%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66248 %T Multidimensional Evaluation of the Process of Constructing Age-Friendly Communities Among Different Aged Community Residents in Beijing, China: Cross-Sectional Questionnaire Study %A Peng,Yingchun %A Zhang,Zhiying %A Zhang,Ruyi %A Zhang,Yiyao %A Wang,Runying %A Zhang,Jiaying %A Zhai,Shaoqi %A Jin,Qilin %A Zhou,Jiaojiao %A Chen,Jingjing %K age-friendly %K positive living experience %K active aging %K healthy aging %K community residents %K older adults %K age-friendly communities %K multiple stakeholders %K evaluating age-friendliness %K urban and suburban areas %D 2025 %7 21.3.2025 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/66248 %U https://publichealth.jmir.org/2025/1/e66248 %U https://doi.org/10.2196/66248 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e49464 %T Understanding Loneliness Through Analysis of Twitter and Reddit Data: Comparative Study %A Shah,Hurmat Ali %A Househ,Mowafa %+ Hamad Bin Khalifa University, Education City, Doha, Qatar, 974 70620740 ext 00, hshah@hbku.edu.qa %K health informatics %K loneliness informatics %K loneliness theory %K health effects %K loneliness interventions %K social media %K lonely %K loneliness %K isolation %K mental health %K natural language processing %K tweet %K tweets %K comparative analysis %D 2025 %7 14.3.2025 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 40085832 %R 10.2196/49464 %U https://www.i-jmr.org/2025/1/e49464 %U https://doi.org/10.2196/49464 %U http://www.ncbi.nlm.nih.gov/pubmed/40085832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66061 %T Migrant-Local Differences in the Relationship Between Oral Health, Social Support, and Loneliness Among Older Adults in Weifang, China: Cross-Sectional Study %A Liu,Hui %A Wang,Jieru %A Chen,Rui %A Xu,Xixing %A Pang,Mingli %A Feng,Kaiyuan %A Li,Bingsong %A Li,Qinling %A Qin,Ziwei %A Yan,Shuyi %A Ibn Ziyat,Nabila %A Kong,Fanlei %K loneliness %K oral health %K social support %K migrant older adults %K local older adults %D 2025 %7 13.3.2025 %9 %J JMIR Public Health Surveill %G English %X 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, χ2 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. %R 10.2196/66061 %U https://publichealth.jmir.org/2025/1/e66061 %U https://doi.org/10.2196/66061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57907 %T 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 %A Liu,Chenxi %A Liu,Yushu %A Liu,Chaojie %A Lin,Rujiao %A Wang,Xi %A Zhang,Xinyi %A Wu,Yibo %A Wang,Dan %+ School of Management, Hubei University of Chinese Medicine, 16 Huangjiahu West Rd, Hongshan District, Wuhan, 430065, China, 86 13476237004, 815310016@qq.com %K problematic internet use %K loneliness %K anxiety %K depression %K mediation and moderation model %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=0.002, 95% CI 0.001-0.002), PIU and anxiety (β=0.001, 95% CI 0.000-0.002), loneliness and depression (β=0.010, 95% CI 0.007-0.013), and loneliness and anxiety (β=0.007, 95% CI 0.004-0.010), but not between PIU and loneliness (β=0.000, 95% CI –0.003 to 0.003). Higher levels of social media identity were significantly associated with lower levels of loneliness (β=–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. %M 40009436 %R 10.2196/57907 %U https://www.jmir.org/2025/1/e57907 %U https://doi.org/10.2196/57907 %U http://www.ncbi.nlm.nih.gov/pubmed/40009436 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e65610 %T Characterizing Experiences With Hikikomori Syndrome on Twitter Among Japanese-Language Users: Qualitative Infodemiology Content Analysis %A Uchiyama,Misa Ashley %A Bekki,Hirofumi %A McMann,Tiana %A Li,Zhuoran %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Drive, MC 0505, La Jolla, CA, 92093, United States, 1 (951) 491 4161, tmackey@ucsd.edu %K hikikomori %K social withdrawal %K hikikomori syndrome %K mental health %K social isolation %D 2025 %7 24.2.2025 %9 Original Paper %J JMIR Infodemiology %G English %X 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: “#引きこもり,” “#ひきこもり,” “#hikikomori,” “#ニート,” “#脱ひきこもり,” “#不登校,” and “#自宅警備員.” 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. %M 39993295 %R 10.2196/65610 %U https://infodemiology.jmir.org/2025/1/e65610 %U https://doi.org/10.2196/65610 %U http://www.ncbi.nlm.nih.gov/pubmed/39993295 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66448 %T Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study %A Kim,Sol I %A Jin,Jae-Chan %A Yoo,Seo-Koo %A Han,Doug Hyun %+ Department of Psychiatry, Chung Ang University Hospital, 102 Heusok ro, Seoul, 06973, Republic of Korea, 82 62993132, hduk70@gmail.com %K coronavirus pandemic %K internet use pattern %K internet games %K short-form videos %K social network system %K depressed mood %K internet use %K pandemic %K internet %K COVID-19 %K video %K internet behavior %K social media %K internet addiction %K depression %K anxiety %K