@Article{info:doi/10.2196/66248, author="Peng, Yingchun and Zhang, Zhiying and Zhang, Ruyi and Zhang, Yiyao and Wang, Runying and Zhang, Jiaying and Zhai, Shaoqi and Jin, Qilin and Zhou, Jiaojiao and Chen, Jingjing", title="Multidimensional Evaluation of the Process of Constructing Age-Friendly Communities Among Different Aged Community Residents in Beijing, China: Cross-Sectional Questionnaire Study", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="21", volume="11", pages="e66248", keywords="age-friendly", keywords="positive living experience", keywords="active aging", keywords="healthy aging", keywords="community residents", keywords="older adults", keywords="age-friendly communities", keywords="multiple stakeholders", keywords="evaluating age-friendliness", keywords="urban and suburban areas", abstract="Background: The World Health Organization (WHO) has made significant efforts to promote age-friendly community initiatives (AFCI) to address the challenges of population aging. Previous studies have discussed the construction of age-friendly communities (AFC) in urban cities, evaluating AFCs often rooted in the WHO's Checklist and focused on a single group, namely older adults, overlooking the role of other age groups in community development. Objective: This study aims to evaluate AFCs from multidimensional aspects, particularly the positive living experiences of older adults, summarize the deficiencies in both hardware and software aspects in the process of constructing AFCs in China, and provide some recommendations to promote AFCIs worldwide. Methods: Using a multistage sampling strategy, 470 community residents from urban and suburban areas participated in this study. A self-designed questionnaire was designed to use a standardized method to evaluate older adults' living experiences across five dimensions, including the degree of age-friendliness in the community, social support, sense of gain, sense of happiness, and sense of security. Respondents rated each dimension on a 10-point scale. This study defined community residents into 3 groups: residents younger than 45 years(Group 1: youth), those aged 45-59 years (Group 2: middle-aged), and those aged ?60 years (Group 3: old-age). Results: In this study, 382 (81.3\%) community residents were unaware of the relevant concepts of AFCs. Most participants highlighted the importance of community support and health services, followed by respect and social inclusion, and outdoor spaces and buildings. The findings showed that the highest-rated dimension was the sense of security. The mean scores for the degree of the sense of security in urban and suburban areas were 7.88 (SD 1.776) and 7.73 (SD 1.853), respectively. For Group 2, the mean scores were 7.60 (SD 2.070) and 8.03 (SD 1.662), while Group 3 had mean scores of 7.34 (SD 2.004) and 7.91 (SD 1.940). The lowest-rated dimension was social support; the mean scores for Group 1 for the degree of social support in urban and suburban areas were 7.63 (SD 1.835) and 7.48 (SD 1.918), respectively. For Group 2, the mean scores were 6.94 (SD 2.087) and 7.36 (SD 2.228), while those for Group 3 were 6.37 (SD 2.299) and 6.84 (SD 2.062). Further, there were significant differences in the scores of residents among different age groups in urban areas regarding age-friendliness (P<.001), social support, (P<.001), and sense of gain (P=.01). Conclusions: China is in the early stages of developing AFCs. We further highlight the importance of continued research on the collaboration and participation among multiple stakeholders. These outcomes have a direct and positive impact on the well?being of older adults. ", doi="10.2196/66248", url="https://publichealth.jmir.org/2025/1/e66248" } @Article{info:doi/10.2196/49464, author="Shah, Ali Hurmat and Househ, Mowafa", title="Understanding Loneliness Through Analysis of Twitter and Reddit Data: Comparative Study", journal="Interact J Med Res", year="2025", month="Mar", day="14", volume="14", pages="e49464", keywords="health informatics", keywords="loneliness informatics", keywords="loneliness theory", keywords="health effects", keywords="loneliness interventions", keywords="social media", keywords="lonely", keywords="loneliness", keywords="isolation", keywords="mental health", keywords="natural language processing", keywords="tweet", keywords="tweets", keywords="comparative analysis", abstract="Background: Loneliness is a global public health issue contributing to a variety of mental and physical health issues. It increases the risk of life-threatening conditions and contributes to the?burden on the economy in terms of the number of productive days lost. Loneliness is a highly varied concept, which is associated with multiple factors. Objective: This study aimed to understand loneliness through a comparative analysis of loneliness data on Twitter and Reddit, which are popular social media platforms. These platforms differ in terms of their use, as Twitter allows only short posts, while Reddit allows long posts in a forum setting. Methods: We collected global data on loneliness in October 2022. Twitter posts containing the words ``lonely,'' ``loneliness,'' ``alone,'' ``solitude,'' and ``isolation'' were collected. Reddit posts were extracted in March 2023. Using natural language processing techniques (valence aware dictionary for sentiment reasoning [VADER] tool from the natural language toolkit [NLTK]), the study identified and extracted relevant keywords and phrases related to loneliness from user-generated content on both platforms. The study used both sentiment analysis and the number of occurrences of a topic. Quantitative analysis was performed to determine the number of occurrences of a topic in tweets and posts, and overall meaningful topics were reported under a category. Results: The extracted data were subjected to comparative analysis to identify common themes and trends related to loneliness across Twitter and Reddit. A total of 100,000 collected tweets and 10,000 unique Reddit posts, including comments, were analyzed. The results of the study revealed the relationships of various social, political, and personal-emotional themes with the expression of loneliness on social media. Both platforms showed similar patterns in terms of themes and categories of discussion in conjunction with loneliness-related content. Both Reddit and Twitter addressed loneliness, but they differed in terms of focus. Reddit discussions were predominantly centered on personal-emotional themes, with a higher occurrence of these topics. Twitter, while still emphasizing personal-emotional themes, included a broader range of categories. Both platforms aligned with psychological linguistic features related to the self-expression of mental health issues. The key difference was in the range of topics, with Twitter having a wider variety of topics and Reddit having more focus on personal-emotional aspects. Conclusions: Reddit posts provide detailed insights into data about the expression of loneliness, although at the cost of the diversity of themes and categories, which can be inferred from the data. These insights can guide future research using social media data to understand loneliness. The findings provide the basis for further comparative investigation of the expression of loneliness on different social media platforms and online platforms. ", doi="10.2196/49464", url="https://www.i-jmr.org/2025/1/e49464" } @Article{info:doi/10.2196/66061, author="Liu, Hui and Wang, Jieru and Chen, Rui and Xu, Xixing and Pang, Mingli and Feng, Kaiyuan and Li, Bingsong and Li, Qinling and Qin, Ziwei and Yan, Shuyi and Ibn Ziyat, Nabila and Kong, Fanlei", title="Migrant-Local Differences in the Relationship Between Oral Health, Social Support, and Loneliness Among Older Adults in Weifang, China: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="13", volume="11", pages="e66061", keywords="loneliness", keywords="oral health", keywords="social support", keywords="migrant older adults", keywords="local older adults", abstract="Background: Increased aging and accelerated urbanization have led to the migration of older adults within China. Migrant older adults (MOAs) may experience physical and psychological discomfort in influx cities, and they are a vulnerable group that has emerged in the course of fast urbanization. Previous studies have confirmed the association between oral health and loneliness as well as the relationship between social support and loneliness; however, no research has been done to clarify the underlying mechanisms and the migrant-local difference between oral health, social support, and loneliness. Objective: This study aimed to test the association between oral health, social support, and loneliness among Chinese older adults, as well as the migrant-local difference on the above relationship. Methods: Multistage cluster random sampling was used to enroll a total of 1205 participants, including 613 MOAs and 592 local older adults (LOAs). Loneliness was assessed by the 6-item short-form UCLA Loneliness Scale; oral health was measured via the Chinese version Geriatric Oral Health Assessment Index (GOHAI); social support was evaluated by the Social Support Rating Scale (SSRS). Descriptive analysis, $\chi$2 tests, and t tests were conducted. Multigroup structural equation modeling (SEM) was employed to clarify the migrant-local difference on the association between oral health, social support, and loneliness among MOAs and LOAs. Results: The mean score of loneliness was 8.58 (SD 3.032) for MOAs and 8.00 (SD 2.790) for LOAs. Oral health and social support were found to be negatively related to loneliness among MOAs and LOAs; the standardized direct effects for MOAs were ?0.168 and ?0.444 (P<.001), and they were ?0.243 and ?0.392 (P<.001) for LOAs, respectively. Oral health generated a direct positive effect on social support, and the direct effect was 0.186 for MOAs (P<.001) and 0.247 for LOAs (P<.001). Conclusions: Loneliness was fairly low among older adults in Weifang, China, while MOAs showed higher loneliness than LOAs. Oral health had both direct and indirect negative effects on loneliness among MOAs and LOAs, with no significant path differences between MOAs and LOAs. Social support was found to be negatively associated with loneliness for both MOA and LOA, while the association was stronger among MOAs than LOAs. Oral health exerted a significantly positive effect on social support for both MOAs and LOAs, while no significant difference existed between them. Measures should be taken by the government, society, and families to increase social support, improve oral health, and further reduce loneliness among MOAs and LOAs. ", doi="10.2196/66061", url="https://publichealth.jmir.org/2025/1/e66061" } @Article{info:doi/10.2196/57907, author="Liu, Chenxi and Liu, Yushu and Liu, Chaojie and Lin, Rujiao and Wang, Xi and Zhang, Xinyi and Wu, Yibo and Wang, Dan", title="The Moderated Mediating Effects of Social Media Identity and Loneliness on the Relationship Between Problematic Internet Use and Mental Health in China: Nationwide Cross-Sectional Questionnaire Study", journal="J Med Internet Res", year="2025", month="Feb", day="26", volume="27", pages="e57907", keywords="problematic internet use", keywords="loneliness", keywords="anxiety", keywords="depression", keywords="mediation and moderation model", abstract="Background: Mental health disorders are a major public health challenge, and problematic internet use (PIU) may play an important role in this issue. However, the underlying mechanisms of PIU and its effects on mental health have not yet been elucidated. Objective: This study examines the mediating effect of loneliness on the relationship between PIU and mental health, as well as the moderating effect of social media identity on the relationships among PIU, loneliness, and mental health. Methods: A cross-sectional questionnaire survey was conducted on 21,292 participants recruited using a multistage stratified sampling strategy from 31 provinces/regions in mainland China from June 20 to August 31, 2022. This study assesses PIU (PIU questionnaire-short form-6), depression (9-item Patient Health Questionnaire [PHQ-9]), anxiety (7-item Generalized Anxiety Disorder scale [GAD-7]), loneliness (3-item loneliness scale), and social media identity (identity bubble reinforcement scale). Additionally, we collected the sociodemographic characteristics of the participants. Participants whose total score of PHQ-9?15 or total score of GAD-7?10 were considered to have moderate or severe symptoms of depression or anxiety, respectively. A moderated mediation model was established to examine the mediating effect of loneliness on the association between PIU and mental health outcomes (depression and anxiety), moderated by social media identity. Results: Approximately 22.80\% (4854/21,292) and 14.20\% (3023/21,292) of the respondents reported moderate or severe symptoms of depression and anxiety, respectively. Loneliness significantly mediated the association between PIU and mental health outcomes, explaining 42.53\% and 45.48\% of the total effect of PIU on depression and anxiety, respectively. Social media identity significantly moderated the associations between PIU and depression ($\beta$=0.002, 95\% CI 0.001-0.002), PIU and anxiety ($\beta$=0.001, 95\% CI 0.000-0.002), loneliness and depression ($\beta$=0.010, 95\% CI 0.007-0.013), and loneliness and anxiety ($\beta$=0.007, 95\% CI 0.004-0.010), but not between PIU and loneliness ($\beta$=0.000, 95\% CI --0.003 to 0.003). Higher levels of social media identity were significantly associated with lower levels of loneliness ($\beta$=--0.018, 95\% CI --0.020 to --0.016). Conclusions: Addressing loneliness may serve as a valuable approach to mitigate the impact of PIU on mental health outcomes. However, social media identity poses a significant challenge in addressing health issues linked to PIU. ", doi="10.2196/57907", url="https://www.jmir.org/2025/1/e57907" } @Article{info:doi/10.2196/65610, author="Uchiyama, Ashley Misa and Bekki, Hirofumi and McMann, Tiana and Li, Zhuoran and Mackey, Tim", title="Characterizing Experiences With Hikikomori Syndrome on Twitter Among Japanese-Language Users: Qualitative Infodemiology Content Analysis", journal="JMIR Infodemiology", year="2025", month="Feb", day="24", volume="5", pages="e65610", keywords="hikikomori", keywords="social withdrawal", keywords="hikikomori syndrome", keywords="mental health", keywords="social isolation", abstract="Background: Hikikomori syndrome is a form of severe social withdrawal prevalent in Japan but is also a worldwide psychiatric issue. Twitter (subsequently