Background: The rapid growth of telemedicine offers convenience, flexibility, and accessibility for patients to have health care services worldwide. To succeed in telemedicine, health care practitioners and telemedicine tools must engage patients through effective communication. However, a research gap exists in understanding the communication strategies used in telemedicine and how they effectively engage patients. Objective: This study aims to identify communication strategies influencing patient engagement in telemedicine with provider-patient interactions, as well as how included studies evaluate patient engagement through a systematic review. Methods: We searched the literature comprehensively using 6 databases, Web of Science, PubMed, Scopus, MEDLINE, CINAHL, and Embase, from inception to October 2025. We included empirical, English-language studies that examined communication strategies affecting patient engagement in telemedicine with provider-patient interactions. Studies lacking actual patients or provider-patient interactions in telemedicine were excluded. We used content analysis to identify texts that were related to Theme 1: the communication strategies affecting patient engagement, and Theme 2: evaluation of patient engagement. Coded texts were analyzed to develop subthemes and themes of identified communication strategies. Methods for evaluating patient engagement were summarized. A narrative synthesis was conducted because of heterogeneity across study design and outcomes. We used the Mixed Methods Appraisal Tool to assess the quality of research included in this study. Results: This study systematically reviewed 34 peer-reviewed articles, revealing 3 overarching themes of effective communication strategies that enhance patient engagement: interpersonal communication strategies, with 6 subthemes (building relationships, supportive attitude, interactive dialogic loop, nonverbal communication, professionalism and accuracy, and tailored communication); team-level communication strategies, with 3 subthemes (training and preparation, teamwork and care coordination, and cultural and linguistic sensitivity); and system-level communication strategies, with 3 subthemes (usefulness of information, ease of use, and data privacy and security). We also found that included studies predominantly used qualitative research methods, such as semistructured interviews and focus groups, to collect patient engagement data. Conclusions: This review provides an innovative synthesis of communication strategies that promote patient engagement in telemedicine by integrating interpersonal (micro), team (meso), and system-level (macro) perspectives. Unlike previous reviews that focused on single aspects or levels of communication, this study offers a holistic framework that advances theoretical understanding of how multilevel communication strategies collectively shape patient engagement. Practically, the findings offer actionable guidance for health care professionals, telemedicine developers, and policymakers seeking to enhance the quality and sustainability of telemedicine services. In real-world settings, the identified strategies can inform professional training, platform design, and policy development to support patient-centered digital care. This review is the first to systematically bring together communication strategies for patient engagement in telemedicine across all 3 levels. Future research should build on this framework by developing and validating quantitative measures of patient engagement and examining the relationships between communication strategies and telemedicine outcomes.

Date Submitted: Jan 17, 2026. Open Peer Review Period: Jan 20, 2026 - Mar 17, 2026.

Date Submitted: Jan 16, 2026. Open Peer Review Period: Jan 20, 2026 - Mar 17, 2026.

Date Submitted: Jan 19, 2026. Open Peer Review Period: Jan 20, 2026 - Mar 17, 2026.

Date Submitted: Jan 14, 2026. Open Peer Review Period: Jan 20, 2026 - Mar 17, 2026.

Background: The broad spectrum of issues that survivors face after critical illness and the contextual factors that help or hinder remain underexplored, as do their perspectives on what is important during recovery. Photovoice methods offer a means to convey experiences through participant-generated photographs and related narratives that can extend existing notions of illness and wellness. Objective: This pilot study aimed to (1) describe intensive care unit (ICU) survivor recovery after hospital discharge depicted through survivor-generated photographs and photograph discussions, (2) assess the #feasibility of recruiting and retaining participants in a web-based group photovoice focused on ICU recovery, and (3) describe the impact of study participation. Methods: The web-based group photovoice involved 5 weekly 2-hour group discussion sessions, after which individual interviews were conducted with each participant. Photographs and transcript data from the group discussions and individual interviews were analyzed using a qualitative interpretive description approach. Results: A total of 5 ICU survivors (4 women and 1 man) participated. The aspects of critical illness recovery that featured prominently included (1) protracted physical recovery; (2) profound psychosocial challenges encompassing fear of the future, emotional turmoil, shifting self-perception, changes in family dynamics, and feelings of disconnection; (3) discrepancies in health needs and support offered; and (4) need for perseverance and resilience. The web-based group photovoice was feasible, with participation characterized as an opportunity to build social connections and draw strength from fellow survivors of critical illness unavailable elsewhere. Conclusions: Given the compelling insights our pilot study provided into lesser-explored aspects of critical illness recovery, along with its potential therapeutic value and ability to foster social connectedness, future research is warranted to assess the impact of a scaled-up application.

