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The patient-centered approach is essential for quality health care and patient safety. Understanding the service user's perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks. This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders. A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied. A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental. The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered.

Digitalization is currently revolutionizing health care worldwide. A promising technology in this context is artificial intelligence (AI). The application of AI can support health care providers in their daily work in various ways. The integration of AI is particularly promising in clinical decision support systems (CDSSs). While the opportunities of this technology are numerous, the problems should not be overlooked. This study aimed to identify challenges and barriers in the context of AI-based CDSSs from the perspectives of experts across various disciplines. Semistructured expert interviews were conducted with different stakeholders. These included representatives of patients, physicians and caregivers, developers of AI-based CDSSs, researchers (studying AI in health care and social and health law), quality management and quality assurance representatives, a representative of an ethics committee, a representative of a health insurance fund, and medical product consultants. The interviews took place on the web and were recorded, transcribed, and subsequently subjected to a qualitative content analysis based on the method by Kuckartz. The analysis was conducted using MAXQDA software. Initially, the problems were separated into \"general,\" \"development,\" and \"clinical use.\" Finally, a workshop within the project consortium served to systematize the identified problems. A total of 15 expert interviews were conducted, and 309 expert statements with reference to problems and barriers in the context of AI-based CDSSs were identified. These emerged in 7 problem categories: technology (46/309, 14.9%), data (59/309, 19.1%), user (102/309, 33%), studies (17/309, 5.5%), ethics (20/309, 6.5%), law (33/309, 10.7%), and general (32/309, 10.4%). The problem categories were further divided into problem areas, which in turn comprised the respective problems. A large number of problems and barriers were identified in the context of AI-based CDSSs. These can be systematized according to the point at which they occur (\"general,\" \"development,\" and \"clinical use\") or according to the problem category (\"technology,\" \"data,\" \"user,\" \"studies,\" \"ethics,\" \"law,\" and \"general\"). The problems identified in this work should be further investigated. They can be used as a basis for deriving solutions to optimize development, acceptance, and use of AI-based CDSSs. RR2-10.2196/preprints.62704.

Abstract Background and Hypothesis Accurate detection of individuals at risk for psychosis with established psychometric instruments such as the Comprehensive Assessment of At-Risk Mental States (CAARMS/2006) is crucial to implement effective preventive strategies. However, the CAARMS/2006’s scalability is limited by its lengthy administration. This study developed and validated a shorter CAARMS/2006 version: the mini-CAARMS. Study Design A total of 490 participants (mean age 23.8 ± 5 years) underwent the full CAARMS/2006 interview (60 items, all individually scored). The development and validation of the mini-CAARMS employed advanced statistical methods: regularized logistic regression with a LASSO penalty within a nested cross-validation framework to retain core items; Cohen’s κ, Harrell’s C index, sensitivity, specificity, balanced accuracy, positive (PPV) and negative (NPV) predictive values to assess performance; Monte Carlo simulations to assess the 2-year prognostic accuracy for predicting psychosis onset. A sensitivity analysis developed and validated an ultra-mini-CAARMS. Study Results The mini-CAARMS retained only 23 items and demonstrated excellent accuracy compared to the full version: Cohen’s κ 0.90; Harrell’s C index 0.93, sensitivity 95.6%, specificity 100%, balanced accuracy 97.8%, PPV 100%, and NPV 86.3%. The prognostic sensitivity and specificity of the mini-CAARMS were 82.2% and 55.1%, respectively. Sensitivity analyses further developed and validated an ultra-mini-CAARMS (based on 12 items only), which achieved comparable performance, with κ 0.90, C index 0.91, sensitivity 94.4%, balanced accuracy 97.2%, PPV 100%, NPV 82.2%, and prognostic sensitivity and specificity 81.2% and 55.1%, respectively. Conclusions The mini-CAARMS maintains high accuracy while substantially reducing administration time, and it could facilitate scalability of preventive psychiatry in low-resource settings.

