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Despite the potential of digital adherence technologies to support patient-centered monitoring for tuberculosis (TB), there is limited research on incorporating indirect and direct adherence monitoring or assessing patients' experiences with these technologies. The TB Treatment Support Tools (TB-TST) includes a comprehensive mobile app for patients and health care providers and a direct adherence metabolite test to report and monitor adherence. This paper describes the iterative refinement process of the TB-TST intervention. To refine the TB-TST intervention, we used an iterative approach involving multiple embedded mixed methods studies guided by the Information Systems Research framework and Design Thinking Process. Embedded studies included a randomized controlled pilot study, interviews, usability testing, and surveys with patients and experts to inform ongoing refinements. The project consisted of interface evaluation, high-level system design, and iterative redesign. The TB-TST intervention was refined through 3 iterative phases. In Phase 1, based on feedback from pilot study participants and 4 experts in TB, improvements included an in-app discussion board, submission confirmations, and enhanced account recovery. Cultural adaptation was based on Hofstede's dimensions. Phase 2 involved 4 Directed Research Groups and 19 stakeholders to redesign user flows, simplify reporting, and transition the app to a progressive web app, improving device compatibility. Phase 3 included usability testing cycles with 48 participants (26 patients and 22 health care professionals), yielding high satisfaction scores: patient app Mobile Health App Usability Questionnaire, mean 5.96 (SD 0.46); provider mobile dashboard IT Usability Evaluation Scale scores ranged from 5.83 to 6.23 out of 7, and optimization of interface and dashboard. Refinements included larger icons, streamlined onboarding, symptom summary enhancements, and a new cohort-level adherence graph. These modifications improved navigation, usability, and remote monitoring for patients with TB and providers in preparation for a multisite clinical trial. Combining multiple methods guided by the Information Systems Research framework and elements of the Design Thinking Process can help researchers and developers leverage the strengths of mixed methods iterative designs to create highly personalized and effective digital health interventions.

Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing.

South Korea is undergoing one of the world's fastest demographic shifts toward an aging society, with projections indicating that by 2047, half of all households will be led by older adults. While digital health technologies such as mobile health apps and telemedicine offer promising solutions for promoting healthy aging and reducing health care expenditures, their adoption among older Koreans remains limited. To address these challenges, this study will use a user-centered design thinking approach to develop a public health care platform tailored to the needs of South Korea's older adults. The primary objective of this study is to develop and evaluate a user-centered digital health care platform tailored to older adults in South Korea, with the aim of overcoming key barriers, such as low digital literacy, interface complexity, and mistrust in artificial intelligence-driven systems, and ultimately bridging the digital divide in health. This mixed methods study will integrate qualitative and quantitative research within a design thinking framework, progressing through 3 operational phases: empathize and define, ideate, and prototype and test. In phase 1, a scoping literature review, field observations at 5 community centers for older people and in-depth interviews with 29 older adults and 15 stakeholders were conducted to identify behavioral barriers and user needs. In phase 2, an open idea contest and expert focus groups were used to generate and prioritize innovative features for the platform. Phase 3 involves co-design workshops, minimum viable product development using a no-code platform, and usability testing with 8 to 10 older adults. The research received a grant (HI22C1477) from the Korea Health Industry Development Institute (2023-2025) and ethical approval (2023-01-014) from Sungkyunkwan University. As of July 2025, data collection for phase 2 is ongoing, and preliminary findings are expected by late 2025. By adopting an inclusive design thinking approach, this study aims to produce a practical and user-centered platform for older adults. The findings will contribute to research on digital health equity and offer actionable insights for community-centered technology design.

