The Annual Wellness Visit Health Risk Assessment: Potential of Patient Portal-Based Completion and Patient-Oriented Education and Support.

Background and Objectives: Patient portals are secure online platforms that allow patients to perform electronic health management tasks and engage in bidirectional information exchange with their care team. Some health systems administer Medicare Annual Wellness Visit (AWV) health risk assessments through the patient portal. Scalable opportunities from portal-based administration of risk assessments are not well understood. Our objective is 2-fold-to understand who receives vs misses an AWV and health risk assessment and explore who might be missed with portal-based administration. Research Design and Methods: This is an observational study of electronic medical record and patient portal data (10/03/2021-10/02/2022) for 12 756 primary care patients 66+ years from a large academic health system. Results: Two-thirds (n = 8420) of older primary care patients incurred an AWV; 81.0% of whom were active portal users. Older adults who were active portal users were more likely to incur AWV than those who were not, though portal use was high in both groups (81.0% with AWV vs 76.8% without; p < .001). Frequently affirmative health risk assessment categories included falls/balance concerns (44.2%), lack of a documented advanced directive (42.3%), sedentary behaviors (39.9%), and incontinence (35.1%). Mean number of portal messages over the 12-month observation period varied from 7.2 among older adults affirmative responses to concerns about safety at home to 13.8 for older adults who reported difficulty completing activities of daily living. Portal messaging varied more than 2-fold across affirmative health risk categories and were marginally higher with greater number affirmative (mean = 13.8 messages/year no risks; 19.6 messages/year 10+ risks). Discussion and Implications: Most older adults were active portal users-a group more likely to have incurred a billed AWV. Efforts to integrate AWV risk assessments in the patient portal may streamline administration and scalability for dissemination of tailored electronically mediated preventive care but must attend to equity issues.

School Health Services' Use of Information and Communication Technologies in Interorganizational Collaboration Regarding Students With Mental Illness: A Scoping Review.

School health services (SHSs) and school nurses play a crucial role in identifying and supporting students with mental illness. The integration of information and communication technology (ICT) can facilitate interorganizational collaboration in this context. Due to the limited research in this area, a scoping review was conducted to explore SHSs' use of ICT in interorganization collaboration regarding students with mental illness. Six articles were reviewed, revealing three key themes: "types of ICT employed by SHSs in interorganizational collaboration," "constellation of SHSs in interorganizational collaboration," and "opportunities and challenges for SHSs using ICT in interorganizational collaboration." Notably, two of the six articles highlighted the absence of school nurses in interorganizational collaboration. Even though ICT plays a crucial role in interorganizational collaboration, no comprehensive solution was found. This scoping review confirms that there are challenges with operability and regulations that govern the exchange of private information between organizations.

Using Mixed Reality Simulation to Improve Junior Medical Trainees' Preparedness to Manage High-Acuity Trauma.

High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality education report sought to investigate whether a simulation course operated via mixed reality (MR) headset devices (Microsoft HoloLens) could enhance the clinical knowledge recall and preparedness to practice of junior trainees with no prior experience managing trauma.The Plan-Do-Study-Act quality improvement method was used to refine six emergency trauma vignettes compatible with an MR teaching platform. Each vignette was curated by a multidisciplinary team of orthopaedic surgeons, clinical fellows and experts in simulation-based medical education. As a baseline assessment, a 2-hour emergency trauma course was delivered using traditional didactic methods to a cohort of pre-registration medical students with no clinical exposure to high-acuity trauma (n=16). Next, we delivered the MR simulation to an equivalent cohort (n=32). Clinical knowledge scores derived from written test papers were recorded for each group during and 2 weeks after each course. Each attendee's end-of-rotation clinical supervisor appraisal grade was recorded, as determined by a consultant surgeon who supervised participants during a 2-week placement on a major trauma ward. Balancing measures included participant feedback and validated cognitive load questionnaires (National Aeronautics and Space Administration-Task Load Index).Overall, attendees of the MR simulation course achieved and sustained higher clinical knowledge scores and were more likely to receive a positive consultant supervisor appraisal. This project serves as a proof of concept that MR wearable technologies can be used to improve clinical knowledge recall and enhance the preparedness to practice of novice learners with otherwise limited clinical exposure to high-acuity trauma.

