JMIR Formative Research

Mobilizing Health Promotion Through Canada’s Student Mental Health Network: Concurrent, Mixed Methods Process Evaluation

2025-02-27T10:45:04-05:00

Background: Mental health issues among Canadian postsecondary students are prevalent. In tandem, an increased acknowledgement of the need for upstream mental health support has been highlighted. While the majority of institutions offer some form of mental health promotion, research suggests students are failing to access supports due to barriers including: lack of awareness, geographical and financial barriers, and/or lack of relevance in offerings. Canada’s Student Mental Health Network is an online knowledge mobilization initiative designed to fill these gaps. With content created and curated “for-students, by-students” and reviewed by subject matter experts, the Network serves as a one-stop shop for evidence-based, mental health support for postsecondary students. Objective: The goal of this research was to conduct the first component of a comprehensive program evaluation of the Network. This paper details a formative, process evaluation after approximately one year of operations, with the goal of assessing acceptability and feasibility. Methods: Using a concurrent mixed methods study design, quantitative and qualitative data was simultaneously collected from students in order to evaluate the acceptability and feasibility of the Network as a mental health promotion resource. Quantitative data was automatically collected through Google Analytics via the website over the course of the first year of operations. Data collected included: number of users accessing the website, user engagement, and user “stickiness”. Quantitative data was used to evaluate both accessibility and feasibility. Qualitative data was collected via individual, online interviews conducted with a modest sample of students (n=8) across areas and levels of study. Qualitative data derived more detailed insights into user experience and website attributes, as well as feedback on content delivery, providing evidence used to evaluate feasibility. Results: A total of 1200 users globally accessed the Network within the first year of operations, with Canadian users accounting for nearly 90% of total website traffic . An overall 66% engagement rate was observed, with the average user visiting 7 pages per session. Further support for the acceptability of the Network is demonstrated in the Canada-wide reach of the content development and review team. Evidence for the feasibility of the Network was observed through website usage statistics indicating the most frequently viewed pages aligned with our goals: providing mental health education and increasing awareness of available resources. Qualitative feedback provided additional context surrounding the feasibility of the space, including positive feedback on the aesthetics, relevance, usability, inclusion, and accessibility. Areas for content expansion and improvements to accessibility were also identified. Conclusions: The results of this study provide evidence in support of the feasibility and acceptability of the Network as an online knowledge mobilization initiative in support of postsecondary students’ mental health and wellbeing. Future research will pursue a summative, impact assessment to evaluate utility.

Monitoring Nystagmus in a Patient With Vertigo Using a Commercial Mini-Infrared Camera and 3D Printer: Cost-Effectiveness Evaluation and Case Report

2025-02-27T10:45:04-05:00

Background: Observing eye movements during episodic vertigo attacks is crucial for accurately diagnosing vestibular disorders. In clinical practice, we commonly encounter cases without vertiginous/dizziness symptoms or clear abnormal findings during outpatient examination. Objective: To report a case in which a novel device integrating an infrared camera with 3D-printed goggles was useful in diagnosing vestibular disorders. Methods: We developed a device that integrates a commercially available mini-infrared charged-coupled device (CCD) camera with 3D-printed goggles, enabling patients to record their eye movements during vertigo attacks at home using a smartphone and to share the recordings with their physicians. Results: A man in his 40s with episodic vertigo visited our hospital. Initial assessments using infrared video Frenzel glasses showed no spontaneous or positional nystagmus, and oculomotor-vestibular function tests revealed no abnormalities. Based on the videos recorded by the patient using our system, geotropic direction-changing positional nystagmus was observed, and lateral semicircular canal-type benign paroxysmal positional vertigo was diagnosed. Treatment with the Gufoni maneuver alleviated the vertigo and nystagmus. Conclusions: Our system aids in the diagnosis of vestibular disorders by enabling the capture of symptomatic eye movements outside of clinical settings. Additionally, it shows promise for use in telemedicine and emergency situations, offering a practical solution for remote monitoring and timely diagnosis.

Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study

2025-02-27T10:30:04-05:00

Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as Ecological Momentary Assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with high food approach. Objective: The main objectives of this study were to: (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents living in the UK with a child aged between 3 and 5 years with avid eating behavior were invited to participate in the 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) provided at least seven ‘full’ days of data (two signal surveys and one event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), three daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the ten days. Over the EMA period, a total of 2,524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD = 0.18, min = 1.7, max = 2.3). The majority of parents felt that the surveys made them more aware of their feelings (N = 105, 89%) and activities (N = 93, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r = .483, P <.001). However, the number of daily food requests per day estimated at baseline (mean = 4.5 ± 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean = 3.7 ± 1.1), (t(116) = 18.8, P <.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection.

Novel Evaluation Metric and Quantified Performance of ChatGPT-4 Patient Management Simulations for Early Clinical Education: Experimental Study

2025-02-27T10:15:04-05:00

Background: Case studies have shown ChatGPT can run clinical simulations at the medical student level. However, no data have assessed ChatGPT’s reliability in meeting desired simulation criteria such as medical accuracy, simulation formatting, and robust feedback mechanisms. Objective: To quantify ChatGPT’s ability to consistently follow formatting instructions and create simulations for preclinical medical student learners according to principles of medical simulation and multimedia educational technology. Methods: Using ChatGPT-4 and a pre-validated starting prompt, the authors ran 360 separate simulations of an acute asthma exacerbation. 180 simulations were given correct answers and 180 were given incorrect answers. ChatGPT was evaluated for its ability to adhere to basic simulation parameters (stepwise progression, free response, interactivity), advanced simulation parameters (autonomous conclusion, delayed feedback, comprehensive feedback), and medical accuracy (vignette, treatment updates, feedback). Significance was determined with chi-squared analyses using 95% confidence intervals for odds ratios. Results: 100% of simulations met basic simulation parameters and were medically accurate. For advanced parameters, 55% of all simulations delayed feedback, while the Correct arm (87%) delayed feedback significantly more than the Incorrect arm (24%) (p<0.001). 79% of simulations concluded autonomously, and there was no difference between the Correct and Incorrect arms in autonomous conclusion (81%, 77%; p=0.364). 78% of simulations gave comprehensive feedback, and there was no difference between the Correct and Incorrect arms in comprehensive feedback (76%, 81%; p=0.306). ChatGPT-4 was significantly more likely to conclude simulations autonomously (p<0.001) and provide comprehensive feedback (p<0.001) when feedback was delayed compared to when feedback was not delayed. Conclusions: ChatGPT simulations performed perfectly on medical accuracy and basic simulation parameters. It performed well on comprehensive feedback and autonomous conclusion. Delayed feedback depended on the accuracy of user inputs. A simulation meeting one advanced parameter was more likely to meet all advanced parameters. These simulations have the potential to be a reliable educational tool for simple simulations and can be evaluated by a novel nine-part metric. Further work must be done to ensure consistent performance across a broader range of simulation scenarios.

Probing Public Perceptions of Antidepressants on Social Media: Mixed Methods Study

2025-02-26T16:15:03-05:00

Background: Antidepressants are crucial for managing major depressive disorders; however, nonadherence remains a widespread challenge, driven by concerns over side effects, fear of dependency, and doubts about efficacy. Understanding patients’ experiences is essential for improving patient-centered care and enhancing adherence, which prioritizes individual needs in treatment. Objective: This study aims to gain a deeper understanding of patient experiences with antidepressants, providing insights that healthcare providers, families, and communities can develop personalized treatment strategies. By integrating patient-centered care, these processes may improve satisfaction and adherence with antidepressants. Methods: Data were collected from AskaPatient and Reddit, analyzed using Natural Language Processing (NLP) and Large Language Models (LLMs). Analytical techniques included sentiment analysis, emotion detection, personality profiling, and topic modeling. Additionally, demographic variations in patient experiences were also examined to offer a comprehensive understanding of discussions around antidepressants. Results: Sentiment and emotion analysis revealed that the majority of discussions (59.3%) expressed neutral sentiment, with negative sentiment following closely (38.4%). The most common emotions were fear (44.66%) and sadness (34.49%). The largest topic, "Mental Health and Relationships," accounts for 11.69% of the discussions, which indicated a significant focus on managing mental health conditions. Discussions around nonadherence are marked by fear, followed by sadness emotion, while self-care discussions show a notable trend of sadness. Conclusions: These psychological insights into public perceptions of antidepressants provide a foundation for developing tailored, patient-centered treatment approaches that align with individual needs, enhancing both effectiveness and empathy of care.

