https://www.i-jmr.org/issue/feed 2024-01-18T09:15:04-05:00 JMIR Publications editor@jmir.org Open Journal Systems Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in the interactive Journal of Medical Research...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://www.i-jmr.org/, as well as this copyright and license information must be included. A new general medical journal for the 21st century, focusing on innovation in health and medical research. https://www.i-jmr.org/2026/1/e64150 2026-09-03T15:15:12-04:00 Kiyomi Tsuyuki Marguerite B Lucea Andrea N Cimino Michael Killian Christina J Catabay Engle Abrams Emmanuel Baffour-Siaw Jacquelyn C Campbell Douglas A Granger Jamila K Stockman

Background: Emerging evidence supports that women with histories of abuse have heightened stress and immune dysregulation. Few studies have examined the biological plausibility of this association in US Black women—a population disproportionately affected by gender-based violence (GBV), health disparities, and generally underrepresented in research. Biomarkers of stress and immune health remain challenging to study due to barriers in recruitment, retention, and protocol adherence. Objective: This study developed and examined the feasibility of an at-home, self-collected, and minimally invasive salivary cortisol awakening response (CAR) collection protocol among Black women with histories of abuse in Baltimore City, Maryland. Methods: Black women were recruited from November 2015 to May 2018 from Baltimore City sexually transmitted disease clinics. Participants received in-person instruction and demonstration on saliva self-collection using the passive drool method, and were provided study-issued cell phones for reminders and adherence tracking. Participants self-collected saliva samples upon waking and 30 minutes post waking on 3 consecutive days to assess CAR. Outcomes included protocol completion, self-reported adherence, and experiences (via saliva collection logs), a weighted protocol adherence score, and cortisol measures (waking, post waking, and CAR). Differences in sociodemographic characteristics and outcome measures were assessed by adult forced sex exposure status using chi-square tests and ANOVA. The Pearson correlation coefficient assessed the day-to-day reproducibility of cortisol measures among women with 2 full days of valid samples. Results: Of the 305 women completing the study survey, 228 completed the saliva specimen collection protocol, with no significant differences in completion between women with and without forced sex histories. Protocol feasibility was high, with 84% (191/228) completing at least 1 full day of adherent saliva collection and more than half (132/228) completing 2 full days. While feasibility did not differ by exposure status, women with adult forced sex exposure demonstrated lower protocol adherence scores compared to their unexposed counterparts. Between-day cortisol measures demonstrated variable reproducibility across waking, post waking, and CAR measures. Conclusions: This at-home salivary cortisol collection protocol was feasible in our robust sample of Black women with histories of abuse. The process of at-home collection of salivary biomarkers, including cortisol measures, was well-documented, and participants were able to adhere to it. The protocol yielded usable data that will facilitate the examination of the physiological and health repercussions of GBV.

2026-09-03T15:15:12-04:00 https://www.i-jmr.org/2026/1/e96541 2026-08-31T14:30:14-04:00 Samuel Thomas Harrold

Health care organizations face a “triple threat” of low analytics maturity, high workforce instability, and semantic technical barriers that together produce a crisis of “institutional amnesia.” Leadership turnover, workforce shortages, and widespread intent to leave among informatics specialists systematically erase the tacit knowledge required to navigate complex clinical data schemas, trapping organizations in a cycle where knowledge loss outpaces knowledge capture. Viewed through the socialization, externalization, combination, and internalization model of knowledge creation by Nonaka, the root cause is a “socialization failure”: high turnover fractures the social networks required for mentorship, rendering the traditional apprenticeship model of informatics unsustainable. To address this failure, we used a design science research approach synthesizing evidence from health care informatics, knowledge management, and natural language processing to develop a sociotechnical framework: human-in-the-loop knowledge governance (HITL-KG). HITL-KG is designed to shift the locus of organizational knowledge from volatile human memory to durable semantic artifacts called “validated query triples,” each comprising a natural language intent, executable SQL, and rationale metadata. By embedding knowledge capture into the daily query workflow, the framework aims to convert ephemeral analytics into permanent institutional assets. The accompanying 3-pillar assessment rubric enables organizations to identify compounding vulnerabilities across analytics maturity, workforce agility, and technical enablement. The “validator paradox” (who validates the AI when experts leave?) is addressed by reframing validation through lean “standard work”: each validated query establishes the current known standard rather than eternal truth, functioning as a “knowledge ratchet” that prevents regression. Decoupling analytical capability from individual tenure lets analytics maturity advance even as the workforce evolves. This paper proposes and theoretically motivates the framework; empirical validation is deferred to a companion study.

