Tag: Health app

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Identifying Behavior Change Techniques for Digital Interventions Addressing Alcohol and Tobacco Co-Use: Findings From a Delphi Consensus Study

Background: Alcohol and tobacco use frequently co-occur and contribute significantly to the global burden of disease. Despite the well-established benefits of addressing both behaviors simultaneously, health care professionals often face substantial challenges in delivering integrated interventions, including limited time, training, and resources. Digital health interventions offer a promising avenue to directly support patients in reducing alcohol and tobacco use, while bypassing some of the barriers encountered in clinical settings. However, there is a lack of consensus on the key behavior change techniques (BCTs) that must be incorporated to ensure that interventions are evidence based and contextually appropriate, making them effective. Objective: The study aims to identify expert opinions on the most suitable and effective BCTs (reflecting both behavioral relevance and delivery feasibility) to be included in a 1-time, self-guided digital intervention intended to initiate behavior change and support alcohol reduction among people trying to quit smoking. Methods: We conducted a 2-round modified Delphi study with 14 panelists with expertise in behavioral science, alcohol and tobacco treatment, and digital interventions. Panelists rated 20 BCTs identified in a previous rapid review using the acceptability, practicability, effectiveness, affordability, safety, and equity (APEASE) criteria. BCTs were deemed “appropriate” if at least 70% (n=10) of panelists agreed on all criteria. Results: Six BCTs were identified as appropriate for implementation: goal setting, action planning (individualized change plan), action planning (reduction strategies), feedback on behavior, reattribution, and pros and cons. These BCTs were considered effective for promoting behavior change through structured planning and personalized strategies. The panel reached partial consensus on several BCTs, while 8 BCTs were deemed inappropriate for a 1-time, unsupervised digital intervention. Conclusions: The results of this study offer a consensus-based view, reflecting expert opinion on the perceived appropriateness and feasibility of the BCTs that should be included in a 1-time digital intervention to address co-occurring alcohol and tobacco use.
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From Alliance to Nexus: Rethinking Digital Therapeutic Relationships

In traditional human psychotherapy, the therapeutic alliance (TA) is regarded as a fundamental factor that describes the client-therapist relationship, mainly due to strong evidence demonstrating its impact on treatment outcomes regardless of theoretical orientation. More recently, advances in artificial intelligence (AI) and other technologies have led to the emergence of the concept of digital TA, used to characterize the relationship between clients and AI-based therapeutic systems. This approach replicates human dynamics but overlooks key differences between human therapists and digital agents. Prematurely translating the concept of TA into the digital context fails to address issues such as the sycophantic tendencies of current systems and the inherent limitations of algorithmic interaction. We propose the digital therapeutic nexus, a framework that recognizes these differences and provides a set of structured criteria for categorizing digital interactions into 3 progressive levels. This Viewpoint argues that only at the highest level can parallels be drawn to the human TA and stratifies the main risks associated with each nexus level. Transitioning from the concept of alliance to that of a nexus offers a more precise conceptual basis for describing and evaluating digital therapeutic relationships, with implications for research, design, and the ethical development of AI-based mental health interventions.
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Adherence to a Digital Knee Rehabilitation Platform Among Patients With Knee Osteoarthritis and Anterior Cruciate Ligament Reconstruction in Hong Kong: Qualitative Study