Análisis de las interrupciones generadas por el uso de los smartphones entre los profesionales sanitarios de Atención Primaria / Analysis of the interruptions generated by the use of smartphones among Primary Care Health professionals

Objetivo: Analizar el uso particular de los smartphones entre los profesionales sanitarios de Atención Primaria durante el acto asistencial y sus consecuencias. Diseño: Estudio multicéntrico, transversal en un entorno de atención primaria, realizado en 3 fases: encuesta a profesionales, checklist de profesionales y encuesta a pacientes. Participantes: Profesionales sanitarios de atención primaria de la Gerencia Territorial de Atención Primaria de Barcelona (encuesta online) y profesionales sanitarios (checklist) y pacientes (encuesta a los pacientes) de 2equipos de Atención Primaria de Barcelona ciudad. Mediciones principales: Análisis descriptivo bivariado de las variables de las distintas encuestas. Utilización del teléfono móvil en la consulta, tiempo, motivo, tipo de uso y percepción de adecuación. Características de las interrupciones. Resultados: En relación con los pacientes, un 31% considera que el profesional sanitario solo debe consultar el teléfono móvil si es para resolver algún aspecto de su motivo de consulta y un 10% lo considera una falta de respeto. El 18% de los pacientes describen interrupciones, siendo la mayoría de entre 10 y 30 s de duración y considerándolas en su mayoría evitables. En relación con los profesionales, la mayoría (96%) afirma tener el teléfono móvil en la consulta y de manera silenciada (77%), y reconociendo solo el 2% su uso en presencia del paciente, lo que contrasta con lo descrito por los pacientes. Además, el 80% de los profesionales afirman pedir permiso para utilizarlo, contrastando con lo que refieren los pacientes (50%). El 85% de los profesionales consideran su uso como adecuado...(AU)

Objective: To analyze the particular use of smartphones among Primary Care Health professionals during the care act and its consequences. Design: Multicenter, cross-sectional study in a primary care setting, carried out in 3phases: survey of professionals, checklist of professionals and survey of patients. Participants: Primary Care Health professionals from the Territorial Primary Care Management of Barcelona (online survey) and health professionals (checklist) and patients (patient survey) from 2primary care teams in Barcelona city. Main measurements: Bivariate descriptive analysis of the variables from the different surveys. Use of the mobile phone in the consultation, time, reason, type of use and perception of appropriateness. Characteristics of interruptions. Results: In relation to patients, 31% consider that the health professional should only consult the mobile phone if it is to resolve some aspect of their reason for consultation and 10% consider it a lack of respect. Eighteen percent of patients describe interruptions, the majority lasting between 10 and 30s and considering them mostly avoidable. In relation to professionals, the majority (96%) claim to have their mobile phone in the consultation and on mute (77%), with only 2% recognizing its use in the presence of the patient, which is in line with what the patients describe. Furthermore, 80% of professionals say they ask permission to use it, contrasting with what patients report (50%). Eighty-five percent of professionals consider its use appropriate. Conclusions: The use of mobile phones is perceived by patients as an interruption that can affect the care act, generating dissatisfaction, which must be taken into account by health professionals. Healthcare organizations should establish recommendations regarding the use of mobile phones in consultations.

A Health Information Technology Protocol to Enhance Colorectal Cancer Screening.

This study addresses barriers to electronic health records-based colorectal cancer screening and follow-up in primary care through the development and implementation of a health information technology protocol.

Evaluating Pilot Implementation of 'PenCS Flu Topbar' App in Medical Practices to Improve National Immunisation Program-Funded Seasonal Influenza Vaccination in Central Queensland, Australia.

