%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25848 %T Adequacy of Web-Based Activities as a Substitute for In-Person Activities for Older Persons During the COVID-19 Pandemic: Survey Study %A Cohen-Mansfield,Jiska %A Muff,Aline %A Meschiany,Guy %A Lev-Ari,Shahar %+ Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv, Israel, 972 03 6407576, jiska@tauex.tau.ac.il %K web-based venues for older adults %K social engagement %K activities %K boredom %K technology barriers for seniors %K COVID-19 %K pandemic %K senior %K elderly %K older adult %K online activity %K engagement %K activity %K loneliness %K isolation %K effectiveness %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Senior centers and other types of clubs provide activities for older adults to address boredom, social isolation, and loneliness. Due to the COVID-19 pandemic, most of these activities have been cancelled. A limited range of web-based activities have been offered as alternatives. However, the effectiveness of these web-based group activities for older adults has scarcely been researched. Objective: We aimed to understand the extent to which web-based activities for older adults provide an adequate substitute for in-person activities. Methods: In this telephone survey, we interviewed 105 older adults in Israel who had been offered the opportunity to participate in web-based activities after routine activities closed due to the COVID-19 pandemic. Of the total sample, 49/105 (46.7%) participated in the activities and 56/105 (53.3%) did not. We inquired about the respondents’ background characteristics, satisfaction with the activities, and reasons for participation or nonparticipation. Results: The respondents who participated in the web-based activities tended to be highly satisfied with at least some of them. They rated the enjoyment derived from the content of the activity as the most important motivator, followed by maintaining a routine and by enjoying the group and the presence of others. Over 50% of the participants (28/49, 57%) wished to continue with the exercise programming after the end of the COVID-19 pandemic, and 41% (20/49) wished to continue with the web-based lectures. Participants were more likely to report partaking in alternative activities than nonparticipants (P=.04). The most common reasons cited by nonparticipants were being unaware of the web-based program (24/56, 43%) despite a notification having been sent to the entire sample, lack of interest in the content (18/56, 32%), and technical issues (13/56, 23%), such as not owning or being able to fully use a computer. Both participants and nonparticipants were interested in a wide range of topics, with many being very particular about the topics they wished to access. Approximately half expressed willingness to pay for access; those who were willing to pay tended to have more years of education (P=.03). Conclusions: Our findings suggest a need for web-based activities for countering boredom and feelings of isolation. The main factors that influence the use, efficacy, and sustainability of online activities are access, motivational and need-fulfilling factors, and whether the activities are sufficiently tailored to individuals’ preferences and abilities. Challenges in substituting in-person services are promoting social relationships that are currently not sufficiently incorporated into most web-based programs, accommodating a wider range of topics, and increasing the accessibility of current programs to older adults, especially those who are homebound, both during and after the COVID-19 pandemic. %M 33439851 %R 10.2196/25848 %U http://www.jmir.org/2021/1/e25848/ %U https://doi.org/10.2196/25848 %U http://www.ncbi.nlm.nih.gov/pubmed/33439851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21275 %T Effects of Web-Based Social Connectedness on Older Adults’ Depressive Symptoms: A Two-Wave Cross-Lagged Panel Study %A Hwang,Juwon %A Toma,Catalina L %A Chen,Junhan %A Shah,Dhavan V %A Gustafson,David %A Mares,Marie-Louise %+ School of Journalism and Mass Communication, University of Wisconsin, 5007 Vilas Hall, 821 University Ave., Madison, WI, 53706, United States, 1 6083324571, jhwang79@wisc.edu %K depressive symptoms %K older adults %K web-based intervention %K online social support %K patient health questionnaire %K longitudinal survey %K mobile phone %D 2021 %7 13.