Adolescent obesity remains a pressing public health challenge, particularly among socioeconomically disadvantaged populations. Artificial intelligence (AI) holds the promise for supporting students in managing daily health behaviors, but few existing studies used AI-based interventions in naturalistic settings such as schools. This study evaluated the feasibility and preliminary impact of ProudMe Tech (Louisiana State University), an AI-assisted web app designed to help students manage 4 obesity-related behaviors: physical activity, screen time, diet, and sleep. The 8-week, 1-arm pilot intervention study recruited 172 participants from 5 middle schools in Louisiana and used the ProudMe Tech to set behavior goals, track behaviors, record reflections, and receive AI-generated feedback. Both engagement (primary focus) and behavior impacts (secondary focus) were examined. Engagement metrics indicated varying levels of usage, averaging 8.9 (SD 7.6) behavior entries and 30.0 (SD 28.3) reflections per student, and receiving 33.5 (SD 29.7) AI feedback messages. Overall, participants recorded 6164 valid daily goals, of which 3934 (63.8%) were achieved. Natural language processing of the reflections and AI feedback messages revealed an overall neutral to positive sentiment. Pre- to postcomparisons showed (1) a significant reduction in screen time from 4.3 (SD 2.6) to 3.4 (SD 2.5) hours per day (21.6% decrease; t164=6.18, P<.001), (2) a small but significant decrease in fruit and vegetable intake from 5.7 (SD 3.8) to 5.2 (SD 3.5) servings per day (8.9% decrease; t169=2.27, P=.46), and (3) no significant changes in physical activity and sleep. These findings suggest that ProudMe Tech is a feasible AI chatbot that can engage adolescents in health behavior management, but more adaptation is needed to effectively elicit improvements in health behaviors and lower the obesity risk in middle school students.

BackgroundBiomedical research studies are increasingly using digital tools to enroll, recruit, and collect data from participants. However, variability in digital literacy and technological acceptance can be challenging for recruitment from groups traditionally underrepresented in research, including those served by Federally Qualified Health Centers.ObjectiveThis study aimed to (1) measure participant accessibility and comfort with digital platforms and (2) examine the interrelation of technology access, digital literacy, and support preferences during enrollment and data submission.MethodsA cross-sectional analysis was conducted using enrollment data from Federally Qualified Health Centers participating in the All of Us Research Program. Participants had the option of High-Touch (staff-assisted) or Low-Touch (self-directed) support for enrollment and survey completion. Survey items assessed internet access and technology comfort, while support type was recorded by the research staff based on participants’ actual selection. Logistic regression models evaluated relationships between technology access, comfort, and enacted support type, while controlling for age, consent language, and education, as well as race and ethnicity.ResultsThe analytic sample included 605 participants. The majority reported access to the internet (539/605, 89.1%) and felt comfortable with technology (448/605, 74.1%). In the group requesting High-Touch support (n=346), 14.5% (n=50) reported no internet access, and 31.5% (n=109) felt uncomfortable with technology. In the group requesting Low-Touch support (n=259), 6.2% (n=16) had no access to the internet, and 3.9% (n=10) reported feeling uncomfortable (P<.001). In the adjusted models, much greater comfort with technology was significantly correlated with reduced odds of requesting High-Touch support (comfortable: adjusted odds ratio 0.118, 95% CI 0.055‐0.255 and neutral: adjusted odds ratio 0.212, 95% CI 0.077‐0.587), but internet access was not significantly correlated.ConclusionsThe strongest predictor for support preference for digital enrollment among the participants was their comfort with technology rather than access alone. These findings illustrate the significance of participant-centric design methods coupling adaptive support paths, mixed enrollment strategies, and individualized onboarding methods aligned with digital confidence to promote equitable engagement in precision health research.