digital platforms %K mobile phone %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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 (χ23=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. %M 39933170 %R 10.2196/66448 %U https://pediatrics.jmir.org/2025/1/e66448 %U https://doi.org/10.2196/66448 %U http://www.ncbi.nlm.nih.gov/pubmed/39933170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59023 %T Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study %A Yang,Lu %A Lynch,Chris %A Lee,John Tayu %A Oldenburg,Brian %A Haregu,Tilahun %+ School of Sociology and Population Studies, Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210049, China, 86 18094233761, Lindsay.yanglu@outlook.com %K digital divide %K health inequity %K China %K longitudinal study %K broadband %K internet connection %K internet %K well-being %K psychosocial %K middle age %K older adult %K inequality %K digital connectivity %K logistic regression %K questionnaire %K survey %K panel data approach %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39928942 %R 10.2196/59023 %U https://www.jmir.org/2025/1/e59023 %U https://doi.org/10.2196/59023 %U http://www.ncbi.nlm.nih.gov/pubmed/39928942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65589 %T Therapeutic Potential of Social Chatbots in Alleviating Loneliness and Social Anxiety: Quasi-Experimental Mixed Methods Study %A Kim,Myungsung %A Lee,Seonmi %A Kim,Sieun %A Heo,Jeong-in %A Lee,Sangil %A Shin,Yu-Bin %A Cho,Chul-Hyun %A Jung,Dooyoung %+ Department of Psychiatry, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 029205505, david0203@gmail.com %K artificial intelligence %K AI %K social chatbot %K loneliness %K social anxiety %K exploratory research %K mixed methods study %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=0.78, 95% CI 0.67 to 0.89), self-disclosure (β=–0.65, 95% CI –1.07 to –0.23) and resilience (β=0.07, 95% CI 0.01 to 0.13) as significant predictors of week 4 loneliness (R2=0.64). Baseline social anxiety (β=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 %M 39808786 %R 10.2196/65589 %U https://www.jmir.org/2025/1/e65589 %U https://doi.org/10.2196/65589 %U http://www.ncbi.nlm.nih.gov/pubmed/39808786 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53850 %T A Mobile App–Based Gratitude Intervention’s Effect on Mental Well-Being in University Students: Randomized Controlled Trial %A Fuller,Chloë %A Marin-Dragu,Silvia %A Iyer,Ravishankar Subramani %A Meier,Sandra Melanie %K gratitude intervention %K smartphone app %K gratitude exercises %K psychological well-being %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X 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 %R 10.2196/53850 %U https://mhealth.jmir.org/2025/1/e53850 %U https://doi.org/10.2196/53850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67627 %T Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study %A Jayaraj,Gautham %A Cao,Xiao %A Horwitz,Adam %A Rozwadowski,Michelle %A Shea,Skyla %A Hanauer,Shira N %A Hanauer,David A %A Tewari,Muneesh %A Shedden,Kerby %A Choi,Sung Won %+ Department of Pediatrics, Medical School, University of Michigan, 1200 E Hospital Dr, Medical Professional Building D4115, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mHealth %K college %K student %K mental health %K positive psychology %K flourishing %K COVID-19 %K wellbeing %K mobile phone %K SARS-CoV-2 %K coronavirus %K pandemic %K COVID %K app %K digital health %K smartphone %K eHealth %K telehealth %K telemedicine %K longitudinal %K higher education %K depression %K anxiety %K loneliness %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=.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 %M 39787592 %R 10.2196/67627 %U https://www.jmir.org/2025/1/e67627 %U https://doi.org/10.2196/67627 %U http://www.ncbi.nlm.nih.gov/pubmed/39787592 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62824 %T The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study %A Valla,Luca Guido %A Rossi,Michele %A Gaia,Alessandra %A Guaita,Antonio %A Rolandi,Elena %+ Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Room 101, 55-59 Gordon Square, London, WC1H 0AL, United Kingdom, 44 02076792000, a.gaia@ucl.ac.uk %K older adults %K information and communication technology %K ICT %K ICT use %K COVID-19 %K social capital %K health %K mental health %K digital divide %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=–4.35, 95% CI 6.38 to –2.32; P<.001), cultural activities (β=–.55, 95% CI –0.75 to –0.35; P<.001), cognitive functioning (β=–1.00, 95% CI –1.28 to –0.72; P<.001), depressive symptoms (β=.42, 95% CI 0.10-0.74; P=.009), physical health (β=.07, 95% CI 0.04-0.10; P<.001), and ICT use (β=–.11, 95% CI –0.18 to –0.03; P=.008). Internet use predicts reduced depressive symptoms (β=–.