Interactive Journal of Medical Research

Landscape, Evidence, Gaps, and Opportunities in Digital Mental Health Interventions for Older Adults: Scoping Review

2026-07-06T11:45:15-04:00

Background: Mental health conditions, including depression, anxiety, and psychological distress, are prevalent among the aging population and affect their health, functioning, and quality of life. Access to proper and high-quality mental health treatment is necessary; however, mental health treatment and care remain underused due to stigma, workforce shortages, cost, and mobility limitations. Digital mental health interventions (DMHIs) are emerging as a promising strategy to improve the accessibility and effectiveness of mental health services for older adults, but older adults have historically been underrepresented in DMHI development and evaluation. Additionally, the effectiveness of different types of DMHIs and how age-centered design approaches influence outcomes remain underexplored. Objective: This scoping review mapped and synthesized evidence on DMHIs focused on adults aged 50 years and older and identified gaps in the evidence base related to study design, age-related adaptations, and clinical outcomes. Specifically, we examined (1) the technologies and therapeutic approaches used, (2) the outcomes and effectiveness of DMHIs, and (3) age-centered adaptations and their outcomes. Methods: This scoping review searched for studies focusing on DMHIs for older adults across PubMed, PsycINFO, Scopus, Ageline, and Web of Science that were published from 2000 to February 2025. Eligible studies evaluated or described the design of DMHIs targeting mental health conditions among adults aged 50 years or older. Two rounds of independent screening and data extraction were conducted by multiple reviewers. Extracted data included study design, sample characteristics, intervention features, technologies used, age-related adaptations, and clinical outcomes. Results: Seventy-two studies met the inclusion criteria, of which 36 were randomized controlled trials and 54 reported clinical outcomes. Web-based cognitive behavioral therapy was the most commonly used approach, followed by games, virtual reality, mobile apps, chatbots, and robots. Fifty-four studies reported positive clinical outcomes, most commonly reductions in depression, anxiety, or psychological distress. However, only one-third of the studies incorporated age-centered design adaptations or co-design approaches, such as simplified interfaces, larger fonts, age-relevant content, or participatory development with older adults. Conclusions: Among studies reporting positive clinical outcomes, DMHIs can reduce depression, anxiety, and psychological distress. However, with only half of the included studies using randomized controlled trial designs, the overall evidence base remains moderate. In addition, age-adaptive design remains underdeveloped. Future research should strengthen trial designs and systematically examine how usability and age-centered adaptations influence DMHI effectiveness.

Determining the Relationship Between People’s Explicit and Implicit Preferences for Gender-Inclusive Sexual and Reproductive Health Content: Randomized Controlled Trial

2026-06-22T15:00:29-04:00

Background: Inclusive health education content has been shown to increase acceptability and accessibility for lesbian, gay, bisexual, transgender, queer, intersex, and asexual, as well as other sexual and gender minority (LGBTQ+) individuals. However, there has been some backlash among general audiences, with claims that such inclusive content is “woke” or otherwise problematic. Objective: The goal of this study was to test whether individuals across the political spectrum notice when sexual and reproductive health content is written with inclusive language in order to demonstrate the acceptability of inclusive content to a broader audience. Methods: This study included 454 adults assigned female at birth from the United States, one-third of whom identified as LGBTQ+, reviewed 2 sets of reproductive health educational handouts designed for adolescents, with 1 gender-inclusive and 1 gender-specific version in each set, randomized in order. Individuals were asked to rate each document and state a preference within each pair (implicit preference). They were then debriefed on the study’s purpose and asked if they had an explicit preference for gender-specific or gender-inclusive content. Results: Preferences for explicit content tended toward gender-specific content: always gender-specific (n=184, 40.5%), sometimes gender-specific (n=59, 13%), no preference (n=131, 28.8%), sometimes gender-inclusive (n=39, 8.6%), and always gender-inclusive (n=41, 9%). However, most people (n=273, 59%) did not notice differences between the first pair of documents they viewed or rate them differently (mean difference −0.19, SD 2.17, range −10 to 12). Furthermore, the majority of individuals who had a stated preference for gender-specific health education documents did choose the gender-specific document as their preferred version for either the first (n=45, 24%) or second pair of documents (n=69, 38%). Individuals who preferred content to always be gender-inclusive were significantly more likely to choose the concordant version of their document (n=20, 49% for the first pair; n=24, 58% for the second pair). A total of 58% (n=262) of the participants stated they did not notice the study design until the debrief. Conclusions: Most participants did not notice when sexual and reproductive health educational content had been made gender-inclusive—even when they had an explicit preference for gender-specific content. This suggests that when inclusive language is not directly called to readers’ attention, inclusive sexual and reproductive health content is broadly acceptable to individuals across a range of political beliefs. The use of inclusive language may therefore be a means of increasing the accessibility and applicability of educational materials to diverse recipients, including LGBTQ+ individuals. Trial Registration: ClinicalTrials.gov NCT07601581; https://clinicaltrials.gov/study/NCT07601581