BackgroundEnhancing care coordination and sharing information in cancer care improves patient experiences by promoting clarity and satisfaction.ObjectiveThis study aims to assess the impact of cross-sectoral video consultation on patient perceptions of care coordination and satisfaction with received information compared to usual care.MethodsThis study presents secondary outcomes on patient perceptions of care coordination and satisfaction with received information from a 7-month follow-up of the Partnership Project. In this randomized controlled trial, patients with cancer were allocated to either an intervention group receiving cross-sectoral video consultation (oncologist, general practitioner, and patient) or a control group receiving usual care. Patients’ perceptions of care coordination and information quality were assessed using the Australian Cancer Care Coordination Questionnaire (CCCQ) and the European Organisation for Research and Treatment of Cancer Quality of Life Information Questionnaire 25 at baseline and 7 months. Changes over time between groups were analyzed using generalized estimating equations.ResultsOf the 278 participants randomized (1:1), only 80 (28.8%) patients received the intervention due to technical and administrative issues. A total of 210 (75.5%) patients completed the baseline questionnaire, while 118 (42.4%) responded at 7 months. No significant differences were observed in the changes over time between the intervention and control groups in any outcome. The estimated differences in the change in score from baseline to 7 months were as follows: for the total CCCQ score, 1.11 (95% CI –2.32 to 4.53; P=.53); for the overall European Organisation for Research and Treatment of Cancer Quality of Life Information Questionnaire 25 score, 1.49 (95% CI –2.98 to 5.96; P=.51); for the CCCQ communication subscale, –1.49 (95% CI –1.33 to 4.31; P=.30); and for the navigation subscale, –0.03 (95% CI –1.52 to 1.46; P=.97).ConclusionsOur findings indicate no statistically significant improvement in patients’ reported care coordination or satisfaction with received information over 7 months. Technical issues with the video setup reduced fidelity rates and follow-up participation. Further research is needed to optimize the structure and content of cross-sectoral video consultations to better support patients’ perceived outcomes.Trial RegistrationClinicalTrials.gov NCT02716168; https://clinicaltrials.gov/study/NCT02716168

BackgroundTopical steroid withdrawal (TSW) is a controversial skin condition among health care providers due to a lack of evidence, but it has an impactful and growing presence on social media. There are few previous reports of health care utilization for symptoms attributed to TSW.ObjectiveThis study aims to investigate health care utilization and requests as well as information sources for TSW among patients with atopic dermatitis (AD).MethodsThis observational cross-sectional study used a questionnaire aimed at adults with AD, experiencing symptoms they attribute to TSW. The questionnaire was posted as a link, free to share with others, in a Swedish TSW−themed Facebook group and remained accessible for 4 weeks. Descriptive statistics and topical text analysis on open-ended items were used to present and interpret the results.ResultsThe participants (n=82) reported dermatologists (n=41, 50%), general practitioners (n=40, 49%), and practitioners of complementary and alternative medicine (CAM; n=32, 39%) as the most frequent health care contacts for TSW. However, among participants with ongoing symptoms attributed to TSW (n=68), ongoing health care contacts with general practitioners, dermatologists, and practitioners of CAM were reported by only 10% (n=7), 22% (n=15), and 13% (n=11), respectively. For symptoms attributed to AD, the frequencies of health care provider contacts were higher. Almost all participants had sought help from a general practitioner (n=81, 99%) or a dermatologist (n=76, 93%) at some point, and many had also consulted a practitioner of CAM (n=59, 72%). Among those with ongoing symptoms attributed to AD, 43% (n=26) had an ongoing contact with a dermatologist. Participant-requested help and support from health care providers included understanding and confirmation of TSW impairments (n=45, 56%), treatment of symptoms (n=26, 32%), and increased awareness and information about TSW from health care providers (n=21, 26%). The most common TSW information sources were Facebook (n=78, 96%), websites (n=75, 93%), and Instagram (n=45, 56%), but YouTube (n=11, 14%), podcasts (n=7, 10%), and TikTok (n=5, 6%) were also reported.ConclusionsThis study investigates health care utilization patterns related to TSW. The results indicate that the participants received insufficient support from health care providers for symptoms they attributed to TSW. The participants initiated and maintained health care provider contacts for symptoms attributed to AD to a greater extent than for TSW and sought information and support for TSW elsewhere. Targeted interventions to overcome this could be educational efforts for general practitioners and dermatologists about the current scientific knowledge of TSW as well as the TSW discourse on social media. In addition, health care providers need to engage and contribute to evidence-based content about TSW on relevant social media platforms to prevent the spread of misinformation about topical glucocorticoids.