Background: During 2024-2025, global emergencies triggered intense online discourse, presenting a unique opportunity to examine how cultural factors shape emotional expression and knowledge dissemination. Understanding these dynamic mechanisms is crucial for enhancing the effectiveness of digital health communication and optimizing crisis response strategies. Objective: We analyzed how cultural and linguistic contexts influence emotional expression and thematic framing in social media comments during major emergencies in 2024-2025. We uncovered cross-cultural differences in collective emotions and narrative focuses, explaining how affective stance and discourse framing jointly shape the public construction of crisis meaning. Methods: We used a cross-sectional, convergent mixed methods design. Data were collected retrospectively from X (formerly Twitter; X Corp) and Weibo (Sina Weibo) between January 1 and December 31, 2024. Using purposive sampling, we selected 5-6 representative emergency events per month based on online visibility (capped at 600 comments/event). The dataset included 19,813 comments from X and 6536 comments from Weibo. Emotions were identified using a Cross-lingual Language Model-Robustly optimized Bidirectional Encoder Representations from Transformers approach, and thematic patterns were extracted with Bidirectional Encoder Representations from Transformers Topic. Integrated Gradients was used to interpret model outputs, while clustering and network analysis were applied to visualize cross-cultural patterns. Hofstede’s cultural dimensions theory helped interpret cultural influences on discourse. This mixed computational approach enabled a detailed comparison of emotional structures and thematic discourse across linguistic communities. Results: Significant cross-platform differences were observed in emotional distribution (χ²8=8025.60; P

Background: Chronic fatigue syndrome, or myalgic encephalomyelitis, is characterized by persistent, unexplained exhaustion unalleviated by rest, with a pathophysiology distinct from underlying medical conditions. It is diagnostically complex due to symptoms that overlap with other disorders and the absence of definitive biomarkers, contributing to limited therapeutic options in current medicine. Lingzhi, a pharmacologically active basidiomycete mushroom, has been empirically used in traditional Chinese medicine for two millennia. This #Study has a dual focus: (1) systematically evaluating the efficacy and safety of lingzhi in managing chronic fatigue and post–#covid19 fatigue syndrome and (2) elucidating its clinical associations with inflammatory, immune, and oxidative stress biomarkers to uncover potential therapeutic mechanisms. Objective: The primary objective is to investigate whether a 6-week intake of CP003, a lingzhi-containing supplement, can reduce physical and mental fatigue in patients with chronic fatigue syndrome (ie, myalgic encephalomyelitis) or post–#covid19 fatigue. Secondary objectives include assessing its effects on sleep quality, anxiety, depression, and general health status and exploring associations with inflammatory, immune, and oxidative stress biomarkers. Methods: This randomized, waitlist-controlled trial will enroll 130 participants in Hong Kong, equally allocated (1:1) to either the CP003 intervention group or a waitlist control group. The intervention period spans 6 weeks, followed by a 6-week follow-up phase to assess the sustained effects. The trial data will be managed using REDCap (#Research Electronic Data Capture) and analyzed via an intention-to-treat approach with inverse probability weighting for missing data, assessed through generalized linear regression (adjusted for covariates and interaction terms) at 6 and 12 weeks and supplemented by subgroup and sensitivity analyses in R, with results reported as mean differences (with 95% CIs) and P

Background: Several factors come into consideration when medical students choose their future specialty. Among these factors, the desire to start a family and planning the best timing for pregnancy may interfere with career advancement in certain specialties. Objective: To the best of our knowledge, this is the first scoping review aimed at understanding medical students’ career choice and parental expectations without restriction of the specialty chosen. This #Protocol describes a scoping review aiming to understand how representations regarding specialties and parenthood influence medical students’ career choice. Methods: We will search PubMed, Embase, Web of Science, ERIC, and PsycInfo for literature. Additionally, references list of included articles will be screened for further inclusion. Rayyan and Endnote will be used to organize data screening and extraction. The database selection will allow us to extract and analyze data from various disciplines. This diversity will increase our understanding of medical students’ career and personal life decisions. This #Protocol and the upcoming scoping review are designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews to ensure the quality of the searching process, the data screening, and the data extraction. Results: This #Study will conduct a thematic synthesis of how the concepts of representations and perceptions of parenthood are used by medical students in the selected literature, comparing them to theoretical frameworks to clarify their meanings. We also plan to identify key themes related to parenthood and medical specialty choice when planning a career. Conclusions: This scoping review aims to better understand medical students’ representations of medical specialties and parenthood, and how these perceptions influence their specialty preferences and career choices. By mapping existing evidence across various disciplines, the review will identify #Research gaps and provide a foundation for future studies. The findings will offer valuable insights into the challenges of balancing career aspirations and family life, particularly in the context of physician shortages and the growing feminization of the medical profession.