Personal health record (PHR) software has the potential of aiding with patient engagement and data collection in longitudinal research to better understand the long-term impact of treatments on patients with rare medical conditions. Neuroendocrine tumors (NETs) represent a rare condition with unique challenges related to symptom management, treatment tracking, and patient-provider communication. This study aimed to design, develop, and evaluate PHR software tailored for patients with NETs as part of a longitudinal research study. Our goal was to create a patient-centered PHR that supports both self-management and research data collection. This included activities spanning the entire development lifecycle from identifying user requirements through focus groups and surveys, iterative prototype refinement via cognitive walkthroughs, and usability testing of the functional PHR system. Feedback from patient advocacy organizations and clinical experts further informed PHR development. The resulting PHR allows patients with NETs to access condition-specific information, track symptoms, monitor treatment regimens, and share data with health care providers. Patients valued the ability to visualize personal health trends and patterns over time, enhancing both self-management and communication with medical teams. Usability testing indicated high levels of patient satisfaction with the system's functionality and design. The development of this PHR demonstrates the value of engaging patients in the design process to ensure that health technologies address real-world needs. Our approach provides a model for designing PHR systems for other rare conditions, highlighting the importance of patient-centered design in supporting both clinical care and longitudinal research.

Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children's difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds.

Personal support workers (PSWs) are often expected to provide ongoing support for complex conditions and have identified an increased need for training in several areas, including dementia and mental health. Web-based interventions may be helpful complements to traditional in-person continuing education and training, but their effectiveness must be explored further. This study's objective was to evaluate the usability, usefulness, satisfaction with, and effectiveness of the web-based Dementia Foundations Program among unregulated care providers who provide care to persons living with dementia or are in training. A cohort of 50 PSWs, PSW trainees, and paid care companions from 3 recruitment sites were invited to access the Dementia Foundations Program, a 4-hour self-paced web-based program composed of 4 courses, for up to 6 weeks. Usability, usefulness, and satisfaction were assessed using surveys after each course and following the program. Dementia knowledge and attitudes were measured using the Dementia Knowledge Assessment Scale and the Dementia Attitudes Scale, with differences between baseline and postprogram scores analyzed using repeated measures ANOVA. Participants reported high levels of satisfaction with the program. Of the 50 participants, 46 (92%) agreed that the web-based training met their expectations, 47 (94%) agreed that the training covered a broad range of topics and was not missing any important content, and 49 (98%) agreed that the web-based training would benefit them. There was a significant postprogram improvement in dementia knowledge as measured by the Dementia Knowledge Assessment Scale, with an average 30% improvement across all cohorts. Dementia Attitudes Scale scores were also significantly improved postprogram across all cohorts. This pilot study in PSWs, PSW trainees, and unregulated care companions demonstrated high satisfaction levels with the web-based Dementia Foundations Program. There were substantial improvements in knowledge and small improvements in attitudes for participants, and it was perceived as a useful tool that complemented their existing education and training. The Dementia Foundations Program is a user-friendly and effective e-learning program, which can be conveniently scaled and spread to enhance unregulated care provider dementia education.

The increasing prevalence of mental health disorders among youth underscores the need for accessible and effective interventions. Digital mental health (dMH) platforms like Innowell offer promising solutions by increasing access to mental health care for young people. Innowell is a web-based platform that supports youth mental health by providing personalized measurement-based care in collaboration with a youth's health care providers. However, understanding youth perspectives on these platforms is crucial for ensuring successful implementation and sustained engagement. This study aimed to explore youth perspectives on the implementation of the Innowell platform, identifying key factors influencing uptake, engagement, and long-term retention. A qualitative descriptive approach was used to examine youth perspectives. Data were collected through 9 focus groups and 1 interview, involving 39 participants aged 15-24 years from urban (23/39, 59%) and rural (16/39, 41%) communities in Alberta, Canada. Participants were recruited through mental health clinics and community organizations. Thematic analysis was conducted on the transcripts to identify factors that support or hinder engagement with the platform. Participants emphasized the importance of privacy, security, and personalization in building trust in the platform, with 72% (28/39) reporting that clear communication about data protection would increase their likelihood of use. Progress tracking features, such as symptom trend visualizations and diaries, were identified by 65% (25/39) of participants as critical for sustaining engagement. Ease of use was highlighted, with 58% (23/39) preferring mobile app functionality over web-based interfaces. Dynamic content and personalized notifications were suggested as strategies to maintain long-term use, with 64% (25/39) of participants valuing customizable reminders to encourage daily interactions. Rural participants (16/39, 41%) noted the need for offline functionality due to inconsistent internet access. In addition, participants recommended features such as crisis support, professional communication channels, and access to local mental health resources. Youth-centered design is essential for enhancing the usability and engagement of dMH platforms like Innowell. Key features prioritized by participants included privacy, security, progress tracking, and personalization. Dynamic and user-friendly interfaces, along with the ability to customize notifications and access professional support, were critical for fostering long-term engagement. Insights from this study provide actionable recommendations for optimizing dMH platforms to meet the mental health needs of young people, particularly in diverse urban and rural settings. Future research should explore implementation strategies tailored to specific user demographics to enhance the scalability and impact of dMH interventions.