BACKGROUND: The 'PenCS Flu Topbar' app was deployed in Central Queensland (CQ), Australia, medical practices through a pilot programme in March 2021. METHODS: We evaluated the app's user experience and examined whether the introduction of 'PenCS Flu Topbar' in medical practices could improve the coverage of NIP-funded influenza vaccinations. We conducted a mixed-method study including a qualitative analysis of in-depth interviews with key end-users and a quantitative analysis of influenza vaccine administrative data. RESULTS: 'PenCS Flu Topbar' app users reported positive experiences identifying patients eligible for NIP-funded seasonal influenza vaccination. A total of 3606 NIP-funded influenza vaccinations was administered in the eight intervention practices, 14% higher than the eight control practices. NIP-funded vaccination coverage within practices was significantly higher in the intervention practices (31.2%) than in the control practices (27.3%) (absolute difference: 3.9%; 95% CI: 2.9%-5.0%; p < 0.001). The coverage was substantially higher in Aboriginal and Torres Strait Islander people aged more than 6 months, pregnant women and children aged 6 months to less than 5 years for the practices where the app was introduced when compared to control practices: incidence rate ratio (IRR) 2.4 (95% CI: 1.8-3.2), IRR 2.7 (95% CI: 1.8-4.2) and IRR 2.3 (1.8-2.9) times higher, respectively. CONCLUSIONS: Our evaluation indicated that the 'PenCS Flu Topbar' app is useful for identifying the patients eligible for NIP-funded influenza vaccination and is likely to increase NIP-funded influenza vaccine coverage in the eligible populations. Future impact evaluation including a greater number of practices and a wider geographical area is essential.

Modelling of physicians' clinical information-seeking behaviour in Iran: a grounded theory study.

OBJECTIVES: Exploring clinical information-seeking behaviour (CISB) and its associated factors contributes to its theoretical advancement and offers a valuable framework for addressing physicians' information needs. This study delved into the dimensions, interactions, strategies and determinants of CISB among physicians at the point of care. DESIGN: A grounded theory study was developed based on Strauss and Corbin's approach. Data were collected by semistructured interviews and then analysed through open, axial and selective coding. SETTING: The study was conducted at academic centres affiliated with Isfahan University of Medical Sciences. PARTICIPANTS: This investigation involved recruiting 21 specialists and subspecialists from the academic centres. RESULTS: The findings revealed that physicians' CISB encompassed multiple dimensions when addressing clinical inquiries. Seven principal themes emerged from the analysis: 'clinical information needs', 'clinical question characteristics', 'clinical information resources', 'information usability', 'factors influencing information seeking', 'action/interaction encountering clinical questions' and 'consequences of CISB'. The core category identified in this study was 'focused attention'. CONCLUSIONS: The theoretical explanation demonstrated that the CISB process was interactive and dynamic. Various stimuli, including causal, contextual and intervening conditions, guide physicians in adopting information-seeking strategies and focusing on resolving clinical challenges. However, insufficient stimuli may hinder physicians' engagement in CISB. Understanding CISB helps managers, policy-makers, clinical librarians and information system designers optimally implement several interventions, such as suitable training methods, reviewing monitoring and evaluating information systems, improving clinical decision support systems, electronic medical records and electronic health records, as well as monitoring and evaluating these systems. Such measures facilitate focused attention on clinical issues and promote CISB among physicians.

Exploring dietitians' views on digital nutrition educational tools in Malaysia: a qualitative study.

BACKGROUND/OBJECTIVES: Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians' perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools. SUBJECTS/METHODS: A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia. Inductive thematic analysis of the responses was conducted using NVivo version 12 software. RESULTS: Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system. CONCLUSION: Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues.

Multi-dimensional challenges in the Indonesian social science information technology-based learning: A systematic literature review.

The development of information technology (IT) has an essential role in education today. Most teachers in Indonesia utilize the traditional method rather than the advancement of IT. Through digital media, the social science learning process becomes fascinating, improves students' skills, and is more engaging. However, implementing Information Technology-based Learning (ITBL) takes a lot of work. It comes with tremendous challenges that should be addressed carefully. Many previous studies explain the feasibility of the media, its effectiveness, and the advantages of using IT-based learning media. However, they still need to present the challenges in IT-based social science learning, even more so in the Indonesian context. Given the vast landscape of ITBL in Indonesia, a case study approach could entail extensive fieldwork, data collection, and data analysis. Therefore, A literature review can be carried out with less resource investment, making it a pragmatic choice for researchers with limited time and resources. This research aims to discover the challenges of students, teachers, and educational institutions in IT-based social science learning in the Indonesian context. The search protocol is based on the P.R.I.S.M.A. (Preferred Reporting Items for Systematic Reviews and Meta-analysis). This systematic literature review results were obtained from 315 articles discussing the challenges of IT-based social science learning published from 2018 until 2022. This research reveals that most challenges students face are internal/self-challenges. For instance, there needs to be more self-regulation and necessary digital literation. On the other hand, teachers' most significant challenge is their lack of skills and experience in implementing IT-based learning media and their inability to operate complex software, even if they have poor digital literacy. The need for facilities and technological training presents challenges for institutions. The need to procure IT infrastructure is due to the difficulty of reaching certain areas (the terrain) in Indonesia. The challenges encountered by students, teachers, and educational institutions are not exclusive to any particular group and extend beyond their respective domains. Addressing the multi-dimensional challenges would be more efficient. The poor digital literacy challenges occurred in other nations, too. This particular challenge can be solved through instructional training. Moreover, the Indonesian government offers numerous free digital training programs for individuals or institutions called "Digitalent."

