The effect of virtual rainforest and a white noise mobile application on satisfaction, tolerance, comfort, and vital signs during arthroscopy.

BACKGROUND AND PURPOSE: This study was conducted to investigate the effect of Virtual Rainforest (VRF) and a White Noise (WN) mobile applications on patient satisfaction, tolerance, comfort, and vital signs during arthroscopic knee surgery. METHODS: This is a randomized, controlled, interventional study. The study was completed with a total of 93 participants, 31 in the VRF group, 31 in the WN group, and 31 in the control group. Data were collected using a Patient Information Form and a Visual Analog Scale for satisfaction, tolerance, and comfort. RESULTS: The results of study showed that there were significant increases in tolerance, satisfaction, comfort, respiratory rate, and oxygen saturation levels and significant decreases in heart rate, systolic and diastolic blood pressures in both VRF and WN groups (p < .05). In the control group, no significant difference was found between the means of the variables before and after the procedure (p > .05). CONCLUSION: According to the results of the study, VRF and WN applied during the arthroscopy procedure increased satisfaction, tolerance, and comfort in patients and had a positive effect on vital signs. TRIAL AND PROTOCOL REGISTRATION: ClinicalTrials.gov, NCT05992714.

The Real-World Impact of App-Based Mindfulness on Headspace Members With Moderate and Severe Perceived Stress: Observational Study.

Background: Perceived stress in the United States has drastically increased since the COVID-19 pandemic and is associated with negative mental health outcomes such as depression and anxiety. Digital mental health (DMH) interventions are efficacious tools to address negative mental health outcomes and have helped reduce the severity of psychological symptoms, such as anxiety, depression, and perceived stress, compared to waitlist controls. Although DMH tools have been studied in controlled settings, less is known about the real-world evidence of such interventions. Objective: This study aimed to (1) characterize patterns in baseline perceived stress and changes in perceived stress among Headspace members with moderate and severe baseline perceived stress and (2) examine associations between engagement with Headspace content and changes in perceived stress (ie, evaluate whether there is a dose-response relationship). Methods: We evaluated real-world perceived stress and engagement data at 2 time points among Headspace app members with baseline moderate and severe perceived stress. Perceived stress was measured using the Perceived Stress Scale (PSS-10) and engagement using active days and active minutes engaged with Headspace as well as the number of user sessions. Descriptive statistics were computed for all variables. Correlations between baseline and follow-up scores, percent change in PSS-10 scores, days between PSS-10 use, active days, active days per week, active minutes, active minutes per day, sessions, and sessions per week were evaluated. We used t tests to investigate differences in the abovementioned parameters between (1) participants who did and those who did not see improvements in PSS-10 scores (yes vs no improvement) and (2) participants who saw ≥30% improvement versus those who saw a <30% improvement in PSS-10 scores. Results: Overall, 21,088 Headspace members were included in these analyses. On average, members saw a 23.52% decrease in PSS-10 scores from baseline to follow-up. On average, members had 2.42 (SD 1.76) active days per week and 25.89 (SD 33.40) active minutes per day, and completed 7.11 (SD 8.34) sessions per week. t tests suggest that members who saw improvements in PSS-10 scores from baseline to follow-up had significantly higher baseline PSS-10 scores (Cohen d=0.56), more active days per week (Cohen d=0.33), and more sessions per week (Cohen d=0.27) than those who did not see improvements in PSS-10 scores (all P<.001). Additional t tests suggest that members with ≥30% improvement in PSS-10 scores had significantly higher baseline PSS-10 scores (Cohen d=0.35), more active days per week (Cohen d=0.36), and more sessions per week (Cohen d=0.31) than those with a >30% improvement (all P<.001). Conclusions: Real-world use of Headspace is associated with decreased perceived stress. Furthermore, data suggest that more engagement, specifically weekly active days and sessions, is associated with a greater likelihood of stress reduction.

Enhanced Knowledge Distillation for Advanced Recognition of Chinese Herbal Medicine.

