BackgroundTaiwan’s status as a super-aged society underscores the need for efficient strategies to promote healthy aging. While the benefits of mindfulness-based interventions for sleep and mental health are evident, there is a shortage of cultural adaptations for Taiwan’s older adults. Current courses mainly focus on mindfulness-based stress reduction, while neglecting mindfulness-based elder care, and mindful sustainable aging principles. However, the abstract nature of some mindfulness concepts, combined with limited digital support and localized resources, makes it challenging for older adults to engage effectively.ObjectiveTo enhance healthy aging outcomes in older community-dwelling adults in Taiwan, this study developed an 8-week theory-based mindfulness curriculum that combined the mindfulness-based stress reduction, mindfulness-based elder care, and mindful sustainable aging frameworks with digital health support.MethodsThis research employed a mixed methods feasibility study design. We used the modified Delphi method in phase 1 to reach agreement on curriculum content and digital material selection. Ten older adults participated in the pilot study, which comprised phase 2. We used quantitative measurements to assess mindfulness, sleep quality, cognition, heart rate variability, perceptions of aging, healthy aging perspectives, and physical function and activity at baseline, at weeks 4 and 8, and at a 1-month follow-up. Qualitative interviews were conducted to gather insights into participants’ experiences.ResultsParticipants achieved significant improvements in mindfulness, sleep quality, aging perception, healthy aging outlook, and physical function during the study (all P<.05). Cognition, heart rate variability, and physical activity levels showed no significant changes throughout the study. The qualitative data supported these findings, as participants selected simple practices, such as mindful breathing, which they practiced daily to enhance their emotional well-being and social connections. Participants valued the digital learning materials for aiding their practice; however, some older adults with reading difficulties faced challenges accessing the content.ConclusionsUsing the Delphi method resulted in an acceptable and feasible theory-based digitally supported mindfulness program that improved several indicators of healthy aging in older adults in Taiwan. Our findings need to be validated using longer trials to assess cognitive and physiological effects. Furthermore, digital accessibility requires further development.

BackgroundMore than 20% of perinatal women experience depression, with suicide being a leading cause of maternal death in the United States. Professional societies emphasize the need to identify those at risk of developing perinatal depression to better target preventive care delivery during pregnancy.ObjectiveWe evaluated receptivity to a machine learning–based predictive screener designed to identify women in the first trimester of pregnancy who were asymptomatic but were at risk for developing moderate to severe depression symptoms later in pregnancy.MethodsOur participants were adult pregnant women with negative first-trimester depression (Patient Health Questionnaire–9) screens at 1 of 4 obstetric practices. Of the 810 women who were clinically eligible, 787 were successfully contacted via their patient portal. Of these, 289 (36.7%) viewed the screener and 255 (88.2%) completed the 6-question predictive screener. In total, 51 (20%) were identified by the screener as being at risk for developing perinatal depression. Participants were asked a series of follow-up questions regarding the acceptability of the predictive screener and desired preventive resources. Chi-square tests were used to compare demographic characteristics, perceived benefits and concerns, and desired resources between those identified as at risk for depression and those who were not. Differences in acceptability ratings between the two risk groups were determined using nonparametric Mann-Whitney U tests.ResultsOn a 5-point Likert scale of agreement, participants found the screener questions easy to complete (median score 5, IQR 5-5) and felt comfortable sharing their answers with their obstetric care providers (median 5, IQR 4-5). Key perceived benefits of completing the screener included opportunities to seek preventive care (75/255, 29.4%) and to receive education on depression risk (66/255, 25.9%). Primary concerns about knowing one’s risk of future depression included worrying about developing depression (90/255, 35.3%) and a lack of prevention opportunities (39/255, 15.3%). Desired preventive resources included counseling (197/255, 77.3%), mind-body interventions (166/255, 65.1%) such as exercise, and prenatal classes or support groups (81/255, 31.8%).ConclusionsParticipants found the screener acceptable and felt comfortable receiving it through their patient portal. Specific preventive care options were commonly endorsed, several of which are scalable and evidence based. A minority of participants voiced addressable concerns about knowing their risk of developing depression in the future.