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 (β=–.73, 95% CI –1.22 to –0.24; P=.003) and cognitive functioning (β=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 %M 39784108 %R 10.2196/62824 %U https://www.jmir.org/2025/1/e62824 %U https://doi.org/10.2196/62824 %U http://www.ncbi.nlm.nih.gov/pubmed/39784108 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63856 %T 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 %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Betty Irene Moore School of Nursing, University of California, Davis, 2750 48th St, Sacramento, CA, 95817, United States, 1 9164262862, pdmartinez@ucdavis.edu %K social isolation %K loneliness %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communication technologies %K ICTs %K digital divide %K technology acceptance model %K mobile phone %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Aging %G English %X 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 (χ2133=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 (β=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU β=.26, P<.001; PU β=.18, P=.01); and ICT use was negatively associated with loneliness (β=–.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 (β=1.66, P=.03; β=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness (β=.31, P<.001; β=.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. %M 39778204 %R 10.2196/63856 %U https://aging.jmir.org/2025/1/e63856 %U https://doi.org/10.2196/63856 %U http://www.ncbi.nlm.nih.gov/pubmed/39778204 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57622 %T Evaluating a Smart Textile Loneliness Monitoring System for Older People: Co-Design and Qualitative Focus Group Study %A Probst,Freya %A Rees,Jessica %A Aslam,Zayna %A Mexia,Nikitia %A Molteni,Erika %A Matcham,Faith %A Antonelli,Michela %A Tinker,Anthea %A Shi,Yu %A Ourselin,Sebastien %A Liu,Wei %+ Department of Engineering, King's College London, Strand Building, Strand Campus, London, WC2R 2LS, United Kingdom, 44 20 7836 5454, wei.liu@kcl.ac.uk %K loneliness %K smart textiles %K wearable technology %K health monitoring %K older people %K co-design %K design requirement %K mobile phone %D 2024 %7 17.12.2024 %9 Original Paper %J JMIR Aging %G English %X 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. %M 39688889 %R 10.2196/57622 %U https://aging.jmir.org/2024/1/e57622 %U https://doi.org/10.2196/57622 %U http://www.ncbi.nlm.nih.gov/pubmed/39688889 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57205 %T Messenger App–Based Information Provision for Promoting Social Participation to Enhance Well-Being Among Community-Dwelling Adults: Randomized Controlled Trial %A Nakagomi,Atsushi %A Abe,Noriyuki %A Chen,Yu-Ru %A Ide,Kazushige %A Kobayashi,Shuhei %A Hanazato,Masamichi %A Kondo,Katsunori %+ Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage Ward, Chiba, 263-8522, Japan, 81 43 251 1111, anakagomi0211@gmail.com %K messenger app %K event information %K happiness %K social participation %K messenger %K app %K well-being %K adults %K aging %K randomized controlled trial %K RCT %K information technology %K social activity %K Japan %K urban community %K health information %K control group %K multivariable regression %K life satisfaction %K digital intervention %K community-dwelling %D 2024 %7 29.11.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 39612209 %R 10.2196/57205 %U https://www.jmir.org/2024/1/e57205 %U https://doi.org/10.2196/57205 %U http://www.ncbi.nlm.nih.gov/pubmed/39612209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63262 %T 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 %A Brandl,Lena %A Jansen-Kosterink,Stephanie %A Brodbeck,Jeannette %A Jacinto,Sofia %A Mooser,Bettina %A Heylen,Dirk %K e-mental health %K digital mental health service %K mental health %K digital health %K internet intervention %K monitoring mental health %K monitor %K e-coach %K coaching %K grieve %K mourn %K old %K affective states %K artificial intelligence %K predictive %K repeatedly measured predictors in regression %K fuzzy cognitive map %K algorithm %K AI %D 2024 %7 28.11.2024 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/63262 %U https://formative.jmir.org/2024/1/e63262 %U https://doi.org/10.2196/63262 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52294 %T 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 %A Peña,Jorge %A Koebner,Ian %A Weisman,William %K pain %K social disconnection %K loneliness %K randomized controlled trial %K art %K museums %K virtual reality %K serious games %K virtual art %K chronic pain and loneliness %K attachment %K priming %K mediation %K intervention %K cyberpsychology %K mental health %D 2024 %7 27.11.2024 %9 %J JMIR Serious Games %G English %X 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) × 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 %R 10.2196/52294 %U https://games.jmir.org/2024/1/e52294 %U https://doi.org/10.2196/52294 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63092 %T Social Robots and Sensors for Enhanced Aging at Home: Mixed Methods Study