Background: Tooth decay is an important public health concern worldwide, including in Canada and affects individuals of all ages. Dietary intake is critical to tooth decay prevention as both the types of foods and beverages you eat as well as how food and beverages are consumed (e.g., frequency) can impact tooth decay. Foods and beverages can both protect against and promote tooth decay. Objective: To explore the types of information targeted to the public on diet and tooth decay available from websites of professional organizations and regulatory bodies in Canada and the readability of this information. Methods: Canadian websites of regulatory bodies and professional organizations for dietitians, oral health professionals, nurses, and physicians in Canada were thoroughly searched by two researchers from June-August 2020 for information related to diet and tooth decay targeted to the public. Webpages were downloaded and underwent Content Analysis using NVIVO 12 software. For each website, approximately two webpages focused on diet and tooth decay were selected to undergo readability testing. Results: Overall, 213 webpages from 23 websites were found to contain information on diet and tooth decay and/or general oral health. Most webpages were from oral health professional organizations; few webpages were from dietitian organizations. Messaging was present on numerous webpages focusing on diet and those that has other focuses (e.g., oral hygiene tips for infants and children, general oral health tips). Messaging depth varied across all webpages, ranging from general advice (e.g., consume a ‘healthy diet,’ ‘balanced diet’) to specific recommendations (e.g., number of meals and snacks to consume per day, amount of juice to consume per day). Of note, many webpages targeted parents and school age children; fewer webpages targeted other age groups (e.g., adolescents, older adults). Three major themes were identified: Foods, Beverages, & Behaviours to Limit; Foods, Beverages, and Behaviours to Choose; and Mixed & Other Unclear Messages. The most frequently discussed topic was sugar (mentioned in 67% of webpages) as it cut across multiple themes, often being discussed in the context of limitation, infant feeding, and tooth-friendly ways to eat sugar. The average webpage grade level reading score was 8.6 ± 1.7 which exceeds the grade six level recommendation. Conclusions: This comprehensive analysis of webpages found that diet and tooth decay was heavily discussed throughout websites for Canadian health professional organizations with many webpages targeting parents and school age children. The readability of many of the analyzed webpages was about the recommended grade 6 reading level. Results from this study provide important insight on how to optimize development of future resources in this area.

Background: With the number of young people presenting with early-stage eating disorders on the rise, and current support services unable to meet increasing demand, digital tools offer a promising alternative. They have the potential to reduce waiting lists, enable early intervention, and help prevent the worsening of symptoms - minimising the psychological, physical and economic burden of prolonged illness. Objective: This paper presents a case study of five individuals aged 19 to 25 who used the Worth Warrior app over a 7-week period. The app is based on Cognitive Behavioural Therapy principles for eating disorders and was designed to help young people manage negative body image, low self-worth, and related early-stage eating difficulties. This report explores both participants’ experiences and changes in clinical symptoms and self-esteem over the course of using the app. Methods: An uncontrolled pre- and post-follow-up design was used over three study phases: baseline, post-app familiarisation, and follow-up. Eligible participants were aged 17–25, with low self-esteem and early-stage eating disorder symptoms, and not receiving treatment or using other mental health interventions. A community sample was recruited through online advertisements, social media, and relevant websites. Standardised self-report tools were completed at each stage, including the Eating Disorder Examination Questionnaire (EDE-Q) and Rosenberg Self-Esteem Scale. Feedback on #usability, accessibility, and safety of the app was also gathered. Case reports were written for the five participants who completed all phases. Results: Participants’ individual experiences with the intervention are discussed. At baseline, four participants scored above the clinical threshold for eating disorders; the fifth scored above the non-clinical population mean. All five reported moderately- to extremely-low self-esteem. By follow-up, three participants scored below the clinical threshold for eating disorders, two of whom scored above-threshold at baseline, and four participants showed improved self-esteem. Eating and weight concerns declined in four participants, while restraint, shape concern, and eating-disorder-related behaviours decreased in three. The app was positively rated for #usability, acceptability, and safety. Interactive features aimed at changing self-perceptions and the journal function were particularly valued. Reported dislikes included a lack of reminders or incentives to encourage regular use and discomfort in practising self-compliments; one participant reported no dislikes. By follow-up, three participants had ceased engaging in at least one previously-reported eating-disorder-related behaviour, and two said the app had prompted them to seek support. Conclusions: These cases highlight the Worth Warrior app’s potential to support young people with early-stage eating disorders and suggest that the app has the potential to be an effective, safe, acceptable, and scalable digital intervention. While findings cannot be generalised, they provide an encouraging foundation for future research and broader implementation.