In-depth interviews are a common method of qualitative data collection, providing rich data on individuals' perceptions and behaviors that would be challenging to collect with quantitative methods. Researchers typically need to decide on sample size a priori. Although studies have assessed when saturation has been achieved, there is no agreement on the minimum number of interviews needed to achieve saturation. To date, most research on saturation has been based on in-person data collection. During the COVID-19 pandemic, web-based data collection became increasingly common, as traditional in-person data collection was possible. Researchers continue to use web-based data collection methods post the COVID-19 emergency, making it important to assess whether findings around saturation differ for in-person versus web-based interviews. We aimed to identify the number of web-based interviews needed to achieve true code saturation or near code saturation. The analyses for this study were based on data from 5 Food and Drug Administration-funded studies conducted through web-based platforms with patients with underlying medical conditions or with health care providers who provide primary or specialty care to patients. We extracted code- and interview-specific data and examined the data summaries to determine when true saturation or near saturation was reached. The sample size used in the 5 studies ranged from 30 to 70 interviews. True saturation was reached after 91% to 100% (n=30-67) of planned interviews, whereas near saturation was reached after 33% to 60% (n=15-23) of planned interviews. Studies that relied heavily on deductive coding and studies that had a more structured interview guide reached both true saturation and near saturation sooner. We also examined the types of codes applied after near saturation had been reached. In 4 of the 5 studies, most of these codes represented previously established core concepts or themes. Codes representing newly identified concepts, other or miscellaneous responses (eg, \"in general\"), uncertainty or confusion (eg, \"don't know\"), or categorization for analysis (eg, correct as compared with incorrect) were less commonly applied after near saturation had been reached. This study provides support that near saturation may be a sufficient measure to target and that conducting additional interviews after that point may result in diminishing returns. Factors to consider in determining how many interviews to conduct include the structure and type of questions included in the interview guide, the coding structure, and the population under study. Studies with less structured interview guides, studies that rely heavily on inductive coding and analytic techniques, and studies that include populations that may be less knowledgeable about the topics discussed may require a larger sample size to reach an acceptable level of saturation. Our findings also build on previous studies looking at saturation for in-person data collection conducted at a small number of sites.

Digital media are easily accessible without time restrictions and are widely used for health- or disease-related purposes. However, their influence on the patient journey and the patient-physician relationship has not yet been sufficiently investigated. This qualitative interview study was designed to explore dermatologists’ and patients’ experiences with digital media for medical purposes in the context of patient journeys and patient-physician relationships. Twenty-eight semistructured video conference–based interviews were conducted and audiorecorded by experienced interviewers between November 2021 and June 2022 in Germany. Eligible patients were those who were aged ≥18 years, were affected by at least one physician-confirmed skin disease, and were fluent in the German language. The eligibility criterion for dermatologists was that they were currently practicing dermatology in an outpatient setting or in a hospital. Randomly selected dermatologists from the listing of the German National Association of Statutory Health Insurance Physicians and dermatologists from personal academic and professional networks were invited for participation via postal mail and asked to identify potential patient volunteers from their patient bases. All recorded data were pseudonymized, fully transcribed verbatim, and subsequently analyzed according to Mayring’s qualitative content analysis by 2 researchers, allowing for both a qualitative interview text analysis and a quantitative assessment of category assignments. In total, 28 participants were interviewed: 16 adult patients and 12 dermatologists. Eight main categories emerged as key areas of interest: (1) the search for diagnosis and symptom triggers, (2) preconsultation digital media use, (3) in-depth information and exchange with other patients, (4) self-treatment, (5) patient-physician interaction, (6) roles of dermatologists and patients, (7) patient eHealth literacy, and (8) opportunities and risks. Categories 1 and 2 were only coded for patients; the other categories were coded for both patients and dermatologists. Patients reported searches for diagnosis or treatment options were most frequently (8/16) caused by a mismatch of symptoms and diagnosis or dissatisfaction with current therapies. Concerns regarding a potentially severe diagnosis prompted searches for initial or in-depth information before or after dermatological consultations. However, the large volume of information of varying quality often confused patients, leading dermatologists to assume the role of evaluating information from preinformed patients. Dermatologists generally encouraged the use of digital media, considered teledermatology advantageous, and viewed big data and artificial intelligence as being potentially beneficial, particularly when searching for rare diagnoses. A single, easily accessible, and free-of-charge platform with high quality information in lay language was recommended by the dermatologists and desired by patients. Digital media are widely accepted by both patients and dermatologists and can positively influence both the dermatological patient journey and patient-physician relationship. Digital media may therefore have great potential to improve specialized health care if patients and dermatologists embrace their new roles.