rebranded X) offers valuable insights into personal experiences with mental health conditions, particularly among isolated individuals or hard-to-reach populations. Objective: This study aimed to examine trends in firsthand and secondhand experiences reported on Twitter between 2021 and 2023 in the Japanese language. Methods: Tweets were collected using the Twitter academic research application programming interface filtered for the following keywords: ``\#?????,'' ``\#?????,'' ``\#hikikomori,'' ``\#???,'' ``\#??????,'' ``\#???,'' and ``\#?????.'' The Bidirectional Encoder Representations From Transformers language model was used to analyze all Japanese-language posts collected. Themes and subthemes were then inductively coded for in-depth exploration of topic clusters relevant to first- and secondhand experiences with hikikomori syndrome. Results: We collected 2,018,822 tweets, which were narrowed down to 379,265 (18.79\%) tweets in Japanese from January 2021 to January 2023. After examining the topic clusters output by the Bidirectional Encoder Representations From Transformers model, 4 topics were determined to be relevant to the study aims. A total of 400 of the most highly interacted with tweets from these topic clusters were manually annotated for inclusion and exclusion, of which 148 (37\%) tweets from 89 unique users were identified as relevant to hikikomori experiences. Of these 148 relevant tweets, 71 (48\%) were identified as firsthand accounts, and 77 (52\%) were identified as secondhand accounts. Within firsthand reports, the themes identified included seeking social support, personal anecdotes, debunking misconceptions, and emotional ranting. Within secondhand reports, themes included seeking social support, personal anecdotes, seeking and giving advice, and advocacy against the negative stigma of hikikomori. Conclusions: This study provides new insights into experiences reported by web-based users regarding hikikomori syndrome specific to Japanese-speaking populations. Although not yet found in diagnostic manuals classifying mental disorders, the rise of web-based lifestyles as a consequence of the COVID-19 pandemic has increased the importance of discussions regarding hikikomori syndrome in web-based spaces. The results indicate that social media platforms may represent a web-based space for those experiencing hikikomori syndrome to engage in social interaction, advocacy against stigmatization, and participation in a community that can be maintained through a web-based barrier and minimized sense of social anxiety. ", doi="10.2196/65610", url="https://infodemiology.jmir.org/2025/1/e65610" } @Article{info:doi/10.2196/66448, author="Kim, I. Sol and Jin, Jae-Chan and Yoo, Seo-Koo and Han, Hyun Doug", title="Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="11", volume="8", pages="e66448", keywords="coronavirus pandemic", keywords="internet use pattern", keywords="internet games", keywords="short-form videos", keywords="social network system", keywords="depressed mood", keywords="internet use", keywords="pandemic", keywords="internet", keywords="COVID-19", keywords="video", keywords="internet behavior", keywords="social media", keywords="internet addiction", keywords="depression", keywords="anxiety", keywords="digital platforms", keywords="mobile phone", abstract="Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents' psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 ($\chi$23=8.16, P=.04). Furthermore, this study showed that the Young's Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. ", doi="10.2196/66448", url="https://pediatrics.jmir.org/2025/1/e66448" } @Article{info:doi/10.2196/59023, author="Yang, Lu and Lynch, Chris and Lee, Tayu John and Oldenburg, Brian and Haregu, Tilahun", title="Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study", journal="J Med Internet Res", year="2025", month="Feb", day="10", volume="27", pages="e59023", keywords="digital divide", keywords="health inequity", keywords="China", keywords="longitudinal study", keywords="broadband", keywords="internet connection", keywords="internet", keywords="well-being", keywords="psychosocial", keywords="middle age", keywords="older adult", keywords="inequality", keywords="digital connectivity", keywords="logistic regression", keywords="questionnaire", keywords="survey", keywords="panel data approach", abstract="Background: Access to digital technology is among the major social determinants of health, and digital divide impacts health inequality. Yet, the impact of digital connectivity on the well-being and psychosocial outcomes in adults has not been fully studied. Objective: The aim of this study was to investigate the association of home broadband connection with health and well-being of middle-aged adults and adults older than 45 years in China. Methods: A panel data study design of the national sample of China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2015, 2018, and 2020. This study included 16,185 participants older than 45 years. The associations between digital connectivity (home broadband connection), loneliness, social participation, and life satisfaction were assessed using mixed effects logistic regression models, adjusting for socioeconomic factors, behavioral factors, and locality. Broadband internet connectivity, feelings of loneliness, social participation, and satisfaction with life were measured using the self-reported CHARLS questionnaire. Results: We observed a substantial increase in digital connectivity from 29.5\% in 2015 to 59.8\% in 2020. Broadband internet connection at home was positively correlated with social participation (adjusted odds ratio [AOR] 1.34, 95\% CI 1.28-1.41) and life satisfaction (AOR 1.30, 95\% CI 1.20-1.40), after adjusting for confounding factors, while the absence of broadband internet connection was associated with increased loneliness (AOR 0.81, 95\% CI 0.77-0.86). These associations were consistent across age, gender, socioeconomic groups, and geographic areas. Conclusions: This study highlights the potential additional health benefits of digital connectivity beyond the known advantages. Our results suggest the importance of expanding broadband access to enhance social inclusion and life satisfaction. Further research is needed to understand the broader implications and digital determinants of health associated with digital connectivity. ", doi="10.2196/59023", url="https://www.jmir.org/2025/1/e59023" } @Article{info:doi/10.2196/65589, author="Kim, Myungsung and Lee, Seonmi and Kim, Sieun and Heo, Jeong-in and Lee, Sangil and Shin, Yu-Bin and Cho, Chul-Hyun and Jung, Dooyoung", title="Therapeutic Potential of Social Chatbots in Alleviating Loneliness and Social Anxiety: Quasi-Experimental Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Jan", day="14", volume="27", pages="e65589", keywords="artificial intelligence", keywords="AI", keywords="social chatbot", keywords="loneliness", keywords="social anxiety", keywords="exploratory research", keywords="mixed methods study", abstract="Background: Artificial intelligence (AI) social chatbots represent a major advancement in merging technology with mental health, offering benefits through natural and emotional communication. Unlike task-oriented chatbots, social chatbots build relationships and provide social support, which can positively impact mental health outcomes like loneliness and social anxiety. However, the specific effects and mechanisms through which these chatbots influence mental health remain underexplored. Objective: This study explores the mental health potential of AI social chatbots, focusing on their impact on loneliness and social anxiety among university students. The study seeks to (i) assess the impact of engaging with an AI social chatbot in South Korea, ``Luda Lee,'' on these mental health outcomes over a 4-week period and (ii) analyze user experiences to identify perceived strengths and weaknesses, as well as the applicability of social chatbots in therapeutic contexts. Methods: A single-group pre-post study was conducted with university students who interacted with the chatbot for 4 weeks. Measures included loneliness, social anxiety, and mood-related symptoms such as depression, assessed at baseline, week 2, and week 4. Quantitative measures were analyzed using analysis of variance and stepwise linear regression to identify the factors affecting change. Thematic analysis was used to analyze user experiences and assess the perceived benefits and challenges of chatbots. Results: A total of 176 participants (88 males, average age=22.6 (SD 2.92)) took part in the study. Baseline measures indicated slightly elevated levels of loneliness (UCLA Loneliness Scale, mean 27.97, SD (11.07)) and social anxiety (Liebowitz Social Anxiety Scale, mean 25.3, SD (14.19)) compared to typical university students. Significant reductions were observed as loneliness decreasing by week 2 (t175=2.55, P=.02) and social anxiety decreasing by week 4 (t175=2.67, P=.01). Stepwise linear regression identified baseline loneliness ($\beta$=0.78, 95\% CI 0.67 to 0.89), self-disclosure ($\beta$=--0.65, 95\% CI --1.07 to --0.23) and resilience ($\beta$=0.07, 95\% CI 0.01 to 0.13) as significant predictors of week 4 loneliness (R2=0.64). Baseline social anxiety ($\beta$=0.92, 95\% CI 0.81 to 1.03) significantly predicted week 4 anxiety (R2=0.65). These findings indicate higher baseline loneliness, lower self-disclosure to the chatbot, and higher resilience significantly predicted higher loneliness at week 4. Additionally, higher baseline social anxiety significantly predicted higher social anxiety at week 4. Qualitative analysis highlighted the chatbot's empathy and support as features for reliability, though issues such as inconsistent responses and excessive enthusiasm occasionally disrupted user immersion. Conclusions: Social chatbots may have the potential to mitigate feelings of loneliness and social anxiety, indicating their possible utility as complementary resources in mental health interventions. User insights emphasize the importance of empathy, accessibility, and structured conversations in achieving therapeutic goals. Trial Registration: Clinical Research Information Service (CRIS) KCT0009288; https://tinyurl.com/hxrznt3t ", doi="10.2196/65589", url="https://www.jmir.org/2025/1/e65589" } @Article{info:doi/10.2196/53850, author="Fuller, Chlo{\"e} and Marin-Dragu, Silvia and Iyer, Subramani Ravishankar and Meier, Melanie Sandra", title="A Mobile App--Based Gratitude Intervention's Effect on Mental Well-Being in University Students: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Jan", day="14", volume="13", pages="e53850", keywords="gratitude intervention", keywords="smartphone app", keywords="gratitude exercises", keywords="psychological well-being", keywords="mobile phone", abstract="Background: Gratitude interventions are used to cultivate a sense of gratitude for life and others. There have been mixed results of the efficacy of gratitude interventions' effect on psychological well-being with a variety of populations and methodologies. Objectives: The objective of our study was to test the effectiveness of a gratitude intervention smartphone app on university students' psychological well-being. Methods: We used a randomized experimental design to test our objective. Participants were recruited undergraduate students from a web-based university study recruitment system. Participants completed 90 web-based survey questions on their emotional well-being and personality traits at the beginning and end of the 3-week research period. Their depression, anxiety, and stress levels were measured with the Depression, Anxiety, and Stress Scale (DASS-21). After the baseline survey, participants were randomly assigned to either the control or the intervention. Participants in the intervention group used both a fully automated mobile sensing app and a gratitude intervention mobile iOS smartphone app designed for youth users and based on previous gratitude interventions and exercises. The gratitude intervention app prompted users to complete daily gratitude exercises on the app including a gratitude journal, a gratitude photo book, an imagine exercise, a speech exercise, and meditation. Participants in the control group used only the mobile sensing app, which passively collected smartphone sensory data on mobility, screen time, sleep, and social interactions. Results: A total of 120 participants met the inclusion criteria, and 27 were lost to follow-up for a total of 41 participants in the intervention group and 52 in the control group providing complete data. Based on clinical cutoffs from the baseline assessment, 56 out of 120 participants were identified as being in a subsample with at least moderate baseline symptomatology. Participants in the subsample with at least moderate baseline symptomatology reported significantly lower symptoms of depression, anxiety, and stress postintervention (Cohen d=?0.68; P=.04) but not in the full sample with low baseline symptomatology (Cohen d=0.16; P=.46). The number of times the app was accessed was not correlated with changes in either the subsample (r=0.01; P=.98) or the full sample (r=?0.04; P=.79). Conclusions: University students experiencing moderate to severe distress can benefit from a gratitude intervention smartphone app to improve symptoms of depression, anxiety, and stress. The number of times the gratitude intervention app was used is not related to well-being outcomes. Clinicians could look at incorporating gratitude apps with other mental health treatments or for those waitlisted as a cost-effective and minimally guided option for university students experiencing psychological distress. Trial Registration: Clinicaltrials.gov NCT06621745; http://clinicaltrials.gov/ct2/show/NCT06621745 ", doi="10.2196/53850", url="https://mhealth.jmir.org/2025/1/e53850" } @Article{info:doi/10.2196/67627, author="Jayaraj, Gautham and Cao, Xiao and Horwitz, Adam and Rozwadowski, Michelle and Shea, Skyla and Hanauer, N. Shira and Hanauer, A. David and Tewari, Muneesh and Shedden, Kerby and Choi, Won Sung", title="Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e67627", keywords="mHealth", keywords="college", keywords="student", keywords="mental health", keywords="positive psychology", keywords="flourishing", keywords="COVID-19", keywords="wellbeing", keywords="mobile phone", keywords="SARS-CoV-2", keywords="coronavirus", keywords="pandemic", keywords="COVID", keywords="app", keywords="digital health", keywords="smartphone", keywords="eHealth", keywords="telehealth", keywords="telemedicine", keywords="longitudinal", keywords="higher education", keywords="depression", keywords="anxiety", keywords="loneliness", abstract="Background: The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care. Objective: This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes. Methods: A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness. Results: The findings indicated an evolving trajectory in students' mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=--2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=--2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=--5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=--7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=--8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=--10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors ($\beta$=.04, SE .016; t3974=2.17; P=.03). Conclusions: In this study, students' mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students' mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students' mental health outcomes. