 2, the strategies were well understood (mean 1.47, SD 0.76), motivational (mean 1.12, SD 0.96), feasible (mean 1.01, SD 1.05), relevant (mean 0.99, SD 1.09), and aligned with the dimensions (mean 1.33, SD 0.89). The use study demonstrated that 60% (486/802) of the patients used Dolodoc only once, indicating that long-term adherence remains a challenge. Within Dolodoc, pain tracking, useful links, and medication logging were the most actively used features. Conclusions: This study highlights the gap between acceptability and long-term adherence to mHealth solutions. Improving personalization and accessibility could increase user engagement and long-term adherence. Future iterations of the app should incorporate tailored interventions and real-time feedback mechanisms. In addition, leveraging a digital navigation follow-up could facilitate user adoption and sustained engagement. Trial Registration:

Using a Digital-Based Mindfulness Curriculum to Enhance Healthy Aging Outcomes in Community-Dwelling Older Adults in Taiwan: Mixed Methods Feasibility Study

2026-05-13T16:45:16-04:00

Background: Taiwan’s status as a super-aged society underscores the need for efficient strategies to promote healthy aging. While the benefits of mindfulness-based interventions for sleep and mental health are evident, there is a shortage of cultural adaptations for Taiwan’s older adults. Current courses mainly focus on mindfulness-based stress reduction, while neglecting mindfulness-based elder care, and mindful sustainable aging principles. However, the abstract nature of some mindfulness concepts, combined with limited digital support and localized resources, makes it challenging for older adults to engage effectively. Objective: To enhance healthy aging outcomes in older community-dwelling adults in Taiwan, this study developed an 8-week theory-based mindfulness curriculum that combined the mindfulness-based stress reduction, mindfulness-based elder care, and mindful sustainable aging frameworks with digital health support. Methods: This research employed a mixed methods feasibility study design. We used the modified Delphi method in phase 1 to reach agreement on curriculum content and digital material selection. Ten older adults participated in the pilot study, which comprised phase 2. We used quantitative measurements to assess mindfulness, sleep quality, cognition, heart rate variability, perceptions of aging, healthy aging perspectives, and physical function and activity at baseline, at weeks 4 and 8, and at a 1-month follow-up. Qualitative interviews were conducted to gather insights into participants’ experiences. Results: Participants achieved significant improvements in mindfulness, sleep quality, aging perception, healthy aging outlook, and physical function during the study (all <.05). Cognition, heart rate variability, and physical activity levels showed no significant changes throughout the study. The qualitative data supported these findings, as participants selected simple practices, such as mindful breathing, which they practiced daily to enhance their emotional well-being and social connections. Participants valued the digital learning materials for aiding their practice; however, some older adults with reading difficulties faced challenges accessing the content. Conclusions: Using the Delphi method resulted in an acceptable and feasible theory-based digitally supported mindfulness program that improved several indicators of healthy aging in older adults in Taiwan. Our findings need to be validated using longer trials to assess cognitive and physiological effects. Furthermore, digital accessibility requires further development.

Organizational Tensions in the Implementation of Modifiable Off-the-Shelf Technologies in a University Hospital: Qualitative Multimethod Study