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Depressive symptoms are the most prevalent mental health concern among older adults (possibly heightened during the COVID-19 pandemic), which raises questions about how such symptoms can be lowered in this population. Existing research shows that offline social connectedness is a protective factor against depression in older adults; however, it is unknown whether web-based social connectedness can have similar effects. Objective: This study investigates whether social connectedness on a support website protects older adults against depressive symptoms over the course of a year, above and beyond the protective effect of offline social connectedness. The secondary aim is to determine whether older adults with increased depressive symptoms are more likely to engage in social connectedness on this website. Thus, we examine depressive symptoms as both an outcome and predictor of web-based social connectedness to fully understand the chain of causality among these variables. Finally, we compare web-based social connectedness with offline social connectedness in their ability to lower depressive symptoms among older adults. Methods: A total of 197 adults aged 65 years or older were given access to a social support website, where they were able to communicate with each other via a discussion forum for a year. Participants’ social connectedness on the web-based platform, conceptualized as message production and consumption, was measured using behavioral log data as the number of messages participants wrote and read, respectively, during the first 6 months (t1) and the following 6 months (t2) of the study. Participants self-reported their offline social connectedness as the number of people in their support networks, and they reported their depressive symptoms using the Patient Health Questionnaire-8 both at baseline (t1) and at 12-month follow-up (t2). To ascertain the flow of causality between these variables, we employed a cross-lagged panel design, in which all variables were measured at t1 and t2. Results: After controlling for the effect of offline support networks at t1, web-based message consumption at t1 decreased older adults’ depressive symptoms at t2 (β=−.11; P=.02), but web-based message production at t1 did not impact t2 depressive symptoms (β=.12; P=.34). Web-based message consumption had a larger effect (β=−.11; P=.02) than offline support networks (β=−.08; P=.03) in reducing older adults’ depressive symptoms over time. Higher baseline depressive symptoms did not predict increased web-based message consumption (β=.12; P=.36) or production (β=.02; P=.43) over time. Conclusions: The more messages older adults read on the web-based forum for the first 6 months of the study, the less depressed they felt at the 1-year follow-up, above and beyond the availability of offline support networks at baseline. This pinpoints the substantial potential of web-based communication to combat depressive symptoms in this vulnerable population. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-015-0713-2 %M 33439143 %R 10.2196/21275 %U http://www.jmir.org/2021/1/e21275/ %U https://doi.org/10.2196/21275 %U http://www.ncbi.nlm.nih.gov/pubmed/33439143 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e22186 %T Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial %A Kramer,Lean L %A Mulder,Bob C %A van Velsen,Lex %A de Vet,Emely %+ Consumption and Healthy Lifestyles, Wageningen University & Research, PO Box 8130, Wageningen, 6700 EW, Netherlands, 31 317 483401, lean.kramer@wur.nl %K embodied conversational agent %K health behavior change %K loneliness %K eating behavior %K older adults %D 2021 %7 6.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner. Objective: We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA. Methods: The web-based eHealth app PACO is a fully automated 8-week intervention in which 2 ECAs engage older adults in dialogue to motivate them to change their dietary behavior and decrease their loneliness. PACO was developed via a human-centered and stakeholder-inclusive design approach and incorporates Self-determination Theory and various behavior change techniques. For this study, an unblinded randomized controlled trial will be performed. There will be 2 cohorts, with 30 participants per cohort. Participants in the first cohort will immediately receive the PACO app for 8 weeks, while participants in the second cohort receive the PACO app after a waiting-list condition of 4 weeks. Participants will be recruited via social media, an online panel, flyers, and advertorials. To be eligible, participants must be at least 65 years of age, must not be in paid employment, and must live alone independently at home. Primary outcomes will be self-assessed via online questionnaires at intake, control, after 4 weeks, and after 8 weeks, and will include eating behavior and loneliness. In addition, the primary outcome—use—will be measured via data logs. Secondary outcomes will be measured at the same junctures, via either validated, self-assessed, online questionnaires