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 ", doi="10.2196/67627", url="https://www.jmir.org/2025/1/e67627" } @Article{info:doi/10.2196/62824, author="Valla, Guido Luca and Rossi, Michele and Gaia, Alessandra and Guaita, Antonio and Rolandi, Elena", title="The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e62824", keywords="older adults", keywords="information and communication technology", keywords="ICT", keywords="ICT use", keywords="COVID-19", keywords="social capital", keywords="health", keywords="mental health", keywords="digital divide", abstract="Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships ($\beta$=--4.35, 95\% CI 6.38 to --2.32; P<.001), cultural activities ($\beta$=--.55, 95\% CI --0.75 to --0.35; P<.001), cognitive functioning ($\beta$=--1.00, 95\% CI --1.28 to --0.72; P<.001), depressive symptoms ($\beta$=.42, 95\% CI 0.10-0.74; P=.009), physical health ($\beta$=.07, 95\% CI 0.04-0.10; P<.001), and ICT use ($\beta$=--.11, 95\% CI --0.18 to --0.03; P=.008). Internet use predicts reduced depressive symptoms ($\beta$=--.56, 95\% CI --1.07 to --0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities ($\beta$=--.73, 95\% CI --1.22 to --0.24; P=.003) and cognitive functioning ($\beta$=1.36, 95\% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 ", doi="10.2196/62824", url="https://www.jmir.org/2025/1/e62824" } @Article{info:doi/10.2196/63856, author="DeLange Martinez, Pauline and Tancredi, Daniel and Pavel, Misha and Garcia, Lorena and Young, M. Heather", title="Adapting the Technology Acceptance Model to Examine the Use of Information Communication Technologies and Loneliness Among Low-Income, Older Asian Americans: Cross-Sectional Survey Analysis", journal="JMIR Aging", year="2025", month="Jan", day="8", volume="8", pages="e63856", keywords="social isolation", keywords="loneliness", keywords="aged", keywords="older adults", keywords="Asian American", keywords="immigrant", keywords="vulnerable populations", keywords="internet", keywords="information and communication technologies", keywords="ICTs", keywords="digital divide", keywords="technology acceptance model", keywords="mobile phone", abstract="Background: Loneliness is a significant issue among older Asian Americans, exacerbated by the COVID-19 pandemic. Older age, lower income, limited education, and immigrant status heighten loneliness risk. Information communication technologies (ICTs) have been associated with decreased loneliness among older adults. However, older Asian Americans are less likely to use ICTs, particularly if they are immigrants, have limited English proficiency, or are low income. The Technology Acceptance Model posits that perceived usefulness (PU), and perceived ease of use (PEOU) are key factors in predicting technology use. Objective: This study aimed to examine associations between PU, PEOU, ICT use, and loneliness among low-income, older Asian Americans. Methods: Cross-sectional survey data were gathered from predominately older Asian Americans in affordable senior housing (N=401). Using exploratory factor analysis and Horn parallel analysis, we examined 12 survey items to identify factors accounting for variance in ICT use. We deployed structural equation modeling to explore relationships among the latent factors and loneliness, adjusting for demographic and cognitive factors. Results: Exploratory factor analysis and Horn parallel analysis revealed 3 factors that accounted for 56.48\% (6.78/12) total variance. PEOU combined items from validated subscales of tech anxiety and comfort, accounting for a 28.44\% (3.41/12) variance. ICT use combined years of technological experience, computer, tablet, and smartphone use frequency, accounting for 15.59\% (1.87/12) variance. PU combined 2 items assessing the usefulness of technology for social connection and learning and accounted for a 12.44\% (1.49/12) variance. The 3-factor structural equation modeling revealed reasonable fit indexes ($\chi$2133=345.132; P<.001, chi-square minimum (CMIN)/df = 2595, comparative fit index (CFI)=0.93, Tucker-Lewis Index (TLI)=0.88). PEOU was positively associated with PU ($\beta$=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU $\beta$=.26, P<.001; PU $\beta$=.18, P=.01); and ICT use was negatively associated with loneliness ($\beta$=--.28, P<.001). Demographic and health covariates also significantly influenced PU, PEOU, ICT use, and loneliness. English proficiency and education positively predicted PEOU (r=0.25, P<.001; r=0.26, P<.001) and ICT use ($\beta$=1.66, P=.03; $\beta$=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness ($\beta$=.31, P<.001; $\beta$=.25, P<.001). Conclusions: This study suggests that targeted interventions enhancing PU or PEOU could increase ICT acceptance and reduce loneliness among low-income Asian Americans. Findings also underscore the importance of considering limited English proficiency and subjective cognitive decline when designing interventions and in future research. ", doi="10.2196/63856", url="https://aging.jmir.org/2025/1/e63856" } @Article{info:doi/10.2196/57622, author="Probst, Freya and Rees, Jessica and Aslam, Zayna and Mexia, Nikitia and Molteni, Erika and Matcham, Faith and Antonelli, Michela and Tinker, Anthea and Shi, Yu and Ourselin, Sebastien and Liu, Wei", title="Evaluating a Smart Textile Loneliness Monitoring System for Older People: Co-Design and Qualitative Focus Group Study", journal="JMIR Aging", year="2024", month="Dec", day="17", volume="7", pages="e57622", keywords="loneliness", keywords="smart textiles", keywords="wearable technology", keywords="health monitoring", keywords="older people", keywords="co-design", keywords="design requirement", keywords="mobile phone", abstract="Background: Previous studies have explored how sensor technologies can assist in in the detection, recognition, and prevention of subjective loneliness. These studies have shown a correlation between physiological and behavioral sensor data and the experience of loneliness. However, little research has been conducted on the design requirements from the perspective of older people and stakeholders in technology development. The use of these technologies and infrastructural questions have been insufficiently addressed. Systems generally consist of sensors or software installed in smartphones or homes. However, no studies have attempted to use smart textiles, which are fabrics with integrated electronics. Objective: This study aims to understand the design requirements for a smart textile loneliness monitoring system from the perspectives of older people and stakeholders. Methods: We conducted co-design workshops with 5 users and 6 stakeholders to determine the design requirements for smart textile loneliness monitoring systems. We derived a preliminary product concept of the smart wearable and furniture system. Digital and physical models and a use case were evaluated in a focus group study with older people and stakeholders (n=7). Results: The results provided insights for designing systems that use smart textiles to monitor loneliness in older people and widen their use. The findings informed the general system, wearables and furniture, materials, sensor positioning, washing, sensor synchronization devices, charging, intervention, and installation and maintenance requirements. This study provided the first insight from a human-centered perspective into smart textile loneliness monitoring systems for older people. Conclusions: We recommend more research on the intervention that links to the monitored loneliness in a way that addresses different needs to ensure its usefulness and value to people. Future systems must also reflect on questions of identification of system users and the available infrastructure and life circumstances of people. We further found requirements that included user cooperation, compatibility with other worn medical devices, and long-term durability. ", doi="10.2196/57622", url="https://aging.jmir.org/2024/1/e57622", url="http://www.ncbi.nlm.nih.gov/pubmed/39688889" } @Article{info:doi/10.2196/57205, author="Nakagomi, Atsushi and Abe, Noriyuki and Chen, Yu-Ru and Ide, Kazushige and Kobayashi, Shuhei and Hanazato, Masamichi and Kondo, Katsunori", title="Messenger App--Based Information Provision for Promoting Social Participation to Enhance Well-Being Among Community-Dwelling Adults: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Nov", day="29", volume="26", pages="e57205", keywords="messenger app", keywords="event information", keywords="happiness", keywords="social participation", keywords="messenger", keywords="app", keywords="well-being", keywords="adults", keywords="aging", keywords="randomized controlled trial", keywords="RCT", keywords="information technology", keywords="social activity", keywords="Japan", keywords="urban community", keywords="health information", keywords="control group", keywords="multivariable regression", keywords="life satisfaction", keywords="digital intervention", keywords="community-dwelling", abstract="Background: Engaging in social activities, interacting with peers, and participating in community events may promote health and well-being. Recently, interventions leveraging information and communications technology have emerged as potent tools for promoting social connections and well-being. Particularly, messenger apps have become an integral part of our daily lives, facilitating communication, information dissemination, and social interaction. However, there remains a gap in the literature regarding the utilization of widely adopted messenger apps for this purpose. Objective: This study aimed to evaluate the impact of messenger app--based information provision aimed at promoting social participation on the enhancement of subjective well-being among Japanese community-dwelling adults. Methods: A 2-arm, parallel-group randomized controlled trial was conducted from October 2022 to January 2023 in the Kashiwa-no-ha campus area, Japan---an urban community with active local events. A total of 358 community-dwelling adults who use messenger apps daily were recruited for the study. Of these, 235 (65.6\%) participants completed the follow-up survey. Participants were randomly assigned to either the intervention group, receiving the health benefits of social participation and information about local events or spots via a messenger app, or the control group, receiving general health information. The primary outcome was subjective happiness after the intervention, measured on an 11-point scale ranging from 0 (Unhappy) to 10 (Happy). Secondary outcomes included life satisfaction, meaning of life, purpose in life, and participation in local events. The outcomes were analyzed with t tests (2-tailed) and multivariable regression based on the intention-to-treat method. Results: After the intervention, the intervention group reported a mean happiness score of 7.7 (SD 1.7), while the control group reported a score of 7.5 (SD 2.0), with no statistically significant difference (P=.40). Multivariable linear regression analysis adjusted for baseline outcome values and covariates showed that the coefficient of the intervention for life satisfaction was 0.30 (95\% CI --0.07 to 0.68; P=.12), while that for meaning of life was 0.33 (95\% CI --0.03 to 0.70; P=.07). There was no significant difference in event participation rates between the 2 groups during the study period (P=.22). However, 82.2\% (102/124) of the intervention group acknowledged the utility of the event information provided. Conclusions: Messenger app--based information provision did not yield a significant increase in subjective happiness, while there was a positive but not significant trend in life satisfaction. The findings underscore the need for more intensive intervention in future studies to harness the potential of digital interventions. Trial Registration: UMIN Clinical Trials Registry UMIN000049047; https://tinyurl.com/2zzrrae8 ", doi="10.2196/57205", url="https://www.jmir.org/2024/1/e57205", url="http://www.ncbi.nlm.nih.gov/pubmed/39612209" } @Article{info:doi/10.2196/63262, author="Brandl, Lena and Jansen-Kosterink, Stephanie and Brodbeck, Jeannette and Jacinto, Sofia and Mooser, Bettina and Heylen, Dirk", title="Moving Toward Meaningful Evaluations of Monitoring in e-Mental Health Based on the Case of a Web-Based Grief Service for Older Mourners: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Nov", day="28", volume="8", pages="e63262", keywords="e-mental health", keywords="digital mental health service", keywords="mental health", keywords="digital health", keywords="internet intervention", keywords="monitoring mental health", keywords="monitor", keywords="e-coach", keywords="coaching", keywords="grieve", keywords="mourn", keywords="old", keywords="affective states", keywords="artificial intelligence", keywords="predictive", keywords="repeatedly measured predictors in regression", keywords="fuzzy cognitive map", keywords="algorithm", keywords="AI", abstract="Background: Artificial intelligence (AI) tools hold much promise for mental health care by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools limit their meaningfulness for health care contexts and therefore also the practical usefulness of such tools for professionals and clients alike. Objective: The aim of this study is to demonstrate the evaluation of an AI monitoring tool that detects the need for more intensive care in a web-based grief intervention for older mourners who have lost their spouse, with the goal of moving toward meaningful evaluation of AI tools in e-mental health. Method: We leveraged the insights from three evaluation approaches: (1) the F1-score evaluated the tool's