The identification and classification of traditional Chinese herbal medicines demand significant time and expertise. We propose the dual-teacher supervised decay (DTSD) approach, an enhancement for Chinese herbal medicine recognition utilizing a refined knowledge distillation model. The DTSD method refines output soft labels, adapts attenuation parameters, and employs a dynamic combination loss in the teacher model. Implemented on the lightweight MobileNet_v3 network, the methodology is deployed successfully in a mobile application. Experimental results reveal that incorporating the exponential warmup learning rate reduction strategy during training optimizes the knowledge distillation model, achieving an average classification accuracy of 98.60% for 10 types of Chinese herbal medicine images. The model boasts an average detection time of 0.0172 s per image, with a compressed size of 10 MB. Comparative experiments demonstrate the superior performance of our refined model over DenseNet121, ResNet50_vd, Xception65, and EfficientNetB1. This refined model not only introduces an approach to Chinese herbal medicine image recognition but also provides a practical solution for lightweight models in mobile applications.

Assessing the Influence of Patient Empowerment Gained Through Mental Health Apps on Patient Trust in the Health Care Provider and Patient Compliance With the Recommended Treatment: Cross-sectional Study.

BACKGROUND: In chronic mental illness, noncompliance with treatment significantly worsens the illness course and outcomes for patients. Considering that nearly 1 billion people worldwide experience mental health issues, including 1 of 5 Canadians in any given year, finding tools to lower noncompliance in these populations is critical for health care systems. A promising avenue is apps that make mental health services more accessible to patients. However, little is known regarding the impact of the empowerment gained from mental health apps on patient compliance with recommended treatment. OBJECTIVE: This study aimed to investigate the impact of patient empowerment gained through mental health apps on patient trust in the health care provider and patient compliance with the recommended treatment. METHODS: A cross-sectional web-based survey was conducted in Canada. Eligible participants were Canadian adults diagnosed with chronic mental health disorders who were using at least one of the following apps: Dialogue, MindBeacon, Deprexis, Ginger, Talkspace, BetterHelp, MindStrong, Mindshift, Bloom, Headspace, and Calm. A total of 347 valid questionnaires were collected and analyzed using partial least-squares structural equation modeling. Trust in the health care provider and patient compliance were measured with multiple-item scales adapted from existing scales. Patient empowerment was conceived and measured as a higher-order construct encompassing the following 2 dimensions: patient process and patient outcome. All the items contributing to the constructs in the model were measured with 7-point Likert scales. The reliability and validity of the measurement model were assessed, and the path coefficients of the structural model were estimated. RESULTS: The results clearly show that patient empowerment gained through mental health apps positively influenced patient trust in the health care provider (ß=.306; P<.001). Patient trust in the health care provider had a positive effect on patient compliance (ß=.725; P<.001). The direct relationship between patient empowerment and patient compliance was not significant (ß=.061, P=.23). Interestingly, the data highlight that the effect of patient empowerment on patient compliance was fully mediated by trust in the health care provider (ß=.222; P<.001). The results show that patient empowerment gained through the mental health app involves 2 dimensions: a process and an outcome. CONCLUSIONS: This study shows that for individuals living with mental health disorders, empowerment gained through mental health apps enhances trust in the health care provider. It reveals that patient empowerment impacts patient compliance but only through the full mediating effect of patient trust in the health care provider, indicating that patient trust is a critical variable to enhance patient compliance. Hence, our results confirm that health care systems could encourage the use of mental health apps to favor a climate that facilitates patients' trust in health care provider recommendations, possibly leading to better compliance with the recommended treatment.

An mHealth Application in German Health Care System: Importance of User Participation in the Development Process.

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications.

Development and initial testing of mindful journey: a digital mindfulness-based intervention for promoting recovery from Substance use disorder.

BACKGROUND/OBJECTIVES: There is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD. PATIENTS/MATERIALS: Ten adults receiving outpatient treatment for SUD. METHODS: Phase 1 (n = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample (n = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support. RESULTS: Across both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently. CONCLUSIONS: Based on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.

Feasibility and Usability of EnergyPoints: A Mobile Health App to Guide Acupressure Use for Cancer Symptom Management.