or an optional interview. Results: As of July 2020, we have begun recruiting participants. Conclusions: By unraveling the mechanisms behind the use of a web-based intervention with ECAs, we hope to gain a fine-grained understanding of both the effectiveness and the use of ECAs in the health context. Trial Registration: ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883 International Registered Report Identifier (IRRID): PRR1-10.2196/22186 %M 33404513 %R 10.2196/22186 %U https://www.researchprotocols.org/2021/1/e22186 %U https://doi.org/10.2196/22186 %U http://www.ncbi.nlm.nih.gov/pubmed/33404513 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22287 %T The COVID-19 Pandemic: A Pandemic of Lockdown Loneliness and the Role of Digital Technology %A Shah,Syed Ghulam Sarwar %A Nogueras,David %A van Woerden,Hugo Cornelis %A Kiparoglou,Vasiliki %+ NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 10865 221262, sarwar.shah@ouh.nhs.uk %K COVID-19 %K coronavirus %K pandemic %K social isolation %K loneliness %K lockdown %K social distancing %K digital technology %K social connectedness %K social networking %K online digital tools %D 2020 %7 5.11.2020 %9 Viewpoint %J J Med Internet Res %G English %X The focus of this perspective is on lockdown loneliness, which we define as loneliness resulting from social disconnection as a result of enforced social distancing and lockdowns during the COVID-19 pandemic. We also explore the role of digital technology in tackling lockdown loneliness amid the pandemic. In this regard, we highlight and discuss a number of the key relevant issues: a description of lockdown loneliness, the burden of lockdown loneliness during the COVID-19 pandemic, characteristics of people who are more likely to be affected by lockdown loneliness, factors that could increase the risk of loneliness, lockdown loneliness as an important public health issue, tackling loneliness during the pandemic, digital technology tools for social connection and networking during the pandemic, assessment of digital technology tools from the end users’ perspectives, and access to and use of digital technology for tackling lockdown loneliness during the COVID-19 pandemic. We suggest that the most disadvantaged and vulnerable people who are more prone to lockdown loneliness are provided with access to digital technology so that they can connect socially with their loved ones and others; this could reduce loneliness resulting from social distancing and lockdowns during the COVID-19 crisis. Nonetheless, some key issues such as access to and knowledge of digital technology tools must be considered. In addition, the involvement of all key stakeholders (family and friends, social care providers, and clinicians and health allied professionals) should be ensured. %M 33108313 %R 10.2196/22287 %U http://www.jmir.org/2020/11/e22287/ %U https://doi.org/10.2196/22287 %U http://www.ncbi.nlm.nih.gov/pubmed/33108313 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e21496 %T Smartphone App to Address Loneliness Among College Students: Pilot Randomized Controlled Trial %A Bruehlman-Senecal,Emma %A Hook,Cayce J %A Pfeifer,Jennifer H %A FitzGerald,Caroline %A Davis,Brittany %A Delucchi,Kevin L %A Haritatos,Jana %A Ramo,Danielle E %+ Hopelab, 100 California Street #1150, San Francisco, CA, 94111, United States, 1 415 728 8387, dramo@hopelab.org %K loneliness %K mental health %K smartphone app %K college %K app %K student %K young adult %K randomized controlled trial %K efficacy %K feasibility %K desirability %D 2020 %7 20.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a widespread and significant problem on college campuses. Prolonged loneliness in young adulthood is a risk factor for concurrent and future mental health problems and attrition, making college a critical time for support. Cognitive and behavioral interventions show promise for decreasing loneliness and can be widely disseminated through technology. Objective: This pilot randomized controlled trial was conducted to examine the initial efficacy, feasibility, and desirability of a smartphone app, Nod, designed to deliver cognitive and behavioral skill-building exercises to reduce loneliness during the transition to college. Methods: First-year college students (N=221, mean age 18.7 years, 59% female) were recruited online during incoming student orientation, and randomized to either receive immediate access to Nod (experimental group, n=100) or access after 4 weeks (control group, n=121). The app delivered skills via fully automated (1) “social challenges,” suggested activities designed to build social connections; (2) reflections, brief cognitive reframing exercises; and (3) student testimonials that encouraged a growth