capacity to classify user monitoring parameters as either in need of more intensive support or recommendable to continue using the web-based grief intervention as is; (2) we used linear regression to assess the predictive value of users' monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention; and (3) we collected qualitative experience data from e-coaches (N=4) who incorporated the monitoring in their weekly email guidance during the 10-week intervention. Results: Based on n=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. Due to minimal change in depression and loneliness scores after the 10-week intervention, only 1 linear regression was conducted. The difference score in grief before and after the intervention was included as a dependent variable. Participants' (N=21) mean score on the self-report monitoring and the estimated slope of individually fitted growth curves and its standard error (ie, participants' response pattern to the monitoring questions) were used as predictors. Only the mean monitoring score exhibited predictive value for the observed change in grief (R2=1.19, SE 0.33; t16=3.58, P=.002). The e-coaches appreciated the monitoring tool as an opportunity to confirm their initial impression about intervention participants, personalize their email guidance, and detect when participants' mental health deteriorated during the intervention. Conclusions: The monitoring tool evaluated in this paper identified a need for more intensive support reasonably well in a nonclinical sample of older mourners, had some predictive value for the change in grief symptoms during a 10-week intervention, and was appreciated as an additional source of mental health information by e-coaches who supported mourners during the intervention. Each evaluation approach in this paper came with its own set of limitations, including (1) skewed class distributions in prediction tasks based on real-life health data and (2) choosing meaningful statistical analyses based on clinical trial designs that are not targeted at evaluating AI tools. However, combining multiple evaluation methods facilitates drawing meaningful conclusions about the clinical value of AI monitoring tools for their intended mental health context. ", doi="10.2196/63262", url="https://formative.jmir.org/2024/1/e63262" } @Article{info:doi/10.2196/52294, author="Pe{\~n}a, Jorge and Koebner, Ian and Weisman, William", title="Using Digital Art and Attachment Priming in a Web-Based Serious Game to Reduce Pain and Social Disconnection in Individuals With Chronic Pain and Loneliness: Randomized Controlled Trial", journal="JMIR Serious Games", year="2024", month="Nov", day="27", volume="12", pages="e52294", keywords="pain", keywords="social disconnection", keywords="loneliness", keywords="randomized controlled trial", keywords="art", keywords="museums", keywords="virtual reality", keywords="serious games", keywords="virtual art", keywords="chronic pain and loneliness", keywords="attachment", keywords="priming", keywords="mediation", keywords="intervention", keywords="cyberpsychology", keywords="mental health", abstract="Background: Arts engagement using virtual reality and serious games represent promising nonpharmacological self-management treatment approaches to chronic pain. This study is the first randomized controlled trial to explore the impact of a web-based serious game that simulated a visit to an art museum on pain and social disconnection among individuals living with chronic pain and loneliness. Objective: This study aimed to test the joint and separate effects of exposure to digital art and attachment figure priming on pain and social disconnection among individuals living with chronic pain and loneliness. Methods: This randomized controlled trial used a 2 (digital artwork present and absent) {\texttimes} 2 (secure attachment and avoidant attachment prime) repeated measures factorial web-based experimental design with a hanging control condition. Mediation and moderation analyses examined how feelings about the social world triggered by the artwork and frequency of museum visits impacted the effects of the interventions on pain and social disconnection. Results: The results are based on 308 participants. Mean age of the participants was 42.78 (SD 13.11; range 18-76) years, and 60.2\% (n=186) were women. Posttest pain was lower than pretest pain for the artwork present (P=.001) and absent (P=.001) conditions. Similarly, posttest pain was lower than pretest pain for the secure (P=.001) and avoidant (P=.001) attachment priming conditions. Relative to the control group, artwork present (P=.001) and absent (P=.01) conditions had decreased posttest pain. The secure (P=.001) and avoidant (P=.001) attachment priming conditions also had lower posttest pain scores relative to the control group. Moreover, social disconnection decreased from pre- to posttest for both the artwork present (P=.04) and the secure attachment priming (P=.002) conditions. Relative to the control group, posttest social disconnection was lower for the artwork present (P=.02) and secure attachment priming condition (P=.03). The artwork-secure attachment (P=.001) and artwork-avoidant attachment (P=.006) conditions had lower posttest pain scores compared with the control group. Social disconnection decreased from pre- to posttest for the artwork-secure attachment (P=.01) and no artwork-secure attachment (P=.05) conditions. Posttest social disconnection was lower for the artwork-secure attachment condition compared with the control group (P=.04). Positive feelings about the social world triggered by artwork exposure and frequency of museum visits in the last year played a mediating and moderating role in these effects. Positive feelings about the social world were associated with decreased pain (B=?.53) and social disconnection (B=?.25), and these effects operated on individuals exposed to digital artwork at low, medium, and high frequency of physical museum visits. Conclusions: Relative to a control group, visiting a web-based art museum reliably decreased pain and social disconnection among individuals living with chronic pain and loneliness. Engaging with digital artwork that triggers positive feelings about the social world may mitigate the burden of chronic pain. Trial Registration: ClinicalTrials.gov NCT05310747; https://clinicaltrials.gov/study/NCT05310747 ", doi="10.2196/52294", url="https://games.jmir.org/2024/1/e52294" } @Article{info:doi/10.2196/63092, author="Vagnetti, Roberto and Camp, Nicola and Story, Matthew and Ait-Belaid, Khaoula and Mitra, Suvobrata and Fowler Davis, Sally and Meese, Helen and Zecca, Massimiliano and Di Nuovo, Alessandro and Magistro, Daniele", title="Social Robots and Sensors for Enhanced Aging at Home: Mixed Methods Study With a Focus on Mobility and Socioeconomic Factors", journal="JMIR Aging", year="2024", month="Nov", day="25", volume="7", pages="e63092", keywords="older adults", keywords="motor difficulties", keywords="socioeconomic status", keywords="social assistive robots", keywords="monitoring technologies", keywords="mixed methods", abstract="Background: Population aging affects society, with a profound impact on daily activities for those of a low socioeconomic status and with motor impairments. Social assistive robots (SARs) and monitoring technologies can improve older adults' well-being by assisting with and monitoring home activities. Objective: This study explored the opinions and needs of older adults, including those with motor difficulties and of a low socioeconomic status, regarding SARs and monitoring technologies at home to promote daily activities and reduce sedentary behaviors. Methods: A mixed methods approach was used, with 31 older adults divided into 3 groups: those of a low socioeconomic status, those with motor difficulties, and healthy individuals. Focus groups were conducted, and they were analyzed using thematic analysis. Perceived mental and physical well-being were assessed using the 12-Item Short Form Health Survey, and attitudes toward robots were evaluated using the Multidimensional Robot Attitude Scale. Results: The results identified 14 themes in four key areas: (1) technology use for supporting daily activities and reducing sedentary behaviors, (2) perceived barriers, (3) suggestions and preferences, and (4) actual home technology use. Lower perceived physical well-being was associated with higher levels of familiarity, interest, perceived utility, and control related to SARs. Lower perceived psychological well-being was linked to a more negative attitude, increased concerns about environmental fit, and a preference for less variety. Notably, older adults from the low--socioeconomic status group perceived less control over SARs, whereas older adults with motor difficulties expressed higher perceived utility compared to other groups, as well as higher familiarity and interest compared to the low--socioeconomic status group. Conclusions: Participants indicated that SARs and monitoring technologies could help reduce sedentary behaviors by assisting in the management of daily activities. The results are discussed in the context of these outcomes and the implementation of SARs and monitoring technologies at home. This study highlights the importance of considering the functional and socioeconomic characteristics of older adults as future users of SARs and monitoring technologies to promote widespread adoption and improve well-being within this population. ", doi="10.2196/63092", url="https://aging.jmir.org/2024/1/e63092" } @Article{info:doi/10.2196/59585, author="Hall, A. Jeffrey", title="Ten Myths About the Effect of Social Media Use on Well-Being", journal="J Med Internet Res", year="2024", month="Nov", day="25", volume="26", pages="e59585", keywords="social media", keywords="well-being", keywords="health promotion", keywords="depressive disorder", keywords="depression", keywords="anxiety", keywords="adolescent", keywords="mental health", doi="10.2196/59585", url="https://www.jmir.org/2024/1/e59585" } @Article{info:doi/10.2196/51214, author="Ware, Paul", title="Social Cohesion and COVID-19: Integrative Review", journal="Interact J Med Res", year="2024", month="Nov", day="21", volume="13", pages="e51214", keywords="social cohesion", keywords="social capital", keywords="COVID-19", keywords="infrastructure", keywords="tool", keywords="social", keywords="economic", keywords="interpersonal", keywords="interpersonal relationship", keywords="emotions", keywords="pandemic", keywords="engagement", keywords="health behaviors", keywords="resilience", keywords="emotional well-being", keywords="well-being", abstract="Background: Nations of considerable wealth and sophisticated health care infrastructures have experienced high rates of illness and death from COVID-19. Others with limited economic means and less developed health systems have achieved much lower burdens. To build a full understanding, an appraisal of the contribution of social relationships is necessary. Social cohesion represents a promising conceptual tool. Objective: This study aimed to examine scholarship on social cohesion during the COVID-19 pandemic: specifically, the constructions of social cohesion being deployed, the variables chosen for representation, and the effects of and on social cohesion being reported. Methods: The PubMed, Scopus, and JSTOR databases were searched for relevant journal articles and gray literature. A total of 100 studies met the inclusion criteria. Data were extracted and analyzed from these using spreadsheet software. Results: Several constructions of social cohesion were found. These concerned interpersonal relationships, sameness and difference, collective action, perceptions or emotions of group members, structures and institutions of governance, locally or culturally specific versions, and hybrid or multidimensional models. Social cohesion was reported to be influential on health outcomes, health behaviors, resilience, and emotional well-being, but there was some potential for it to drive undesirable outcomes. Scholarship reported increases or decreases in quantitative measures of social cohesion, a temporary ``rally round the flag'' effect early in the pandemic, the variable impacts of policy on social cohesion, and changing interpersonal relationships due to the pandemic conditions. There are numerous issues with the literature that reflect the well-documented limitations of popular versions of the concept. Conclusions: Social cohesion has been used to express a range of different aspects of relationships during the pandemic. It is claimed to promote better health outcomes, more engagement with positive health behaviors, and greater resilience and emotional well-being. The literature presents a range of ways in which it has been altered by the pandemic conditions. There are significant weaknesses to this body of knowledge that greatly impede its overall quality. ", doi="10.2196/51214", url="https://www.i-jmr.org/2024/1/e51214" } @Article{info:doi/10.2196/64681, author="Park, Jinyoung and Lee, Jungeun and Noh, Dabok", title="Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach", journal="JMIR Hum Factors", year="2024", month="Nov", day="21", volume="11", pages="e64681", keywords="out-of-home youth", keywords="mental health intervention", keywords="mobile app", keywords="intervention mapping", keywords="youth", keywords="mental health", keywords="mHealth", keywords="mobile health", keywords="app", keywords="interview", keywords="need", keywords="focus group", keywords="emotion", keywords="emotional", keywords="young adult", keywords="independent living", keywords="emotional support", keywords="tool", keywords="emotion regulation", keywords="user", keywords="app usage", abstract="Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app's adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app's impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app's effectiveness in real-world settings and refine it continuously based on user input. ", doi="10.2196/64681", url="https://humanfactors.jmir.org/2024/1/e64681" } @Article{info:doi/10.2196/64626, author="McAlister, L. Kelsey and Beatty, C. Clare and Smith-Caswell, E. Jacqueline and Yourell, L. Jacqlyn and Huberty, L. Jennifer", title="Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors", journal="JMIR Ment Health", year="2024", month="Nov", day="4", volume="11", pages="e64626", keywords="adolescent social media", keywords="social media bans", keywords="emotion regulation", keywords="youth", keywords="adolescent", keywords="media use", keywords="social platform", keywords="social network", keywords="self-regulation", keywords="behavioral