2026-08-31T14:30:14-04:00 https://www.i-jmr.org/2026/1/e89803 2026-08-28T16:45:11-04:00 Srinjaya Saha Yvonne Latham Carol Holland

Background: Digital medication adherence interventions for individuals diagnosed with chronic conditions have been developed, but their long-term efficacy in improving medication adherence has been limited. Exploring mechanisms and contexts related to outcomes of digital medication adherence interventions is important for these to be effectively tailored for different populations and contexts. A realist review was conducted to assess which intervention components might work for whom, and under what circumstances. Methods: A realist review of literature published between 2002‐2024 was conducted. Studies reporting digital medication adherence interventions for people diagnosed with chronic diseases and experiencing unintentional medication nonadherence issues were included. MEDLINE, CINAHL, PsycInfo, Web of Science, Scopus, Embase, and gray literature databases, Overton, and Policy Commons were searched. Data regarding contexts, mechanisms, and outcomes were extracted and synthesized into program theories. Program theories from the realist review were triangulated with findings from two rounds of workshops (three workshops in each round), in which context-mechanism-outcome (CMO) configurations were cocreated with various stakeholders of a project aimed at implementing a digital medication adherence intervention to reduce unintentional nonadherence among people with chronic diseases. There were 12 participants in each round. Results: The analysis of 83 papers and content of the cocreation workshops led to 35 CMOs theories in seven theory areas, which were (1) building and maintaining medication intake habits; (2) solving medication-related barriers to adherence; (3) enabling collection of prescription medications on time; (4) supporting people with unpredictable health conditions and sensory or motor impairments; (5) supporting individuals with high anxiety, low medication self-efficacy, and low social support; (6) supporting individuals who are uncomfortable with technology; and (7) economic, policy, and organizational factors affecting implementation of smart medication devices. Fourteen CMOs came from both the literature and workshops, 7 CMOs from the literature alone, and 14 CMOs from the workshops alone. Conclusions: Analysis of the program theories suggested a range of intervention components considering contextual factors that may improve medication adherence of individuals. These were used to form recommendations for intervention developers and implementers. Further studies are required on policy and economic factors affecting large-scale implementation of digital medication adherence interventions in different settings. Future interventions should report intervention content and delivery in detail and codevelop effective implementation strategies with professionals who can support the implementation of the intervention. Trial Registration: PROSPERO CRD42025641383; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025641383

2026-08-28T16:45:11-04:00 https://www.i-jmr.org/2026/1/e91603 2026-08-28T16:30:14-04:00 Pauline Kaboth Lorenz Harst Jochen Schmitt Madlen Scheibe

Background: With the ongoing digitalization of health care, digital health literacy (DHL) is becoming increasingly important, requiring appropriate measurement instruments (DHLMIs). However, the wide range of available DHLMIs makes selection difficult and raises questions about their suitability and comparability. Objective: This review aimed to provide an overview of available DHLMIs for adult populations and to compare their dimensions, identifying overlaps and differences to determine which (key) dimensions are most commonly studied and thus define DHL. Methods: A narrative overview of reviews was conducted. The database search was conducted in November 2024, with an updated search in March 2026, in PubMed and Google Scholar using specific search terms and predefined inclusion and exclusion criteria. This was complemented by a forward citation search in Web of Science. All identified records were screened in a multistage process. At the review level, systematic and scoping reviews published since January 1, 2020, were included that analyzed DHLMIs in adult populations. At the primary study level, studies were included in which DHLMIs were used for self-assessment, performance-based evaluation, or a combination of both. Data extraction was performed by one reviewer and verified by a second reviewer. Data on underlying theories, methods of data collection (performance-based or self-reported), and target groups were extracted. DHL dimensions, their definitions, and the associated items were categorized by 2 researchers using qualitative content analysis according to Kuckartz. Results: A total of 12 reviews were included. Of the 170 measurement instruments examined in these reviews, 33 (19%) were selected for detailed analysis after applying the inclusion and exclusion criteria. The majority of the included measurement instruments (n=20, 61%) were not based on a theory, 20 (61%) measured DHL exclusively via self-report, and 21 (64%) addressed specific target groups. The measurement instruments encompassed a total of 209 original dimensions of DHL. The number of dimensions measured per instrument varied between 2 and 22. The qualitative content analysis identified a total of 30 assigned dimensions. Key dimensions captured in almost all instruments, although under different names, include evaluating health information, using health information, researching health information, and the ability to use technology. Conclusions: The large number of measurement instruments and original dimensions makes it difficult to select suitable instruments for measuring DHL and to compare and synthesize study results. Nevertheless, we were able to identify key dimensions as relevant regardless of target groups and types of digital applications, which could be used to develop a core outcome set for DHL. Our findings offer a foundation for refining existing instruments and developing new ones. They provide practical guidance for researchers and health care professionals in selecting suitable DHLMIs. Additionally, our review underlines the importance of theory to ensure content validity and comparability of DHLMIs.