Generosity as a Scientific Method: Building Knowledge and Community in a Competitive World

2026-06-18T18:00:25-04:00

Generosity can function as a scientific method—a disciplined stance that aligns curiosity with openness, credit-sharing, and stewardship of data, specimens, and ideas. Rather than a soft add-on, generosity structures how questions are framed, teams are built, and results are disseminated, thereby improving rigor, reproducibility, and impact. This viewpoint article advances a conceptual and operational framework for “generosity in science,” aimed at researchers, institutions, and funders seeking alternatives to competition-driven models of knowledge production. I examine generosity as practice at the levels of people, collectives, and institutions and argue that persistent global challenges in health demand pro-collaborative architectures. Seen this way, generosity is not mere altruism; it is part of the epistemic engine that turns uncertainty into shared knowledge while distributing opportunity and recognition more fairly. I define core principles of generous research and organize them across three domains: research design, governance, and evaluation. The paper draws on illustrative examples and relevant literature to situate generosity within ongoing debates on open science, team science, and research assessment reform. I outline practical principles for embedding generosity into research design, governance, and evaluation and discuss how these principles can counter vanity metrics and short-term incentives. I conclude that embedding generosity in the infrastructure of science enables better questions, faster learning, and greater public value.

Barriers and Facilitators to Physician-Patient Communication in Chinese Tertiary Hospitals From the Perspectives of Hospital-Based Physicians and Patient Relations Coordinators: Qualitative Study

2026-06-11T11:00:22-04:00

Background: Effective physician-patient communication is essential for building trust and sustaining positive relationships, yet becomes increasingly challenging in China’s tertiary hospitals, where physicians face heavy workloads. Objective: This study explored the barriers and facilitators of physician-patient communication by synthesizing perspectives from Chinese hospital-based physicians and patient relations coordinators. Methods: A qualitative study using semistructured interviews was conducted with 17 participants (11 physicians and 6 patient relations coordinators) from tertiary hospitals in China (April-July 2025). Data were analyzed using thematic analysis following Braun and Clarke’s framework. Results: Barriers and facilitators of physician-patient communication were organized into a multilevel framework comprising patient-level, physician-level, and system-level factors. Patient-level barriers included individual background differences, inadequate expression and limited health literacy, and psycho-emotional states with expectation misalignment, whereas facilitators included effective expectation management, good health literacy and communication readiness, and trust in physicians with shared decision-making. Physician-level barriers involved communication style deficiencies, empathy gaps, and time pressure constraints; facilitators included active listening and patient-centeredness, empathy and emotional support, and clear explanations with cultural adaptability. At the system level, barriers included hospital environment and medical visit settings, legal and policy deficiencies, insufficient communication training, and media-driven distrust with digitally mediated information challenges, while facilitators included institutional support and security assurance, educational training and policy promotion, process optimization and patient health education, and artificial intelligence–assisted baseline knowledge. Conclusions: Physician-patient communication is influenced by multiple factors, necessitating comprehensive intervention measures: enhancing patient education, improving physician communication skills, and strengthening organizational support systems. Notably, special attention should be directed toward addressing the unique challenges posed by digital technologies while concurrently leveraging the opportunities they present to optimize communication outcomes.