health", keywords="mental health", keywords="digital health", keywords="technology", keywords="digital literacy", doi="10.2196/64626", url="https://mental.jmir.org/2024/1/e64626" } @Article{info:doi/10.2196/59818, author="Wu, Yuting and Gong, Cong and Pi, Lifang and Zheng, Meixin and Liu, Weifang and Wang, Yamei", title="Interrelationships Among Individual Factors, Family Factors, and Quality of Life in Older Chinese Adults: Cross-Sectional Study Using Structural Equation Modeling", journal="JMIR Aging", year="2024", month="Oct", day="28", volume="7", pages="e59818", keywords="quality of life", keywords="older adults", keywords="individual factor", keywords="family factor", keywords="structural equation modeling (SEM)", abstract="Background: China's rapidly aging population necessitates effective strategies for ensuring older adults' quality of life (QOL). While individual factors (IF) and family factors (FF) are known to influence QOL, existing research often examines these factors in isolation or focuses on specific subpopulations, overlooking potential interactions and mediating pathways. Objective: This study aims to examine both direct and indirect pathways connecting IF and FF to older adults' QOL, focusing on the mediating roles of health risks (HR) and health care service demand (HSD). Methods: This study uses structural equation modeling (SEM) to analyze cross-sectional data from 8600 older participants in the 2015 China Health and Retirement Longitudinal Study (CHARLS), a nationally representative study using a multistage probability proportional to size sampling method. Results: Among the 8600 participants, the majority (5586/8502, 65.7\%) were aged 60-70 years, with a near-equal distribution of males and females at around 50\%. The average PCS score was 76.77, while the MCS score averaged 59.70. Both IF ($\beta$=0.165, P<.001) and FF ($\beta$=0.189, P<.001) had a direct positive effect on QOL. Furthermore, the indirect effects of IF ($\beta$=0.186, P<.001) and FF ($\beta$=0.211, P<.001) through HR and HSD were also significant. In the direct model, IF and FF had a greater impact on MCS ($\beta$=0.841) than on PCS ($\beta$=0.639). However, after including the 2 mediating factors, HR and HSD, the influence of IF and FF on MCS ($\beta$=0.739) became consistent with that on PCS ($\beta$=0.728). Subgroup analyses revealed that the direct effect of IF on QOL was significant in the 60-70 age group ($\beta$=0.151, P<.001) but not in those over 70 years old ($\beta$=0.122, P=.074). Comorbidity status significantly influenced the pathway from HR to HSD, with older adults having 2 or more chronic diseases ($\beta$=0.363) showing a greater impact compared to those with fewer than 2 chronic diseases ($\beta$=0.358). Conclusions: Both IF (education, per capita disposable income, and endowment insurance) and FF (satisfaction with a spouse and children) directly impact the QOL in older people. Meanwhile, IF and FF have equal influence on QOL through the mediating role of HR and HSD. Recognizing the interplay among these factors is crucial for targeted interventions to enhance the well-being of older adults in China. ", doi="10.2196/59818", url="https://aging.jmir.org/2024/1/e59818" } @Article{info:doi/10.2196/59501, author="Dana, Zara and Nagra, Harpreet and Kilby, Kimberly", title="Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study", journal="JMIR Form Res", year="2024", month="Oct", day="25", volume="8", pages="e59501", keywords="digital peer support", keywords="social loneliness", keywords="chat-based interactions", keywords="older adults", abstract="Background: Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users' autonomy, competence, and relatedness. Objective: This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ?65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism. Methods: Participants were each prompted with a single question: ``What's your struggle?'' Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts. Results: Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively. Conclusions: Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options. ", doi="10.2196/59501", url="https://formative.jmir.org/2024/1/e59501", url="http://www.ncbi.nlm.nih.gov/pubmed/39453688" } @Article{info:doi/10.2196/52640, author="Ch{\^a}tel, L. Bas D. and Janssen, M. Jeroen H. and Peeters, E. Geeske M. E. and Corten, Rense and Tieben, Rob and Deen, Menno and Hendriks, M. Elmy J. and Olde Rikkert, M. Marcel G.", title="Social Gaming to Decrease Loneliness in Older Adults: Recruitment Challenges and Attrition Analysis in a Digital Mixed Methods Feasibility Study", journal="JMIR Serious Games", year="2024", month="Oct", day="16", volume="12", pages="e52640", keywords="loneliness", keywords="digital health", keywords="serious gaming", keywords="older adults", keywords="recruitment", keywords="feasibility study", abstract="Background: Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact. Objective: This study aims to evaluate the feasibility of a social gaming app in reducing loneliness among older adults by evaluating recruitment strategies, data collection procedures, and gameplay activity. Methods: This mixed methods study recruited participants via newsletters, articles, and a social media campaign. We used semistructured interviews and descriptive analysis of questionnaire answers and game data to assess feasibility. Key measures included recruitment reach and efficiency, participant demographics, in-app activity, and app usability and engagement feedback. Results: The social media campaign reached 192,641 potential participants, resulting in 1363 game downloads. A total of 155 participants (aged 65 years and older: n=34, 21.9\% and aged less than 65 years: n=121, 78.1\%) provided informed consent, yielding a conversion rate of 0.08\%. The recruitment campaign focusing on distanced playful interaction had a significantly (P<.001) higher click-through rate (1.98\%) than a campaign focusing on research participation (click-through rate=0.51\%; P<.001). The overall conversion rate from advertisement exposure to research participation was 0.08\%. Participants had a mean age of 48 (SD 16) years. The 65 years and older group averaged 70 (SD 5) years, while the less 65 years group averaged 42 (SD 12) years. Additionally, 45.2\% (57/126) reported at least moderate levels of loneliness at baseline. Of the initial 554 players, 91 (16.4\%) remained active after the first week, and 32 (5.8\%) remained active for more than 90 days. Active participants tended to interact with those within their own age group, as indicated by a Pearson correlation of r=0.31 between the ages of the message sender and receiver. Interviews with 12 (48\%) participants (aged 65-79 years; female: n=12, 83\%) revealed barriers such as excessive chatbot questions and a mismatch between the target group and app design focus. Questionnaire completion rates dropped from 46\% at baseline to 10\% at follow-up. Conclusions: These findings underscore the challenges of recruitment and retention for older adults in a fully digital social gaming intervention. Effective recruitment strategies and targeted app design are crucial for engagement. Based on these insights, future interventions should focus on simplified interfaces, clear guidance for gameplay, and addressing the specific needs and preferences of older adults, thereby enhancing the effectiveness of digital mental health interventions. ", doi="10.2196/52640", url="https://games.jmir.org/2024/1/e52640", url="http://www.ncbi.nlm.nih.gov/pubmed/39412863" } @Article{info:doi/10.2196/57294, author="Debrot, Anik and Efinger, Liliane and Kheyar, Maya and Pomini, Valentino and Berthoud, Laurent", title="A French-Language Web-Based Intervention Targeting Prolonged Grief Symptoms in People Who Are Bereaved and Separated: Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Oct", day="16", volume="8", pages="e57294", keywords="web-based interventions", keywords="randomized controlled trial", keywords="grief", keywords="bereavement", keywords="separation", keywords="guidance", abstract="Background: Losing a loved one, through death or separation, counts among the most stressful life events and is detrimental to health and well-being. About 15\% of people show clinically significant difficulties coping with such an event. Web-based interventions (WBIs) are effective for a variety of mental health disorders, including prolonged grief. However, no validated WBI is available in French for treating prolonged grief symptoms. Objective: This study aimed to compare the efficacy and adherence rates of 2 WBIs for prolonged grief symptoms following the loss of a loved one through death or romantic separation. Methods: LIVIA 2.0 was developed relying on theoretical and empirical findings on bereavement processes and WBIs, and is compared with LIVIA 1, which has already demonstrated its efficacy. We conducted a randomized controlled trial and provided on-demand guidance to participants. Outcomes were assessed through web-based questionnaires before the intervention, after the intervention (12 weeks later), and at follow-up (24 weeks later). Primary outcomes were grief symptoms, depressive symptoms, and well-being. Secondary outcomes were anxiety symptoms, grief coping strategies, aspects related to self-identity, and program satisfaction. Results: In total, 62 participants were randomized (intent-to-treat [ITT] sample), 29 (47\%) in LIVIA 2.0 (active arm) and 33 (53\%) in LIVIA 1 (control arm). The dropout rate was 40\% (37/62), and 10 participants were removed due to exclusion criteria, leading to a final per-protocol sample of 27 (44\%) completers who differed from noncompleters only based on reporting fewer anxiety symptoms (t60=3.03; P=.004). Participants who are separated reported more grief symptoms (t60=2.22; P=.03) and attachment anxiety (t60=2.26; P=.03), compared to participants who are bereaved. There were pre-post within-group differences for both programs in the ITT sample, with significant reductions in grief (Cohen d=?0.90), depressive symptoms (Cohen d=?0.31), and centrality of the loss (Cohen d=?0.45). The same pattern was observed in the per-protocol sample, with the exception that anxiety symptoms also significantly diminished (Cohen d=?0.45). No difference was found in efficacy between the 2 programs (all P>.33). Participants (ITT sample) reported overall high levels of program satisfaction (mean 3.18, SD 0.54; over a maximum of 4). Effect stability was confirmed at the 6-month follow-up for all outcomes, with an improvement in self-concept clarity. Conclusions: The 2 grief-related WBIs were effective in reducing grief, depressive and anxiety symptoms for participants who are bereaved or separated. The analyses did not reveal any pre-post between-group differences, suggesting that the innovations brought to LIVIA 2.0 did not significantly affect the outcome. However, caution is warranted with the interpretation of the results given the limited power of the sample, which only allows the detection of medium effect sizes. Trial Registration: ClinicalTrials.gov NCT05219760; https://clinicaltrials.gov/study/NCT05219760 International Registered Report Identifier (IRRID): RR2-10.2196/39026 ", doi="10.2196/57294", url="https://formative.jmir.org/2024/1/e57294", url="http://www.ncbi.nlm.nih.gov/pubmed/39412869" } @Article{info:doi/10.2196/59029, author="Onishi, Ryuta", title="Parenting-Related Social Networking Site Use and Psychological Distress in Parents of Infants: Cross-sectional Study Exploring the Moderating Effects of Loneliness and Parenting Anxiety", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="11", volume="7", pages="e59029", keywords="social networking sites", keywords="social media", keywords="psychological distress", keywords="loneliness", keywords="anxiety", keywords="social support", keywords="mother", keywords="father", keywords="infant", keywords="psychological", keywords="distress", keywords="children", keywords="web-based questionnaire", keywords="parent", abstract="Background: In the digital age, social networking sites (SNSs) have revolutionized the approach to parenting. These platforms, widely used to access parenting information and support, affect parents both positively and negatively, with negative effects potentially increasing for those experiencing loneliness or anxiety. Objective: This study examined the relationship between SNS use and psychological distress among parents of young children, controlling for the moderating effects of loneliness and parenting anxiety. We hypothesized that higher SNS use correlates to greater psychological distress, particularly among parents with elevated levels of loneliness or parenting anxiety. Methods: A cross-sectional survey design using a closed web-based questionnaire was employed. Participants included 429 parents (205 mothers and 224 fathers) of children aged 0?3 years recruited through a web-based survey company in Japan. The majority of the participants were couples, with some living with extended family members. The sample also encompassed individuals in cohabiting partnerships and single parents. The survey included measures of psychological distress, loneliness, parenting anxiety, frequency of SNS use for parenting, and covariates. Analytical models to explain psychological distress included interactions between loneliness or parenting anxiety and SNS use, individually for both fathers and mothers. Results: For mothers, a significant interaction effect was determined only between parenting anxiety and SNS use (b=0.247, SE 0.091; P=.008). Meanwhile, for fathers, significant interaction effects were observed for both loneliness (b=0.324, SE 0.127; P=.012) and parenting anxiety (b=0.144, SE 0.069; P=.038) with SNS use. A simple slope analysis for mothers indicated that SNS use was related to psychological distress only at higher levels of parenting anxiety (b=0.304, SE 0.090, $\beta$=.317; P<.001). Among fathers, SNS use was associated with psychological distress at higher levels of either parenting anxiety (b=0.330, SE 0.069, $\beta$=.346; P<.001) or loneliness (b=0.390, SE 0.098, $\beta$=.409; P<.001). Conclusions: The study concluded that the relationship between SNS use and psychological distress among parents of young children is moderated by loneliness and parenting anxiety. The findings highlight the need for tailored approaches to help parents manage SNS use, particularly focusing on those with higher levels of loneliness and parenting anxiety. It is imperative that health professionals provide nuanced guidance to parents on SNS use, considering individual psychological factors and