The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs.

Family caregivers provide essential care in the home to millions of individuals around the globe annually. However, family caregiving results in considerable burden, financial hardship, stress, and psychological morbidity. Identifying and managing stress in caregivers is important as they have a dual role in managing their own health as well as that of the person they care for. If stress becomes overwhelming, a caregiver may no longer be able to perform this essential role. Digital methods of stress monitoring may be 1 strategy for identifying effective interventions to relieve caregiver burden and stress. This study aims to explore the perceived acceptability, challenges, and opportunities of using digital and biosensing technologies to measure caregiver stress. We conducted a descriptive qualitative study using semistructured interviews with an interview guide structured to obtain qualitative data addressing our study aims. We used reflexive thematic analysis methods. We recruited adult family caregivers (aged 18 years and older) currently or previously caring for an adult in the home with significant health issues. Interview questions focused on stress monitoring more generally and on ecological momentary assessment, remote monitoring technologies such as smartwatches, and fluid biosensors. We recruited 27 family caregivers of whom 19 (70%) were currently in a caregiving role, and the remainder were previously in a caregiving role. We identified 3 themes with 10 subthemes addressing elements of acceptability, challenges, and opportunities of using digital and biosensing technologies to measure caregiver stress The themes comprised \"providing meaningful data\" with subthemes of \"monitoring without action is pointless,\" \"monitoring that enables self-management,\" and \"seeing the bigger picture\"; \"low-burden monitoring\" with subthemes of \"low effort,\" \"practical alongside daily routines,\" and \"retaining control over monitoring\"; and \"inadvertent harms of stress monitoring\" with subthemes of \"stigma of stress,\" \"need for discretion,\" \"contributing to stress,\" and \"trust.\" In this descriptive qualitative study examining the perspectives of a diverse sample of family caregivers on methods of stress monitoring, we identified 3 themes addressing elements of acceptability, challenges, and opportunities. These provide useful considerations for the use of stress monitoring and implementation of interventions to ameliorate family caregivers' stress of relevance to social care and community teams, researchers, and policy makers. These include providing meaningful situationally specific data resulting in action, that does not contribute to caregiver burden, or inadvertent harm to either the caregiver or the care recipient.

Background Exercise has the potential to attenuate the high levels of cardiovascular morbidity and mortality present in kidney transplant recipients (KTRs). Despite this, activity levels in KTRs remain low. The aim of this qualitative study was to explore the barriers and facilitators of exercise in KTRs. Methods Thirteen KTRs (eight males; mean ± SD; age 53 ± 13 years; estimated glomerular filtration rate 53 ± 21 ml/min/1.73 m2) were recruited and completed semistructured one‐to‐one interviews at University Hospitals of Leicester NHS Trust. All KTRs were eligible if their kidney transplant was completed >12 weeks before interview and their consultant considered them to have no major contraindications to exercise. All interviews were audio recorded, transcribed verbatim and subject to framework analysis to identify and report themes. Results Themes were organized into personal, behavioural and environmental factors based on social cognitive theory. Facilitators of exercise were largely internal: enjoyment, exercise for general health and health of the transplanted kidney and desire to maintain normality. Social interaction, support and guidance of healthcare professionals and goal setting were perceived as motivational. Harming the kidney, a lack of guidance, self‐motivation and accessibility were barriers to exercise. Conclusion These results provide detailed insight into the development of interventions designed to increase physical activity in KTRs. They provide strong evidence that specific exercise guidelines are required for this population and that the healthcare system could have a key role in supporting KTRs to become more physically active. Interventions need to be multifaceted to appeal to the differing levels of support desired by KTRs. Patient or Public Contribution KTRs were involved in the development of the interview topic guide to ensure all relevant topics were explored.