Identification of the Core Competencies Required in Endodontics for Undergraduate Students in Syrian Dental Schools by Using a Modified Delphi Technique: Prospective Exploratory Survey Study

2026-06-09T06:30:03-04:00

Background: There is a worldwide movement toward competency-based medical education to equip dental students with essential competencies required to meet health care needs. In Syria, dental faculties currently lack a formal competency-based curriculum for endodontics at the undergraduate level. Moreover, the quality of root canal treatment performed by general dentists is frequently described as inadequate or substandard. Objective: This study aimed to develop a national consensus on the required competencies for undergraduate endodontics in Syria in order to establish a foundation for a standardized national curriculum, which can guide educators in adopting best practices in both dental education and clinical endodontics. Methods: This study was conducted at Syrian Virtual University between April and June 2025. A modified Delphi technique was used to determine endodontic competencies. Initially, a group of 5 Syrian endodontic consultants identified preliminary competencies. In the first round, 53 experts evaluated these competencies by using a 5-point Likert scale. Based on these results, a second round was conducted with 38 experts. Competencies with a weighted average above 4.20 were considered essential. Data analysis was performed using IBM SPSS package 27, and survey reliability was measured by Cronbach α. Results: Following the final Delphi round, a set of 31 competencies was established, comprising 9 knowledge, 13 skills, and 9 attitudes competencies. Cronbach α was more than 0.9 in the first and second round. The standard deviation across all questionnaires was low (≤0.85). The standard error was also minimal (≤0.12). Conclusions: This study identified a set of core endodontic competencies for the undergraduate level in Syria. These competencies are intended to support students in acquiring the required knowledge, skills, and attitudes, and assisting policymakers in implementing competency-based medical education within Syria and similar contexts.

Digital Interventions Addressing Cognitive and Psychological Symptoms in Long COVID: Scoping Review of Multicomponent Approaches

2026-06-08T15:45:12-04:00

Background: Long COVID, or postacute COVID-19 syndrome, presents with persistent cognitive and psychological symptoms such as , anxiety, depression, and fatigue, significantly impacting quality of life and daily functioning. Digital health interventions offer a scalable, accessible solution to bridge care gaps, especially where conventional neuropsychological support is limited. However, evidence regarding their effectiveness for neuropsychiatric symptoms in long COVID remains fragmented. Objective: This scoping review aimed to systematically identify and map the existing evidence on digital interventions targeting cognitive and psychological symptoms in individuals with long COVID. The review also sought to categorize intervention types, assess reported outcomes, and identify methodological gaps to inform future clinical and research priorities. Methods: The review followed the Arksey and O’Malley framework and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Comprehensive searches were conducted in 4 databases (PubMed, Scopus, Web of Science, and ScienceDirect) from December 2024 to February 2025. Eligible studies included peer-reviewed and gray literature published in English or Spanish since 2020. Studies were screened and selected based on predefined inclusion and exclusion criteria. Data were extracted using a standardized charting form and synthesized narratively, with thematic grouping by intervention type. Results: Of 888 records identified, 25 (2.82%) were included. Intervention types encompassed telehealth platforms, mobile health apps, virtual reality, online cognitive and psychological therapies, game-based cognitive training, neuromodulation (transcranial direct current stimulation), and multicomponent programs. Most studies reported improvements in psychological well-being, emotional regulation, and cognitive domains such as attention and memory. However, findings varied, with some interventions showing no significant cognitive gains or sustained effects. Common limitations included small sample sizes, lack of control groups, heterogeneity in outcomes and intervention protocols, and short follow-up durations. The underrepresentation of older adults and underserved populations was also noted. Conclusions: Digital interventions show promise for addressing cognitive and psychological symptoms in long COVID, particularly when delivered as multicomponent programs. Nonetheless, the evidence base remains preliminary. Future research should prioritize high-quality randomized trials with standardized outcome measures, long-term follow-up, and diverse participant samples. Addressing barriers related to digital literacy and access will be essential to ensure equity and real-world effectiveness. Trial Registration: OSF Registries 10.17605/OSF.IO/HX7UE; https://osf.io/hx7ue/overview

COVID-19 Rebound in Nirmatrelvir Plus Ritonavir Treatment and Control Groups: Prospective Cohort Study