mindset toward social connection building. Main intention-to-treat analyses were used to compare the conditions on self-assessed loneliness, depressive symptoms, and other mental health and college adjustment outcomes at week 4, controlling for baseline values on those variables. Analyses were also performed to test the hypothesis that the treatment benefits would be particularly pronounced for participants with heightened psychological vulnerability at baseline (ie, higher baseline depressive symptoms and loneliness). Results: Retention was 97% at week 4, and participants viewed an average 36.7 pages of app content. There were no significant condition differences in loneliness at week 4 (F1, 211=0.05, P=.82; ηp2 <.001). However, there was a significant condition-by-baseline depression interaction to predict week-4 loneliness (F1,209=9.65, P=.002; ηp2 =.04). Simple slope analyses indicated that baseline depression positively predicted week-4 loneliness among control participants (r=0.30, t209=3.81, P<.001), but not among experimental participants (r=–0.09, t209=–0.84, P=.40), suggesting that Nod buffered participants with high baseline depression scores from experiencing heightened midquarter loneliness. Similarly, there were no significant condition differences in other week-4 outcomes. However, moderation by baseline vulnerability was found for week-4 depressive symptoms, sleep quality, and indices of college adjustment (eg, perceived social support and campus belonging). Conclusions: Although Nod exposure did not impact outcomes for the full sample, these results provide initial evidence of its benefit for vulnerable students. The results of this trial suggest that cognitive and behavioral skills delivered via a mobile app can buffer psychologically vulnerable college students against heightened loneliness and depressive symptoms, as well as other negative college adjustment outcomes. Future work will aim to improve upon app engagement, and to address loneliness among other key populations. Trial Registration: ClinicalTrials.gov NCT04164654; https://clinicaltrials.gov/ct2/show/NCT04164654 %M 33079071 %R 10.2196/21496 %U http://mental.jmir.org/2020/10/e21496/ %U https://doi.org/10.2196/21496 %U http://www.ncbi.nlm.nih.gov/pubmed/33079071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17586 %T Challenges and Benefits of an Internet-Based Intervention With a Peer Support Component for Older Adults With Depression: Qualitative Analysis of Textual Data %A Chen,Annie T %A Slattery,Krystal %A Tomasino,Kathryn N %A Rubanovich,Caryn Kseniya %A Bardsley,Leland R %A Mohr,David C %+ Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, 850 Republican Street, Box 358047, UW Medicine South Lake Union, Seattle, WA, 98109, United States, 1 2062219218, atchen@uw.edu %K aged %K depression %K internet %K peer group %K social support %K qualitative research %D 2020 %7 16.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technological interventions provide many opportunities for improving the health and quality of life of older adults. However, interaction with new technologies can also cause frustration. Although these themes have been explored in extant research, much remains to be learned with regard to how the challenges of aging and technology use and the experiences of participating in a social and learning environment are interrelated. Objective: This study aimed to perform a qualitative analysis of data collected from MoodTech, a pilot study of an internet-based intervention with a peer support component for older adults with symptoms of depression, to better understand the participants’ experience of using technological interventions, including the challenges and benefits that they experienced over the course of these interventions. Methods: We employed an inductive qualitative analysis method based on grounded theory methodology and interpretative phenomenological analysis to analyze participant textual data. These textual data were of 3 main types: (1) assignments in which participants challenged their negative thoughts, (2) status updates, and (3) comments in the peer support component of the intervention. Results: We have presented the results through 3 main themes: (1) the challenges of aging as seen through the participants’ comments, (2) the difficulties experienced by the participants in using MoodTech, and (3) the benefits they derived from participating. Conclusions: This paper offers several contributions concerning study participants’ experiences with internet-based cognitive behavioral therapy (iCBT) interventions with a peer support component and design considerations for developing complex technological interventions that support the challenges participants