Background: Exercise therapy is fundamental to rehabilitation for knee osteoarthritis and anterior cruciate ligament (ACL) reconstruction, yet adherence to prescribed exercise typically declines once clinical supervision ends. Digital rehabilitation platforms offer a promising means of supporting sustained exercise adherence, but qualitative evidence on how patients experience these platforms in real-world clinical practice remains limited, particularly in non-Western health care contexts. Objective: This study aimed to explore how patients with different knee conditions experienced the Healthy Knees digital rehabilitation platform in Hong Kong and to identify the factors shaping their platform engagement and exercise adherence. Methods: A qualitative design was adopted using reflexive thematic analysis. Fifteen adults (9 with ACL, 6 with osteoarthritis) who had been prescribed the Healthy Knees web-based platform at Prince of Wales Hospital participated in semistructured, in-person interviews (30‐45 min). Interviews were conducted in Cantonese or Mandarin, transcribed verbatim, translated into English, and analyzed inductively. Ethics approval was obtained from the Chinese University of Hong Kong and the University of New South Wales. Results: Participants were aged 21 to 79 years, with most being male (11/15). Younger participants were predominantly patients with postoperative ACL, while older participants were predominantly patients with preoperative osteoarthritis. Three interrelated themes were identified, collectively describing the fit between the platform and participants’ contexts. Content fit captured the alignment between exercise content and rehabilitation needs; participants across both groups perceived substantial overlap with existing physiotherapy, and content was often mismatched to their recovery stage. Motivational fit captured the alignment between platform support features and motivational needs; pain functioned as both a driver and a deterrent to exercise, and participants ranged from highly self-directed to reliant on external scaffolding, not following a simple age pattern. Access fit captured the alignment between the platform’s delivery mechanism and participants’ technological circumstances; QR code–dependent access, absence of a dedicated mobile app, and display issues created friction that led several participants to migrate to alternative resources, maintaining exercise adherence while abandoning platform engagement. Conclusions: Adherence to digital knee rehabilitation was shaped by the degree of fit between the platform and users’ contexts across content, motivational, and access dimensions. When access fit failed, participants often substituted alternative exercise resources rather than ceasing exercise entirely, highlighting a distinction between platform engagement and exercise adherence. As the sample’s clinical and demographic characteristics were closely linked, these findings should not be interpreted as diagnostic comparisons between ACL and osteoarthritis populations but as patterns shaped by the recovery phase and age. These findings suggest that digital rehabilitation platforms should incorporate adaptive content aligned with the recovery stage, integrated feedback mechanisms, and reduced access friction to sustain platform engagement within an ecosystem of competing alternatives.
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Young Adults’ Perspectives on an Ecological Momentary Intervention for Drinking to Cope: Qualitative Study

<strong>Background:</strong> Young adults have high rates of mental health problems, such as mood or anxiety symptoms, and high rates of problematic drinking. Many young adults who undergo psychiatric hospitalization to address depression and anxiety symptoms also engage in risky drinking and tend to drink to cope with negative emotions. However, in many cases, treatment programs focusing on mood and anxiety symptoms often fail to adequately address problematic alcohol use in young adults. <strong>Objective:</strong> This study aimed to address this treatment gap by investigating patient perspectives on a potential ecological momentary intervention mobile app. Researchers used qualitative methods to gather perspectives of young adults hospitalized for psychiatric care on their use of drinking to cope with negative emotions and their feedback for a prospective app designed to suggest healthy coping strategies when participants report low mood and cravings to drink. <strong>Methods:</strong> We recruited a total of 12 young adults admitted to a partial hospitalization program to participate in a qualitative interview. To be eligible, participants needed to be aged 18-25 years and report drinking at least once weekly, binge drinking at least once monthly, drinking to cope with negative emotions, and depression and/or anxiety symptoms. <strong>Results:</strong> Qualitative analysis of our data resulted in 4 major themes. These included (1) motivations to use substances, (2) healthy coping, (3) general reactions to the proposed app, and (4) suggestions for the app. Participants generally had insight about their use of alcohol to cope and were able to identify several motivations for drinking; the most frequent motivations were to alleviate anxiety and depression, although many participants noted drinking to cope with other emotions, such as guilt or loneliness. Participants overall had positive responses to the prospective intervention and reported that they would appreciate the portability of a digital intervention in helping them “step down” from higher levels of psychiatric care. Participants also made several valuable suggestions about content, features, and usability, such as suggesting ways to “gamify” the app to increase use. <strong>Conclusions:</strong> This feedback will be crucial in designing and testing an ecological momentary intervention designed to reduce drinking to cope in young adults hospitalized for psychiatric care.
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An Evaluation of the Usability and Feasibility of the 50K4Life Mobile App for Delivering Walking Challenges to Public School Administrative Employees: Beta Testing Study

Background: Mobile health apps show promise for delivering physical activity interventions, but uptake remains low due to usability barriers. Beta testing is essential to optimize user experience before full implementation. Objective: This study aimed to evaluate the usability, acceptability, and feasibility of the 50K4Life mobile app prototype for delivering a 2-week walking challenge to public school administrative employees. Methods: Following the Integrate, Design, Assess, and Share framework, we conducted a single-group beta test with 12 public school administrative employees in El Paso County, Texas. Participants used the 50K4Life app built on the Pathverse platform for a 2-week walking challenge. Data collection included acceptability surveys, satisfaction questionnaires, app use metrics, and qualitative debriefing sessions. Results: All 12 participants completed the walking challenge. Acceptability was high for app design (n=12, 91.7%), layout (n=9, 75%), and battery impact (n=10, 83.3% reported no issues). However, participants experienced difficulties with navigation (n=7, 58.3%), delays in updating step counts (n=8, 66.7%), and completion of assigned tasks (n=5, 41.7% could not locate all features). App use was high: 100% (n=12) accessed the leaderboard and walking challenge page, and 91.6% (n=11) synced step data and set step goals. Results from participants’ responses in the surveys and feedback from debrief interviews identified needs for improving user engagement features, synchronization, and visual appeal. Conclusions: The application of a participatory approach and Integrate, Design, Assess, and Share framework yielded valuable insights into the acceptability of the 50K4Life app reported by this study cohort and potential for enhanced features in <i>real-world</i> use contexts.
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Acoustic stimulation in pain management: neurobiological mechanisms and clinical applications—a narrative review

