TY - JOUR AB - BACKGROUND: Multisystemic complications post-COVID-19 infection are increasingly described in the literature, yet guidance on the management remains limited. OBJECTIVES: This study aimed to assess the needs, preferences, challenges, and existing interventions for individuals with post-COVID-19 symptoms. Based on this, we aimed to develop a context-adapted intervention to improve the overall health and well-being of individuals with post-COVID-19 complications. METHODS: We conducted a cross-sectional mixed-methods situation analysis assessing the needs, preferences, challenges, and existing interventions for patients with post-COVID-19 symptoms. We collected data through questionnaires, semistructured in-depth interviews, and focus group discussions (FGDs) from individuals diagnosed with COVID-19 within the previous 18-month period and health care providers who managed patients with COVID-19 in both inpatient and outpatient settings. Quantitative data were summarized using descriptive statistics, qualitative data were transcribed, and deductive analysis focused on suggestions for future interventions. Findings guided the development of a group intervention. RESULTS: We conducted 60 questionnaires, 13 interviews, and 3 FGDs. Questionnaires showed limited knowledge of post-COVID-19 complications at 26.7% (16/60). Of those who received any rehabilitation for COVID-19 (19/60, 31.7%), 94.7% (18/19) found it helpful for their recovery. Just over half (23/41, 56%) of those who did not receive rehabilitation reported that they would have liked to. The majority viewed rehabilitation as an important adjunct to post-COVID-19 care (56/60, 93.3%) and that support groups would be helpful (53/60, 88.3%). Qualitative results highlighted the need for mental health support, structured post-COVID-19 follow-up, and financial aid in post-COVID-19 care. Based on the insights from the situation analysis, the theory of change framework, and existing post-COVID-19 evidence, we designed and conducted a pilot support group and rehabilitation intervention for individuals with post-COVID-19 complications. Our main objective was to assess the change in physical and psychological well-being pre- and postintervention. The intervention included 8 weekly themed group sessions supplemented by home tasks. Effectiveness of the intervention was evaluated by questionnaires pre- and postintervention on post-COVID-19 symptoms, quality of life with the EuroQoL 5-Dimension 5-Level, short Warwick-Edinburgh Mental Wellbeing Scale, and physical function by spirometry and 1-minute sit-to-stand test. We also assessed the feasibility and acceptability of the intervention by questionnaires and semistructured in-depth interviews. The intervention outcome analysis is yet to be conducted. CONCLUSIONS: Insights from patients and health care providers on the characteristics of post-COVID-19 complications helped guide the development of a context-adapted intervention program with potential to improve health and well-being post-COVID-19. AU - Glover, N.A.* AU - Sathar, F.* AU - Mokome, P.* AU - Mathabela, N.* AU - Taleni, S.* AU - van Blydenstein, S.A.* AU - Mekota, A.M.* AU - Charalambous, S.* AU - Rachow, A. AU - Ivanova, O.* C1 - 74038 C2 - 57301 CY - 130 Queens Quay East, Unit 1100, Toronto, On M5a 0p6, Canada TI - Improving health and well-being of people with post-COVID-19 consequences in South Africa: Situation analysis and pilot intervention design. JO - JMIR Form. Res. VL - 9 PB - Jmir Publications, Inc PY - 2025 SN - 2561-326X ER - TY - JOUR AB - BACKGROUND: Harboring dysfunctional depressogenic cognitions contributes to the development and maintenance of depression. A central goal of cognitive behavioral therapy (CBT) for depression is to invalidate such cognitions via cognitive reappraisal (CR). However, relatively low remission rates and high dropout rates in CBT demonstrate the need for further improvement. Potentially, the effects of CBT could be enhanced by addressing not only dysfunctional depressogenic cognitions but also body states associated with depression. This may be done, for example, by systematically pairing the invalidation of depressogenic cognitions with the performance of antidepressive kinesthesia. OBJECTIVE: This study aimed to examine the feasibility and clinical potential of a smartphone-based cognitive restructuring task that required users to deliberately perform antidepressive kinesthesia in conjunction with the rejection of depressogenic statements and the affirmation of antidepressive statements. This feasibility study was conducted as a precursor to a large-scale randomized controlled trial. METHODS: In total, 10 healthy participants engaged in a single 90-120-minute session of smartphone-based CR training. During the training, they completed 2 phases in which they were required to reject 20 depressogenic and affirm 20 antidepressive statements, respectively. Diagnostic assessments were conducted 1 week (T1) before and directly prior (T2) to the training, and again directly posttraining (T3) and at a 2-week follow-up posttraining (T4). Feasibility outcomes assessed at T3 included