With a Focus on Mobility and Socioeconomic Factors %A Vagnetti,Roberto %A Camp,Nicola %A Story,Matthew %A Ait-Belaid,Khaoula %A Mitra,Suvobrata %A Fowler Davis,Sally %A Meese,Helen %A Zecca,Massimiliano %A Di Nuovo,Alessandro %A Magistro,Daniele %+ Department of Sport Science, School of Science and Technology, Nottingham Trent University, College Drive, Clifton, Nottingham, NG11 8NS, United Kingdom, 44 1158483522, daniele.magistro@ntu.ac.uk %K older adults %K motor difficulties %K socioeconomic status %K social assistive robots %K monitoring technologies %K mixed methods %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Aging %G English %X 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. %M 39586076 %R 10.2196/63092 %U https://aging.jmir.org/2024/1/e63092 %U https://doi.org/10.2196/63092 %U http://www.ncbi.nlm.nih.gov/pubmed/39586076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59585 %T Ten Myths About the Effect of Social Media Use on Well-Being %A Hall,Jeffrey A %+ Department of Communication Studies, University of Kansas, Bailey Hall, 1440 Jayhawk Boulevard, Lawrence, KS, 66045, United States, 1 7858641082, hallj@ku.edu %K social media %K well-being %K health promotion %K depressive disorder %K depression %K anxiety %K adolescent %K mental health %D 2024 %7 25.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X This viewpoint reviews the empirical evidence regarding the association between social media use and well-being, including life satisfaction and affective well-being, and the association between social media use and ill-being, including loneliness, anxiety, and depressive symptomology. To frame this discussion, this viewpoint will present 10 widely believed myths about social media, each drawn from popular discourse on the topic. In rebuttal, this viewpoint will offer a warranted claim supported by the research. The goal is to bring popular beliefs into dialogue with state-of-the-art quantitative social scientific evidence. It is the intention of this viewpoint to provide a more accurate and nuanced claim to challenge each myth. This viewpoint will bring attention to the importance of using rigorous scientific evidence to inform public debates about social media use and well-being, especially among adolescents and young adults. %M 39586087 %R 10.2196/59585 %U https://www.jmir.org/2024/1/e59585 %U https://doi.org/10.2196/59585 %U http://www.ncbi.nlm.nih.gov/pubmed/39586087 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e51214 %T Social Cohesion and COVID-19: Integrative Review %A Ware,Paul %+ Department of Social and Community Health, School of Population Health, University of Auckland, Park Road, Auckland, New Zealand, 64 99236549, paul.ware@auckland.ac.nz %K social cohesion %K social capital %K COVID-19 %K infrastructure %K tool %K social %K economic %K interpersonal %K interpersonal relationship %K emotions %K pandemic %K engagement %K health behaviors %K resilience %K emotional well-being %K well-being %D 2024 %7 21.11.2024 %9 Review %J Interact J Med Res %G English %X 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. %M 39571166 %R 10.2196/51214 %U https://www.i-jmr.org/2024/1/e51214 %U https://doi.org/10.2196/51214 %U http://www.ncbi.nlm.nih.gov/pubmed/39571166 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e64681 %T Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach %A Park,Jinyoung %A Lee,Jungeun %A Noh,Dabok %+ College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13135, Republic of Korea, 82 31 740 7415, daboknoh@eulji.ac.kr %K out-of-home youth %K mental health intervention %K mobile app %K intervention mapping %K youth %K mental health %K mHealth %K mobile health %K app %K interview %K need %K focus group %K emotion %K emotional %K young adult %K independent living %K emotional support %K tool %K emotion regulation %K user %K app usage %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39571152 %R 10.2196/64681 %U https://humanfactors.jmir.org/2024/1/e64681 %U https://doi.org/10.2196/64681 %U http://www.ncbi.nlm.nih.gov/pubmed/39571152 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e64626 %T Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors %A McAlister,Kelsey L %A Beatty,Clare C %A Smith-Caswell,Jacqueline E %A Yourell,Jacqlyn L %A Huberty,Jennifer L %K adolescent social media %K social media bans %K emotion regulation %K youth %K adolescent %K media use %K social platform %K social network %K self-regulation %K behavioral health %K mental health %K digital health %K technology %K digital literacy %D 2024 %7 4.11.2024 %9 %J JMIR Ment Health %G English %X Social media is an integral part of adolescents’ daily lives, but the significant time they invest in social media has raised concerns about the effect on their mental health. Bans and severe restrictions on social media use are quickly emerging as an attempt to regulate social media use; however, evidence supporting their