experience due to aging and cognitive difficulties. First, technical issues encountered by older adults within the context of the intervention can interact with and exacerbate the insecurities they experience in life, and it is important to consider how intervention components might be designed to mitigate these issues. Second, peer support can be employed as a mechanism to facilitate communication, support, and collaborative problem solving among participants in an intervention. The insights from this paper can inform the design of iCBT interventions for older adults. %M 32543448 %R 10.2196/17586 %U https://www.jmir.org/2020/6/e17586 %U https://doi.org/10.2196/17586 %U http://www.ncbi.nlm.nih.gov/pubmed/32543448 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15976 %T How Geographical Isolation and Aging in Place Can Be Accommodated Through Connected Health Stakeholder Management: Qualitative Study With Focus Groups %A Chen,Sonia Chien-I %A Liu,Chenglian %A Wang,Zhenyuan %A McAdam,Rodney %A Brennan,Michael %A Davey,Shirley %A Cheng,Teng Yuan %+ Faculty of Economics and Management, East China Normal University, Room 307, S Fashang Building, No 500, Dongchuan Rd, Minhang District, Shanghai, 201108, China, 86 15800705298, wangzhenyuan@dbm.ecnu.edu.cn %K connected health care %K remote areas %K business strategy %K Taiwan %K population aging %K knowledge sharing %D 2020 %7 27.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In remote areas, connected health (CH) is needed, but as local resources are often scarce and the purchasing power of residents is usually poor, it is a challenge to apply CH in these settings. In this study, CH is defended as a technological solution for reshaping the direction of health care to be more proactive, preventive, and precisely targeted—and thus, more effective. Objective: The objective of this study was to explore the identity of CH stakeholders in remote areas of Taiwan and their interests and power in order to determine ideal strategies for applying CH. We aimed to explore the respective unknowns and discover insights for those facing similar issues. Methods: Qualitative research was conducted to investigate and interpret the phenomena of the aging population in a remote setting. An exploratory approach was employed involving semistructured interviews with 22 participants from 8 remote allied case studies. The interviews explored perspectives on stakeholder arrangements, including the power and interests of stakeholders and the needs of all the parties in the ecosystem. Results: Results were obtained from in-depth interviews and focus groups that included identifying the stakeholders of remote health and determining how they influence its practice, as well as how associated agreements bring competitive advantages. Stakeholders included people in government sectors, industrial players, academic researchers, end users, and their associates who described their perspectives on their power and interests in remote health service delivery. Specific facilitators of and barriers to effective delivery were identified. A number of themes, such as government interests and power of decision making, were corroborated across rural and remote services. These themes were broadly grouped into the disclosure of conflicts of interest, asymmetry in decision making, and data development for risk assessment. Conclusions: This study contributes to current knowledge by exploring the features of CH in remote areas and investigating its implementation from the perspectives of stakeholder management. It offers insights into managing remote health through a CH platform, which can be used for preliminary quantitative research. Consequently, these findings could help to more effectively facilitate diverse stakeholder engagement for health information sharing and social interaction. %M 32459181 %R 10.2196/15976 %U http://www.jmir.org/2020/5/e15976/ %U https://doi.org/10.2196/15976 %U http://www.ncbi.nlm.nih.gov/pubmed/32459181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16423 %T The Relationship Between Engagement in Online Support Groups and Social Isolation Among Military Caregivers: Longitudinal Questionnaire Study %A Trail,Thomas %A Friedman,Esther %A Rutter,Carolyn M %A Tanielian,Terri %+ RAND Corporation, 1200 South Hayes St, Arlington, VA, 22202, United States, 1 703 413 1100, ttrail@rand.org %K caregivers %K family caregivers %K social isolation %K loneliness %K depression %K social support %K online intervention %K self-help groups %K veterans health %D 2020 %7 23.