Abstract BackgroundUniversity students face substantial underserved mental health needs. Digital “front doors” that combine brief screening, decision support, and timely counselor follow-up may help close access and workflow gaps on campus. SISKA (Sistem Informasi Layanan Konseling Akademik; ObjectiveThe study aims to evaluate the feasibility, acceptability, and usability of SISKA in Indonesian public universities and to identify strengths and friction points to inform implementation at scale. MethodsThis exploratory sequential mixed-methods study recruited trained lecturer-counselors (n=20) who provided qualitative input on practicality and integration and 3 student cohorts to assess (1) usability (n=35 students who completed all 10 System Usability Scale [SUS] questions), (2) use analytics (n=1057 active accounts from December 2024 to October 2025), and (3) changes in mental health before and after the intervention (n=119 students with ≥1 counseling session and paired daily mental health assessment scores). This was a single-arm feasibility study without a comparator group. Analyses included descriptive summaries and paired tests; qualitative data were analyzed thematically to explain quantitative patterns. ResultsMonthly uptake showed a launch spike, a mid-year trough, and a late-year uptick. Usability metrics showed a short learning curve and manageable cognitive load (SUS mean score 83.3, SD 10.5) with strong item agreement on ease, quick learning, and integration. In the pre- and postintervention cohort, daily mental health assessment scores declined from a mean 33.9 (SD 8.07) to a mean 32.8 (SD 8.94; Δ=−1.14; P ConclusionsSISKA appears feasible and acceptable for campus deployment, enabling earlier support pathways and showing proximal improvement among counseled students. Priorities for scaling up the app include user interface standardization, streamlined confirmation flows, and reliable, context-sensitive notifications, alongside embedding measurement-based care loops to convert routine self-reports into timely feedback and action. These findings support the readiness of the app for structured implementation in university settings.
Wellness4Teachers is a daily supportive text messaging program implemented to mitigate psychological distress and support teachers’ well-being in Canada. This study aimed to assess whether Wellness4Teachers can reduce the severity and prevalence of psychological issues and improve resilience among teachers in Alberta, Newfoundland and Labrador, and Nova Scotia. This study used a single-arm prospective longitudinal design with a secondary exploratory naturalistic contemporaneous comparison. Teachers self-subscribed to the program for 6 months and completed web-based surveys. Longitudinal outcomes were assessed at baseline, 6 weeks, 3 months, and 6 months. The naturalistic comparison included an intervention group (IG), which received messages for 6 months and completed 6-month assessments between March 1 and June 30, 2023, and a control group (CG), which enrolled and completed baseline assessments during the same period before receiving messages. Standardized scales were used for assessing psychological symptoms. Likely generalized anxiety disorder (GAD), likely major depressive disorder (MDD), resilience, burnout, and stress were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, the Patient Health Questionnaire-9 (PHQ-9), the Brief Resilience Scale, the Maslach Burnout Inventory-Educator Survey, and the Perceived Stress Scale-10 (PSS-10), respectively. Data were analyzed using SPSS. Paired- and independent-sample t tests were used to compare longitudinal changes and groups, respectively. McNemar and chi-square tests were used to examine categorical variables. Missing follow-up data were addressed using