effectiveness is limited. Adolescents experience several benefits from social media, including increased social connection, reduced loneliness, and a safe space for marginalized groups (eg, LGBTQ+) to interact. Rather than enforcing bans and severe restrictions, emotion regulation should be leveraged to help adolescents navigate the digital social environment. This viewpoint paper proposes a nuanced approach toward regulating adolescent social media use by (1) discontinuing the use of ineffective bans, (2) recognizing the benefits social media use can have, and (3) fostering emotion regulation skills in adolescents to encourage the development of self-regulation. %R 10.2196/64626 %U https://mental.jmir.org/2024/1/e64626 %U https://doi.org/10.2196/64626 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59818 %T Interrelationships Among Individual Factors, Family Factors, and Quality of Life in Older Chinese Adults: Cross-Sectional Study Using Structural Equation Modeling %A Wu,Yuting %A Gong,Cong %A Pi,Lifang %A Zheng,Meixin %A Liu,Weifang %A Wang,Yamei %+ Department of Cardiology, Renmin Hospital of Wuhan University, No.115 Donghu Road, Luojia Mount Wuchang, Wuhan, 430072, China, 86 27 68759302, liu-wf@whu.edu.cn %K quality of life %K older adults %K individual factor %K family factor %K structural equation modeling (SEM) %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Aging %G English %X 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 (β=0.165, P<.001) and FF (β=0.189, P<.001) had a direct positive effect on QOL. Furthermore, the indirect effects of IF (β=0.186, P<.001) and FF (β=0.211, P<.001) through HR and HSD were also significant. In the direct model, IF and FF had a greater impact on MCS (β=0.841) than on PCS (β=0.639). However, after including the 2 mediating factors, HR and HSD, the influence of IF and FF on MCS (β=0.739) became consistent with that on PCS (β=0.728). Subgroup analyses revealed that the direct effect of IF on QOL was significant in the 60-70 age group (β=0.151, P<.001) but not in those over 70 years old (β=0.122, P=.074). Comorbidity status significantly influenced the pathway from HR to HSD, with older adults having 2 or more chronic diseases (β=0.363) showing a greater impact compared to those with fewer than 2 chronic diseases (β=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. %M 39467284 %R 10.2196/59818 %U https://aging.jmir.org/2024/1/e59818 %U https://doi.org/10.2196/59818 %U http://www.ncbi.nlm.nih.gov/pubmed/39467284 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59501 %T Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study %A Dana,Zara %A Nagra,Harpreet %A Kilby,Kimberly %+ Supportiv, 2222 Harold Way, Berkeley, CA, 94704, United States, 1 800 845 0015, harpreet@supportiv.com %K digital peer support %K social loneliness %K chat-based interactions %K older adults %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39453688 %R 10.2196/59501 %U https://formative.jmir.org/2024/1/e59501 %U https://doi.org/10.2196/59501 %U http://www.ncbi.nlm.nih.gov/pubmed/39453688 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52640 %T Social Gaming to Decrease Loneliness in Older Adults: Recruitment Challenges and Attrition Analysis in a Digital Mixed Methods Feasibility Study %A Châtel,Bas D L %A Janssen,Jeroen H M %A Peeters,Geeske M E E %A Corten,Rense %A Tieben,Rob %A Deen,Menno %A Hendriks,Elmy J M %A Olde Rikkert,Marcel G M %+ Department of Geriatric Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, Netherlands, 31 0243616772, bastiaan.chatel@gmail.com %K loneliness %K digital health %K serious gaming %K older adults %K recruitment %K feasibility study %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 39412863 %R 10.2196/52640 %U https://games.jmir.org/2024/1/e52640 %U https://doi.org/10.2196/52640 %U http://www.ncbi.nlm.nih.gov/pubmed/39412863 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57294 %T A French-Language Web-Based Intervention Targeting Prolonged Grief Symptoms in People Who Are Bereaved and Separated: Randomized Controlled Trial %A Debrot,Anik %A Efinger,Liliane %A Kheyar,Maya %A Pomini,Valentino %A Berthoud,Laurent %+ Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Géopolis, Rue de la Mouline 11, Lausanne, 1015, Switzerland, 41 216923239, anik.debrot@unil.ch %K web-based interventions %K randomized controlled trial %K grief %K bereavement %K separation %K guidance %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 39412869 %R 10.2196/57294 %U https://formative.jmir.org/2024/1/e57294 %U https://doi.org/10.2196/57294 %U http://www.ncbi.nlm.nih.gov/pubmed/39412869 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59029 %T 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 %A Onishi,Ryuta %K social networking sites %K social media %K psychological distress %K loneliness %K anxiety %K social support %K mother %K father %K infant %K psychological %K distress %K children %K web-based questionnaire %K parent %D 2024 %7 11.10.2024 %9 %J JMIR Pediatr Parent %G English %X 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, β=.