intervention safety recorded by study therapists, compliance, technical feasibility, usability assessed using the Short Version of the User Experience Questionnaire (UEQ-S), and acceptability assessed using the UEQ-S and self-developed items. Preliminary clinical potential was evaluated via single-item ratings of current depressed and positive mood assessed continuously during the training. Feasibility outcomes were analyzed descriptively, and clinical potential was examined using paired-sample t tests of pre and post ratings of mood at each training phase. RESULTS: Overall, the results indicated that the training was safe, feasible, and usable (UEQ-S pragmatic quality scale: mean 1.45, SD 0.71). However, acceptance was limited (UEQ-S hedonic quality scale: mean 1.05, SD 0.79). While 80% (8/10) of the participants were generally satisfied with the training, 80% (8/10) would recommend it to a friend, 90% (9/10) found it interesting, and 80% (8/10) rated it as "leading edge," 40% (4/10) to 70% (7/10) did not consider it particularly helpful and 50% (5/10) found it repetitive. Preliminary results regarding clinical potential were promising, with significant increases in positive mood (rejection: Hedges g=0.63; affirmation: Hedges g=0.25), whereas changes in depressed mood were not significant. CONCLUSIONS: This study evaluated the feasibility and acceptability of a smartphone-based CR training augmented with validating and invalidating kinesthesia. This provided valuable insights for further optimizing the intervention for the subsequent randomized controlled trial, but also potential similar interventions. If future studies confirm their clinical potential, such interventions offer a promising approach to enhancing CBT for depression. TRIAL REGISTRATION: OSF Registries pw6ma; https://osf.io/pw6ma/. AU - Keinert, M.* AU - Schindler-Gmelch, L.* AU - Rupp, L.H.* AU - Sadeghi, M.* AU - Richer, R.* AU - Capito, K.* AU - Eskofier, B.M. AU - Berking, M.* C1 - 74081 C2 - 57329 CY - 130 Queens Quay East, Unit 1100, Toronto, On M5a 0p6, Canada TI - The empkinS-EKSpression reappraisal training augmented with kinesthesia in depression: One-armed feasibility study. JO - JMIR Form. Res. VL - 9 PB - Jmir Publications, Inc PY - 2025 SN - 2561-326X ER - TY - JOUR AB - BACKGROUND: Hepatitis B virus (HBV) can be transmitted from mother to child either through transplacental infection or via blood-to-blood contact during or immediately after delivery. Early and accurate risk assessments are essential for guiding clinical decisions and implementing effective preventive measures. Data mining techniques are powerful tools for identifying key predictors in medical diagnostics. OBJECTIVE: This study aims to develop a robust predictive model for mother-to-child transmission (MTCT) of HBV using decision tree algorithms, specifically Iterative Dichotomiser 3 (ID3) and classification and regression trees (CART). The study identifies clinically and paraclinically relevant predictors, particularly hepatitis B e antigen (HBeAg) status and peripheral blood mononuclear cell (PBMC) concentration, for effective risk stratification and prevention. Additionally, we will assess the model's reliability and generalizability through cross-validation with various training-test split ratios, aiming to enhance its applicability in clinical settings and inform improved preventive strategies against HBV MTCT. METHODS: This study used decision tree algorithms-ID3 and CART-on a data set of 60 hepatitis B surface antigen (HBsAg)-positive pregnant women. Samples were collected either before or at the time of delivery, enabling the inclusion of patients who were undiagnosed or had limited access to treatment. We analyzed both clinical and paraclinical parameters, with a particular focus on HBeAg status and PBMC concentration. Additional biochemical markers were evaluated for their potential contributory or inhibitory effects on MTCT risk. The predictive models were validated using multiple training-test split ratios to ensure robustness and generalizability. RESULTS: Our analysis showed that 20 out of 48 (based on a split ratio of 0.8 from a total of 60 cases, 42%) to 27 out of 57 (based on a split ratio of 0.95 from a total of 60 cases, 47%) training cases with HBeAg-positive status were associated with a significant risk of MTCT of HBV (χ28=21.16, P=.007, df=8). Among HBeAg-negative women, those with PBMC concentrations ≥8 × 106 cells/mL exhibited a low risk of MTCT, whereas individuals with PBMC concentrations <8 × 106 cells/mL demonstrated a negligible risk. Across all training-test split ratios, the decision tree models consistently identified HBeAg status and PBMC concentration as the most influential predictors, underscoring their robustness and critical role in MTCT risk stratification. CONCLUSIONS: This study demonstrates that decision tree models are effective tools for stratifying the risk of MTCT of HBV by integrating key clinical and paraclinical markers. Among these, HBeAg status and PBMC concentration emerged as the most critical predictors. While the analysis focused on untreated patients, it provides a strong foundation for future investigations involving treated populations. These findings offer actionable insights to support the development of more targeted and effective HBV MTCT prevention strategies. AU - Nguyen Tien, D.