Digital remote monitoring using smartphones and wearable devices is a promising solution for psychosis management, where precise, time-sensitive intervention is crucial. Combining active symptom monitoring (ASM) and passive sensing (PS) can support self-management by allowing remote, low-burden mental health monitoring. This study aimed to explore (1) views on collecting data using ASM and PS methods and comfort levels with different types of data gathered via these methods, (2) views on using smartphones and wearable devices in the context of mental health care, and (3) the ownership and usage of smartphones and wearable devices. We conducted a cross-sectional survey study with service users with psychosis in the United Kingdom between March 2023 and March 2024. A total of 309 participants completed the survey. They reported mixed views on using ASM and PS technologies for monitoring mental health, with more participants endorsing the concept than opposing it (ASM: n=145, 46.9% and PS: n=132, 42.7%). However, the type of data gathered using these methods was an important factor. Collecting personal information was deemed less acceptable (P<.001) than other data types (physical health, mental health, environment, and nonpersonal device information). We found that participants were comfortable with using apps and wearables for digital remote monitoring, though personal information was less acceptable than other data types due to privacy and surveillance concerns. This highlights the importance of further exploring trust issues related to digital monitoring and ensuring that end users have choices regarding the types of data that digital systems gather and share with mental health services.

In Bangladesh, as well as throughout the world, children's screen time has significantly increased. Children spend a lot of time on the internet and digital screens for entertainment, education, and communication, which has increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children's mental, physical, and social health have drawn attention. This study aimed to explore the effect of high exposure to screens on the health and mental well-being of school-going children and adolescents in Dhaka, Bangladesh. This cross-sectional descriptive study was conducted from July 2022 to June 2024. A total of 420 school-going children and adolescents aged 6 to 14 years were enrolled from 3 English-language and 3 Bangla-language schools in Dhaka using a stratified random sampling technique. Anthropometric measurements, a semistructured questionnaire, and the Pittsburgh Sleep Quality Index, the Development and Well-Being Assessment scale, and the Strengths and Difficulties Questionnaire, all of which were validated in Bangla, were used to gather data. We considered students who were exposed to screens for less than 2 hours a day as the low-exposure group and those who were exposed for more than 2 hours a day as the high-exposure group. A total of 83.3% (350/420) of the students were in the high-exposure group, and their average screen time per day was 4.6 (SD 2.3) hours. Eye problems were reported by 35.7% (150/420) of the students, and a significant difference was found between the low- and high-exposure groups. In total, 96% (144/150) of the students with eye problems were from the high-exposure group, whereas 4% (6/150) were from the low-exposure group. Headaches were reported by 80% (336/420) of the students, and they were common in the high-exposure group (279/336, 83%). Moreover, students from the high-exposure group had a short duration and poor quality of sleep (mean 7.3, SD 1.4 hours), which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (P<.001). Our study revealed that, overall, 31% (130/420) of the students had at least one mental health problem and 9.8% (41/420) had more than one mental health problem using the Development and Well-Being Assessment scale, and mental health problems were greater in the high-exposure group than the low-exposure group. Although behavioral problems such as conduct issues (119/420, 28.3%) and peer difficulties (121/420, 28.8%) were observed among the participants, no statistically significant difference was found between the 2 groups. A collaborative and coordinated multistage approach is essential to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on a larger scale can be conducted to determine the impacts of screen time on aspects of health.

Behavioral health concerns are common in pediatric practice, with pediatricians reporting a lack of skills related to providing effective behavioral management strategies to parents. A prior human-facilitated, screen-based virtual reality training curriculum proved effective in enhancing behavioral health communication skills among pediatric residents. However, barriers to spread and scale of the curriculum included the need for human facilitation. This study explored the usability of an automated virtual reality-based behavioral health anticipatory guidance curriculum for pediatric residents. Through a partnership with BreakAway Ltd, an automated prototype was developed that required verbalization by users to support progress through simulated scenarios and included the receipt of personalized feedback to enable deliberate practice of communication skills. Usability of the prototype was assessed using mixed methods that included in-person completion of the prototype, a semistructured interview, and completion of survey instruments including the System Usability Scale and the Measurement, Effects, Conditions: Spatial Presence Questionnaire. Nine individuals completed usability testing. Qualitatively, users indicated that the system was easy to use, realistic, gamified, and likely most helpful for novice learners. Quantitatively, the ease of system usability was rated highly with some limitations related to spatial presence noted. Usability testing of an automated curriculum to support behavioral health counseling skills in pediatric residents was completed, providing data to support adaptations in preparation for implementation.