BackgroundThe clinical and cost-related consequences of internet-based depression screening, in combination with automated feedback, have been rarely investigated. We aimed to conduct a cost-effectiveness analysis of DISCOVER, a 3-armed, observer-masked, randomized controlled trial that focused on 2 versions of automated feedback interventions after internet-based depression screening.ObjectiveThis study aimed to evaluate the cost-effectiveness of automated nontailored and tailored feedback interventions after internet-based depression screening from a societal perspective.MethodsParticipants were recruited from the general population via traditional and social media. Participants who were undiagnosed but screened positive for depression on an online version of the Patient Health Questionnaire-9 (≥10 points) were randomized to automatically receive no feedback, nontailored feedback, or tailored feedback. The feedback interventions included the depression screening result, a recommendation to seek professional advice, and brief general information about depression. The tailored feedback was additionally framed according to the participants’ symptom profiles, treatment preferences, health insurance plans, and local residency. The time horizon was 6 months. The main outcome was the incremental cost-effectiveness ratio (ICER) from a societal perspective using quality-adjusted life years (QALY) based on the EuroQol-5D-5L. Cost-effectiveness acceptability curves were constructed. Furthermore, several sensitivity analyses and explorative subgroup analyses were conducted.ResultsA total of 1012 participants (no feedback: n=343, 33.9%; nontailored feedback: n=338, 33.4%; and tailored feedback: n=331, 32.7%) were included. Differences in costs and effects were not statistically significant. However, ICER results indicated that both no feedback and tailored feedback exhibited dominance over nontailored feedback. The ICER of tailored feedback compared to no feedback was €109,730 per QALY (a currency exchange rate of €1=US $1.02 was applicable as of December 31, 2022), whereas both costs and QALYs were lower in tailored feedback. The cost-effectiveness probability of tailored feedback compared to no feedback ranged between 41% and 80%. Sensitivity analyses exhibited similar trends.ConclusionsSix months postintervention, feedback interventions had no statistically significant effect on costs from a societal perspective or on QALYs. Tailored feedback was associated with moderate cost-effectiveness probabilities compared to no feedback. Explorative subgroup analyses revealed subpopulations for which the interventions might be cost-effective.

Correction: Effectiveness, Usability, and Satisfaction of a Self-Administered Digital Intervention for Reducing Depression, Anxiety, and Stress in a University Community in the Andean Region of Peru: Randomized Controlled Trial

BackgroundUniversity students are facing a multitude of challenges and an increase in mental health issues that affect their academic performance and overall well-being. In response, Erasmus University Rotterdam launched the Student Wellbeing Programme in 2019, offering comprehensive, tailored support through a stepped-care framework to enhance student success and well-being. One of the tools developed for students is ROOM to Grow, an anonymous and accessible preventative mental health app.ObjectiveThis paper describes the process and outcomes of ROOM’s design and development, guided by the Centre for eHealth Research (CeHRes) road map and privacy-by-design principles, and highlights the lessons learned throughout this process.MethodsThis paper describes the first 4 phases of the CeHRes Road map: contextual inquiry, value specification, design, and operationalization. It outlines the population (ie, stakeholders), methods (ie, literature reviews, expert groups, cognitive walkthroughs, interviews, experimental designs), and outcomes of each phase.ResultsThe most common mental health struggles among our target population were stress, anxiety symptoms, perfectionistic tendencies, and loneliness. Students often recognized these issues only once they became overwhelming. Regarding digital tools, students seek credible content specific to their experiences, as well as adaptable and intuitive systems; they are mindful of data privacy and aim to reduce their screen time. ROOM was developed to address the diverse needs and preferences of university students through a transdiagnostic approach to mental health. It targets emotion regulation (ER) skills and self-awareness, which underlie the mental health challenges experienced by our target users. ROOM comprises 26 brief exercises (ie, micro-interventions) that support the development and use of adaptive ER. The exercises incorporate techniques from various therapeutic approaches (ie, self-compassion, positive psychology, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy) to accommodate students’ diverse content preferences. To help students recognize their struggles earlier, ROOM includes a mood tracker and a self-assessment module with questionnaires that evaluate both traits (eg, perfectionistic tendencies) and states (eg, stress levels), providing personalized feedback. ROOM further implements an intelligent recommender system that connects users to relevant content, enhancing the tool’s personalization and responsiveness to users’ needs. As students aim to minimize screen time, ROOM’s goal is not prolonged app use but the application of ER skills in real life, supported by features that facilitate skill transfer into everyday settings. Finally, ROOM was developed within a “privacy-by-design” framework to address students’ privacy concerns, implementing strict privacy and security regulatory standards.ConclusionsCompromises were necessary to balance user needs, resource constraints, and privacy-by-design and security standards, often limiting ROOM’s interactivity. Other challenges included simplifying complex psychological concepts into brief formats, fostering interdisciplinary collaboration, balancing academic rigor with industry production pace, and operating with fixed resources while maintaining an iterative process. This paper may serve as a primer for designing transdiagnostic, adaptive mental health interventions for youth, blending therapeutic approaches and promoting skill transfer.