Pain affects over 30% of the global population, with an underlying pathogenesis involving a complex interplay of biopsychosocial factors. Despite the availability of conventional pharmacological and interventional therapies, their clinical utility is frequently constrained by concerns regarding substance misuse, surgical complications, and other adverse sequelae. Acoustic stimulation (AS) has emerged as a promising alternative in pain management, characterized by its non-invasive nature, favorable safety profile, and high cost-effectiveness. However, current literature lacks a comprehensive evaluation of cutting-edge AS technologies and a profound decryption of its pleiotropic analgesic mechanisms, which has hindered the integration of AS into multimodal analgesic strategies. This review provides the first comprehensive synthesis of the neurobiological mechanisms and clinical applications of AS. We comprehensively evaluate the analgesic efficacy of diverse modalities, ranging from established interventions—such as music therapy (MT), natural sounds (NS)/noise, and auditory beat stimulation (ABS)—to emerging approaches, including vibroacoustic therapy (VAT) and immersive interactive technologies that integrate multisensory acoustic information. Emerging evidence suggests that AS exerts its therapeutic effects via a multidimensional neurobiological framework, notably through the modulation of corticothalamic circuits, the activation of descending pain-inhibitory systems, and the dynamic regulation of neurochemical mediators. Clinical data consistently highlight the adjunctive value of MT, NS/noise, and VAT in the management of both acute and chronic pain. Furthermore, the convergence of AS with immersive interactive technologies is pioneering a novel digital intervention paradigm, facilitating the seamless integration of AS into multimodal analgesic frameworks. Collectively, these findings suggest that AS represents a robust, non-pharmacological strategy that warrants further exploration as a cornerstone of future personalized, multimodal pain management.
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Digital Platform to Provide Health Data Feedback for Neurorehabilitation Patients: User-Centered Development and Proof-of-Concept Usability Study

Background: An increasing amount of digital health data are being collected across rehabilitation settings, but their integration into routine clinical practice remains limited, despite its potential to motivate patients or inform clinical decision-making. Specifically, effective visualization and communication of assessment outcomes to both patients and health care practitioners (HCPs) represent a key gap in the neurorehabilitation practice. Objective: This study describes the development and evaluation of RehaLink (author ND, ETH Zürich), a proof-of-concept mobile app that delivers structured, interpretable feedback from conventional and technology-based assessments to neurorehabilitation patients and HCPs. Methods: The app was developed through a 3-step iterative co-design process involving 17 inpatients with multiple sclerosis and 15 HCPs from a single rehabilitation center. The app integrates a full battery of conventional assessments routinely conducted at the clinic, as well as digital health metrics from the Virtual Peg Insertion Test, a validated technology-based assessment of upper limb function, as a proof of concept for integrating technology-based assessment data into clinical workflows. Three structured feedback sessions were conducted, in which participants evaluated feedback types, visualization formats, and app usability using Likert-scale ratings, preference rankings, open-ended questions, and the System Usability Scale. Data were analyzed using descriptive statistics and directed content analysis. Results: Across all 3 sessions, progress bars and color-coded indicators were consistently preferred over text-heavy or abstract formats by both patients and HCPs. A persistent set of competing demands was observed, with participants requesting both visual simplicity and access to absolute values and normative comparisons. HCPs tended to underestimate patients’ preference for informative visualizations. The perceived value of structured feedback increased over the course of the study; patients’ median ratings rose from 4.0 to 5.0 and HCPs’ from 4.0 to 4.5 on a 5-point Likert scale. The resulting mobile app prototype demonstrated high usability, with patients achieving a mean System Usability Scale score of 93.6 (mean 6.4; best imaginable) and HCPs 80.9 (SD 8.1; good), according to established benchmarks. Conclusions: These findings demonstrate the feasibility and value of a co-designed digital feedback tool for neurorehabilitation. By combining conventional and technology-based assessment outcomes in an accessible, user-centered format, the app has the potential to enhance patient engagement, support clinical decision-making, and advance the implementation of value-based, personalized care.
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