Facing the digital frontier: exploring user acceptance of electronic health records in an urban, rural and remote setting in the Philippines.

OBJECTIVES: A thorough understanding of user needs and behavioural intent-to-use underpins the development of a responsive health information system. This study aimed to examine health workers' intent-to-use an electronic health record (EHR) system in an urban, rural and remote setting in the Philippines. METHODS: Following the Unified Theory of Acceptance and Use of Technology framework, user acceptance and the factors influencing intent-to-use the EHR were examined through a self-administered questionnaire. A total of 128 EHR users, comprising physicians, nurses, midwives, barangay health workers and administrative staff, were surveyed. Median scores for each domain were compared across the sites using the Kruskal-Wallis test. Ridge regression analysis was used to identify factors associated with behavioural intent-to-use. RESULTS: Over 94% of users across all sites reported their intent-to-use the EHR in the near future. Of the seven predictor variables examined, only self-efficacy was found to be significantly associated with behavioural intent-to-use. Intent-to-use the EHR increased by 31% (p=0.007) for each unit increase in self-efficacy score among participants. DISCUSSION: Acceptance was high across the three sites, with self-efficacy being a predictor of intent-to-use the technology. This suggests that users are more likely to adopt an EHR if they believe they have the capacity to successfully navigate the technology and perform their designated tasks with it. CONCLUSION: Co-producing interventions with primary care providers is crucial in sustaining EHR systems. Rather than developing a technology based on the surveillance needs of policymakers, an EHR developed from the grassroots was shown to be well-received by end-users.

Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review.

BACKGROUND: Discomfort and distressing symptoms are common at the end of life, while people in this stage are often no longer able to express themselves. Technologies may aid clinicians in detecting and treating these symptoms to improve end-of-life care. This review provides an overview of noninvasive monitoring technologies that may be applied to persons with limited communication at the end of life to identify discomfort. METHODS: A systematic search was performed in nine databases, and experts were consulted. Manuscripts were included if they were written in English, Dutch, German, French, Japanese or Chinese, if the monitoring technology measured discomfort or distressing symptoms, was noninvasive, could be continuously administered for 4 hours and was potentially applicable for bed-ridden people. The screening was performed by two researchers independently. Information about the technology, its clinimetrics (validity, reliability, sensitivity, specificity, responsiveness), acceptability, and feasibility were extracted. RESULTS: Of the 3,414 identified manuscripts, 229 met the eligibility criteria. A variety of monitoring technologies were identified, including actigraphy, brain activity monitoring, electrocardiography, electrodermal activity monitoring, surface electromyography, incontinence sensors, multimodal systems, and noncontact monitoring systems. The main indicators of discomfort monitored by these technologies were sleep, level of consciousness, risk of pressure ulcers, urinary incontinence, agitation, and pain. For the end-of-life phase, brain activity monitors could be helpful and acceptable to monitor the level of consciousness during palliative sedation. However, no manuscripts have reported on the clinimetrics, feasibility, and acceptability of the other technologies for the end-of-life phase. CONCLUSIONS: Noninvasive monitoring technologies are available to measure common symptoms at the end of life. Future research should evaluate the quality of evidence provided by existing studies and investigate the feasibility, acceptability, and usefulness of these technologies in the end-of-life setting. Guidelines for studies on healthcare technologies should be better implemented and further developed.

Digital health technologies: Compounding the existing ethical challenges of the 'right' not to know.