2026-08-28T16:30:14-04:00 https://www.i-jmr.org/2026/1/e95238 2026-08-26T16:30:14-04:00 Weijie Wang Erika Penney Jaime Garcia

Background: Perinatal mental health issues are widely recognized as a significant public health concern; however, fathers remain underrecognized and underserved within perinatal care systems. Existing reviews have largely focused on mothers, infants, couples, or general paternal mental health interventions, leaving limited synthesis of technology-based and digitally delivered support relevant to paternal perinatal depression. Digital interventions, including SMS programs, online groups, web-based platforms, mobile health apps, and hybrid digital follow-up, may offer flexible ways of engaging fathers; however, their evidence base remains unclear. Objective: This scoping review aimed to map the available evidence on technology-based, digitally delivered, and hybrid interventions relevant to paternal postnatal depression and paternal perinatal mental health. Specifically, it examined the types of evidence available; how interventions varied by delivery mode, methodology, and population; how interventions were characterized in terms of format and duration; and what outcomes had been measured across studies. Methods: This review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework. A comprehensive search was conducted between February and April 2025 and updated in June 2026 across multidisciplinary electronic databases. Search terms covered 4 concepts: fathers or nonbirthing parents, perinatal mental health, digital or technology-based modalities, and intervention or evaluation purpose. Eligible studies were peer-reviewed English-language articles in which fathers, expectant fathers, new fathers, male partners, or nonbirthing parents were active participants, target users, or reported subgroups, and in which a digital, technology-based, or hybrid support strategy was described or evaluated. Data were charted and synthesized descriptively and comparatively. Results: Six studies met the inclusion criteria. The evidence included a feasibility study of an SMS-based, father-specific program, randomized controlled trials of hybrid psychoeducational or paternal support interventions, a pilot randomized feasibility trial of an online cognitive behavioral therapy–based intervention for pregnant people and partners, a mixed methods online group intervention for new fathers, and a feasibility, acceptability, and usability study of a father-specific mobile health app. Delivery modes included SMS messaging, WhatsApp follow-up, online video, telephone follow-up, online groups, web-based intervention content, and mobile app features. Outcomes included depression, anxiety, stress, parenting stress, dyadic adjustment, marital quality, resilience, usability, acceptability, engagement, adherence, and qualitative user experience. Findings were most consistent for feasibility, acceptability, and engagement, while evidence for effectiveness in reducing paternal postnatal depression remained limited and mixed. Conclusions: The current evidence base is small, heterogeneous, and preliminary. Digital interventions may offer acceptable ways to engage some fathers and partners during the perinatal period. However, there is insufficient evidence to draw firm conclusions about effectiveness, scalability, or suitability for fathers experiencing perinatal depression. Future research should prioritize father-specific, theory-informed, co-designed digital interventions using validated paternal outcomes, longer follow-up, transparent engagement reporting, and more diverse samples.

2026-08-26T16:30:14-04:00 https://www.i-jmr.org/2026/1/e76867 2026-08-26T11:45:11-04:00 Oscar Aguila-Gimeno Norina Gasteiger Emma Stanmore Marius Brazaitis Rima Solianik Erika Karkauskiene Laura Jarutienė Júlia Romeu-Busquets Javier Jerez-Roig