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, β=.346; P<.001) or loneliness (b=0.390, SE 0.098, β=.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. %R 10.2196/59029 %U https://pediatrics.jmir.org/2024/1/e59029 %U https://doi.org/10.2196/59029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60387 %T United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study %A Hill,Miranda %A Greene,Meredith %A Johnson,Julene K %A Tan,Judy Y %+ Cancer Research Center for Health Equity, Division of Population Sciences, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, United States, 1 3104231499, judy.tan@cshs.org %K HIV %K AIDS %K mental health %K loneliness %K older adults %K music-based interventions %K technology %K mobile phone %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39378071 %R 10.2196/60387 %U https://formative.jmir.org/2024/1/e60387 %U https://doi.org/10.2196/60387 %U http://www.ncbi.nlm.nih.gov/pubmed/39378071 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56355 %T 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 %A Iyer,Priya %A Iyer,Lina %A Carter,Nicole %A Iyer,Ranjani %A Stirling,Amy %A Priya,Lakshmi %A Sriraman,Ushma %+ Department of Education, Heartfulness Institute, 2200 Goldenrod Ln, San Ramon, CA, 94582, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness, anxiety, loneliness, high school, satisfaction with life %K self-care %K develop %K stress %K stress management %K effectiveness %K life satisfaction %K students %K student %K support %K web-based program %K time management %K educational %K mental health %K tool %K tools %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 39047180 %R 10.2196/56355 %U https://formative.jmir.org/2024/1/e56355 %U https://doi.org/10.2196/56355 %U http://www.ncbi.nlm.nih.gov/pubmed/39047180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64196 %T Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial %A Kawaguchi,Kenjiro %A Nakagomi,Atsushi %A Ide,Kazushige %A Kondo,Katsunori %+ Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage, Chiba, 263-8522, Japan, 81 90 7596 8742, kawaguchikenjiro@chiba-u.jp %K gerontology %K geriatrics %K older adults %K elderly %K older people %K community dwelling older adult %K aging %K social participation %K walking %K mHealth %K apps %K smartphone %K digital health %K digital technology %K digital interventions %K physical activity %K exercise %D 2024 %7 30.9.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 39348180 %R 10.2196/64196 %U https://www.jmir.org/2024/1/e64196 %U https://doi.org/10.2196/64196 %U http://www.ncbi.nlm.nih.gov/pubmed/39348180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41093 %T Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study %A Yoo,In-jin %A Park,Do-Hyung %A Lee,Othelia EunKyoung %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte, 9201 University City Boulevard, Woodward 310H, Charlotte, NC, 28223-0001, United States, 1 7046878668, al.park@uncc.edu %K socially assistive robot %K older adults %K robot use pattern %K time series clustering %K profiling analysis %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39298762 %R 10.2196/41093 %U https://formative.jmir.org/2024/1/e41093 %U https://doi.org/10.2196/41093 %U http://www.ncbi.nlm.nih.gov/pubmed/39298762 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54402 %T 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 %A Wang,Lizhu %A Li,Li %A Qiu,Yang %A Li,Sihan %A Wang,Zhonghua %+ School of Health Policy and Management, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13851584945, wzh04@njmu.edu.cn %K Type 2 diabetes %K social support %K self-efficacy %K self-management %K quality of life %K structural equation modeling %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 39298755 %R 10.2196/54402 %U https://publichealth.jmir.org/2024/1/e54402 %U https://doi.org/10.2196/54402 %U http://www.ncbi.nlm.nih.gov/pubmed/39298755 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58791 %T Digital Interventions for Reducing Loneliness and Depression in Korean College Students: Mixed Methods Evaluation %A Kang,Boyoung %A Hong,Munpyo %+ Sungkyunkwan University, 25-2, Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 2 740 1770, bykang2015@gmail.com %K loneliness %K depression %K digital interventions %K college students %K mental health %K mixed methods evaluation %K Woebot %K Happify %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 39264705 %R 10.2196/58791 %U https://formative.jmir.org/2024/1/e58791 %U https://doi.org/10.2196/58791 %U http://www.ncbi.nlm.nih.gov/pubmed/39264705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52978 %T COVID-19–Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey %A Guo,Yufang %A Yue,Fangyan %A Lu,Xiangyu %A Sun,Fengye %A Pan,Meixing %A Jia,Yannan %+ School of Nursing and Rehabilitation, Shandong University, 44 Wen Hua Xi Road, Jinan, 250012, China, 86 15269163352, cdguoyufang@163.com %K COVID-19 pandemic %K internet gaming disorder %K self-control %K social isolation %K university students %K game %K gaming %K games %K addict %K addictive %K addiction %K addictions %K university %K universities %K college %K colleges %K postsecondary %K higher education %K student %K students %K China %K Chinese %K isolation %K isolated %K self-compassion %K mental health %K association %K associations %K correlation %K causal %K correlated %K correlations %D 2024 %7 10.9.