OBJECTIVE: To examine the feasibility and usability of EnergyPoints™, an innovative mobile health app that teaches and guides people with cancer to implement daily acupressure to self-manage their fatigue and sleep disturbances. METHODS AND INTERVENTION: The study used an integrated agile, human-centered approach. Adults (age 18 years and over) with cancer experiencing at least moderate fatigue, and living in the Greater New York City community, were recruited from social media, patient advocacy groups, and referrals. Twenty participants (in 3 sprints of 3, 5, and 12) were video-recorded thinking aloud while using the app for the first time. They then used the app at home to self-administer acupressure (twice daily for 1 week) while continuously wearing a fitness tracker. Each participant completed an exit interview and modified Computer System Usability Questionnaire post-participation. RESULTS: Participants were ages 40 to 76 years and 65% female; 65% were non-Hispanic white. Mean pass rates per ritual exceeded 80%. Users completed (totally or partially) greater than 90% of stimulating acupressure and 70% of relaxing acupressure rituals. Sprint 3 SPs totally completed at least 1 ritual 87% of the time. The majority agreed or strongly agreed the app was easy to use (90%), easy to learn (85%), easy to understand (75%), and effective in helping perform self-acupressure (85%). In an analysis of ease of completing 5 key tasks, all successfully completed the tasks; 3 users required some assistance. Of 654 usability statements, those coded as personal experience/context (197), content related to acupressure learning (105), and content related to the onboarding/profile (71) were most frequent. The design team integrated recommendations into the app before the next sprint. CONCLUSIONS: Findings supported feasibility and usability, as well as acceptability, and led to significant alterations and improvements. EnergyPoints™ offers an opportunity to mainstream acupressure and help cancer survivors self-manage their symptoms.

Which client with generalized anxiety disorder benefits from a mindfulness ecological momentary intervention versus a self-monitoring app? Developing a multivariable machine learning predictive model.

Precision medicine methods (machine learning; ML) can identify which clients with generalized anxiety disorder (GAD) benefit from mindfulness ecological momentary intervention (MEMI) vs. self-monitoring app (SM). We used randomized controlled trial data of MEMI vs. SM for GAD (N = 110) and tested three ML models to predict one-month follow-up reliable improvement in GAD severity, perseverative cognitions (PC), trait mindfulness (TM), and executive function (EF). Eleven baseline predictors were tested regarding differential reliable change from MEMI vs. SM (age, sex, race, EF errors, inhibitory dyscontrol, set-shifting deficits, verbal fluency, working memory, GAD severity, TM, PC). The final top five prescriptive predictor models of all outcomes performed well (AUC = .752 .886). The following variables predicted better outcome from MEMI vs. SM: Higher GAD severity predicted more GAD improvement but less EF improvement. Elevated PC, inhibitory dyscontrol, and verbal dysfluency predicted better improvement in most outcomes. Greater set-shifting and TM predicted stronger improvements in GAD symptoms and TM. Older age predicted more alleviation of GAD and PC symptoms. Women exhibited more enhancements in trait mindfulness and EF than men. White individuals benefitted more than non-White. PC, TM, EF, and sociodemographic data might help predictive models optimize intervention selection for GAD.

Tranceformation: Digital dissemination of hypnosis.

Hypnosis is an underutilized tool despite evidence of efficacy from randomized clinical trials. In this NeuroView, I discuss potential mechanisms in the context of brain networks and propose the use of app-based instruction in self-hypnosis.

Implementation of Direct-to-Patient Mobile Teledermatology in VA.

BACKGROUND: Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. OBJECTIVE: We evaluated Department of Veterans Affairs' (VA's) implementation of My VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person. DESIGN /PARTICIPANTS/APPROACH: Following pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app's implementation using qualitative and quantitative data consisting of encounter data from VA's corporate data warehouse; app usage from VA's Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff. KEY RESULTS: Implementation policies and practices included VA's vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process. CONCLUSIONS: Considerable heterogeneity existed in implementing mobile teledermatology, despite VA's common mission, integrated healthcare system, and stakeholders' broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier. CLINICAL TRIALS REGISTRATION: NCT03241589.

Design and Implementation of a Brief Digital Mindfulness and Compassion Training App for Health Care Professionals: Cluster Randomized Controlled Trial.