Child-centered care (CCC) is standard practice in pediatrics, emphasizing the child as an individual with rights while acknowledging the child's role within the family. A key aspect of CCC is the involvement of the child in health care decisions alongside parents and professionals. Although this is a right recognized by the United Nations Convention on the Rights of the Child, it may not always be applied in practice. The aim of this study is to explore the participation preferences of 3- to 5-year-old children in health care from both their own viewpoint (the child's perspective) and the viewpoint of their parents and health care professionals. Q methodology was used to study preferences, comparing responses from 12 children, 14 parents, and 12 health professionals who ranked 25 statements about ways in which children could participate in health care situations. Factor analysis was used to reveal similarities and differences in views on participation preferences. The children's rankings were also analyzed separately for comparison. Analysis of rankings from children, their parents, and health care professionals identified 3 perspectives with different preferences: direct communication between the child and healthcare professionals; understanding and shared decision-making; and responsive and child-led participation. A separate analysis of children's rankings resulted in 3 perspectives: being included in and setting their own terms for participation; small choices, meaningful outcomes; and trust through familiarity and shared decision-making. This study suggests that children value shared decision-making and situational control but prefer to leave major decisions to adults. It affirms that preschool-aged children can meaningfully participate in health care when given age-appropriate choices, support, and tools. Children's perspectives must be acknowledged directly rather than adults assuming their views. The findings support CCC principles and reinforce the United Nations Convention on the Rights of the Child mandate to respect children's views regarding all issues relevant to them.

Smart home emergency response systems (SHERS) leverage existing smart home infrastructure to detect critical events and alert emergency services without manual activation. Unlike personal emergency response systems, which require users to trigger alarms, SHERS initiate alerts autonomously. Although technically feasible, user acceptance has received limited empirical attention. This study examined factors influencing the intention to adopt SHERS in private households, identifying key facilitators and barriers to acceptance. A mixed methods study followed the Double Diamond framework. In the discover/define phases, expert interviews (n=3) and secondary data analysis informed persona and scenario development. In the "develop" phase, brainwriting workshops (6-3-5 method, n=12) generated design requirements translated into a low-fidelity prototype. In the "deliver" phase, an online survey (n=85) assessed acceptance using the Technology Usage Inventory. Structural equation modeling tested hypothesized relationships, and methodological triangulation integrated qualitative and quantitative findings. Perceived accessibility was the strongest positive predictor of intention to use (β=0.33, P=.02), while skepticism showed a marginally negative effect (β=-0.34, P=.06). The model explained 66% of variance in behavioral intention (R²=0.66). Triangulation confirmed that concerns about complexity, false alarms, and data privacy underlie these effects. Experts emphasized that technology should support rather than replace human decision-making; workshop participants stressed intuitive setup and user control over alarm cancellation. SHERS acceptance is primarily associated with perceived accessibility, while skepticism may act as a barrier. Developers should prioritize seamless integration with existing ecosystems, clear feedback mechanisms to prevent false alarms, and strong data protection.

Previous studies indicate that 37% to 92% of patients presenting to hospital emergency eye clinics (EECs) could be seen in commissioned community optometrist enhanced service schemes (ESSs), reducing pressure on hospital services and moving eye care into the community. Digital triage tools may have the potential to support effective triage and use of ESSs. This study sought to evaluate the effectiveness of a recently developed online symptom triage tool in real-world EEC practice and assess its usability and acceptance by patients. This was a prospective, real-world study comparing automated dispositions suggested by the eye+dot online triage tool with nursing triage, using ophthalmologist dispositions and subsequent clinical findings as the reference standard. Patients aged 13 years and older were sent an SMS text message invitation to use eye+dot prior to their scheduled EEC appointment. Age, time required to complete the symptom questionnaire, and acceptability (using an in-application visual Likert scale) were also recorded. The accuracy of the different triage methods at assigning patients to eye assessments within 24 hours, 48 to 72 hours, or a week based on symptom urgency was compared. Eye+dot's accuracy in identifying patient suitability for ESSs was analyzed. A total of 282 eligible patients with a mean age of 53.14 (SD 19.8; range 13-92) years were included. The mean eye+dot test duration was 5.6 (SD 2.4) minutes, with 80.4% (168/209) of patients rating the test as good or excellent. For high-acuity symptomatology (defined via retrospective ophthalmologist recommendation for assessment within 24 hours), sensitivity was similar between eye+dot and nurse triage (58/76, 76.3%; 95% CI 65.2%-85.3% and 65/76, 85.5%; 95% CI 75.6%-92.5%, respectively; P=.19). However, eye+dot specificity was significantly higher (132/206, 64.1%; 95% CI 57.1%-70.6% vs 47/206, 22.8%; 95% CI 17.3%-29.2%; P<.001). Of 224 urgent nursing dispositions, 203 (90.6%) patients were downrated (considered suitable for nonurgent assessment) by ophthalmologist assignment, and 93 (41.5%) were downrated by eye+dot. In total, 90.8% (256/282) of the patients were considered suitable for ESS assessment through eye+dot triage. A total of 56.6% (145/256) of these patients subsequently received only medical advice without specialist investigations or management at their EEC visit, suggesting suitability for community eye care. Eye+dot-automated triage has similar sensitivity but superior specificity to nursing triage for identifying high-acuity symptomatology. This small study suggests its potential to improve patient scheduling in EECs throughout the working week and improve the use of community services. A larger study is planned to establish the utility of the triage tool and develop an implementation model to scale up and spread the technology.