INTRODUCTION: Doctors hold a prima facie duty to respect the autonomy of their patients. This manifests as the patient's 'right' not to know when patients wish to remain unaware of medical information regarding their health, and poses ethical challenges for good medical practice. This paper explores how the emergence of digital health technologies might impact upon the patient's 'right' not to know. METHOD: The capabilities of digital health technologies are surveyed and ethical implications of their effects on the 'right' not to know are explored. FINDINGS: Digital health technologies are increasingly collecting, processing and presenting medical data as clinically useful information, which simultaneously presents large opportunities for improved health outcomes while compounding the existing ethical challenges generated by the patient's 'right' not to know. CONCLUSION: These digital tools should be designed to include functionality that mitigates these ethical challenges, and allows the preservation of their user's autonomy with regard to the medical information they wish to learn and not learn about.

Overcoming Electronic Medical Records Adoption Challenges in Saudi Arabia.

In the digital era, the seamless integration of electronic medical records (EMR) stands as a pivotal milestone in transforming healthcare delivery, with Saudi Arabia at the forefront of this revolution in the Middle East. This literature review comprehensively explores the challenges and opportunities associated with adopting EMR in the Kingdom of Saudi Arabia (KSA) in alignment with the nation's Vision 2030 healthcare objectives. The review synthesizes research from various scholarly sources, utilizing databases such as PubMed, Scopus, Google Scholar, and regional databases, and focuses on literature published between 2010 and 2023. Our methodology included a strategic combination of keywords and a stringent selection criterion to ensure a focus on relevant EMR adoption studies within KSA. The review addresses key aspects of EMR adoption, including technical challenges, financial constraints, human factors, cultural and organizational barriers, privacy and security concerns, and policy and regulatory challenges. It also explores the integration of EMR with other digital health initiatives like telehealth, personal health records, and community pharmacy services. The findings reveal a complex interplay of factors influencing EMR adoption, highlighting the need for comprehensive strategies that address technical, financial, cultural, and policy-related barriers. The review concludes that while significant challenges exist, strategic approaches and solutions tailored to the specific context of Saudi Arabia can effectively facilitate EMR integration, thereby enhancing healthcare quality and efficiency in line with the nation's Vision 2030 goals.

Impact of IoT System Imperfections and Passenger Errors on Cruise Ship Evacuation Delay.

Cruise ships and other naval vessels include automated Internet of Things (IoT)-based evacuation systems for the passengers and crew to assist them in case of emergencies and accidents. The technical challenges of assisting passengers and crew to safety during emergencies include various aspects such as sensor failures, imperfections in the sound or display systems that are used to direct evacuees, the timely selection of optimum evacuation routes for the evacuees, as well as computation and communication delays that may occur in the IoT infrastructure due to intense activities during an emergency. In addition, during an emergency, the evacuees may be confused or in a panic, and may make mistakes in following the directions offered by the evacuation system. Therefore, the purpose of this work is to analyze the effect of two important aspects that can have an adverse effect on the passengers' evacuation time, namely (a) the computer processing and communication delays, and (b) the errors that may be made by the evacuees in following instructions. The approach we take uses simulation with a representative existing cruise ship model, which dynamically computes the best exit paths for each passenger, with a deadline-driven Adaptive Navigation Strategy (ANS). Our simulation results reveal that delays in the evacuees' reception of instructions can significantly increase the total time needed for passenger evacuation. In contrast, we observe that passenger behavior errors also affect the evacuation duration, but with less effect on the total time needed to evacuate passengers. These findings demonstrate the importance of the design of passenger evacuation systems in a way that takes into account all realistic features of the ship's indoor evacuation environment, including the importance of having high-performance data processing and communication systems that will not result in congestion and communication delays.

Population health in primary care.

Population health in the United States continues to lag behind other wealthy nations. Primary care has the promise of enhancing population health; however, the implementation of a population health approach within primary care deserves further consideration. Clinicians and staff from a national sample of 10 innovative primary care practices participated in a working conference to reflect upon population health approaches in primary care. A series of small- and large-group discussions were recorded, transcribed, and coded through an immersion/crystallization approach. Two prominent themes emerged: (1) Transitioning to a population health focus generally develops through stages, with early implementation focusing on risk stratification and later, more advanced stages focusing on community health; and (2) Several inherent barriers confront implementation of a population health approach, including tensions with patient-centered care, and limitations of health information technology. A broader conceptualization of population health in terms of community health could more effectively allow partnerships among primary care, large health care systems, public health organizations, patients, and other partners in the community.