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a lack of research on the effectiveness of online peer support groups for reducing social isolation and depressive symptoms among caregivers, and previous research has mixed results. Objective: This study aimed to test whether military caregivers who joined a new online peer support community or engaged with an existing online community experienced decreased perceived social isolation and improved depressive symptoms over 6 months. Methods: We conducted a longitudinal study of 212 military caregivers who had newly joined an online community and those who were members of other military caregiver groups. Multiple indicators of perceived social isolation and depressive symptoms were assessed at baseline and at 3 and 6 months. Results: Compared with caregivers in the comparison group, caregivers who joined the new group experienced less perceived social isolation at 3 months (eg, number of caregivers in social network [unstandardized regression coefficients] b=0.49, SE 0.19, 95% CI 0.87 to 0.02), but this effect did not persist at 6 months. Those who engaged more with new or existing groups experienced less perceived social isolation over time (eg, number of caregivers in social network b=0.18, SE 0.06, 95% CI 0.02 to 0.27), and this relationship was mediated by increased interactions with other military caregivers (95% CI 0.0046 to 0.0961). Engagement with an online group was not associated with improvements in depressive symptoms. Conclusions: Online communities might help reduce social isolation when members engage with the group, but more intensive treatment is needed to improve depressive symptoms. %M 32324141 %R 10.2196/16423 %U http://www.jmir.org/2020/4/e16423/ %U https://doi.org/10.2196/16423 %U http://www.ncbi.nlm.nih.gov/pubmed/32324141 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e17188 %T Analyzing Trends of Loneliness Through Large-Scale Analysis of Social Media Postings: Observational Study %A Mazuz,Keren %A Yom-Tov,Elad %+ Microsoft Research, 13 Shenkar St, Herzeliya, 46733, Israel, 972 747111359, eladyt@yahoo.com %K loneliness %K text postings %K behavior online %K social media %K computer-based analysis %K online self-disclosure %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness has become a public health problem described as an epidemic, and it has been argued that digital behavior such as social media posting affects loneliness. Objective: The aim of this study is to expand knowledge of the determinants of loneliness by investigating online postings in a social media forum devoted to loneliness. Specifically, this study aims to analyze the temporal trends in loneliness and their associations with topics of interest, especially with those related to mental health determinants. Methods: We collected a total of 19,668 postings from 11,054 users in the loneliness forum on Reddit. We asked seven crowdsourced workers to imagine themselves as writing 1 of 236 randomly chosen posts and to answer the short-form UCLA Loneliness Scale. After showing that these postings could provide an assessment of loneliness, we built a predictive model for loneliness scores based on the posts’ text and applied it to all collected postings. We then analyzed trends in loneliness postings over time and their correlations with other topics of interest related to mental health determinants. Results: We found that crowdsourced workers can estimate loneliness (interclass correlation=0.19) and that predictive models are correlated with reported loneliness scores (Pearson r=0.38). Our results show that increases in loneliness are strongly associated with postings to a suicidality-related forum (hazard ratio 1.19) and to forums associated with other detrimental behaviors such as depression and illicit drug use. Clustering demonstrates that people who are lonely come from diverse demographics and from a variety of interests. Conclusions: The results demonstrate that it is possible for unrelated individuals to assess people’s social media postings for loneliness. Moreover, our findings show the multidimensional nature of online loneliness and its correlated behaviors. Our study shows the advantages of studying a hard-to-reach population through social media and suggests new directions for future studies. %M 32310141 %R 10.2196/17188 %U http://mental.jmir.org/2020/4/e17188/ %U https://doi.org/10.2196/17188 %U http://www.ncbi.nlm.nih.gov/pubmed/32310141 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e14035 %T The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study %A Savolainen,Iina %A Oksanen,Atte %A Kaakinen,Markus %A Sirola,Anu %A Paek,Hye-Jin %+ Faculty of Social Sciences, Tampere University, Kalevantie 4, Tampere, 33014, Finland, 358 504377111, iina.savolainen@tuni.fi %K youth %K problem behavior %K excessive alcohol consumption %K internet %K gambling %K loneliness %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction. Objective: Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions. Methods: A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17% women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42% women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00% women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction. Results: Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables. Conclusions: The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use. %M 31895044 %R 10.2196/14035 %U https://mental.jmir.org/2020/1/e14035 %U https://doi.org/10.2196/14035 %U http://www.ncbi.nlm.nih.gov/pubmed/31895044 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e13440 %T A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study %A Bott,Nicholas %A Wexler,Sharon %A Drury,Lin %A Pollak,Chava %A Wang,Victor %A Scher,Kathleen %A Narducci,Sharon %+ Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, 75 Alta Road, Stanford, CA, 94305, United States, 1 650 814 9383, nbott@stanford.edu %K digital health %K older adults %K loneliness %K delirium %K falls %K embodied conversational agent %K chatbot %K relational agent %K information and communication technology %D 2019 %7 17.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA’s usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. Objective: The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. Methods: This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. Results: Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. Conclusions: The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults. %M 31625949 %R 10.2196/13440 %U http://www.jmir.org/2019/10/e13440/ %U https://doi.org/10.2196/13440 %U http://www.ncbi.nlm.nih.gov/pubmed/31625949 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14112 %T Promoting Social Connection and Deepening Relations Among Older Adults: Design and Qualitative Evaluation of Media Parcels %A Zaine,Isabela %A Frohlich,David Mark %A Rodrigues,Kamila Rios Da Hora %A Cunha,Bruna Carolina Rodrigues %A Orlando,Alex Fernando %A Scalco,Leonardo Fernandes %A Pimentel,Maria Da Graça Campos %+ University of São Paulo, Institute of Mathematics and Computer Sciences, Avenida Trabalhador São Carlense, 400 - Parque Arnold Schimidt, São Carlos - SP, 13566-590, Brazil, 55 163373 9700, isabela.zaine@gmail.com %K social interaction %K interpersonal relations %K communication %K intervention %K experience sampling %K mobile apps %K photography %K video-audio media %K elderly %D 2019 %7 3.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Being socially connected is related to well-being, and one way of avoiding social isolation is to deepen existing relationships. Even though existing relationships can be reinforced by regular and meaningful communication, state-of-the-art communication technologies alone do not increase the quality of social connections. Thus, there is a need for the involvement of a trained human facilitator in a network of older adults, preferably for a short period, to promote the deepening of their relationships. Objective: This study aimed to evaluate the hypothesis that a human-facilitated, media-sharing social networking system can improve social connection in a small group of older people, who are more vulnerable to social isolation than most, and deepen their relationships over a period of a few weeks. Methods: We conducted the design and evaluation of Media Parcels, a novel human-facilitated social networking system. Media Parcels is based on the metaphor of a facilitator collecting and delivering parcels in the physical mail. Extending the metaphor, the system supports a facilitator in designing time-based dialogue requesting parcels from participants that bring out their memories and feelings, in collecting the parcels, wrapping them in annotations that communicate the corresponding requests, and delivering the wrapped parcel to a target person. Qualitative evaluation was carried out in two trials with a group of three people each, one with family members (children and father; aged 55, 56, and 82 years old) and the other with a group of friends (aged 72, 72, and 74 years old), over two weeks. In each trial, data were collected in three interviews (pre-, mid-, and posttrial) and via system logging. Results: Collected data indicate positive social effects for deepening and developing relationships. The parcel metaphor was easily understood and the computational system was readily adopted. Preferences with regard to media production or consumption varied among participants. In the family group, children preferred receiving media parcels (because of their sentimental value) to producing them, whereas the father enjoyed both. In the