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=–.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. %M 39255486 %R 10.2196/52978 %U https://www.jmir.org/2024/1/e52978 %U https://doi.org/10.2196/52978 %U http://www.ncbi.nlm.nih.gov/pubmed/39255486 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51653 %T Loneliness and Social Isolation Factors Under the Prolonged COVID-19 Pandemic in Japan: 2-Year Longitudinal Study %A Sugaya,Nagisa %A Yamamoto,Tetsuya %A Suzuki,Naho %A Uchiumi,Chigusa %+ National Institute of Occupational Safety and Health, Japan, 6-21-1 Nagao,Tama-ku, Kawasaki, 214-8585, Japan, 81 44 865 6111 ext 8568, sugaya-nagisa@h.jniosh.johas.go.jp %K COVID-19 %K pandemic %K loneliness %K social isolation %K longitudinal survey %K epidemiology %K mental health %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 39250195 %R 10.2196/51653 %U https://publichealth.jmir.org/2024/1/e51653 %U https://doi.org/10.2196/51653 %U http://www.ncbi.nlm.nih.gov/pubmed/39250195 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53309 %T Online Ambassador Visits for Hospitalized Children With Cancer: Qualitative Evaluation of Implementation %A Boensvang,Natasha Nybro %A Weibel,Mette %A Wakefield,Claire E %A Bidstrup,Pernille Envold %A Olsen,Marianne %A Nissen,Karin Bækgaard %A Spager,Vibeke %A Fridh,Martin Kaj %A Larsen,Hanne Bækgaard %+ Department of Paediatrics and Adolescent Medicine, University Hospital of Copehagen (Rigshospitalet), Blegdamsvej 60, 94-2-2, Copenhagen, 2100, Denmark, 45 35459647, hanne.baekgaard.larsen@regionh.dk %K Children %K cancer %K school-aged %K peers %K interaction %K online %K in-hospital %K social %K relationship %K quality of life %K intervention %K qualiative %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 39231427 %R 10.2196/53309 %U https://pediatrics.jmir.org/2024/1/e53309 %U https://doi.org/10.2196/53309 %U http://www.ncbi.nlm.nih.gov/pubmed/39231427 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56669 %T Improving the Social Well-Being of Single Older Adults Using the LOVOT Social Robot: Qualitative Phenomenological Study %A Tan,Cheng Kian %A Lou,Vivian W Q %A Cheng,Clio Yuen Man %A He,Phoebe Chu %A Khoo,Veronica Eng Joo %+ S R Nathan School of Human Development, Singapore University of Social Sciences, 463 Clementi Rd, Singapore, 599494, Singapore, 65 62489777, kelvintanck@suss.edu.sg %K companionship %K older adults %K social well-being %K pets %K social robots %K elderly %K wellbeing %K qualitative research %K robot %K companion %K body temperature %K development %K research design %K design %K interviews %K psychosocial support %K support %K psychosocial %K temperature regulation %K social %K care home %K aging %K ageing %K robotics %K older adults %K well-being %K loneliness %K technology %K mobile phone %D 2024 %7 23.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39178408 %R 10.2196/56669 %U https://humanfactors.jmir.org/2024/1/e56669 %U https://doi.org/10.2196/56669 %U http://www.ncbi.nlm.nih.gov/pubmed/39178408 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57101 %T 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 %A Imai,Ayu %A Matsuoka,Teruyuki %A Nakayama,Chikara %A Hashimoto,Nana %A Sano,Mutsuo %A Narumoto,Jin %+ Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan, 81 075 251 5612, tmms2004@koto.kpu-m.ac.jp %K loneliness %K virtual reality %K VR %K Alzheimer disease %K predementia %K intervention %K subjective cognitive decline %K mild cognitive impairment %K dementia %K older adult %K geriatric %K depression %K cognitive impairments %D 2024 %7 1.