Implementing weight maintenance with existing staff and electronic health record tools in a primary care setting: Baseline results from the MAINTAIN PRIME trial.

BACKGROUND: There is need for interventions that can assist with long-term maintenance of healthy body weight and be sustainably integrated into existing primary care teams. The goal of MAINTAIN PRIME (Promoting Real (World) IMplEmentation) is to evaluate whether a successful electronic health record (EHR)-based weight maintenance intervention can be adapted to a new clinical setting with primary care staff serving as coaches. METHODS: EHR tools include tracking tools, standardized surveys, and standardized "SmartPhrases" for coaching. Inclusion criteria were age 18-75 years, voluntary 5% weight loss in the past 2 years with prior BMI ≥ 25 kg/m2, and no bariatric procedures in past 2 years. Participants were randomized 1:1 to tailored online coaching with EHR tracking tools (coaching) or EHR tracking tools alone (tracking). RESULTS: We screened 405 individuals between September 2021 and April 2023; 269 participants enrolled (134 coaching; 135 tracking). The most common reason for not enrolling was ineligibility (55%). At baseline, participants were 50.3 (SD 15.02) years old, 66.4% female, and 84% White; 83.7% reported moderate physical activity. Average weight and BMI at baseline were 205.0 (SD 48.9) lbs. and 33.2 (6.8) kg/m2, respectively. Participants lost an average of 10.7% (SD 5.2) of their body weight before enrolling. We recruited 39 primary care coaches over the same period. Conclusion The study successfully identified and recruited primary care patients with recent intentional weight loss for participation in a weight maintenance program that uses EHR-based tools. We also successfully recruited and trained primary care staff as coaches.

Usability and Acceptability of a Conversational Agent Health Education App (Nthabi) for Young Women in Lesotho: Quantitative Study.

BACKGROUND: Young women in Lesotho face myriad sexual and reproductive health problems. There is little time to provide health education to women in low-resource settings with critical shortages of human resources for health. OBJECTIVE: This study aims to determine the acceptability and usability of a conversational agent system, the Nthabi health promotion app, which was culturally adapted for use in Lesotho. METHODS: We conducted a descriptive quantitative study, using a 22-item Likert scale survey to assess the perceptions of the usability and acceptability of 172 young women aged 18-28 years in rural districts of Lesotho, who used the system on either smartphones or tablets for up to 6 weeks. Descriptive statistics were used to calculate the averages and frequencies of the variables. χ2 tests were used to determine any associations among variables. RESULTS: A total of 138 participants were enrolled and completed the survey. The mean age was 22 years, most were unmarried, 56 (40.6%) participants had completed high school, 39 (28.3%) participants were unemployed, and 88 (63.8%) participants were students. Respondents believed the app was helpful, with 134 (97.1%) participants strongly agreeing or agreeing that the app was "effective in helping them make decisions" and "could quickly improve health education and counselling." In addition, 136 (98.5%) participants strongly agreed or agreed that the app was "simple to use," 130 (94.2 %) participants reported that Nthabi could "easily repeat words that were not well understood," and 128 (92.7%) participants reported that the app "could quickly load the information on the screen." Respondents were generally satisfied with the app, with 132 (95.6%) participants strongly agreeing or agreeing that the health education content delivered by the app was "well organised and delivered in a timely way," while 133 (96.4%) participants "enjoyed using the interface." They were satisfied with the cultural adaptation, with 133 (96.4%) participants strongly agreeing or agreeing that the app was "culturally appropriate and that it could be easily shared with a family or community members." They also reported that Nthabi was worthwhile, with 127 (92%) participants reporting that they strongly agreed or agreed that they were "satisfied with the application and intended to continue using it," while 135 (97.8%) participants would "encourage others to use it." Participants aged 18-24 years (vs those aged 25-28 years) agreed that the "Nthabi app was simple to use" (106/106, 100% vs 30/32, 98.8%; P=.01), and agreed that "the educational content was well organised and delivered in a timely way" (104/106, 98.1% vs 28/32, 87.5%; P=.01). CONCLUSIONS: These results support further study of conversational agent systems as alternatives to traditional face-to-face provision of health education services in Lesotho, where there are critical shortages of human resources for health. TRIAL REGISTRATION: ClinicalTrials.gov NCT04354168; https://www.clinicaltrials.gov/study/NCT04354168.