Anonymous, 24/7 digital peer support (DPS) offers a scalable solution to support employees' emotional well-being. Understanding sociobehavioral factors, such as timing of engagement and the impact of shared resources, can help employers and employee assistance programs (EAPs) integrate digital tools to better support workforce well-being. This study examines (1) outcomes via overall sentiment changes among DPS users; (2) sociobehavioral differences between employees who accessed real-time, anonymous DPS during versus outside business hours; (3) differences in sentiment outcomes based on time of use; and (4) the impact of in-session resource sharing on sentiment improvement. Using OpenAI's large language model (LLM) GPT-4o-mini with a few-shot learning approach, 24,818 anonymous chat conversations from 13,879 employees at 5 large employers were evaluated for subclinical sentiment variables, including loneliness, sadness, stress, anxiety, depression, despair, helplessness, and optimism. Distinct activity patterns were observed between employees during and outside business hours, with a median user age of 36 years. During business hours, employees reported higher baseline stress (Δ1.6%), whereas outside business hours, baseline depression (Δ1.7%) and loneliness (Δ1.2%) were higher. After DPS use, LLM-derived negative sentiment scores decreased (loneliness 46% reduced, sadness 45%, stress 46%, anxiety ~39%, depression ~40%, despair ~40%, and helplessness ~38%), and optimism increased (~77%). Outside business hours, users engaged more (~68% of all sessions), remained in sessions 19% longer, and discussed 13% more topics, whereas users during business hours reported greater improvements in depression (Δ2.3%), helplessness (Δ1.9%), and loneliness (Δ0.5%). Resource sharing was associated with greater improvements in loneliness (Δ2.9%), stress (Δ1.3%), anxiety (Δ1.9%), depression (Δ7.3%), despair (Δ3.0%), helplessness (Δ2.8%), and optimism (Δ8.8%), but not sadness. DPS complements employers' EAPs by addressing employee engagement gaps, reducing barriers to mental health care, and promoting emotional well-being among the workforce.

BackgroundWhile patient health records (PHRs) are becoming ubiquitous, nationwide evidence on the drivers of user satisfaction in the United Kingdom remains scarce.ObjectiveThis study aimed to quantify determinants of PHR user satisfaction in a nationally representative sample of United Kingdom adults and to contrast real-world experiences with hypothetical expectations among individuals without PHR exposure.MethodsWe conducted a cross-sectional online survey in March 2022 using stratified quota sampling (eg, age, sex, ethnicity) through the Prolific platform. Of 1001 respondents, 533 (53%) were female (mean age 41, SD13) years, 468 (47%) reported previous PHR use (“experienced” cohort), and 533 (53%) respondents did not (“hypothetical” cohort). Primary outcomes were five satisfaction items (5-point Likert), overall PHR evaluation (0‐100), and stated/anticipated PHR functions. Two-sample t-tests with unequal variances examined between-group differences; multivariate analysis of variance (MANOVA) assessed demographic equivalence. Significance was set at P<.05.ResultsRespondents with PHR experience rated their record easy-to-use in 79% (370/468) of cases versus an anticipated 93% (498/533) among nonusers (P<.001). Experienced users rated appointment-scheduling time-saving at 68% (319/468) compared with 72% (387/533) of nonusers (P=.17). Mean overall evaluation scores were 71.0 (SD 19.5) versus 74.2 (SD 18.6) (t₉₉₇=2.25, P=.02). MANOVA confirmed demographic balance (Wilks Λ=.99, F₇,₉₉₃=1.48, P=.18). Preferred functions across cohorts were viewing personal health information (experience 81%, hypothetical 90%) and lab results (50% vs 76%). Users lacking experience consistently over-estimated future use of carer-related functions (eg, children’s data: 36% vs 12%, P<.001).ConclusionsAdults in the United Kingdom value PHRs primarily for personal data access and scheduling convenience. Nonusers displayed optimistic expectations about carer-related features and breadth of functionality, indicating an information gap. Enhancing transparency about current capabilities and expanding features that facilitate caregiving could increase satisfaction and adoption.