Background: Tele#Rehabilitation has been widely adapted to meet the growing #Rehabilitation demand, but is often limited by unstable internet connection, poor audiovisual resolution, and difficult #Virtual assessment. The Shoulder Telehealth Assessment Tool(STAT) was developed to address these limitations. Objective: This #Study aimed to develop a linguistically valid and culturally appropriate Filipino version of STAT, and to evaluate its content validity, internal consistency, understandability and ease of performing. Methods: A cross-sectional #Study on Filipino STAT was conducted in three phases- 1. linguistic validation by experts, 2. cross-cultural adaptation through pre-testing of 12 participants diagnosed with musculoskeletal shoulder condition in the Philippine General Hospital and 3. pilot #Study on 47 participants of the same population. Results: Results: The Filipino STAT has an excellent content validity (scale validity index=0.80-0.97), excellent interrater reliability (Kappa coefficient=0.82-1.00), and good internal consistency (Cronbach’s alpha=0.87). Understandability is excellent for #Pain and activity (98%), good for range of motion(ROM) and special test(85%), and poor for strength(37%). 11 participants found the tool difficult to understand with the use of some Tagalog words as the primary barrier, followed by non-familiarity with the tool, and difficulty reading the text. Conclusions: Development of Filipino STAT through a rigorous linguistic validation and cultural adaptation has produced a culturally approriate, valid, and reliable tool. #Pain and activity, ROM and special test subdomains are suitable for clinical assessment, while strength subdomain needs further improvement in understandability.

This cross-sectional survey study (63.5% response rate) characterized how patients with atopic #dermatitis (AD) perceive and experience the effects of climate change on their AD. Most participants reported that environmental factors such as heat and air pollution worsened their AD and expressed a desire for climate-health education, yet few had discussed these concerns with their #dermatologist. These findings reveal a gap in patient-centered #dermatologic care and support the development of tools to integrate environmental health into atopic #dermatitis management.

Background: Quality in use (QiU), a stakeholder-centered dimension of software quality encompassing effectiveness, efficiency, satisfaction, and freedom from risk, is essential in evaluating #Digital systems, particularly in health-related domains. Although QiU has been explored in various fields, its application within connected mental health (CMH) systems remains fragmented and understudied. Given the rapid rise in CMH technologies, ranging from mobile apps to teletherapy platforms, understanding how QiU is conceptualized, evaluated, and reported in this domain has become increasingly urgent. Objective: This #Study aims to systematically map and synthesize existing #Research on QiU in CMH applications. It seeks to identify current trends, #Research gaps, evaluation methods, and the range of technologies examined concerning QiU. Methods: A systematic mapping methodology following the guidelines by Petersen et al will be used. The process includes defining mapping questions, developing a classification scheme, and systematically searching and analyzing peer-reviewed literature from databases—Scopus, PubMed, IEEE Xplore, and ACM #Digital Library. Eight mapping questions will guide the analysis, focusing on publication trends, #Research types, empirical evaluations, QiU characteristics and subcharacteristics, and technologies studied. Results: As this paper presents the #Protocol for an ongoing mapping #Study, results are not yet available. The literature search and data analysis are scheduled for completion in 2026. Preliminary screening suggests variability in how QiU is defined and evaluated across CMH technologies, highlighting the need for systematic synthesis. Conclusions: This systematic mapping #Study will fill a critical gap by providing a comprehensive overview of QiU #Research in the context of CMH. By organizing and classifying the existing literature, the #Study will inform future #Research, support the development of more user-centered CMH tools, and contribute to establishing more consistent evaluation practices in this growing field.