Social media serves as a tool for increased digital interconnectedness and has resulted in playing an instrumental role in sharing health-related information with a wide audience. In conjunction with the vast availability of information, there has been a rapid spread of misinformation, leading to public mistrust, safety concerns, and discrimination. The COVID-19 pandemic has amplified the threat of misinformation resulting in detrimental health outcomes due to individuals becoming fatigued with COVID-19 health guidance. Although vaccinations are the key to combating COVID-19, the overwhelming amount of misinformation has resulted in diminished vaccine acceptance. This study aims to (1) train and deploy a group of health care workers and student volunteers to address antivaccine sentiment on Facebook (Meta Platforms, Inc) and (2) evaluate the intervention through semistructured interviews to determine lessons learned and suggestions for future initiatives to address internet-based misinformation online. The project used volunteers to address vaccine-hesitant comments on Facebook (Meta Platforms, Inc), with the overall goal of empowering health care professionals to counteract the spread of vaccine misinformation. Eligible participants included health care workers and students in health care-related disciplines recruited through social media and email advertising campaigns. Informational training sessions followed, to better equip volunteers with the ability to use their working knowledge of health communication and behavior change to correct web-based misinformation. The volunteers were provided a file containing Facebook posts that discussed COVID-19 vaccines to act as a starting point for leaving or responding to comments that spread vaccine misinformation. Participants were provided with working knowledge of health communication, behavior change, and correct misinformation through the informational training sessions. Qualitative evaluation in the form of interviews was used to examine participant experiences. Three main themes emerged regarding the project's format and training model, the factors motivating volunteers to participate, and overall experiences tackling misinformation on a social media platform. The first theme showcased that the training format was effective due to its use of interactive components and overall flexibility, resulting in it being well received by volunteers. The second identified theme highlighted that a main driving factor for participation included a balance of professional development and societal good. The third theme revealed that the volunteers' experiences in interacting with the public revealed a rich tapestry of emotions and perspectives, where vaccine hesitancy is interconnected with emotional responses and personal beliefs. The Informed Choice Project provided an opportunity to increase self-efficacy and confidence for more than a dozen health care professionals and students while engaging in vaccine-related conversations on social media. To enhance both participant satisfaction and compliance, future interventions should consider using a self-paced format, flexible hours, and highlight the vitality of health care professionals as key advocates for trusted sources of information for the public.

Understanding cultural dimensions of human/environment relationships is now widely seen as key to effective management, yet characterizing these dimensions remains a challenge. We report on an approach for considering the nonmaterial values associated with ecosystems, i.e., cultural ecosystem services. We applied the approach in Kona, Hawai‘i, using 30 semistructured interviews and 205 in-person surveys, striving to balance pragmatism and depth. We found spirituality, heritage, and identity-related values to be particularly salient, with expression of some of these values varying among respondents by ethnicity and duration of residence in Hawai‘i. Although people of various backgrounds reported strong spirituality and heritage-related values, Native Hawaiians rated heritage connections as deeper, and lifetime residents portrayed ecosystem-identity connections as more integral to their well-being than did people from other backgrounds. The approach also proved useful in identifying concerns not addressed in survey and interview prompts, including postcolonial issues, access to ecosystems, and relationships between people of different ethnic backgrounds. Although understanding these nonmaterial dimensions of human-ecosystem relationships can be complex, emerging techniques eliciting qualitative and quantitative data provide feasible ways of deepening that understanding.