* AU - Thi Thu Bui, H.* AU - Hoang Thi Ngoc, T.* AU - Thi Pham, T.* AU - Trung Nguyen, D.* AU - Nguyen Thi Thu, H.* AU - Thu Hang Vu, T.* AU - Lan Anh Luong, T.* AU - Thu Hoang, L.* AU - Cam Tu, H.* AU - Körber, N. AU - Bauer, T. AU - Khanh Ho, L.* C1 - 74794 C2 - 57596 CY - 130 Queens Quay East, Unit 1100, Toronto, On M5a 0p6, Canada TI - A data-driven approach to assessing hepatitis B mother-to-child transmission risk prediction model: Machine learning perspective. JO - JMIR Form. Res. VL - 9 PB - Jmir Publications, Inc PY - 2025 SN - 2561-326X ER - TY - JOUR AB - BACKGROUND: Despite an increase in hospital-based deliveries, neonatal mortality remains high in low-resource settings. Due to limited laboratory diagnostics, there is significant reliance on clinical findings to inform diagnoses. Accurate, evidence-based identification and management of neonatal conditions could improve outcomes by standardizing care. This could be achieved through digital clinical decision support (CDS) tools. Neotree is a digital, quality improvement platform that incorporates CDS, aiming to improve neonatal care in low-resource health care facilities. Before this study, first-phase CDS development included developing and implementing neonatal resuscitation algorithms, creating initial versions of CDS to address a range of neonatal conditions, and a Delphi study to review key algorithms. OBJECTIVE: This second-phase study aims to codevelop and implement neonatal digital CDS algorithms in Malawi and Zimbabwe. METHODS: Overall, 11 diagnosis-specific web-based workshops with Zimbabwean, Malawian, and UK neonatal experts were conducted (August 2021 to April 2022) encompassing the following: (1) review of available evidence, (2) review of country-specific guidelines (Essential Medicines List and Standard Treatment Guidelinesfor Zimbabwe and Care of the Infant and Newborn, Malawi), and (3) identification of uncertainties within the literature for future studies. After agreement of clinical content, the algorithms were programmed into a test script, tested with the respective hospital's health care professionals (HCPs), and refined according to their feedback. Once finalized, the algorithms were programmed into the Neotree software and implemented at the tertiary-level implementation sites: Sally Mugabe Central Hospital in Zimbabwe and Kamuzu Central Hospital in Malawi, in December 2021 and May 2022, respectively. In Zimbabwe, usability was evaluated through 2 usability workshops and usability questionnaires: Post-Study System Usability Questionnaire (PSSUQ) and System Usability Scale (SUS). RESULTS: Overall, 11 evidence-based diagnostic and management algorithms were tailored to local resource availability. These refined algorithms were then integrated into Neotree. Where national management guidelines differed, country-specific guidelines were created. In total, 9 HCPs attended the usability workshops and completed the SUS, among whom 8 (89%) completed the PSSUQ. Both usability scores (SUS mean score 75.8 out of 100 [higher score is better]; PSSUQ overall score 2.28 out of 7 [lower score is better]) demonstrated high usability of the CDS function but highlighted issues around technical complexity, which continue to be addressed iteratively. CONCLUSIONS: This study describes the successful development and implementation of the only known neonatal CDS system, incorporated within a bedside data capture system with the ability to deliver up-to-date management guidelines, tailored to local resource availability. This study highlighted the importance of collaborative participatory design. Further implementation evaluation is planned to guide and inform the development of health system and program strategies to support newborn HCPs, with the ultimate goal of reducing preventable neonatal morbidity and mortality in low-resource settings. AU - Gannon, H.* AU - Larsson, L. AU - Chimhuya, S.* AU - Mangiza, M.* AU - Wilson, E.* AU - Kesler, E.* AU - Chimhini, G.* AU - Fitzgerald, F.* AU - Zailani, G.* AU - Crehan, C.* AU - Khan, N.* AU - Hull-Bailey, T.* AU - Sassoon, Y.* AU - Baradza, M.* AU - Heys, M.* AU - Chiume, M.* C1 - 69856 C2 - 55287 TI - Development and implementation of digital diagnostic algorithms for neonatal units in Zimbabwe and Malawi: Development and usability study. JO - JMIR Form. Res. VL - 8 IS - 1 PY - 2024 SN - 2561-326X ER - TY - JOUR AB - BACKGROUND: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. OBJECTIVE: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. METHODS: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. RESULTS: A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is -26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=-0.21, P<.001). CONCLUSIONS: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. AU - Grube, L.* AU - Petit, P.* AU - Vuillerme, N.* AU - Nitschké, M.J.E.* AU - Nwosu, O.B.* AU - Knitza, J.* AU - Krusche, M.* AU - Seifer, A.K.