BACKGROUND: Several studies show that intense work schedules make health care professionals particularly vulnerable to emotional exhaustion and burnout. OBJECTIVE: In this scenario, promoting self-compassion and mindfulness may be beneficial for well-being. Notably, scalable, digital app-based methods may have the potential to enhance self-compassion and mindfulness in health care professionals. METHODS: In this study, we designed and implemented a scalable, digital app-based, brief mindfulness and compassion training program called "WellMind" for health care professionals. A total of 22 adult participants completed up to 60 sessions of WellMind training, 5-10 minutes in duration each, over 3 months. Participants completed behavioral assessments measuring self-compassion and mindfulness at baseline (preintervention), 3 months (postintervention), and 6 months (follow-up). In order to control for practice effects on the repeat assessments and calculate effect sizes, we also studied a no-contact control group of 21 health care professionals who only completed the repeated assessments but were not provided any training. Additionally, we evaluated pre- and postintervention neural activity in core brain networks using electroencephalography source imaging as an objective neurophysiological training outcome. RESULTS: Findings showed a post- versus preintervention increase in self-compassion (Cohen d=0.57; P=.007) and state-mindfulness (d=0.52; P=.02) only in the WellMind training group, with improvements in self-compassion sustained at follow-up (d=0.8; P=.01). Additionally, WellMind training durations correlated with the magnitude of improvement in self-compassion across human participants (ρ=0.52; P=.01). Training-related neurophysiological results revealed plasticity specific to the default mode network (DMN) that is implicated in mind-wandering and rumination, with DMN network suppression selectively observed at the postintervention time point in the WellMind group (d=-0.87; P=.03). We also found that improvement in self-compassion was directly related to the extent of DMN suppression (ρ=-0.368; P=.04). CONCLUSIONS: Overall, promising behavioral and neurophysiological findings from this first study demonstrate the benefits of brief digital mindfulness and compassion training for health care professionals and compel the scale-up of the digital intervention. TRIAL REGISTRATION: Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN94766568, https://www.isrctn.com/ISRCTN94766568.

Impact of a Mindfulness Mobile Application on Weight Loss and Eating Behavior in People with Metabolic Syndrome: a Pilot Randomized Controlled Trial.

BACKGROUND: Weight-loss approaches involving mindfulness have been reported to reduce overeating behavior. We conducted a preliminary evaluation of the feasibility and effectiveness of a mindfulness mobile application (MMA) combined with a comprehensive lifestyle intervention (CLI) focused on weight loss and eating behaviors for people with metabolic syndrome based on post-intervention follow-up data. METHOD: Participants were randomly assigned (1:1) to a CLI group or a CLI + MMA group. Participants received weekly CLI for 13 weeks, followed by telephone counseling for 13 weeks. The CLI + MMA group also had access to the MMA. Feasibility was assessed by the number of people who refused to participate, rate of adherence to the MMA, follow-up rate, and participant satisfaction. The preliminary endpoint was weight change (at 26 weeks). Participants completed the Dutch Eating Behavior Questionnaire (DEBQ). A mixed linear model was used for efficacy analysis. RESULTS: Eight of the 40 participants declined to participate. The MMA was used 4.4 ± 1.7 days per week, but the rate of adherence declined over time. The follow-up rate was 100%, and there was no difference in participant satisfaction between the groups. There was no significant group-by-time interaction for weight loss (p = 0.924), but there was a significant interaction for the DEBQ restrained eating score (p = 0.033). CONCLUSIONS: This study found that CLI plus MMA was highly feasible and moderately acceptable. There were no significant differences in weight loss between the groups, but the CLI + MMA group showed an increase in restrained eating. Further large-scale studies are needed. TRIAL REGISTRATION: Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000042626.

Exploring the relevance of a psychology-based resilience app (JoyPop™) for Indigenous youth.

BACKGROUND: Despite facing challenges to mental wellness from ongoing multifold trauma, Indigenous youth continue to galvanize their resilience. One pathway undertaken is embracing technology. The JoyPop™ youth resilience mobile application (app) was invited by Six Nations of the Grand River (SN) leadership to consider its use with their reserve youth. OBJECTIVE: This study explored the feasibility of JoyPop™ research from the SN community adult perspective for appropriateness and relevance to SN youth, as a precursor to a user-experience study with community youth. METHODS: Semi-structured, online interviews with 19 adult community members (26 % male) about JoyPop™ were conducted with nominated stakeholders from SN. Based on a standard presentation of the app, comments were solicited about app features, design, and relevance to Haudenosaunee culture. Interviews were transcribed, coded in a double-blind fashion, and analyzed for themes. RESULTS: Most offered positive feedback, with some level of support for each feature of JoyPop™. Themes were identified (Need for Indigenous Design, Incorporation of Indigenous Culture, Appreciation of Ease, Flexibility and Personalization), stemming from comments of appraisal and suggestions for adaptations (e.g., incorporating more cultural elements, localized resources, simplification of app). CONCLUSIONS: The JoyPop™ app was viewed as positive and relevant, based on feedback from adults within SN. Adaptations were identified by adults to better fit SN youth needs, and research with SN youth is pending before implementation of adaptations. Research with other communities is encouraged to expand the reach of technology interventions, to holistically support Indigenous youth mental health in a culturally relevant way.