Background: Urinary incontinence (UI) is the most prevalent pelvic floor dysfunction, with incidence increasing with age. Numerous studies have demonstrated the effectiveness of pelvic floor exercises in improving UI. However, access to pelvic floor treatment remains limited due to lengthy waiting lists and poor adherence to prescribed exercises. Digital solutions incorporating behavior change techniques (BCTs), including gamification elements, may support self-management of bladder health for individuals aged 50 years and older who may face challenges in accessing conventional treatments. Objective: This study aimed to identify mobile apps and websites integrating BCTs, including gamification elements, to facilitate bladder health self-management among adults aged 50 years and older. Methods: The search was initiated in July 2024 and updated in January 2025 across three sources: (1) mobile app stores (Google Play Store and Apple App Store available in Spain, Lithuania, and the United Kingdom) using the keywords “pelvic floor,” “urinary incontinence,” and “bladder”; (2) websites; and (3) academic databases (PubMed, Scopus, CINAHL, and Google Scholar) for journal articles, book chapters, and conference papers published in English, Spanish, or Lithuanian. Inclusion criteria required that solutions be independently usable without health care supervision, incorporate at least one BCT (eg, training, education), be evidence-informed (ie, include participants aged ≥50 years in their design or piloting phase or explicitly target this demographic), and be available in Spain, the United Kingdom, or Lithuania. The Mobile App Rating Scale (MARS) was used to assess app quality, and the taxonomy of 93 BCTs was used for BCT classification. All review and data extraction processes were conducted in duplicate. Results: Twenty-one studies met the inclusion criteria, identifying 8 eligible mobile apps and 1 website. Among the apps, only 2 were available on either Google Play or the Apple App Store. No apps were identified in Lithuania, whereas 1 app was found in Spain and 3 apps in the United Kingdom. Of these, 1 UK app was accessible on both Google Play and the Apple App Store, whereas the others were limited to a single platform. BCT extraction showed that the apps included between 9 and 16 BCTs (mean 12, SD 3.27). Regarding quality, all assessed apps obtained MARS scores ranging from 3 to 4 out of 5. Website searches did not identify any scientifically validated platforms across the 3 countries, except for 1 website cited in a scientific publication. UI reduction on the International Consultation on Incontinence Questionnaire ranged from –3.9 to –2.1 points, while perceived improvement reached 91.7% in the Tät app. Conclusions: Evidence-based digital interventions for individuals aged 50 years and older remain limited. Existing apps suggest potential benefits in UI reduction and quality of life improvement; however, further research and development are needed to enhance accessibility and efficacy. Trial Registration: PROSPERO CRD42024597624; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024597624

2026-08-26T11:45:11-04:00 https://www.i-jmr.org/2026/1/e92610 2026-08-25T11:30:09-04:00 XiuLi Wu Aimei Kang

Background: With population aging and the growing burden of chronic diseases, the number of patients with cardiovascular disease (CVD) in China continues to rise. Nursing robots have been recognized as one potential approach to help alleviate nursing workload. However, patient-centered functional needs with respect to such robots among patients with CVD remain insufficiently explored in China. Objective: On the basis of the Kano model, this study aimed to analyze attitudes toward and demand priorities regarding nursing robot functions among patients with CVD. The findings may provide evidence to support function optimization and wider clinical application of nursing robots in China. Methods: A cross-sectional study was conducted at Wuhan Asia Heart Hospital from July 2024 to June 2025. Convenience sampling was used to enroll 156 patients with CVD. Data were collected using a self-designed questionnaire, including demographic characteristics and a 15-item Kano scale for nursing robot functions. Data were analyzed using descriptive statistics, Kano classification, better-worse coefficients, and a 4-quadrant diagram. Results: Among 15 functional items, accompanying care, consulting education, information management, and monitoring and warning were classified as must-be attributes; activity management, rehabilitation physiotherapy, drug management, security management, and logistics transfer were one-dimensional attributes; infection management, first aid skills, and nutritional care were attractive attributes; and sampling operation, personal hygiene management, and excretory care were indifferent attributes. Conclusions: Our study reveals that patients with CVD generally exhibited high acceptance of nursing robots, but there were significant differences in functional requirements. When introducing nursing robots into clinical settings, priority should be given to essential attributes such as monitoring and warning, as well as educational consultation, along with expected attributes such as medication management. At the same time, attractive attributes such as infection management can be developed as value-added features. For nondifferentiated attributes such as personal hygiene management, selective configurations can be implemented based on clinical needs to enhance the clinical applicability and patient acceptance of nursing robots.

2026-08-25T11:30:09-04:00 https://www.i-jmr.org/2026/1/e101905 2026-08-24T16:45:11-04:00 Gabrielle Genovesi

This multifacility retrospective analysis of 25 hospitals using BioVigil Technologies’ electronic hand hygiene monitoring system demonstrated a mean of 46.95% (95% CI 35.5%‐58.4%) sustained reductions in health care–associated infections in 2024 compared to pre-implementation baselines, highlighting the clinical and operational value of automated hand hygiene monitoring at scale.

2026-08-24T16:45:11-04:00 https://www.i-jmr.org/2026/1/e108273 2026-08-18T13:00:40-04:00 JMIR Publications Editorial Office 2026-08-18T13:00:40-04:00 https://www.i-jmr.org/2026/1/e105480 2026-08-18T13:00:22-04:00 JMIR Publications Editorial Office 2026-08-18T13:00:22-04:00