Automated Digital Safety Planning Interventions for Young Adults: Qualitative Study Using Online Co-design Methods

2025-02-26T16:00:26-05:00

Background: Young adults in the United States are experiencing accelerating rates of suicidal thoughts and behaviors but have the lowest rates of formal mental health care. Digital suicide prevention interventions have the potential to increase access to suicide prevention care by circumventing attitudinal and structural barriers that prevent access to formal mental health care. These tools should be designed in collaboration with young adults who have lived experience of suicide-related thoughts and behaviors to optimize acceptability and use. Objective: This study aims to identify the needs, preferences, and features for an automated SMS text messaging–based safety planning service to support the self-management of suicide-related thoughts and behaviors among young adults. Methods: We enrolled 30 young adults (age 18-24 years) with recent suicide-related thoughts and behaviors to participate in asynchronous remote focus groups via an online private forum. Participants responded to researcher-posted prompts and were encouraged to reply to fellow participants—creating a threaded digital conversation. Researcher-posted prompts centered on participants’ experiences with suicide-related thought and behavior-related coping, safety planning, and technologies for suicide-related thought and behavior self-management. Focus group transcripts were analyzed using thematic analysis to extract key needs, preferences, and feature considerations for an automated SMS text messaging–based safety planning tool. Results: Young adult participants indicated that an automated digital SMS text message–based safety planning intervention must meet their needs in 2 ways. First, by empowering them to manage their symptoms on their own and support acquiring and using effective coping skills. Second, by leveraging young adults’ existing social connections. Young adult participants also shared 3 key technological needs of an automated intervention: (1) transparency about how the intervention functions, the kinds of actions it does and does not take, the limits of confidentiality, and the role of human oversight within the program; (2) strong privacy practices—data security around how content within the intervention and how private data created by the intervention would be maintained and used was extremely important to young adult participants given the sensitive nature of suicide-related data; and (3) usability, convenience, and accessibility were particularly important to participants—this includes having an approachable and engaging message tone, customizable message delivery options (eg, length, number, content focus), and straightforward menu navigation. Young adult participants also highlighted specific features that could support core coping skill acquisition (eg, self-tracking, coping skill idea generation, reminders). Conclusions: Engaging young adults in the design process of a digital suicide prevention tool revealed critical considerations that must be addressed if the tool is to effectively expand access to evidence-based care to reach young people at risk for suicide-related thoughts and behaviors. Specifically, automated digital safety planning interventions must support building skillfulness to cope effectively with suicidal crises, deepening interpersonal connections, system transparency, and data privacy.

Person-Specific Analyses of Smartphone Use and Mental Health: Intensive Longitudinal Study