* AU - Eskofier, B.M. AU - Schett, G.* AU - Morf, H.* C1 - 71744 C2 - 56423 CY - 130 Queens Quay East, Unit 1100, Toronto, On M5a 0p6, Canada TI - Complementary app-based yoga home exercise therapy for patients with axial spondyloarthritis: Usability study. JO - JMIR Form. Res. VL - 8 PB - Jmir Publications, Inc PY - 2024 SN - 2561-326X ER - TY - JOUR AB - BACKGROUND: Mobile eHealth apps have been used as a complementary treatment to increase the quality of life of patients and provide new opportunities for the management of rheumatic diseases. Telemedicine, particularly in the areas of prevention, diagnostics, and therapy, has become an essential cornerstone in the care of patients with rheumatic diseases. OBJECTIVE: This study aims to improve the design and technology of YogiTherapy and evaluate its usability and quality. METHODS: We newly implemented the mobile eHealth app YogiTherapy with a modern design, the option to change language, and easy navigation to improve the app's usability and quality for patients. After refinement, we evaluated the app by conducting a study with 16 patients with AS (4 female and 12 male; mean age 48.1, SD 16.8 y). We assessed the usability of YogiTherapy with a task performance test (TPT) with a think-aloud protocol and the quality with the German version of the Mobile App Rating Scale (MARS). RESULTS: In the TPT, the participants had to solve 6 tasks that should be performed on the app. The overall task completion rate in the TPT was high (84/96, 88% completed tasks). Filtering for videos and navigating to perform an assessment test caused the largest issues during the TPT, while registering in the app and watching a yoga video were highly intuitive. Additionally, 12 (75%) of the 16 participants completed the German version of MARS. The quality of YogiTherapy was rated with an average MARS score of 3.79 (SD 0.51) from a maximum score of 5. Furthermore, results from the MARS questionnaire demonstrated a positive evaluation regarding functionality and aesthetics. CONCLUSIONS: The refined and tested YogiTherapy app showed promising results among most participants. In the future, the app could serve its function as a complementary treatment for patients with AS. For this purpose, surveys with a larger number of patients should still be conducted. As a substantial advancement, we made the app free and openly available on the iOS App and Google Play stores. AU - Eskofier, B.M. C1 - 68983 C2 - 55004 CY - 130 Queens Quay East, Unit 1100, Toronto, On M5a 0p6, Canada TI - Refinement and usability analysis of an eHealth app for ankylosing spondylitis as a complementary treatment to physical therapy: Development and Usability study. JO - JMIR Form. Res. VL - 7 IS - 1 PB - Jmir Publications, Inc PY - 2023 SN - 2561-326X ER - TY - JOUR AB - BACKGROUND: Large-scale PCR-based SARS-CoV-2 testing is expensive, resource-intensive, and time-consuming. A self-collection approach is a probable alternative; however, it requires evaluating the feasibility, expenses, and the ability to prevent infections. OBJECTIVE: This study aims to compare an innovative self-collection approach with a regular SARS-CoV-2 testing strategy in a large European industrial manufacturing site. METHODS: The feasibility of a telemedical PCR-based self-collection approach was assessed for 150 employees (intervention group) and compared with a regular SARS-CoV-2 testing approach (n=143, control group). Acceptance, ergonomics, and efficacy were evaluated using a software application. A simulation model was implemented to evaluate the effectiveness. An interactive R shiny app was created to enable customized simulations. RESULTS: The test results were successfully communicated and interpreted without uncertainty by 76% and 77% of the participants in the intervention and control groups, respectively (P=.96). The ratings for the acceptability, ergonomics, and efficacy of the intervention group were noninferior when compared with those of the control group (acceptability: 71.6% versus 37.6%; ergonomics: 88.1% versus 74.5%; efficacy: 86.4% versus 77.5%). The self-collection approach was found to be less time consuming (23 min versus 38 min, P<0.001). The simulation model indicated that both testing approaches reduce the risk of infection and the self-collection approach tends to be slightly less effective owing to the lower sensitivity. CONCLUSIONS: The self-collection approach for SARS-CoV-2 diagnosis is technically feasible and is well rated in terms of acceptance, ergonomics, and efficacy. The simulation model facilitates the evaluation of the test effectiveness; nonetheless, considering the context specificity, appropriate adaption by the companies is required. AU - Würstle, S.* AU - Erber, J.* AU - Hanselmann, M.* AU - Hoffmann, D. AU - Werfel, S.* AU - Hering, S. AU - Weidlich, S.* AU - Schneider, J.* AU - Franke, R.* AU - Maier, M.* AU - Henkel, A.* AU - Schmid, R.M.* AU - Protzer, U. AU - Laxy, M.* AU - Spinner, C.D.* C1 - 63635 C2 - 51646 TI - A telemedicine-guided self-collection approach for PCR-based SARS-CoV-2 testing: Comparative study. JO - JMIR Form. Res. VL - 6 IS - 1 PY - 2022 SN - 2561-326X ER -