Background: Non-adherence to antipsychotic medication remains one of the most significant challenges in the management of schizophrenia, contributing to relapse, rehospitalization, and functional decline. Although psychoeducational interventions are a key intervention for relapse prevention, traditional formats often lack interactivity and cultural resonance, thereby limiting engagement and sustained impact. Digital health innovations offer an opportunity to improve both treatment adherence and user experience, but evidence in schizophrenia populations remains limited. Objective: This study aimed to evaluate the usage patterns, usability, and effectiveness of a narrative-based psychoeducational digital intervention designed to enhance medication adherence among individuals with schizophrenia in the maintenance phase. By employing a mixed-methods design, the study integrated quantitative measures of adherence and functioning with qualitative insights into participants’ experiences and perceptions. Methods: A 6-month parallel mixed-methods randomized controlled trial was conducted in community mental health settings in Shanghai. Seventy individuals with schizophrenia in a stable phase were randomly assigned (1:1) to the intervention group, which received the digital narrative-based psychoeducation application (Healing Town) to routine community care, or to the control group, which received routine community rehabilitation only. Quantitative evaluation focused on medication adherence, drug attitude, social functioning, and psychiatric symptoms. In parallel, qualitative data were collected through semi-structured interviews with patients, caregivers, and clinicians to examine intervention usage, usability, engagement, and perceived impact. Results: Seventy participants (mean age 44.2 years; 61% male) were enrolled, and 69 (98.6%) completed the 6-month trial, with one dropout during the intervention period. At 6 months, the intervention group showed significantly higher medication adherence (mean difference=1.27, 95% CI 0.30–2.24; P=.02) and more positive drug attitudes (mean difference=3.41, 95% CI 1.18-5.65; P=.002) compared with controls. Improvements in social functioning were significant within the intervention group (P=.03) but not between groups. No significant group differences were observed in psychiatric symptoms. Qualitative findings identified three overarching themes: (1) Adherence and usability—patients reported enhanced treatment knowledge, confidence, and motivation, though some described challenges with feedback tone and pacing; (2) Experiences and attitudes—users valued cultural relevance, immersive narratives, and gamified elements but noted occasional overstimulation; and (3) Expectations and recommendations—participants expressed demand for personalized features, reminders, and dynamic content to sustain engagement. Conclusions: This mixed-methods study provides preliminary evidence that a narrative-based digital psychoeducational intervention may enhance medication adherence and attitudes toward medication among individuals with schizophrenia in the maintenance phase, while being perceived as engaging, usable, and culturally relevant. Furthermore, the qualitative findings suggest that supportive feedback, adaptive difficulty, and personalized features may enhance user motivation and optimize future scalability. Overall, this narrative-based digital psychoeducation represents a promising and potentially cost-effective approach to supporting community-based psychiatric rehabilitation, meriting further longitudinal and multi-site investigation. Clinical Trial: The trial was prospectively registered on ClinicalTrials.gov (NCT06175559)

Background: Gender concordance [GC] between patients and physicians has been linked to trust and satisfaction in traditional healthcare. However, its role in telemedicine, especially in culturally complex settings like India, is underexplored. In India’s culturally diverse and gender-sensitive context, understanding Gender concordance becomes particularly relevant for specialties such as gynecology, dermatology, psychiatry, and urology, where discussions often involve intimate or stigmatized concerns. Despite rapid telemedicine expansion, little empirical evidence exists on whether GC affects patient-reported outcomes in this context. Objective: This study examined whether gender concordance [GC] significantly influences patient satisfaction and self-reported recovery in teleconsultations across India, with a focus on specialty-specific effects in culturally sensitive specialties. Methods: We conducted a retrospective cross-sectional analysis of 286,196 anonymized teleconsultation records from a national telemedicine platform (January 2023–December 2024) spanning across 20 medical specialties using binary logistic regression. Records missing gender or satisfaction data were excluded from the analysis, recovery analyses included only consultations with completed day-21 follow-up surveys (n=1,170, 0.4%). Outcomes included patient satisfaction (ratings 4–5 on a five-point scale) and self-reported recovery at follow-up. Logistic regression models (Stata 17.0) tested associations between gender concordance and outcomes controlling for consultation time, duration, and physician experience Subgroup analyses were conducted for top 5 specialities. Each record included key data on consultation duration, timing, physician experience, specialty type, patient satisfaction rating, and self-reported recovery status.The study excluded Pediatrics specialty form the analysis to control for the parental bias. Results: Of the 286,196 consultations, 164,008 (60.4%) were gender-concordant. Overall, 261,213 of 286,196 patients (91.3%) reported good satisfaction. Gender concordance had a statistically significant negative association with patient satisfaction [OR=0.87, 95% CI: 0.85–0.90; P