BackgroundParenting skills programs are the primary intervention for conduct disorders in children. The Pause app enhances these programs by providing digital microinterventions that reinforce learning between sessions and after program completion. The potential of artificial intelligence (AI) in this context remains untapped. Hackathons have proven effective for health care innovation and can facilitate collaborative development in this space.ObjectiveWe aimed to rapidly build AI-powered features in the Pause app to enhance parenting skills.MethodsWe undertook a 1-day hackathon that included an ideation phase drawing on the Design Council’s double diamond framework and a development phase using microsprints based on agile and scrum approaches. The interdisciplinary participants included medical professionals, developers, and product managers.ResultsParticipants identified 3 core problems: generating age-appropriate distractions, receiving feedback on parenting efforts, and effectively using the journal function. During the solution phase, a wide range of options were explored, resulting in 3 key solutions: AI-assisted idea generation, a tool for summarizing parenting interactions, and a weekly journal roundup. During the development phase, participants completed 4 microsprints. Teams focused on 3 workstreams: building a “weekly roundup” module, creating an AI-based distraction generator, and developing a summarizer for active play sessions. These prototypes were integrated into the preproduction environment, with each workstream producing a functional component. Participant feedback (n=4) was unanimously positive, with all participants rating the event as “excellent” and highlighting the value of in-person collaboration.ConclusionsThis 1-day hackathon used the double diamond approach to develop AI-powered features for parenting programs. Three solutions were explored across workstreams, resulting in 2 fully functioning and 1 near-functioning app component. The rapid problem-solving approach mirrors other health technology hackathons and highlights the untapped potential of AI in digital parenting support, surpassing traditional e-learning or video-based methods. This work suggests broader applications of AI-driven coaching in fields like social care. Despite a small team, the hackathon was focused and productive, generating relevant solutions based on prior engagement with parents and practitioners. Future research will assess the impact of the app’s AI-powered features on parenting outcomes.

BackgroundThe rapid expansion of mobile health (mHealth) apps has transformed health care delivery worldwide. Despite their potential to improve epilepsy care, a substantial treatment gap remains, especially in low- and middle-income countries, due to limited resources, stigma, and low adoption of digital technologies. Although mHealth apps can bridge these disparities, their impact depends on acceptance and use by the target population.ObjectiveWe aimed to assess the awareness, feasibility, willingness, perception, and factors influencing these behaviors for the usage of mHealth apps among people living with epilepsy in Pakistan.MethodsWe conducted a cross-sectional analytical survey between March and July 2024 among people living with epilepsy attending the Pakistan Institute of Medical Sciences (PIMS). Participants completed a validated, self-administered questionnaire with 33 items across 5 domains. We recruited 406 participants through convenience sampling and analyzed the data using SPSS version 23.0 (IBM Corp). Through multivariable linear regression analysis, we explored factors associated with people living with epilepsy willingness to use mHealth apps. Correlation analysis was used to elucidate the association among awareness, perception, feasibility, and willingness.ResultsAmong 406 participants, 53.7% (n=218) were male, 64.5% (n=262) were married, and 89.2% (n=362) were identified as Muslim. Although 86.2% (n=350) of participants have heard about mHealth apps for epilepsy management, 78.1% (n=317) expressed negative perceptions of their use. More than half, 69% (n=280), reported concerns about the privacy of their medical information online, and 78.1% (n=317) were not comfortable using mHealth apps on smartphones or tablets. Multivariable linear regression analysis revealed that rural residents (P=.05), those with a college education (P<.001), and participants with a treatment duration of 2-3 years (P<.001) significantly influenced participants’ willingness. Correlation analysis showed a weak negative relationship between awareness and feasibility (ρ=–0.124; P=.01) and a weak positive relationship between awareness and willingness (ρ=0.013; P=.07).ConclusionsTo expand mHealth use for epilepsy care in Pakistan, stakeholders must address concerns about digital literacy, data privacy, and trust. Collaborative efforts involving government, technologists, nongovernmental organizations, academia, and health care providers can improve education, enhance data security, and adapt mHealth tools to local needs, ultimately improving treatment access and outcomes for people living with epilepsy.