2026-05-13T06:30:03-04:00

Background: Hospitals face increasing pressure to accelerate digital transformation. Modifiable off-the-shelf technologies (MOTs) combine standardized products with limited adaptability, offering promising opportunities for rapid digitalization. However, implementing MOTs in complex hospital settings involves multiple barriers, facilitators, and organizational dynamics that require deeper investigation. Objective: This study identifies barriers and facilitators in the implementation of MOTs in hospitals and explores how organizational dynamics, conceptualized as tensions, emerge throughout this process. Methods: Guided by a constructivist-interpretivist paradigm, the study followed a collaborative action research approach. A qualitative multimethod design was used, including observations, workshops, and focus groups with clinical and project management staff. Data were analyzed using deductive-inductive qualitative content analysis following Kuckartz’s approach. Results: We analyzed 12 deidentified researcher protocols from 5 observations, 3 workshops, and 4 focus groups. Across these activities, 129 individuals from various wards and departments participated. Barriers and facilitators were clustered into 6 categories representing inhibiting and enabling conditions of MOT implementation. Barriers included product limitations (22.6%, 88/390), misaligned implementation process (4.4%, 17/390), absence of available individuals (3.8%, 15/390), structural challenges (2.8%, 11/390), and resource constraints (2.8%, 11/390). Facilitators included orchestrated implementation process (13.8%, 54/390), product alignment (14.4%, 56/390), effective coordination and communication (9.2%, 36/390), presence of available individuals (6.7%, 26/390), available resources (3.1%, 12/390), and structural assets (1.8%, 7/390). These categories were conceptualized into 3 organizational tensions: limited relative advantage of generic systems, structured participation challenges in complex settings, and constrained engagement despite motivation due to limited resources. Conclusions: Tensions in MOT implementation reflect organizational misfits that go beyond concrete barriers or facilitators and instead require systemic and agile organizational structures. The analysis introduces the concept of user:ability as an organizational capacity for enabling engagement with MOTs. We derive 3 tailored strategies to mitigate the tensions: ensuring relative advantage through IT integration and learning; empowering user participation through digital transformation and communication; and enabling clinician engagement through dedicated resources and systematic implementation. This study advances prior work by deepening the understanding of implementation determinants into organizational tensions and offering actionable strategies to address them. It also illustrates how collaborative, agile research approaches can illuminate complex organizational dynamics and support hospitals during transformative change.

The Quality and Characteristics of Digital Mental Health Apps: Mixed Methods Study

2026-05-11T16:30:13-04:00

Background: There are around 20,000 mental health apps available in app stores. The Organisation for the Review of Care and Health Apps (ORCHA), a United Kingdom digital health compliance company, has assessed a number of digital mental health apps with regard to their quality, professional and clinical assurance, data privacy, and user experience. This study analyzes the data that were collected by ORCHA when they assessed mental health apps. Objective: This study aimed to examine the characteristics of mental health apps regarding their quality, target users, features, underpinning evidence, and data privacy. Methods: A dataset comprising ORCHA Baseline Review assessments of over 2000 digital health apps, including 436 mental health apps, was used. This study uses exploratory data analysis to gain insight into the quality and characteristics of mental health apps. Methods such as descriptive and inferential statistics, k-modes clustering, and association rule mining were used to explore the quality of mental health apps as well as reveal insights into the different cost types, target users, app features, data types, and evidence of app content. Results: Information provision, data capture, and data sharing were the most common features within the 436 mental health apps. The examined apps primarily targeted the following groups: adults (n=229, 52.5%), everyone (n=184, 42.2%), and teens (n=135, 31%). The cost of apps has not been linked to the quality of mental health apps, although paid apps or apps with in-app purchases may include additional services. Indicated user acceptance or benefit is the most common type of evidence provided by these mental health apps. A total of 241 (55.3%) apps included a qualified professional in app development, and 251 (57.6%) apps provided evidence within the app that the developer validated any guidance with relevant reliable information sources or references. Usage data and email were the most commonly collected data types. Association rule mining showed that email, IP address, name, and usage data are often co-collected by the same apps. K-modes cluster analysis showed that mental health apps can be categorized into 2 clusters, where one cluster of apps (n=182, 41.7%) collected more data than apps in the other cluster. Conclusions: Mental health apps are commonly targeted for everyone to use, but many apps are targeted toward teens or adults. Our study suggests that many publicly available mental health apps did not take the precautions (such as the involvement of appropriate health professionals, literature references, or conducting tests) to ensure that their content is valid and research based. Greater effort on behalf of mental health app developers is needed to ensure that the public is provided with high-quality apps. Moreover, our study indicates that the mental health apps that collect more data tend to score better on the ORCHA Baseline Review assessment.

Soma Design for Digital Mental Health and Well-Being Interventions: Scoping Review