Background: The growing reliance on virtual consultations in primary care has reshaped traditional General Practitioner (GP)-patient communication dynamics, presenting new challenges that affect care quality and safety. Objective: This study explores communication challenges and gaps, particularly relevant to virtual consultations compared to face-to-face interactions, as well as identifying mitigation strategies from both GPs’ and patients’ perspectives. Methods: This qualitative study employed four online focus group discussions with a purposive sample of UK-based GPs and patients. Data were analysed using a deductive-inductive thematic approach with NVivo software. The extended Shannon-Weaver Communication Model (SWCM) and the Capability, Opportunity, Motivation and Behaviour (COM-B) model guided the analysis of communication challenges and mitigation strategies, respectively. The consolidated criteria for reporting qualitative research (COREQ) were followed to ensure rigorous reporting. Results: A total of 21 participants (12 patients and 9 GPs) took part in four online focus group discussions, two for patients and two for GPs. Six key themes on communication challenges emerged: five aligned with the extended SWCM (related to the sender-encoder, message, channel, receiver-decoder-feedback, and context), and a new one inductively identified (patient autonomy and inclusivity). GPs, as senders, highlighted missing visual cues, affecting message clarity in remote communication channels. Patients, as receivers, reported difficulties explaining symptoms remotely and reduced emotional connection and perceived empathy, linked to contextual challenges and the need for inclusive communication. Mitigation strategies were mapped to the COM-B model: capability (training/resources), opportunity (triage/tools), and motivation (patient engagement/system adaptability), with participants emphasising tailored training, standardised approaches, and flexible models to support effective, inclusive virtual communication. Conclusions: This study highlights communication gaps in virtual consultations and proposes actionable mitigation strategies. Tailored use of virtual modalities, supported by structured training and policy efforts, is essential to ensure effective and safe remote communication.

Background: Counseling in family dementia care aims to support caregivers in mastering challenges. The use of information and communication technologies (ICT) to administer counseling can improve accessibility. Evidence syntheses report inconsistent findings on the effectiveness of technology-assisted counseling. There is a considerable heterogeneity in outcomes assessed in clinical trials, and approaches to develop and evaluate interventions are not guided by theory in most cases. Objective: To develop an initial program theory of a technology-assisted counseling intervention for family dementia caregivers and to create the data basis for the consensus process of a core outcome set. Methods: We integrated the methodological strands for the development of a program theory and a core outcome set in an innovative way. A scoping review was conducted to collect data on characteristics and theoretical foundations of technology-mediated counseling interventions as well as outcomes of clinical studies. We explored the lived experience of relevant interest-holders and conducted semi-structured interviews applying a phenomenological approach to data analysis. Synthesis of findings was performed by developing a logic model and formulating an initial program theory. Results: We included 69 records reporting on 34 interventions. Designs and other study characteristics vary and interventions are heterogeneous in terms of components and ICT used for delivering counseling. We conducted interviews with 15 family caregivers and 12 counselors. The themes Being affected; Feeling insecure and helpless in the face of the healthcare system; and Search for information and communicative exchange illustrate the caregivers’ lifeworld perception. Themes identified in counselors’ interviews comprise Work attitude and standards; Unpredictability; Expectations; Working conditions; Organizational influence; and Tools: techniques and networking. The constitutive pattern of Having/being somebody to count on was incorporated into the program theory. In the theory of change, we describe the way to a sustainable supportive cooperation between caregivers and counselors ensuring ongoing support throughout the caregiving process. We explicate the effects of the technology-assisted counseling intervention such as improved knowledge, attitude, and interaction, as well as stability and safety of care in the outcome chain. The theory of action comprises the inputs, activities, and outputs of the intervention. The graphical synthesis of findings is presented in the logic model. Conclusions: To effectively develop, implement, and evaluate technology-assisted counseling in family dementia care, a theory-led approach is essential. A carefully modeled intervention that combines technological options with in-person counseling may help to overcome disparities in access to healthcare and improve accessibility to counseling. A supportive working environment for counselors, in which artificial intelligence is used to reduce time spent on documentation and administrative tasks, may help mitigate the effects of the growing shortage of skilled professionals. Clinical Trial: Core Outcome Measures in Effectiveness Trials (COMET) Initiative; https://www.comet-initiative.org/Studies/Details/2884.