potential gender differences in the impact of SNSs on mental well-being. ", doi="10.2196/59029", url="https://pediatrics.jmir.org/2024/1/e59029" } @Article{info:doi/10.2196/60387, author="Hill, Miranda and Greene, Meredith and Johnson, K. Julene and Tan, Y. Judy", title="United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study", journal="JMIR Form Res", year="2024", month="Oct", day="8", volume="8", pages="e60387", keywords="HIV", keywords="AIDS", keywords="mental health", keywords="loneliness", keywords="older adults", keywords="music-based interventions", keywords="technology", keywords="mobile phone", abstract="Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV. ", doi="10.2196/60387", url="https://formative.jmir.org/2024/1/e60387", url="http://www.ncbi.nlm.nih.gov/pubmed/39378071" } @Article{info:doi/10.2196/56355, author="Iyer, Priya and Iyer, Lina and Carter, Nicole and Iyer, Ranjani and Stirling, Amy and Priya, Lakshmi and Sriraman, Ushma", title="Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study", journal="JMIR Form Res", year="2024", month="Sep", day="30", volume="8", pages="e56355", keywords="Heartfulness, anxiety, loneliness, high school, satisfaction with life", keywords="self-care", keywords="develop", keywords="stress", keywords="stress management", keywords="effectiveness", keywords="life satisfaction", keywords="students", keywords="student", keywords="support", keywords="web-based program", keywords="time management", keywords="educational", keywords="mental health", keywords="tool", keywords="tools", abstract="Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder---Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 ", doi="10.2196/56355", url="https://formative.jmir.org/2024/1/e56355", url="http://www.ncbi.nlm.nih.gov/pubmed/39047180" } @Article{info:doi/10.2196/64196, author="Kawaguchi, Kenjiro and Nakagomi, Atsushi and Ide, Kazushige and Kondo, Katsunori", title="Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Sep", day="30", volume="26", pages="e64196", keywords="gerontology", keywords="geriatrics", keywords="older adults", keywords="elderly", keywords="older people", keywords="community dwelling older adult", keywords="aging", keywords="social participation", keywords="walking", keywords="mHealth", keywords="apps", keywords="smartphone", keywords="digital health", keywords="digital technology", keywords="digital interventions", keywords="physical activity", keywords="exercise", abstract="Background: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. Objective: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, ``Shakai Sanka no Susume;'' Hitachi) in promoting social participation and physical activity among community-dwelling older adults. Methods: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. Results: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95\% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95\% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95\% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95\% CIs that did not encompass zero. Conclusions: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. Trial Registration: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000055781 ", doi="10.2196/64196", url="https://www.jmir.org/2024/1/e64196", url="http://www.ncbi.nlm.nih.gov/pubmed/39348180" } @Article{info:doi/10.2196/41093, author="Yoo, In-jin and Park, Do-Hyung and Lee, EunKyoung Othelia and Park, Albert", title="Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study", journal="JMIR Form Res", year="2024", month="Sep", day="19", volume="8", pages="e41093", keywords="socially assistive robot", keywords="older adults", keywords="robot use pattern", keywords="time series clustering", keywords="profiling analysis", abstract="Background: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. Objective: This study aims to examine the characteristics and use patterns of SARs. Methods: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Results: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. Conclusions: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions. ", doi="10.2196/41093", url="https://formative.jmir.org/2024/1/e41093" } @Article{info:doi/10.2196/54402, author="Wang, Lizhu and Li, Li and Qiu, Yang and Li, Sihan and Wang, Zhonghua", title="Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="19", volume="10", pages="e54402", keywords="Type 2 diabetes", keywords="social support", keywords="self-efficacy", keywords="self-management", keywords="quality of life", keywords="structural equation modeling", abstract="Background: Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated. Objective: This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries. Methods: This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy. Results: It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36\% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2\% and 28.6\% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01). Conclusions: The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group. ", doi="10.2196/54402", url="https://publichealth.jmir.org/2024/1/e54402" } @Article{info:doi/10.2196/58791, author="Kang, Boyoung and Hong, Munpyo", title="Digital Interventions for Reducing Loneliness and Depression in Korean College Students: Mixed Methods Evaluation", journal="JMIR Form Res", year="2024", month="Sep", day="12", volume="8", pages="e58791", keywords="loneliness", keywords="depression", keywords="digital interventions", keywords="college students", keywords="mental health", keywords="mixed methods evaluation", keywords="Woebot", keywords="Happify", abstract="Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot (Woebot Health, Inc) and Happify (Twill Inc), have shown promise in alleviating these symptoms. Objective: This study aims to investigate the effectiveness and acceptability of Woebot and Happify in reducing loneliness and depression among college students after the COVID-19 pandemic. Methods: A mixed methods approach was used over 4 months. A total of 63 participants aged 18 to 27 years from Sungkyunkwan University in Seoul, South Korea, were initially recruited, with an inclusion criterion of University of California, Los Angeles (UCLA) Loneliness Scale score ?34. The final sample consisted of 27 participants due to attrition. Participants were randomly assigned to Woebot (15/27, 55\%); Happify (9/27, 33\%); or a control group using Bondee (Metadream), a metaverse social network messenger app (3/27, 11\%). Quantitative measures (UCLA Loneliness Scale and Patient Health Questionnaire-9) and qualitative assessments (user feedback and focused interviews) were used. Results: Although mean decreases in loneliness and depression were observed in the control and intervention groups after the intervention, the differences between the control and intervention groups were not statistically significant (UCLA Loneliness: P=.67; Patient Health Questionnaire-9: P=.35). Qualitative data indicated user satisfaction, with suggestions for improved app effectiveness and personalization. Conclusions: Despite limitations, this study highlights the potential of well-designed digital interventions in alleviating college students' loneliness and depression. The findings contribute to the growing body of research on accessible digital mental health tools and underscore the importance of comprehensive support systems. Further research with larger and more diverse samples is needed to better understand the effectiveness and optimization of such interventions. Trial Registration: Clinical Research Information Service KCT0009449; https://bit.ly/4d2e4Bu ", doi="10.2196/58791", url="https://formative.jmir.org/2024/1/e58791" } @Article{info:doi/10.2196/52978, author="Guo, Yufang and Yue, Fangyan and Lu, Xiangyu and Sun, Fengye and Pan, Meixing and Jia, Yannan", title="COVID-19--Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey", journal="J Med Internet Res", year="2024", month="Sep", day="10", volume="26", pages="e52978", keywords="COVID-19 pandemic", keywords="internet gaming disorder", keywords="self-control", keywords="social isolation", keywords="university students", keywords="game", keywords="gaming", keywords="games", keywords="addict", keywords="addictive", keywords="addiction", keywords="addictions", keywords="university", keywords="universities", keywords="college", keywords="colleges", keywords="postsecondary", keywords="higher education", keywords="student", keywords="students", keywords="China", keywords="Chinese", keywords="isolation", keywords="isolated", keywords="self-compassion", keywords="mental health", keywords="association", keywords="associations", keywords="correlation", keywords="causal", keywords="correlated", keywords="correlations", abstract="Background: Internet gaming disorder among university students has become a great concern for university counsellors worldwide since the COVID-19 pandemic. The factors influencing the development of internet gaming disorder in students during the COVID-19 pandemic could be different from those before the pandemic. Objective: This study aims to explore the associations among social isolation, self-control, and internet gaming disorder in Chinese university students and to examine whether self-control mediates the positive effects of social isolation on internet gaming disorder. Methods: A cross-sectional survey was employed to collect data from university students in Shandong province of China from April to September 2022. The Isolation subscale of the Self-Compassion Scale, Self-Control Scale, and Internet Gaming Disorder Scale were used to assess the social isolation, self-control, and internet gaming disorder among university students, respectively. Models 4 and 5 of PROCESS software were used to analyze the mediating role of self-control and the moderating role of gender on the association between social isolation and internet gaming disorder. Results: A total of 479 students were recruited from 6 universities located in 3 different regions of Shandong, China. Students had low levels of internet gaming disorder and moderate levels of social isolation and self-control, with mean scores of 8.94 (SD 9.06), 12.04 (SD 3.53), and 57.15 (SD 8.44), respectively. Social isolation was positively correlated with internet gaming disorder (r=0.217; P<.001), and self-control was negatively correlated with social isolation (r=--0.355; P<.001) and internet gaming disorder (r=--0.260; P<.001). Self-control played a mediating role in the association between social isolation and internet gaming disorder ($\beta$=--.185, 95\% CI --.295 to --.087). The effects of social isolation on internet gaming disorder among female students were lower than those among male students. Conclusions: Self-control was a mediator in the association between social isolation and internet gaming disorder. Moreover, gender played a moderating role in the association between social isolation and internet gaming disorder. This study highlights the need to alleviate the development of internet gaming disorder among students during a pandemic, especially that of male students. Effective interventions that lessen social isolation and promote self-control should be developed. ", doi="10.2196/52978", url="https://www.jmir.org/2024/1/e52978" } @Article{info:doi/10.2196/51653, author="Sugaya, Nagisa and Yamamoto, Tetsuya and Suzuki, Naho and Uchiumi, Chigusa", title="Loneliness and Social Isolation Factors Under the Prolonged COVID-19 Pandemic in Japan: 2-Year Longitudinal Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="9", volume="10", pages="e51653", keywords="COVID-19", keywords="pandemic", keywords="loneliness", keywords="social isolation", keywords="longitudinal survey", keywords="epidemiology", keywords="mental health", abstract="Background: Worsening loneliness and social isolation during the COVID-19 pandemic have become serious public health concerns worldwide. Despite previous research reporting persistent loneliness and social isolation under repeated emergency declarations and prolonged pandemics, long-term studies are needed to identify the actual conditions of loneliness and social isolation, and the factors that explain them. Objective: In this study, 3 web-based surveys were conducted at 1-year intervals during the 2 years after the first state of emergency to examine changes in loneliness and social isolation and the psychosocial factors associated with them in the Japanese population. Methods: The first survey (phase 1, May 11-12, 2020) was conducted at the end of the first emergency declaration period, the second survey (phase 2, June 14-20, 2021) was conducted at the end of the third emergency declaration period, and the third survey (phase 3, May 13-30, 2022) was conducted when the state of emergency had not been declared but many COVID-19--positive cases occurred during this period. We collected data on 3892 inhabitants (n=1813, 46.58\% women; age: mean 50.3, SD 13.4 y) living in the 4 prefectures where emergency declaration measures were applied in phases 1 and 2. A linear mixed model analysis was performed to examine the association between psychosocial variables as explanatory variables and loneliness scores as the dependent variable in each phase. Results: While many psychosocial and physical variables showed improvement for the 2 years, loneliness, social isolation, and the relationship with familiar people deteriorated, and the opportunities for exercise, favorite activities, and web-based interaction with familiar people decreased. Approximately half of those experiencing social isolation in phase 1 remained isolated throughout the 2-year period, and a greater number of people developed social isolation than those who were able to resolve it. The results of the linear mixed model analysis showed that most psychosocial and physical variables were related to loneliness regardless of the phase. Regarding the variables that showed a significant interaction with the phase, increased altruistic preventive behavior and a negative outlook for the future were more strongly associated with severe loneliness in phase 3 (P=.01 to <.001), while the association between fewer social networks and stronger loneliness tended to be more pronounced in phase 2. Although the interaction was not significant, the association between reduced face-to-face interaction, poorer relationships with familiar people, and increased loneliness tended to be stronger in phase 3. Conclusions: This study found that loneliness and social isolation remained unresolved throughout the long-term COVID-19 pandemic. Additionally, in the final survey phase, these issues were influenced