2026-06-02T16:00:05-04:00

Background: Observation of COVID-19 rebound after nirmatrelvir plus ritonavir (NPR) has driven important questions surrounding one of the only direct-acting antiviral treatments for COVID-19. Objective: The objective of this study was to examine the epidemiology of COVID-19 rebound among COVID-19–positive outpatients in the United States who independently decided whether or not to take NPR. Methods: This prospective, decentralized observational cohort study was conducted from August 2022 through December 2023 and included frequent proctored COVID-19 rapid antigen tests and self-report symptom surveys for 15 days. The primary outcome was the incidence of viral and symptom rebound. Secondary outcomes included time to initial viral and symptom clearance, rebound probability among patients who cleared by day 15, and symptom frequency. Results: Of 917 consenting participants, 669 (73%) were eligible for inclusion in the analysis (n=443, 66% in the NPR group; n=226, 34% in the control group). The mean age was 46.1 (SD 12.9) years, 62.6% (n=419) of participants were female, and 49.2% (n=329) had at least one preexisting condition. Overall, 15-day cumulative incidence was higher in the NPR group than the control group for both viral (70/443, 15.8% vs 12/226, 5.3%) and symptom (73/443, 16.5% vs 19/226, 8.4%) rebound. Time to initial viral and symptom clearance was similar between groups, and among those who experienced clearance by day 15, the probability of viral rebound (NPR: 19.1%, 95% CI 15.1%-24.0% vs control: 7%, 95% CI 4.0%-12.6%; <.001) and symptom rebound (NPR: 47.7%, 95% CI 36.1%-60.8% vs control: 16.9%, 95% CI 10.9%-25.7%; <.001) was higher in the NPR group than the control group. Conclusions: This study demonstrates that while COVID-19 rebound occurs in both NPR-treated and untreated outpatients, the incidence is higher in the NPR group.

Constructs Influencing Patient Perceptions of Use of AI in Medical Imaging Analysis: Systematic Review

2026-06-01T16:30:52-04:00

Background: The use of artificial intelligence (AI) in medical imaging has been growing exponentially. Understanding patient perceptions and factors influencing their views of AI is critical to develop adequate strategies to support implementation and acceptance. Objective: This study aims to investigate the constructs that influence patients’ perceptions and acceptance of AI’s use in the analysis of their medical images to support screening and diagnosis. Methods: A systematic review was conducted to meet the research objective. Relevant articles were found by searching 5 databases. Data were extracted using an iteratively refined framework and synthesized narratively due to heterogeneity in study designs, populations, health care contexts, and outcomes. Results: A total of 59 relevant studies were included in the review. Patient acceptance of AI in medical image analysis emerged from multiple interacting factors. The most consistently reported determinant in 48 studies was that AI implementation should prioritize human-in-the-loop models, positioning AI as supportive tools, working in conjunction with health care providers rather than as an autonomous decision-maker. Other factors identified were performance of the AI, clarity of accountability, trust, and ethical factors. Patients’ individual characteristics such as demographics and health history were also noted to influence acceptance indirectly. The review findings were used to draft a conceptual model to draw attention to the complex relationship among the identified factors. Conclusions: This review informed the development of a conceptual model illustrating the complex and interactive factors shaping patient acceptance of AI in medical imaging, which can be tested prospectively in future studies. Our results highlight that patients’ likelihood of accepting AI cannot be attributed to a few factors. Instead, promoting acceptance will require a holistic approach where multiple factors are considered simultaneously and adapted for each use case.