App-based mindfulness training supported eudaimonic wellbeing during the COVID19 pandemic.

A randomized-controlled-trial study (N = 219) tested two pre-registered hypotheses that mobile-phone app-based mindfulness training improves wellbeing and increases self-transcendent emotions: gratitude, self-compassion, and awe. Latent change score modeling with a robust maximum likelihood estimator was used to test how those changes are associated in the training versus the waiting-list group. The training increased wellbeing and all self-transcendent emotions regardless of interindividual variance in the changes across time. Changes in all self-transcendent emotions were positively associated with changes in wellbeing. The strength of those associations was comparable in the waiting-list group and the training group. More studies are needed to test whether the effects of mindfulness practice on wellbeing are driven by increases in self-transcendent emotions. The study was conducted over 6 weeks during the COVID19 pandemic. The results indicate that the mindfulness training can be an easily accessible effective intervention supporting eudaimonic wellbeing in face of adversity.

A Systematic Review of Telehealth-Based Pediatric Cancer Rehabilitation Interventions on Disability.

Background: Telehealth is an emerging method which may overcome barriers to rehabilitation access for pediatric cancer survivors (aged ≤19 years). This systematic review aimed to examine telehealth-based rehabilitation interventions aimed at preventing, maintaining, or improving disability in pediatric cancer survivors. Methods: We performed systematic searches in Ovid MEDLINE, Ovid EMBASE, Cochrane Library, SCOPUS, Web of Science, and CINAHL Plus between 1994 and 2022. Eligible studies included telehealth-based interventions assessing disability outcomes in pediatric cancers. Results: Database searches identified 4,040 records. Nine unique interventions met the eligibility criteria. Telehealth delivery methods included telephone (n = 6), email (n = 3), mobile health applications (n = 3), social media (n = 3), videoconferencing (n = 2), text messaging (n = 2), active video gaming (n = 2), and websites (n = 2). Interventions focused on physical activity (n = 8) or self-management (n = 1). Outcomes assessing disability varied (n = 6). Three studies reported statistically and clinically significant results. Narrative synthesis of findings was constructed based on the Picker's principles for patient-centered care: (1) values, preferences, and needs; (2) involve family and friends; (3) coordination of care; (4) provide social support; (5) holistic well-being; and (6) information and communication. Conclusions: Telehealth-based rehabilitation interventions for pediatric cancer survivors is an emerging research area with potential to improve disability outcomes. Adequately powered trials with consistency in disability outcome measures are warranted. Additional research is needed to determine the effectiveness and best practices for telehealth-based pediatric cancer rehabilitation.

Conception and pilot testing of a self-management health application for patients with pollen-related allergic rhinitis and allergic asthma-the APOLLO app.

It has been shown that pollen information services are an important self-management tool for patients with pollen-related allergic rhinitis (AR) and allergic asthma (AA). This study aimed to design an online application for patients with AR and AA, which supports patients to better manage their disease as well as to evaluate the app and present the first results of the pilot study. The pollen data were obtained from the electronic pollen information network of Bavaria, Germany. Participants were asked to fill in their allergy-related complaints in the app over a 60-day period. Subsequently, the app was evaluated. Indices and diagrams visualized the participants' individual complaints as well as the daily pollen concentration in the air. In order to motivate participants to complete the app on a daily basis, we used elements of gamification. Two thirds of the participants (N = 46) reported feeling better informed about pollen counts and their allergy when using the app. The app's simple and comprehensible design was rated positively. More than 80% of the participants would recommend the app to their family and friends. The app can be a tool for patients with AR and AA to better understand their disease.

Effect of a mindfulness training app on a cigarette quit attempt: an investigator-blinded, 58-county randomized controlled trial.