Young adult (YA) cancer survivors frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). YAs also have expressed a desire that behavioral interventions be convenient. In response to this, our team has developed a 10-week, group-based, supportive care intervention titled TOGETHER to improve YA cancer survivors' HRQOL. TOGETHER is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. In an effort to increase convenience, the goal of this 2-part study was to design and test a website to host the TOGETHER intervention for YA cancer survivors aged 18-39 years at the time of participation and aged 15-39 years at the time of initial cancer diagnosis. In part 1, we leveraged an existing web-based platform and adapted it to meet the needs of TOGETHER. We conducted 3 iterative waves of usability testing with 3 YAs per wave to refine the website. In part 2, we conducted a single-group feasibility trial of TOGETHER using the website. Primary outcomes were feasibility (ie, recruitment, retention, and attendance) and acceptability (ie, satisfaction). Usability testing participants (n=9) indicated that the TOGETHER website was easy to use (mean 5.9, SD 1.3) and easy to learn (mean 6.5, SD 0.9; possible ranges 1-7). Qualitative feedback identified needed revisions to the aesthetics (eg, images), content (eg, session titles), function (eg, clarity of functionality), and structure (eg, expandable sections), which were implemented. In the feasibility trial, participants (n=7) were an average of 25 (SD 4.7) years old and mostly non-Hispanic White (n=4, 57%). Recruitment (58%) and retention (71%) rates and average session attendance (mean 7.1 , SD 4.2) supported feasibility. Participant agreement with positive statements about TOGETHER and average satisfaction ratings (mean 5.06, SD 1.64; possible range: 1-7) demonstrated acceptability. Results supported the usability, feasibility, and acceptability of the TOGETHER program and website. By providing the content digitally, the program effectively addresses YAs' expressed preference for convenience. Future studies are needed to increase TOGETHER's efficiency and explore its efficacy for improving targeted outcomes.

Web-based tools have gained popularity to inform and empower individuals in advance care planning. We have developed an interactive website tailored to the unique needs of people with dementia and their families to support advance care planning. This website aims to break away from the rigid pathways shown in other tools that support advance care planning, in which advance care planning is shown as a linear process from information to reflection, communication, and documentation. This study aimed to assess the website's usage by people with dementia and their family caregivers, identify distinct user engagement patterns, and visualize how users navigated the website. We analyzed the website's log data obtained from an 8-week evaluation study of the site. Interactions with the website were collected in log data files and included visited web pages or clicked-on hyperlinks. Distinct user engagement patterns were identified using K-means clustering process mining, a technique that extracts insights from log data to model and visualize workflows, was applied to visualize user pathways through the website. A total of 52 participants, 21 individuals with dementia and their family caregivers as dyads and 10 family caregivers were included in the study. Throughout the 8-week study, users spent an average of 35.3 (SD 82.9) minutes over 5.5 (SD 3.4) unique days on the website. Family caregivers mostly used the website (alone or with a person with dementia) throughout the 8-week study. Only 3 people with dementia used it on their own. In total, 3 distinct engagement patterns emerged: low, moderate, and high. Low-engagement participants spent less time on the website during the 8 weeks, following a linear path from information to communication to documentation. Moderate- and high-engagement users showed more dynamic patterns, frequently navigating between information pages and communication tools to facilitate exploration of aspects related to advance care planning. The diverse engagement patterns underscore the need for personalized support in advance care planning and challenge the conventional linear advance care planning representations found in other web-based tools.

Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents' values. We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family's experience. Parents' use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app.