Innovation Deimplementation in Emergency Departments During the COVID-19 Pandemic: Qualitative Study of Clinicians’ Decision-Making

2026-05-22T17:15:15-04:00

Background: During a public health emergency, emergency department (ED) clinicians can improve care delivery if they identify and adopt innovations that are safe and effective. However, little is known about the factors that impact ED clinicians’ decision-making around using or discontinuing innovations when evidence-based information is limited. Objective: The goal of this study was to understand the processes and factors that led ED clinicians to discontinue (deimplement) the use of COVID-19 care innovations. Methods: This is a qualitative study using semistructured focus groups with ED clinicians from 8 hospitals across the United States. Hospitals were purposively sampled and recruited to capture a diversity of perspectives based on location, facility type (academic or community hospital), rurality (urban or rural), and safety-net status. In this study, 17 physicians, 7 advanced practice providers, 18 nurses, and 7 respiratory therapists participated. We utilized both inductive and deductive techniques to perform content and thematic analysis of transcripts. Results: Clinicians shared that their own experiences (eg, direct observation of patient outcomes), contextual factors, and emerging research evidence contributed heavily to decisions about deimplementing innovations during the COVID-19 pandemic. Processes related to discontinuing innovations depended on leadership guidance and collaboration among colleagues. However, in some cases, there were no official processes to discontinue innovations, and innovations were passively deimplemented. Conclusions: Decision-making regarding the discontinuation of innovation in ED settings during the COVID-19 pandemic differed from routine conditions due to the lack of information and the rapid evolution of evidence within a short period of time. The level of evidence required to implement and deimplement innovations was significantly lower. Our findings indicate that factors influencing deimplementation during a public health emergency were highly localized and were treated similarly to pilot tests of new innovations. Future work is necessary to develop mechanisms for implementing promising innovations during evolving public health emergencies and monitoring their effectiveness and safety after implementation, enabling evidence-based decisions about whether to continue implementation or proceed with deimplementation.

Pulse Discovery Toolkit, a Multicomponent Nutrition Intervention for Preschool Children in Childcare Centers: Mixed Methods Pilot Study

2026-05-22T16:45:14-04:00

Background: Children’s eating habits are formed at an early age, making childhood a crucial period for introducing novel foods, such as pulse-based food products. Pulse Discovery Toolkit (PDTK) intervention was designed to increase familiarity with pulses and to eventually contribute to the consumption of pulse-based foods among preschool children in childcare centers (CCs). Objective: To determine PDTK’s impact on knowledge, acceptability, and consumption of pulse-based foods among preschool children attending CCs, and to assess its feasibility and acceptability by early childhood educators (ECE) and cooks. The nutrient contents and food group servings of pulse-based intervention recipes in the PDTK were also compared with regular CC recipes. Method: The PDTK intervention was delivered over a 3-month period in 2 CCs in Saskatoon (50 children, 8 staff). The intervention, which integrated taste exposure and nutrition education, consisted of 12 child-friendly weekly lessons, a food service guide for cooks, 15 recipes for pulse-based foods, 4 intervention recipes incorporated in the CC menu, and 4 parent newsletters. Mixed methods were used with pre- and postintervention knowledge tests, plate waste measurement, sensory evaluation, ECE and cook’s perspective, and nutrient content comparison of the intervention and control foods from the regular childcare menu to evaluate the intervention’s impact. Result: Improvements in correct identification of chickpeas (2/21 [10%] at preintervention to 7/21 [33%] at postintervention, =.074), beans (8/21 [38%] to 11/21 [52%], =.68), and peas (6/21 [27%] to 8/21 [38%], =.61) were not statistically significant. Children consumed higher amounts of the regular recipes (293.54, SD 27.65; 178.46, SD 24.33) than the intervention recipes (211.56, SD 25.61; 108.83, SD 21.97) at both times, respectively. However, at the end of the intervention, significant differences were only observed in the amount of total food consumption (=.049) and the protein content (=.04) when consumption proportion was examined, with both being higher for the control recipes in comparison to the intervention recipes. The majority (92% and 72%) of the children rated the refried bean wrap and lentil smoothie, “yummy,” respectively. Most of the intervention recipes have lower energy, fat, and sodium content compared with the regular CC recipes. Findings from ECE semistructured interviews and the lesson plan evaluations revealed that the ECEs reacted favorably to the curriculum. The cooks from the participating CCs did not report any barriers to cooking pulses in their facility. However, the need for modification to make the recipes easier to cook in CCs was noted in our study. Conclusions: With a few modifications to make some of the lessons more age-appropriate and some of the recipes easier to cook, it is feasible to implement the PDTK in CCs in order to promote regular consumption of pulses. International Registered Report Identifier (IRRID): RR2-10.2196/22775