Background: Traditional rehabilitation research often excludes the voices of individuals with lived experience of traumatic brain injury (TBI), resulting in interventions that lack relevance, accessibility, and effectiveness. Community-Based Participatory Research (CBPR) offers an alternative framework that emphasizes collaboration, power-sharing, and sustained engagement with patients, caregivers, and clinicians. Objective: The objective of this paper is to demonstrate how CBPR can be systematically applied to the formative design and evaluation of Electronic Problem-Solving Training (ePST), a metacognitive, evidence-based mobile health (mHealth) intervention for individuals with TBI. Methods: A multi-step, mixed-methods design case methodology was adopted, guided by CBPR principles and Learning Experience Design (LXD). Participatory mechanisms included a 33-member Community Advisory Board (CAB) and 10 Community Engagement Studios (CES), which engaged TBI survivors, caregivers, clinicians, and researchers throughout the Discover, Define, Develop, and Deliver phases of the Double Diamond model. Iterative activities included empathy interviews (n=14), persona development (n=10), rapid prototyping, and usability testing with five TBI participants using think-aloud protocols and the Comprehensive Assessment of Usability for Learning Technologies (CAUSLT). Results: Usability evaluation demonstrated high user satisfaction with CAUSLT scores averaging 87.3 out of 100 and 80% accuracy on knowledge assessments. The participatory process yielded three key findings: (1) iterative community feedback directly enhanced technical usability through specific design modifications including microlearning modules (5-12 minutes), badge system refinements, and voiceover tone adjustments; (2) multi-stakeholder representation systematically identified design considerations that single-stakeholder approaches overlook, with caregivers contributing family involvement features, clinicians providing evidence-based validation, and individuals with lived experience prioritizing autonomy elements; and (3) TBI-specific design requirements emerged, including the need for linear content progression over branching navigation, higher technical performance standards, and explicit content signaling with clarity prioritized over novel interface design. Think-aloud protocols revealed that participants struggled with mobile navigation and branching structures but excelled with sequential content progression. This study provides evidence that systematic CBPR implementation produces measurable improvements in rehabilitation technology usability while contributing methodological insights for participatory design in cognitive rehabilitation. Conclusions: This study provides evidence that systematic CBPR implementation produces measurable improvements in rehabilitation technology usability while contributing methodological insights for participatory design in cognitive rehabilitation. Findings demonstrate that sustained community engagement (spanning entire development cycles) creates superior technical outcomes compared to traditional consultation approaches, establishing CBPR as both an ethical imperative and practical methodology for developing effective, accessible rehabilitation interventions.

Background: Lung cancer screening with low-dose computed tomography (LDCT) among heavy smokers can decrease lung cancer mortality. Smoking cessation intervention is recommended within the screening program, however, the methods for smoking cessation in LDCT screening context are not well established. We have previously shown that a novel smartphone application can increase the chance for smoking cessation along with lung cancer screening. Effects of lung cancer screening, smoking cessation, and use of smartphone application to health-related quality of life (HRQoL) are widely unknown. Objective: This study aims to investigate the effect of lung cancer screening, smoking cessation, and use of smoking cessation application to HRQoL, an exploratory endpoint of the LDCT-SC-FI study. Methods: This study was conducted as a part of the LDCT–SC–FI (NCT05630950) which was a randomized controlled trial investigating different smoking cessation methods in subjects undergoing lung cancer screening with LDCT. The main inclusion criteria included an age of 50–74, a marked smoking history (smoked ≥15 cigarettes/day for ≥25 years or smoked ≥10 cigarettes/day for ≥30 years), an active smoking status and access to a smartphone. The recruitment was carried out by newspaper and internet advertisements and informing relevant healthcare units at hospital district. The study subjects (n=200), all at Oulu University Hospital) were randomized in 1:1 fashion to a yearly LDCT with standard smoking cessation (written material) or stand-alone smartphone application-based cessation. HRQoL, an exploratory study endpoint, was assessed at baseline and at one year with QLQ-C30 and EQ-5D. Results: 199 and 186 individuals had both questionnaires completed at baseline and at one year, respectively. We did not detect a change in HRQoL between the time points using QLQ-C30 global health score (GHS) or EQ-5D index score. Smoking cessation at one year time did not affect QLQ-C30 GHS or EQ-5D. We observed improved quality of life scores by EQ-5D at one year (mean of 0.720 in control vs. 0.799 in application; improved in 18.4% of controls vs. 31.2% in application arm) while there was no difference in means at baseline. Smartphone application arm reported reduced pain (EQ-5D ES 0.049 (95% CI 0.006-0.12) P=.011, adjusted ES 0.026, P=.007; QLQ-C30 ES .076 (95% CI 0.02-0.16), P