BACKGROUND: Cigarette smoking is the leading cause of preventable cancers. A majority of the 34 million people who currently smoke report wanting to quit. Mindfulness training apps offer a guided telehealth intervention to foster individuals' behavioral meditation practice. We present the main outcomes of a parallel-group randomized controlled trial that tested app-based mindfulness training vs attention control on smoking behavior. METHODS: We enrolled adult residents from across California who smoked daily and were willing to make a quit attempt (N = 213). Participants completed daily sessions in 10-minute segments for 14 consecutive days. Participants then started a quit attempt and reported daily smoking for 28 days following the quit date using the timeline follow-back measure. RESULTS: Seven-day point-prevalence abstinence for each week during the 4-week quit period ranged from 21.8% to 27.7% for app-based mindfulness training and 17.9% to 19.6% for controls. The intention-to-treat sample revealed that app-based mindfulness training outperformed controls on the proportion of abstinence days during the quit period (odds ratio = 2.00, 95% confidence interval = 1.03 to 3.87, P = .041). Although the 7-day point prevalence abstinence for week 4 favored app-based mindfulness training, significance was not reached (odds ratio = 1.65, 95% confidence interval = 0.84 to 3.23, P = .148). The mean number of cigarettes smoked per day among smokers was 4.95 for app-based mindfulness training vs 5.69 for controls (odds ratio = 0.81, 95% confidence interval = 0.71 to 0.92, P = .002), suggesting harm reduction in continued smokers. CONCLUSION: A mindfulness training app prescribed for 2 weeks leading up to a quit date showed an advantage over controls for total abstinence days and fewer cigarettes smoked in a diverse sample consisting of urban and rural residents. These findings yield implications for the use of apps to reduce exposure to the carcinogenic properties of cigarette smoke.

Efficacy and acceptability of mobile application-delivered acceptance and commitment therapy for posttraumatic stress disorder in China: A randomized controlled trial.

Due to the COVID-19 pandemic and its extensive effects, the incidence of posttraumatic stress disorder (PTSD) symptoms is rapidly increasing in China. This research aimed to assess the efficacy and acceptability of a mobile application delivering Acceptance and Commitment Therapy (ACT) in reducing PTSD symptoms. 221 Chinese individuals with elevated PTSD symptoms were randomly assigned to app-delivered ACT (ACT condition), app-delivered mindfulness (MI condition), or a waitlist (WL condition). Assessments were performed pre- and post-intervention. The results showed that participants in both the ACT and MI groups had significantly greater improvements across mental health outcomes compared to the WL group. No significant differences were observed between the ACT and MI groups except for psychological flexibility, which improved more in ACT than MI (d = -0.37). Compared to WL, the ACT group showed a greater improvement in PTSD symptoms (d = -0.79), anxiety (d = -0.62), depression (d = -0.51), posttraumatic growth (d = 0.46), and psychological flexibility (d = 0.76). The drop-out rates in the ACT and MI were 25.76% and 39.71%, respectively. Participants in the ACT condition reported medium program satisfaction. The study suggests app-delivered ACT is efficacious in reducing PTSD symptoms and improving overall mental health among Chinese adults.

Development, validation, and usability testing of prototype mobile application for oral health promotion during pregnancy in India.

Background: Oral diseases are a silent epidemic. Objectives: The objectives of the study were to develop, validate, and assess the usability of an oral health prototype mobile application for oral health promotion among pregnant women in India. Materials and Methods: A cross-sectional study was conducted in Tertiary Care Hospital in Delhi, India, after obtaining Ethical Clearance from the Institutional Ethical Committee Board. The study was conducted in three phases: development of the prototype app, its validation, followed by usability testing of the app. Mobile app was validated by 30 pregnant women and 30 subject experts using Heuristic Analysis Scale and usability testing by 30 pregnant women based on System Usability Scale (SUS). Data were analyzed with IBM SPSS version 21.0. Results: Majority (over 90%) of pregnant women and subject experts strongly acknowledged that the app educated the users using positive motivation strategies, instilling comprehensive knowledge and faced no issues with the appropriate functionality of the app. The prototype app scored 73.75 on SUS, indicating high usability. Conclusion: This study holistically explored various dimensions of oral health care in pregnant women. Its novelty is proven by the fact that the content of the prototype application has been phase wise developed and validated by pregnant women and subject experts. Usability testing of the app indicated its high acceptability and ease of use among pregnant women in India.

The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial.

BACKGROUND: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. OBJECTIVE: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study's core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. METHODS: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. RESULTS: The 4-week program showed significant stress reduction (Wald χ22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald χ42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald χ22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM -0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. CONCLUSIONS: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407.