last observation carried forward, with sensitivity analyses comparing baseline scores with those at 6 weeks, 3 months, and 6 months. The group type (IG vs CG) was entered as a variable together with all demographic and work-related variables into 9 separate logistic regression models. In the longitudinal analysis, PSS-10, Maslach Burnout Inventory-Emotional Exhaustion subscale, PHQ-9, PHQ-9 item 3 (sleep disturbance), PHQ-9 item 9 (suicidal ideation/self-harm), and GAD-7 scores decreased significantly at 6 months, by 5.50% (mean difference [MD]=1.29, 95% CI 0.86-1.72), 4.48% (MD=1.67, 95% CI 0.43-2.92), 18.58% (MD=2.10, 95% CI 1.39-2.80), 17.54% (MD=0.30, 95% CI 0.15-0.44), 37.50% (MD=0.09, 95% CI 0.02-0.17), and 13.52% (MD=1.30, 95% CI 0.62-1.99), respectively. Likely MDD decreased from 55.2% (n=116) to 41.0% (n=86), a 14.2% reduction. In the exploratory contemporaneous comparison, the IG (n=166) had lower PSS-10 (6.04%; MD=–1.41, 95% CI –2.17 to –0.65), PHQ-9 (21.16%; MD=–2.33, 95% CI –3.59 to –1.06), and GAD-7 (22.48%; MD=–2.19, 95% CI –3.39 to –0.98) scores than the CG (n=152). Likely MDD and GAD prevalence were 20.6% and 20.3% lower, respectively. Adjusted analyses showed IG status was associated with lower odds of high stress (odds ratio [OR] 0.42, 95% CI 0.19-0.95), likely MDD (OR 0.47, 95% CI 0.28-0.81), and likely GAD (OR 0.37, 95% CI 0.21-0.64). Wellness4Teachers was associated with improvements in several psychological outcomes over 6 months and may offer a promising approach to support teachers’ psychological well-being. RR2-10.2196/37934
Abstract Background Hospital-at-home (HaH) services are transformative for delivering acute care in a patient’s home, with support from a multidisciplinary team and remote monitoring technologies, and there is a growing demand for innovation and digital solutions. Digital twin (DT) technology offers the possibility of leveraging real-time data to personalize care, predict risk, and improve patient management. However, perceptions of the workforce regarding the application of HaH DTs remain underexplored, and addressing this is crucial for successful adoption and sustainability. Objective This qualitative study aimed to explore health and care professionals’ perceptions of the concept of a HaH DT model of care and its perceived impact. Methods A total of 26 semistructured interviews were conducted between June and December 2025. Participants were based in the United Kingdom and were recruited through purposive sampling via known contacts, professional networking, and social media. A short vignette on DTs was presented to participants at the start of the interview. An interview topic guide centered around acceptability and the domains of the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was used to explore complexity in implementation and potential management. Data analysis involved a hybrid approach drawing on reflexive thematic analysis. Results Seven overarching themes were identified, highlighting a mixture of perceived benefits, concerns, and recommendations. Participants noted value in personalized, holistic care enabled by real-time data-driven interventions and appropriate patient-clinician contact. However, concerns included trust in DTs, with participants highlighting that implementation requires adapting workforce roles, strong education and training, system-level infrastructure, and a supporting evidence base. Conclusions This work provides the foundations for stakeholders and developers to better understand the likely adoption of a HaH DT and the likely impact on individuals, organizations, and systems. Findings from this study highlight key recommendations, and further research and implementation efforts should prioritize stakeholder involvement to develop clear actionable plans.