2025-02-26T15:30:04-05:00

Background: Contrary to popular concerns about the harmful effects of media use on mental health, research on this relationship is ambiguous, stalling advances in theory, interventions, and policy. Scientific explorations of the relationship between media and mental health have mostly been found null or have small associations, with the results often blamed on the use of cross-sectional study designs or imprecise measures of media use and mental health. Objective: This exploratory empirical demonstration aims to answer whether mental health effects are associated with media use experiences by (1) redirecting research investments to granular and intensive longitudinal recordings of digital experiences to build models of media use and mental health for single individuals over the course of 1 year, (2) using new metrics of fragmented media use to propose explanations of mental health effects that will advance person-specific theorizing in media psychology, and (3) identifying combinations of media behaviors and mental health symptoms that may be more useful for studying media effects than single measures of dosage and affect or assessments of clinical symptoms related to specific disorders. Methods: The activity on individuals’ smartphone screens was recorded every 5 seconds when devices were in use over 1 year, resulting in a dataset of 6,744,013 screenshots and 123 fortnightly surveys from 5 adult participants. Each participant contributed between 0.8 and 2.7 million screens. Six media use metrics were derived from smartphone metadata. Fortnightly surveys captured symptoms of depression, attention-deficit/hyperactivity disorder, state anxiety, and positive affect. Idiographic filter models (p-technique canonical correlation analyses) were applied to explore person-specific associations. Results: Canonical correlations revealed substantial person-specific associations between media use and mental health, ranging from r=0.82 (P=.008) to r=0.92 (P=.03). The specific combinations of media use metrics and mental health dimensions were different for each person, reflecting significant individual variability. For instance, the media use canonical variate for 1 participant was characterized by higher loadings for app-switching, which, in combination with other behaviors, correlated strongly with a mental health variate emphasizing anxiety symptoms. For another, prolonged screen time, alongside other media use behaviors, contributed to a mental health variate weighted more heavily toward depression symptoms. These within-person correlations are among the strongest reported in this literature. Conclusions: Results suggest that the relationships between media use and mental health are highly individualized, with implications for the development of personalized models and precision smartphone-informed interventions in mental health. We discuss how our approach can be extended generally, while still emphasizing the importance of idiographic approaches. This study highlights the potential for granular, longitudinal data to reveal person-specific patterns that can inform theory development, personalized screening, diagnosis, and interventions in mental health.

Formative Evaluation of Suicide Prevention Websites for Men: Qualitative Study with Men at Risk of Suicide and with Potential Gatekeepers

2025-02-26T15:00:25-05:00

Background: The suicide rate among men exceeds that of women worldwide. One important measure in suicide prevention for men is digital communication interventions, as they enable easy and anonymous access to information resources. This is especially important for men who might not be reached by traditional, in-person prevention methods. Thus, as part of an interdisciplinary project on suicide prevention for men, two specific digital communication prevention measures were developed: (1) a website to inform men at risk about suicide prevention, and (2) a website to educate potential gatekeepers who are in contact with men at risk of suicide about appropriate life-saving measures. Both websites needed evaluation to explore how they are perceived by (1) men and by (2) potential gatekeepers of men at risk of suicide. This is crucial, as existing research lacks formative evaluation that informs the development of intervention communication materials. Objective: This study aimed to analyze whether these websites were perceived as (1) comprehensible and engaging, (2) authentic and trustworthy, as well as (3) useful by (potential) users. Furthermore, we examined (4) additional ideas for effective communication about suicide prevention. Methods: We conducted (1) individual videoconference interviews with 24 men to evaluate the website and (2) four focus groups with 8 gatekeepers in each group (32 participants) to evaluate the online education program. The focus group sample was equally distributed regarding gender and age. Recruitment was conducted together with a field research partner who posted adverts on Facebook and Instagram (Meta) to reach as many potential participants as possible in an efficient way. All participants were asked to evaluate the intervention materials using a fictitious scenario of a man experiencing a mental health crisis before the interviews or focus groups took place. Results: The videos were perceived as (1) catchy, comprehensible, and empathetic, but too long for a short introduction. A balanced mix of emotional and informative content was considered appropriate and helpful. The health information provided was perceived as (2) serious and trustworthy due to citing scientific institutions and video material of men who had experienced suicidal ideation. (3) The intervention’s applicability for men experiencing acute crisis was critiqued, but it was regarded as very useful for comprehensive information. (4) Further communication channels and addressing other male subgroups or gender identities were presented as possible extensions of the program. Conclusions: Effective suicide prevention research should address both the groups at risk and their support network. Digital communication interventions can provide low-threshold access. Videos with personalized examples are important to give men someone to identify with, which validates their emotional responses and supports their self-esteem, while videos with experts provide relevant and credible information. Trial Registration:

The Feasibility of Large Language Models in Verbal Comprehension Assessment: Mixed Methods Feasibility Study