friendship group, preferences varied: one friend enjoyed both producing and receiving, while the other two preferred one over the other. In general, participants reported a preference for the production of items of a certain type depending on the associated content. Apart from having a strong engagement with the system, participants reported feeling closer to each other than usual. Conclusions: For both groups, Media Parcels was effective in promoting media sharing and social connections, resulting in the deepening of existing relationships. Its design informs researchers who are attempting to promote social connection in older adults. %M 31584001 %R 10.2196/14112 %U https://www.jmir.org/2019/10/e14112 %U https://doi.org/10.2196/14112 %U http://www.ncbi.nlm.nih.gov/pubmed/31584001 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13209 %T Identifying Behavioral Phenotypes of Loneliness and Social Isolation with Passive Sensing: Statistical Analysis, Data Mining and Machine Learning of Smartphone and Fitbit Data %A Doryab,Afsaneh %A Villalba,Daniella K %A Chikersal,Prerna %A Dutcher,Janine M %A Tumminia,Michael %A Liu,Xinwen %A Cohen,Sheldon %A Creswell,Kasey %A Mankoff,Jennifer %A Creswell,John D %A Dey,Anind K %+ School of Computer Science, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 4123045320, adoryab@gmail.com %K mobile health %K loneliness %K machine learning %K statistical data analysis %K data mining %K digital phenotyping %D 2019 %7 24.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Feelings of loneliness are associated with poor physical and mental health. Detection of loneliness through passive sensing on personal devices can lead to the development of interventions aimed at decreasing rates of loneliness. Objective: The aim of this study was to explore the potential of using passive sensing to infer levels of loneliness and to identify the corresponding behavioral patterns. Methods: Data were collected from smartphones and Fitbits (Flex 2) of 160 college students over a semester. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire at the beginning and end of the semester. For a classification purpose, the scores were categorized into high (questionnaire score>40) and low (≤40) levels of loneliness. Daily features were extracted from both devices to capture activity and mobility, communication and phone usage, and sleep behaviors. The features were then averaged to generate semester-level features. We used 3 analytic methods: (1) statistical analysis to provide an overview of loneliness in college students, (2) data mining using the Apriori algorithm to extract behavior patterns associated with loneliness, and (3) machine learning classification to infer the level of loneliness and the change in levels of loneliness using an ensemble of gradient boosting and logistic regression algorithms with feature selection in a leave-one-student-out cross-validation manner. Results: The average loneliness score from the presurveys and postsurveys was above 43 (presurvey SD 9.4 and postsurvey SD 10.4), and the majority of participants fell into the high loneliness category (scores above 40) with 63.8% (102/160) in the presurvey and 58.8% (94/160) in the postsurvey. Scores greater than 1 standard deviation above the mean were observed in 12.5% (20/160) of the participants in both pre- and postsurvey scores. The majority of scores, however, fell between 1 standard deviation below and above the mean (pre=66.9% [107/160] and post=73.1% [117/160]). Our machine learning pipeline achieved an accuracy of 80.2% in detecting the binary level of loneliness and an 88.4% accuracy in detecting change in the loneliness level. The mining of associations between classifier-selected behavioral features and loneliness indicated that compared with students with low loneliness, students with high levels of loneliness were spending less time outside of campus during evening hours on weekends and spending less time in places for social events in the evening on weekdays (support=17% and confidence=92%). The analysis also indicated that more activity and less sedentary behavior, especially in the evening, was associated with a decrease in levels of loneliness from the beginning of the semester to the end of it (support=31% and confidence=92%). Conclusions: Passive sensing has the potential for detecting loneliness in college students and identifying the associated behavioral patterns. These findings highlight intervention opportunities through mobile technology to reduce the impact of loneliness on individuals’ health and well-being. %M 31342903 %R 10.2196/13209 %U http://mhealth.jmir.org/2019/7/e13209/ %U https://doi.org/10.2196/13209 %U http://www.ncbi.nlm.nih.gov/pubmed/31342903