by a broader and more complex set of factors compared to earlier phases. ", doi="10.2196/51653", url="https://publichealth.jmir.org/2024/1/e51653", url="http://www.ncbi.nlm.nih.gov/pubmed/39250195" } @Article{info:doi/10.2196/53309, author="Boensvang, Nybro Natasha and Weibel, Mette and Wakefield, E. Claire and Bidstrup, Envold Pernille and Olsen, Marianne and Nissen, B{\ae}kgaard Karin and Spager, Vibeke and Fridh, Kaj Martin and Larsen, B{\ae}kgaard Hanne", title="Online Ambassador Visits for Hospitalized Children With Cancer: Qualitative Evaluation of Implementation", journal="JMIR Pediatr Parent", year="2024", month="Sep", day="4", volume="7", pages="e53309", keywords="Children", keywords="cancer", keywords="school-aged", keywords="peers", keywords="interaction", keywords="online", keywords="in-hospital", keywords="social", keywords="relationship", keywords="quality of life", keywords="intervention", keywords="qualiative", abstract="Background: Children with cancer or cancer-like disease risk treatment-related isolation, which can negatively impact their peer relationships and social competencies and exacerbate their loneliness. During the COVID-19 pandemic, increased online socialization became the new normal imposed by national isolation guidelines. To adhere to the treatment-related isolation guidelines, children with cancer were offered online classmate ``ambassador'' visits during hospitalization. Objective: This study aimed to identify facilitators and barriers to online classmate ``ambassador'' visits during children with cancer's hospitalization through a qualitative descriptive process evaluation using the Consolidated Framework for Implementation Research. Methods: From January to April 2022, we conducted 39 individual semistructured interviews with hospitalized children (n=16), their classmates (n=16), teachers from their schools (n=3), and study nurses (n=4) from involved hospitals. Most interviews (n=37, 95\%) were conducted online using Microsoft Teams or Google Meet, while 2 (5\%) interviews were conducted in person at the participants' residences. This approach allowed us to gain a broad understanding of the facilitators and barriers to online ambassador visits. Results: We identified four themes: (1) working together, (2) ensuring participation, (3) staying connected, and (4) together online. The themes are described in terms of facilitators and barriers to online ambassador visits with 3 Consolidated Framework for Implementation Research domains: innovation, individuals, and the implementation process. Conclusions: Addressing the social needs of hospitalized children through online visits with their classmates may be relevant when one-on-one meetings are problematic. The online visits are highly dependent on collaboration between study nurses and teachers and assessing the needs of the hospitalized children. While a high degree of adult engagement and a stable internet connection are pivotal, these online visits can promote much-needed social interaction between children across physical settings. ", doi="10.2196/53309", url="https://pediatrics.jmir.org/2024/1/e53309" } @Article{info:doi/10.2196/56669, author="Tan, Kian Cheng and Lou, Q. Vivian W. and Cheng, Man Clio Yuen and He, Chu Phoebe and Khoo, Joo Veronica Eng", title="Improving the Social Well-Being of Single Older Adults Using the LOVOT Social Robot: Qualitative Phenomenological Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="23", volume="11", pages="e56669", keywords="companionship", keywords="older adults", keywords="social well-being", keywords="pets", keywords="social robots", keywords="elderly", keywords="wellbeing", keywords="qualitative research", keywords="robot", keywords="companion", keywords="body temperature", keywords="development", keywords="research design", keywords="design", keywords="interviews", keywords="psychosocial support", keywords="support", keywords="psychosocial", keywords="temperature regulation", keywords="social", keywords="care home", keywords="aging", keywords="ageing", keywords="robotics", keywords="well-being", keywords="loneliness", keywords="technology", keywords="mobile phone", abstract="Background: This study examined the social well-being of single older adults through the companionship of a social robot, LOVOT (Love+Robot; Groove X). It is designed as a companion for older adults, providing love and affection through verbal and physical interaction. We investigated older adults' perceptions of the technology and how they benefitted from interacting with LOVOT, to guide the future development of social robots. Objective: This study aimed to use a phenomenological research design to understand the participants' experiences of companionship provided by the social robot. Our research focused on (1) examining the social well-being of single older adults through the companionship of social robots and (2) understanding the perceptions of single older adults when interacting with social robots. Given the prevalence of technology use to support aging, understanding single older adults' social well-being and their perceptions of social robots is essential to guide future research on and design of social robots. Methods: A total of 5 single women, aged 60 to 75 years, participated in the study. The participants interacted independently with the robot for a week in their own homes and then participated in a poststudy interview to share their experiences. Results: In total, 4 main themes emerged from the participants' interactions with LOVOT, such as caring for a social robot, comforting presence of the social robot, meaningful connections with the social robot, and preference for LOVOT over pets. Conclusions: The results indicate that single older adults can obtain psychosocial support by interacting with LOVOT. LOVOT is easily accepted as a companion and makes single older adults feel like they have a greater sense of purpose and someone to connect with. This study suggests that social robots can provide companionship to older adults who live alone. Social robots can help alleviate loneliness by allowing single older adults to form social connections with robots as companions. These findings are particularly important given the rapid aging of the population and the increasing number of single-person households in Singapore. ", doi="10.2196/56669", url="https://humanfactors.jmir.org/2024/1/e56669" } @Article{info:doi/10.2196/57101, author="Imai, Ayu and Matsuoka, Teruyuki and Nakayama, Chikara and Hashimoto, Nana and Sano, Mutsuo and Narumoto, Jin", title="Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study", journal="JMIR Res Protoc", year="2024", month="Aug", day="1", volume="13", pages="e57101", keywords="loneliness", keywords="virtual reality", keywords="VR", keywords="Alzheimer disease", keywords="predementia", keywords="intervention", keywords="subjective cognitive decline", keywords="mild cognitive impairment", keywords="dementia", keywords="older adult", keywords="geriatric", keywords="depression", keywords="cognitive impairments", abstract="Background: Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. Objective: This study aims to assess the impact of a virtual reality (VR)--based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. Methods: The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. Results: Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. Conclusions: This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR's impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. Trial Registration: University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5 International Registered Report Identifier (IRRID): DERR1-10.2196/57101 ", doi="10.2196/57101", url="https://www.researchprotocols.org/2024/1/e57101", url="http://www.ncbi.nlm.nih.gov/pubmed/39088243" } @Article{info:doi/10.2196/52292, author="Lu, Yinn Si and Yoon, Sungwon and Yee, Qi Wan and Heng Wen Ngiam, Nerice and Ng, Yi Kennedy Yao and Low, Leng Lian", title="Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study", journal="JMIR Aging", year="2024", month="Apr", day="25", volume="7", pages="e52292", keywords="digital divide", keywords="digital learning", keywords="smartphones", keywords="social gerontology", keywords="older adults", keywords="COVID-19 pandemic", keywords="technology adoption", abstract="Background: Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults' behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education. Few empirical studies have examined how older adults experiencing social and economic disadvantages perceive the learning of digital tools. Objective: This study aims to examine the motivations, experiences, and perceptions toward a community-based digital intervention among older adults residing in public rental flats in a low-income neighborhood. Specifically, we explored how their attitudes and behaviors toward learning the use of smartphones are shaped by their experiences related to age and socioeconomic challenges. Methods: This study adopted a qualitative methodology. Between December 2020 and March 2021, we conducted semistructured in-depth interviews with 19 participants aged ?60 years who had completed the community-based digital intervention. We asked participants questions about the challenges encountered amid the pandemic, their perceived benefits of and difficulties with smartphone use, and their experiences with participating in the intervention. All interviews were audio recorded and analyzed using a reflexive thematic approach. Results: Although older learners stated varying levels of motivation to learn, most expressed ambivalence about the perceived utility and relevance of the smartphone to their current needs and priorities. While participants valued the social interaction with volunteers and the personalized learning model of the digital intervention, they also articulated barriers such as age-related cognitive and physical limitations and language and illiteracy that hindered their sustained use of these digital devices. Most importantly, the internalization of ageist stereotypes of being less worthy learners and the perception of smartphone use as being in the realm of the privileged other further reduced self-efficacy and interest in learning. Conclusions: To improve learning and sustained use of smartphones for older adults with low income, it is essential to explore avenues that render digital tools pertinent to their daily lives, such as creating opportunities for social connections and relationship building. Future studies should investigate the relationships between older adults' social, economic, and health marginality and their ability to access digital technologies. We recommend that the design and implementation of digital interventions should prioritize catering to the needs and preferences of various segments of older adults, while working to bridge rather than perpetuate the digital divide. ", doi="10.2196/52292", url="https://aging.jmir.org/2024/1/e52292", url="http://www.ncbi.nlm.nih.gov/pubmed/38662423" } @Article{info:doi/10.2196/48027, author="Chaves, Antonio and Arn{\'a}ez, Sandra and Garc{\'i}a-Soriano, Gemma", title="The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study", journal="JMIR Mhealth Uhealth", year="2024", month="Mar", day="29", volume="12", pages="e48027", keywords="obsessive-compulsive disorder", keywords="OCD", keywords="mental health literacy", keywords="stigma", keywords="app", keywords="help-seeking intention", keywords="seek help", keywords="mobile phone", abstract="Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people's lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the ``stigma monster'' over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory--Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire--27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86\% (n=78) were allocated to intervention. Of these 78 participants, 79\% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69\% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90\% (56/62). Moreover, 90\% (56/62) of the participants reported that they had learned or learned a lot, and 98\% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69\%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. ", doi="10.2196/48027", url="https://mhealth.jmir.org/2024/1/e48027", url="http://www.ncbi.nlm.nih.gov/pubmed/38551629" } @Article{info:doi/10.2196/50534, author="Marziali, Alessandra Rachele and Franceschetti, Claudia and Dinculescu, Adrian and Nistorescu, Alexandru and Krist{\'a}ly, Mircea Dominic and Mo?oi, Alexandru Adrian and Broekx, Ronny and Marin, Mihaela and Vizitiu, Cristian and Moraru, Sorin-Aurel and Rossi, Lorena and Di Rosa, Mirko", title="Reducing Loneliness and Social Isolation of Older Adults Through Voice Assistants: Literature Review and Bibliometric Analysis", journal="J Med Internet Res", year="2024", month="Mar", day="18", volume="26", pages="e50534", keywords="voice assistant", keywords="loneliness", keywords="social isolation", keywords="older adults", keywords="literature review", keywords="bibliometric analysis", keywords="mobile phone", abstract="Background: Loneliness and social isolation are major public health concerns for older adults, with severe mental and physical health consequences. New technologies may have a great impact in providing support to the daily lives of older adults and addressing the many challenges they face. In this scenario, technologies based on voice assistants (VAs) are of great interest and potential benefit in reducing loneliness and social isolation in this population, because they could overcome existing barriers with other digital technologies through easier and more natural human-computer interaction. Objective: This study aims to investigate the use of VAs to reduce loneliness and social isolation of older adults by performing a systematic literature review and a bibliometric cluster mapping analysis. Methods: We searched PubMed, Embase, and Scopus databases for articles that were published in the last 6 years, related to the following main topics: voice interface, VA, older adults, isolation, and loneliness. A total of 40 articles were found, of which 16 (40\%) were included in this review. The included articles were then assessed through a qualitative scoring method and summarized. Finally, a bibliometric analysis was conducted using VOSviewer software (Leiden University's Centre for Science and Technology Studies). Results: Of the 16 articles included in the review, only 2 (13\%) were considered of poor methodological quality, whereas 9 (56\%) were of medium quality and 5 (31\%) were of high quality. Finally, through bibliometric