Background: Thrombolysis and mechanical thrombectomy represent the most successful stroke innovations over the last 30 years. Quantifying innovation in stroke is essential for identifying productive research lines and prioritizing funding, but health care lacks validated methods for measuring innovation. Objective: This study aimed to systematically evaluate the relationship between stroke-related patents and publications, demonstrate the feasibility of using large language models (LLMs) in this process, and identify the most rapidly advancing innovations in stroke care by mapping them to a theoretical innovation life cycle. Methods: The Open Patent Services (European Patent Office) and PubMed databases were searched between 1993 and 2023 for “stroke OR cerebrovascular.” In this bibliometric patent-publication analysis, a 13 billion–parameter Llama LLM was trained to identify patents related to stroke disease, as opposed to other references to the word “stroke,” on a manually labeled subset of 5000 patents and assessed using 5-fold cross-validation. The LLM filtered irrelevant results, and the resulting patent codes were grouped into innovation clusters. For each cluster, annual patent and publication counts were normalized to adjust for global trends. Cluster-specific growth curves were plotted to analyze the rates and characteristics of growth. The innovation life cycle stage for each innovation cluster was estimated by fitting a sigmoid curve to the patent and publication data consistent with the diffusion of innovations theory by Rogers. Results: The cross-validated accuracy of the LLM was 99.2%, with a sensitivity of 96.5% and a specificity of 99.6%. An initial bibliometric search retrieved 237,035 patents and 486,664 research publications. A manual review of a random sample of patents before filtering revealed that only 11.2% (56/500) were relevant to stroke. After LLM filtering, of the 237,035 patents, 28,225 (11.9%) stroke-related patents remained. These were grouped into 7 innovation clusters: pharmacological treatment, alternative medicine, rehabilitation devices, medical imaging, diagnostic testing, surgical devices, and artificial intelligence (AI) methods. Patent and publication counts were strongly correlated across clusters (Spearman rs=0.65-0.92; P

Date Submitted: Jan 16, 2026. Open Peer Review Period: Jan 17, 2026 - Mar 14, 2026.

Background: Use of technological resources that provide support for mental health (ie, digital mental health tools) and opportunities to use the internet to communicate with others or receive information about mental health (ie, online mental health communication) are growing in popularity among young adults (ages 18-29). However, whether exposure to the negative experience of racism online is associated with use of digital mental health tools and online mental health communication remains an important empirical question for Black young adults, given their frequent online use and engagement. Objective: This study sought to examine (1) how the frequency of exposure to online racism is associated with use of digital mental health tools and engagement in online mental health communication, and (2) how these associations differ for Black young adults with either anxiety and depression versus those without. Methods: Conducted from July to September 2024, data came from a larger cross-sectional study of 1005 monoracial Black young adults (N = 1005; Mage = 24.07, SDage = 3.04, 50.6% women) who completed an online survey and self-reported measures of exposure to online racism, use of digital mental health tools, frequency of engaging in online mental health communication, and anxiety and depressive symptoms. Two separate path analysis regression models were conducted for the outcomes of depression and anxiety. Results: Our results showed that more frequent exposure to online racism was associated with a greater likelihood of using digital mental health tools (ORs range 1.72-1.84, p

Date Submitted: Jan 12, 2026. Open Peer Review Period: Jan 20, 2026 - Mar 17, 2026.

Date Submitted: Jan 19, 2026. Open Peer Review Period: Jan 20, 2026 - Mar 17, 2026.