2025-02-24T17:00:23-05:00

Background: Cognitive assessment is an important component of applied psychology, but limited access and high costs make these evaluations challenging. Objective: This study aimed to examine the feasibility of using large language models (LLMs) to create personalized artificial intelligence–based verbal comprehension tests (AI-BVCTs) for assessing verbal intelligence, in contrast with traditional assessment methods based on standardized norms. Methods: We used a within-participants design, comparing scores obtained from AI-BVCTs with those from the Wechsler Adult Intelligence Scale (WAIS-III) verbal comprehension index (VCI). In total, 8 Hebrew-speaking participants completed both the VCI and AI-BVCT, the latter being generated using the LLM Claude. Results: The concordance correlation coefficient (CCC) demonstrated strong agreement between AI-BVCT and VCI scores (Claude: CCC=.75, 90% CI 0.266-0.933; GPT-4: CCC=.73, 90% CI 0.170-0.935). Pearson correlations further supported these findings, showing strong associations between VCI and AI-BVCT scores (Claude: r=.84, P<.001; GPT-4: r=.77, P=.02). No statistically significant differences were found between AI-BVCT and VCI scores (P>.05). Conclusions: These findings support the potential of LLMs to assess verbal intelligence. The study attests to the promise of AI-based cognitive tests in increasing the accessibility and affordability of assessment processes, enabling personalized testing. The research also raises ethical concerns regarding privacy and overreliance on AI in clinical work. Further research with larger and more diverse samples is needed to establish the validity and reliability of this approach and develop more accurate scoring procedures.

Development and Implementation of MyPainHub, a Web-Based Resource for People With Musculoskeletal Conditions and Their Health Care Professionals: Mixed Methods Study

2025-02-24T16:30:04-05:00

Background: Musculoskeletal conditions, including low back pain (LBP), neck pain, and knee osteoarthritis, are the greatest contributors to years lived with disability worldwide. Resources aiming to aid both patients and health care professionals (HCPs) exist but are poorly implemented and adopted. Objective: We aimed to develop and implement MyPainHub, an evidence-based web-based resource designed to provide comprehensive, credible and accessible information for people with, and HCPs who manage, common musculoskeletal conditions. Methods: This mixed methods study adhered to the New South Wales Translational Research Framework and was evaluated against the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Consultation with key stakeholders (patients, HCPs, researchers, industry, consumer groups, and website developers) informed content, design, features, and functionality. Development then aimed to meet the identified need for a “one-stop shop”—a central location for information about common musculoskeletal conditions tailored to a person’s condition and risk of poor outcomes. MyPainHub was then developed through an iterative process and implementation strategies were tailored to different health care settings. Quantitative and qualitative evaluation occurred with patients and HCPs. Results: In total, 127 stakeholders participated in the development phase; initial consultation with them led to embedding 2 validated screening tools (the Short Form Örebro Musculoskeletal Pain Screening Questionnaire and the Keele STarT MSK tool) in MyPainHub to guide information tailoring for patients based on risk of poor outcomes. Development occurred in parallel and feedback from stakeholders informed design and content including structure, functionality, and phrasing and images to use to emphasize key points. Consultation resulted in information for patients being categorized using key guideline-based messages (general information, your pathway, exercise, and imaging) while information for clinicians was categorized into assessment, management, and prognosis. Implementation occurred in different health care settings with the most effective strategies being interactive education via webinars and workshops. The evaluation phase involved web-based questionnaires (patients: n=44; HCPs: n=29) and focus groups (patients: n=6; HCPs: n=6). Patients and HCPs found MyPainHub user-friendly, acceptable, credible, and potentially able to support self-management. Patient participants identified areas for improvement such as including more specific information on preventative measures and pain relief options. Despite positive feedback, only 35% (10/29) of HCPs used MyPainHub with their patients. HCP participants identified challenges including insufficient training and lack of familiarity with using web-based resources in existing clinical workflows. Following implementation, the information contained on MyPainHub changed knowledge and practice for some patients and HCPs. Conclusions: Following extensive and iterative stakeholder engagement, MyPainHub was developed as an evidence-based web-based resource and perceived by patients and HCPs as user-friendly, credible, and acceptable. Active implementation strategies are required for adoption and implementation and greater training focusing on strategies to implement MyPainHub into clinical practice may be necessary. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000871145; https://tinyurl.com/438kkyt3