analysis, 221 keywords were extracted, of which 36 (16\%) were selected. The most important keywords, by number of occurrences and by total link strength; results of the analysis with the Association Strength normalization method; and default values were then presented. The final bibliometric network consisted of 36 selected keywords, which were grouped into 3 clusters related to 3 main topics (ie, VA use for social isolation among older adults, the significance of age in the context of loneliness, and the impact of sex factors on well-being). For most of the selected articles, the effect of VA on social isolation and loneliness of older adults was a minor theme. However, more investigations were done on user experience, obtaining preliminary positive results. Conclusions: Most articles on the use of VAs by older adults to reduce social isolation and loneliness focus on usability, acceptability, or user experience. Nevertheless, studies directly addressing the impact that using a VA has on the social isolation and loneliness of older adults find positive and promising results and provide important information for future research, interventions, and policy development in the field of geriatric care and technology. ", doi="10.2196/50534", url="https://www.jmir.org/2024/1/e50534", url="http://www.ncbi.nlm.nih.gov/pubmed/38498039" } @Article{info:doi/10.2196/49462, author="Chou, Ya-Hsin and Lin, Chemin and Lee, Shwu-Hua and Lee, Yen-Fen and Cheng, Li-Chen", title="User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Mar", day="13", volume="8", pages="e49462", keywords="geriatric psychiatry", keywords="mental health", keywords="loneliness", keywords="chatbot", keywords="user experience", keywords="health promotion", keywords="older adults", keywords="technology-assisted interventions", keywords="pandemic", keywords="lonely", keywords="gerontology", keywords="elderly", keywords="develop", keywords="design", keywords="development", keywords="conversational agent", keywords="geriatric", keywords="geriatrics", keywords="psychiatry", abstract="Background: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. Objective: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Methods: Participants were older adults belonging to two age groups (?65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot's content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. Results: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74\% (n=26) female and 26\% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82\% engaging with the chatbot daily. Loneliness significantly improved in the older group ?65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. Conclusions: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic. ", doi="10.2196/49462", url="https://formative.jmir.org/2024/1/e49462", url="http://www.ncbi.nlm.nih.gov/pubmed/38477965" } @Article{info:doi/10.2196/43999, author="Fritz, Johanna and von Heideken W{\aa}gert, Petra and Gusdal, K. Annelie and Johansson-Pajala, Rose-Marie and Eklund, Caroline", title="Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives", journal="JMIR Aging", year="2024", month="Feb", day="26", volume="7", pages="e43999", keywords="information and communication technology", keywords="implementation", keywords="determinants", keywords="social isolation", keywords="loneliness", keywords="organization", keywords="digitalization", keywords="facilitators", keywords="barriers", keywords="older people", abstract="Background: Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. Objective: This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. Methods: This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. Results: The results included 7 categories of determinants for implementing the ICT tool. Being able to introduce the ICT tool in an appropriate manner concerns the personnel's options for introducing and supporting the ICT tool, including their competencies in using digital equipment. Organizational structure concerns a structure for communication within the organization. Leadership concerns engagement and enthusiasm as driving forces for implementation. The digital maturity of the social services personnel concerns the personnel's skills and attitudes toward using digital equipment. Resources concern time and money. IT support concerns accessibility, and legal liability concerns possibilities to fulfill legal responsibilities. Conclusions: The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results. ", doi="10.2196/43999", url="https://aging.jmir.org/2024/1/e43999", url="http://www.ncbi.nlm.nih.gov/pubmed/38407955" } @Article{info:doi/10.2196/47908, author="Sen, Keya and Laheji, Nida and Ramamonjiarivelo, Zo and Renick, Cecil and Osborne, Randall and Beauvais, Brad", title="Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students' Attitude Toward Companionship: Content Analysis", journal="JMIR Aging", year="2024", month="Jan", day="30", volume="7", pages="e47908", keywords="intergenerational befriending", keywords="social isolation", keywords="boredom", keywords="contactless socialization", keywords="service learning", keywords="internal motivation", keywords="mobile phone", abstract="Background: Intergenerational friendship, a mechanism of social support, is an effective intervention to reduce the increasing risk of social isolation (SI) and develop companionship in the older adult population. The COVID-19 pandemic provided a unique opportunity to examine the psychosocial intervention of befriending via technology use as a primary form of contactless socialization. Objective: The study aims to explore the effectiveness of the befriending intervention through a contactless, intergenerational service-learning project on older adult emotions, especially boredom and loneliness as the key attributes of SI, and on students' attitude toward companionship. Methods: During the months of January to April 2022 , undergraduate students enrolled in a health administration course with a special focus on culture were asked to be involved in a contactless, intergenerational service-learning project (n=46). In this study, contactless intervention meant communication using the telephone and apps such as FaceTime and Zoom. Students were paired with older adults to have at least a 30-minute weekly conversation, for 8 weeks, via telephone or an internet-based app such as FaceTime. Students were asked to write a half-page diary after each interaction and a 1-page reflection at the end of the fourth week and at the end of the service-learning project. At the completion of the project, the researchers also surveyed the older adults to assess the impact of the project using a 5-item open-ended questionnaire. Following a heuristic approach and content analysis, student artifacts (110,970 words; 118-page, single-spaced Microsoft Word document) and the older adult surveys were analyzed using MAXQDA, (VERBI GmbH). Qualitative data were extracted to assess the impact of service learning on SI by measuring the attributes of boredom and loneliness among 46 older adults. Students' attitudes toward companionship were also assessed using data from their diaries and reflections. Results: Overall, three major constructs were identified: (1) meaningful engagement, defined as feeling safe, having increased confidence, and having reduced boredom; (2) internal motivation to participate in the weekly interaction, defined as discussion about daily life experience, level of happiness, and ability to exert personal control over the situation; and (3) intergenerational befriending, defined as perceived benefits from the friendly nature of the interaction, ability to comfortably connect with students, and positive feeling and attitude toward the student. Conclusions: The contactless, intergenerational befriending intervention reduced boredom and loneliness among older adults and enhanced positive attitude and confidence among university students. Students helped older adults to develop digital skills for the use of apps and social media. Older adults showed interest in the intervention and shared their daily life experiences with the students, which helped to reduce the gap between generations. Findings indicate the effectiveness of an intergenerational service-learning intervention on SI reduction and increased positive attitude among college students. ", doi="10.2196/47908", url="https://aging.jmir.org/2024/1/e47908", url="http://www.ncbi.nlm.nih.gov/pubmed/38175944" } @Article{info:doi/10.2196/48175, author="Thangavel, Gomathi and Memedi, Mevludin and Hedstr{\"o}m, Karin", title="Information and Communication Technology for Managing Social Isolation and Loneliness Among People Living With Parkinson Disease: Qualitative Study of Barriers and Facilitators", journal="J Med Internet Res", year="2024", month="Jan", day="17", volume="26", pages="e48175", keywords="social isolation", keywords="loneliness", keywords="Parkinson disease", keywords="ICT", keywords="information and communication technology", abstract="Background: Parkinson disease (PD) is a complex, noncurable, and progressive neurological disease affecting different areas of the human nervous system. PD is associated with both motor and nonmotor symptoms, which negatively affect patients' quality of life and may cause changes in socialization such as intentional social withdrawal. This may further lead to social isolation and loneliness. The use of information and communication technology (ICT) plays an important role in managing social isolation and loneliness. Currently, there is a lack of research focusing on designing and developing ICT solutions that specifically address social isolation and loneliness among people living with PD. Objective: This study addresses this gap by investigating barriers and social needs in the context of social isolation, loneliness, and technology use among people living with PD. The insights gained can inform the development of effective ICT solutions, which can address social isolation and loneliness and improve the quality of life for people living with PD. Methods: A qualitative study with 2 phases of data collection were conducted. During the first phase, 9 health care professionals and 16 people living with PD were interviewed to understand how PD affects social life and technology use. During the second phase, 2 focus groups were conducted with 4 people living with PD in each group to gather insights into their needs and identify ways to manage social isolation and loneliness. Thematic analysis was used to analyze both data sets and identify key themes. Results: The results showed that the barriers experienced by people living with PD due to PD such as ``fatigue,'' ``psychological conditions,'' ``social stigma,'' and ``medication side effects'' affect their social life. People living with PD also experience difficulties using a keyboard and mouse, remembering passwords, and navigating complex applications due to their PD-related physical and cognitive limitations. To manage their social isolation and loneliness, people living with PD suggested having a simple and easy-to-use solution, allowing them to participate in a digital community based on their interests, communicate with others, and receive recommendations for social events. Conclusions: The new ICT solutions focusing on social isolation and loneliness among people living with PD should consider the barriers restricting user's social activities and technology use. Given the wide range of needs and barriers experienced by people living with PD, it is more suitable to adopt user-centered design approaches that emphasize the active participation of end users in the design process. Importantly, any ICT solution designed for people living with PD should not encourage internet addiction, which will further contribute to the person's withdrawal from society. ", doi="10.2196/48175", url="https://www.jmir.org/2024/1/e48175", url="http://www.ncbi.nlm.nih.gov/pubmed/38231548" } @Article{info:doi/10.2196/49253, author="Pang, Mingli and Wang, Jieru and Zhao, Mingyue and Chen, Rui and Liu, Hui and Xu, Xixing and Li, Shixue and Kong, Fanlei", title="The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="9", volume="10", pages="e49253", keywords="loneliness", keywords="social support", keywords="sleep disturbance", keywords="older adults", keywords="migrant-local difference", keywords="structural equation modeling", abstract="Background: Driven by the accelerated aging of the population of China, the number of older adults has increased rapidly in the country. Meanwhile, following children, migrant older adults (MOA) have emerged as a vulnerable group in the process of fast urbanization. Existed studies have illustrated the association between social support and loneliness and the relationship between sleep disturbance and loneliness; however, the underlying mechanisms and the migrant-local difference in the association between social support, sleep disturbance, and loneliness have not been identified. Objective: This study aimed to clarify the migrant-local difference in the relationship between social support, sleep disturbance, and loneliness in older adults in China. Methods: Multistage cluster random sampling was used to select participants: 1205 older adults (n=613, 50.9\%, MOA and n=592, 49.1\%, local older adults [LOA]) were selected in Weifang City, China, in August 2021. Loneliness was assessed with the 6-item short-form University of California, Los Angeles Loneliness Scale, social support was evaluated with the Social Support Rating Scale, and sleep disturbance was measured with the Pittsburgh Sleep Quality Index. The chi-square test, t test, and structural equation modeling (SEM) were adopted to explore the migrant-local difference between social support, sleep disturbance, and loneliness among the MOA and LOA. Results: The mean score of loneliness was 8.58 (SD 3.03) for the MOA and 8.00 (SD 2.79) for the LOA. SEM analysis showed that social support exerts a direct negative effect on both sleep disturbance (standardized coefficient=--0.24 in the MOA and --0.20 in the LOA) and loneliness (standardized coefficient=--0.44 in the MOA and --0.40 in the LOA), while sleep disturbance generates a direct positive effect on loneliness (standardized coefficient=0.13 in the MOA and 0.22 in the LOA). Conclusions: Both MOA and LOA have a low level of loneliness, but the MOA show higher loneliness than the LOA. There is a negative correlation between social support and loneliness as well as between social support and sleep disturbance among the MOA and LOA (MOA>LOA), while loneliness is positively associated with sleep disturbance in both populations (MOA