Background Effective patient portal access and use require both digital navigation and understanding of clinical information. Health literacy and eHealth literacy reflect these different demands. Although the 2 constructs overlap, prior research often treats them as interchangeable. It remains unclear whether health literacy and eHealth literacy are associated differently across stages of portal engagement and patterns of portal use. A systematic review is therefore needed to identify consistent patterns across studies. Objective This study aimed to synthesize associations of health literacy and eHealth literacy with patient portal access, general use, feature-specific use, and frequency of use. Methods We searched PubMed, Scopus, CINAHL, PsycINFO, Web of Science, and Embase from inception to March 2026 using keywords related to health literacy, eHealth literacy, patient portals, and portal access or use. We included English-language peer-reviewed articles and gray literature involving adults who used real-world patient portals, measured health literacy or eHealth literacy using validated instruments, and reported quantitative associations with portal access or use. Because studies differed substantially in literacy instruments, portal outcomes, and outcome measures, we used direction-based vote counting, complemented by narrative synthesis. Reporting followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement, whereas synthesis methods were guided by the Cochrane Handbook for synthesis without meta-analysis. For full-text, peer-reviewed journal articles, we assessed the risk of bias by using the Joanna Briggs Institute (JBI) critical appraisal tools. Results Among 1107 screened studies, 30 met the inclusion criteria. Of these, 17 examined health literacy only, 10 examined eHealth literacy only, and 3 examined both constructs in the same sample. Studies focused far more on portal use than on portal access and emphasized general portal use over feature-specific outcomes. Any use was assessed more often than frequency of use. Nine of 10 directionally codable eHealth literacy studies of general portal use showed lower use among individuals with lower eHealth literacy, whereas health literacy findings for general portal use were mixed. Lower health literacy showed a more consistent pattern of lower portal access and several feature-specific outcomes, although comparable eHealth literacy evidence for these outcomes was limited. Most studies met the majority of JBI criteria, although most measured portal use via self-report rather than objective system data. Conclusions Nearly every directionally codable eHealth literacy study reported lower portal use among patients with lower eHealth literacy. Lower health literacy showed similar patterns for portal access and several feature-specific outcomes. These consistent associations point to literacy-related disparities at multiple stages of portal engagement, although comparable within-sample evidence remains limited. Future studies should measure both constructs in the same sample, use comparable modeling approaches, use objective portal log data when possible, and distinguish access, any use, frequency, and feature-specific behaviors to identify where literacy-related disparities emerge.
Background Chronic obstructive pulmonary disease (COPD) is characterized by acute exacerbations that frequently result in hospitalization, highlighting the need for improved follow-up care. Hybrid care incorporates digital health strategies such as remote patient monitoring (RPM). This could offer the opportunity to detect early signs of disease worsening by remotely tracking selected health indicators. However, it is unknown how RPM can effectively be integrated into current practice. Objective This study aims to cocreate a theoretical hybrid COPD care pathway integrating RPM into the existing care trajectory, considering the expertise of participating care pathway stakeholders. Methods This 2-phase study was conducted between May and August 2025. At first, semistructured interviews were conducted with stakeholders (ie, patients and health care professionals [HCPs]) involved in COPD care to map the existing care pathway in a single tertiary care hospital in Belgium. Patients were approached during hospitalization based on predefined eligibility criteria, whereas HCPs were recruited through convenience sampling. In phase 2, patient representatives and HCPs were recruited through patient-organization networks and professional referral, respectively, using convenience sampling, and participated in separate interactive workshops. These workshops reviewed existing care pathway phases and HCP roles and explored the integration of RPM, including timing, duration, implementation, data monitoring, and follow-up responsibilities, to codevelop a theoretical hybrid care pathway. Interview and workshop data were independently reviewed by 2 researchers to extract information on care pathway elements, stakeholder roles, limitations, and proposed adaptations. Findings were organized according to the relevant care pathway phase, independently summarized and compared, with discrepancies resolved through discussion and consensus. Interview findings informed the development of an initial infographic representing the existing care pathway, which was subsequently adapted based on workshop findings to represent the proposed cocreated theoretical hybrid care pathway. Results In total, 10 stakeholders participated in the interviews (5 patients and 5 HCPs), and 6 stakeholders participated in the workshops (3 patient representatives and 3 HCPs). The existing COPD care pathway involves multiple stakeholders whose activities can be organized into 5 functional domains: support, treatment, medical advice, patient education, and monitoring. Stakeholders can be divided into hospital-based, community-based, or cross-setting. The workshop participants identified the need for a stakeholder dedicated to RPM activities in order to integrate RPM strategies into the care pathway. This individual could be responsible for all RPM-related activities (ie, RPM device installation, providing RPM-related education, data review, alert management, and RPM discontinuation) and could serve as the bridge between patients and physicians, ensuring close communication. Conclusions This study resulted in a cocreated theoretical hybrid COPD care pathway. Stakeholders highlighted the potential value of a dedicated RPM role to coordinate and deliver RPM activities as part of the COPD care pathway. Further research is needed to assess its feasibility and clinical applicability.