2026-05-11T15:30:13-04:00

Background: Digital interventions for mental health and well-being are increasingly moving beyond screen-based applications toward more embodied approaches, necessitating design methodologies that emphasize bodily experiences. Soma design offers a distinctive interaction design approach that integrates bodily awareness with aesthetic appreciation, viewing the mind and body as an inseparable whole. Objective: This scoping review aims to map and analyze the emerging applications of soma design within digital mental health and well-being (DMHW) interventions, offering a comprehensive overview of this holistic design methodology for researchers and practitioners. Methods: This review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies were included if they used soma design to develop DMHW intervention. Results: Nine papers were eligible for inclusion. The interventions varied in their stage of development: 5 were conceptual design concepts created by adolescents, while 6 were prototypes or experiential artifacts developed by researchers and/or participants. All interventions incorporated soma awareness exercises, with Feldenkrais lessons being the most commonly used. Toolkits, such as Soma Bits and the Menarche toolkit, supported the design of 2 interventions. Soma design methods benefited both designers and users: designers used embodied practices to inform interaction design, while users reported increased bodily awareness, full-body engagement, emotional comfort, and relaxation. Conclusions: Soma design represents a valuable approach for developing embodied, user-sensitive DMHW interventions. It offers a participatory, holistic co-design methodology that can meaningfully engage end users. However, many interventions identified in this review remain in early stages of development and lack systematic evaluation. Advancing the field will require interdisciplinary collaboration among mental health professionals, human-computer interaction researchers, clinicians, industry partners, and individuals with lived experience. These partnerships are essential for co-designing, testing, and implementing interventions that are both effective and scalable, ultimately extending the reach and impact of soma design in digital mental health contexts.

Persuasive Systems Design Features of Smartphone Apps for Psychosis: Systematic Review

2026-05-07T13:00:24-04:00

Background: It is unclear why some smartphone apps designed for people with psychosis are engaging, while others are not. One possible explanation is the apps’ persuasive features and the operationalization and implementation of these features. Objective: This systematic review set out to quantify and describe the persuasive features used in smartphone apps for psychosis, investigate whether there was any association between persuasive features and attrition or adherence rates. and document the quality of the included apps. Methods: We searched electronic databases PsycINFO, PubMed, and Google Scholar for eligible papers published between the years of 2013 and 2025. Hand searches of reference lists were completed. Apps were selected if they were designed for people with psychosis and there were published empirical studies investigating the apps. Two reviewers from the review team (TT, JP, DK, and SD) independently screened papers and extracted data on adherence and attrition, as well as coded papers for evidence of persuasive features according to the persuasive systems design (PSD) model. Available data were synthesized descriptively and narratively. We attempted to access apps via app stores or by correspondence with the research team. Results: We found 22 apps for psychosis, with 30 associated published papers. The persuasive features were as follows: personalization (18 apps); reminders (15 apps); suggestions (11 apps); tunneling and self-monitoring (10 apps); reduction (9 apps); liking (8 apps); social role (6 apps); rehearsal, praise, and similarity (5 apps); rewards (4 apps); simulation, real-world feel, and social learning (3 apps); surface credibility and normative influence (2 apps); and trustworthiness, social comparison, and social facilitation (1 app). Expertise, authority, third-party endorsements, verifiability, cooperation, competition, and recognition were present in zero apps. Features in the categories of primary task support and dialogue support were well represented, while social support and system credibility support were underused. It was found that there was no association between the number of persuasive features and attrition; an association between persuasive features and adherence could not be assessed. The quality of the apps could not be judged due to 20 of the 22 apps being inaccessible either through the research papers’ authors or through app stores. Conclusions: Our findings indicate that in psychosis apps there is potential to include a broader range of persuasive features, which might maximize engagement. Psychosis apps may benefit from incorporating more features that leverage the persuasive impact of having users interact (social support) and incorporating features that emphasize system credibility and trustworthiness. Further studies could determine whether an increase in the number of persuasive features will impact app engagement and which features are most impactful in this context.

Examining the Effect of Online Engagement on Older Adults’ Subjective Memory Capability: Cross-Sectional Path Analysis

2026-05-06T15:45:16-04:00

Background: The utility of online engagement in enhancing quality of life and mitigating social isolation among older adults is well documented. However, its relationship with cognitive functioning, particularly through online engagement, requires further exploration. Objective: This study investigated whether active online engagement via the Virtual Senior Center (VSC) program was associated with subjective memory capability among older adults and whether subjective memory capability was associated with psychological well-being and loneliness. Methods: This study included a cross-sectional sample of 53 homebound older adults participating in the VSC program, which offers diverse online classes to promote social interaction. Path analysis was conducted to examine the associations among online engagement, subjective memory capability, quality of life, and loneliness. Results: Increased participation in VSC activities was associated with higher subjective memory capability (β=0.29, 95% CI 0.04-0.54; <.02). Subjective memory capability was associated with better quality of life (β=0.29, 95% CI 0.04-0.54; <.001) and lower loneliness (β=0.29, 95% CI 0.04-0.54; <.003). No direct associations were observed between online engagement and quality of life or loneliness. Conclusions: Subjective memory capability was associated with better quality of life and lower loneliness. Although online engagement had no direct association with quality of life and loneliness, the observed indirect pattern suggests that subjective memory capability may represent a psychologically meaningful pathway through which structured online engagement relates to well-being. These findings highlight the potential of digital platforms to complement traditional forms of socialization, particularly for older adults facing physical or geographic barriers to interaction.

Digital Episodic Future Thinking Intervention (Luminaut): Co-Design and Iterative Development Study

2026-05-06T13:00:09-04:00

Background: Digital health interventions can be effective at changing behavior, but achieving long-term adherence remains a challenge. One psychological barrier to health behavior change is , or the tendency to prefer smaller, short-term rewards over larger, long-term rewards. Episodic Future Thinking (EFT) can disrupt future discounting and is a promising technique for improving health behavior, but such interventions have not been co-designed to address end user needs. Objective: This study aimed to co-design an app with end users to deliver an EFT intervention aimed at promoting health behavior change in those in the prerisk phase for chronic conditions. Methods: Community members participated in up to 2 series of face-to-face co-design workshops. A prototype of the app was reviewed, and insights were gathered to understand (1) the optimal characteristics of the app and (2) the concepts of future discounting and EFT. Themes were generated using inductive thematic analysis. Results: Participants were South Australian adults (n=30) who were predominately affluent women (27/30, 90%) aged 25‐44 years (mean 36.37, SD 5.65 years). Feedback generated from the first workshop series resulted in 26 suggestions of which 15 informed iterative app development. Higher-level principles were identified and categorized into 5 overarching themes: concept acceptance, triggers and barriers, personalization, gamification, and user-friendly interface. Conclusions: This study used co-design methodology to develop an app-based EFT intervention. Ongoing engagement with end users and key stakeholders (eg, health care professionals) is needed to ensure that the app meets changing needs. Future work will aim to evaluate its effectiveness in a large-scale clinical trial.

Feasibility and Acceptability of a Prevention-Focused Screener for Perinatal Depression Risk: Mixed Methods Cohort Study

2026-05-05T16:15:13-04:00

Background: More than 20% of perinatal women experience depression, with suicide being a leading cause of maternal death in the United States. Professional societies emphasize the need to identify those at risk of developing perinatal depression to better target preventive care delivery during pregnancy. Objective: We evaluated receptivity to a machine learning–based predictive screener designed to identify women in the first trimester of pregnancy who were asymptomatic but were at risk for developing moderate to severe depression symptoms later in pregnancy. Methods: Our participants were adult pregnant women with negative first-trimester depression (Patient Health Questionnaire–9) screens at 1 of 4 obstetric practices. Of the 810 women who were clinically eligible, 787 were successfully contacted via their patient portal. Of these, 289 (36.7%) viewed the screener and 255 (88.2%) completed the 6-question predictive screener. In total, 51 (20%) were identified by the screener as being at risk for developing perinatal depression. Participants were asked a series of follow-up questions regarding the acceptability of the predictive screener and desired preventive resources. Chi-square tests were used to compare demographic characteristics, perceived benefits and concerns, and desired resources between those identified as at risk for depression and those who were not. Differences in acceptability ratings between the two risk groups were determined using nonparametric Mann-Whitney tests. Results: On a 5-point Likert scale of agreement, participants found the screener questions easy to complete (median score 5, IQR 5-5) and felt comfortable sharing their answers with their obstetric care providers (median 5, IQR 4-5). Key perceived benefits of completing the screener included opportunities to seek preventive care (75/255, 29.4%) and to receive education on depression risk (66/255, 25.9%). Primary concerns about knowing one’s risk of future depression included worrying about developing depression (90/255, 35.3%) and a lack of prevention opportunities (39/255, 15.3%). Desired preventive resources included counseling (197/255, 77.3%), mind-body interventions (166/255, 65.1%) such as exercise, and prenatal classes or support groups (81/255, 31.8%). Conclusions: Participants found the screener acceptable and felt comfortable receiving it through their patient portal. Specific preventive care options were commonly endorsed, several of which are scalable and evidence based. A minority of participants voiced addressable concerns about knowing their risk of developing depression in the future.