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39088243 %R 10.2196/57101 %U https://www.researchprotocols.org/2024/1/e57101 %U https://doi.org/10.2196/57101 %U http://www.ncbi.nlm.nih.gov/pubmed/39088243 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52292 %T Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study %A Lu,Si Yinn %A Yoon,Sungwon %A Yee,Wan Qi %A Heng Wen Ngiam,Nerice %A Ng,Kennedy Yao Yi %A Low,Lian Leng %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K digital divide %K digital learning %K smartphones %K social gerontology %K older adults %K COVID-19 pandemic %K technology adoption %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Aging %G English %X 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. %M 38662423 %R 10.2196/52292 %U https://aging.jmir.org/2024/1/e52292 %U https://doi.org/10.2196/52292 %U http://www.ncbi.nlm.nih.gov/pubmed/38662423 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48027 %T 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 %A Chaves,Antonio %A Arnáez,Sandra %A García-Soriano,Gemma %+ Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963983389, gemma.garcia@uv.es %K obsessive-compulsive disorder %K OCD %K mental health literacy %K stigma %K app %K help-seeking intention %K seek help %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 38551629 %R 10.2196/48027 %U https://mhealth.jmir.org/2024/1/e48027 %U https://doi.org/10.2196/48027 %U http://www.ncbi.nlm.nih.gov/pubmed/38551629 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50534 %T Reducing Loneliness and Social Isolation of Older Adults Through Voice Assistants: Literature Review and Bibliometric Analysis %A Marziali,Rachele Alessandra %A Franceschetti,Claudia %A Dinculescu,Adrian %A Nistorescu,Alexandru %A Kristály,Dominic Mircea %A Moșoi,Adrian Alexandru %A Broekx,Ronny %A Marin,Mihaela %A Vizitiu,Cristian %A Moraru,Sorin-Aurel %A Rossi,Lorena %A Di Rosa,Mirko %+ Centre for Innovative Models for Aging Care and Technology, IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, Ancona, 60124, Italy, 39 0718004788, c.franceschetti@inrca.it %K voice assistant %K loneliness %K social isolation %K older adults %K literature review %K bibliometric analysis %K mobile phone %D 2024 %7 18.3.2024 %9 Review %J J Med Internet Res %G English %X 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. %M 38498039 %R 10.2196/50534 %U https://www.jmir.org/2024/1/e50534 %U https://doi.org/10.2196/50534 %U http://www.ncbi.nlm.nih.gov/pubmed/38498039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49462 %T User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study %A Chou,Ya-Hsin %A Lin,Chemin %A Lee,Shwu-Hua %A Lee,Yen-Fen %A Cheng,Li-Chen %+ Department of Information and Finance Management, National Taipei University of Technology, 1, Sec 3, Zhongxiao E Rd, Taipei, 10608, Taiwan, 886 2771 2171, lijen.cheng@gmail.com %K geriatric psychiatry %K mental health %K loneliness %K chatbot %K user experience %K health promotion %K older adults %K technology-assisted interventions %K pandemic %K lonely %K gerontology %K elderly %K develop %K design %K development %K conversational agent %K geriatric %K geriatrics %K psychiatry %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38477965 %R 10.2196/49462 %U https://formative.jmir.org/2024/1/e49462 %U https://doi.org/10.2196/49462 %U http://www.ncbi.nlm.nih.gov/pubmed/38477965 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e43999 %T Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives %A Fritz,Johanna %A von Heideken Wågert,Petra %A Gusdal,Annelie K %A Johansson-Pajala,Rose-Marie %A Eklund,Caroline %+ School of Health, Care and Social Welfare, Mälardalen University, Box 883, Eskilstuna/Västerås, 721 23, Sweden, 46 21101503, johanna.fritz@mdu.se %K information and communication technology %K implementation %K determinants %K social isolation %K loneliness %K organization %K digitalization %K facilitators %K barriers %K older people %D 2024 %7 26.2.2024 %9 Original Paper %J JMIR Aging %G English %X 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. %M 38407955 %R 10.2196/43999 %U https://aging.jmir.org/2024/1/e43999 %U https://doi.org/10.2196/43999 %U http://www.ncbi.nlm.nih.gov/pubmed/38407955 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e47908 %T Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students’ Attitude Toward Companionship: Content Analysis %A Sen,Keya %A Laheji,Nida %A Ramamonjiarivelo,Zo %A Renick,Cecil %A Osborne,Randall %A Beauvais,Brad %+ School of Health Administration, Texas State University, 601 University Drive, San Marcos, TX, 78666, United States, 1 512 245 3508, Keyasen@txstate.edu %K intergenerational befriending %K social isolation %K boredom %K contactless socialization %K service learning %K internal motivation %K mobile phone %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Aging %G English %X 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. %M 38175944 %R 10.2196/47908 %U https://aging.jmir.org/2024/1/e47908 %U https://doi.org/10.2196/47908 %U http://www.ncbi.nlm.nih.gov/pubmed/38175944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48175 %T Information and Communication Technology for Managing Social Isolation and Loneliness Among People Living With Parkinson Disease: Qualitative Study of Barriers and Facilitators %A Thangavel,Gomathi %A Memedi,Mevludin %A Hedström,Karin %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 70281, Sweden, 46 19302471, gomathi.thangavel@oru.se %K social isolation %K loneliness %K Parkinson disease %K ICT %K information and communication technology %D 2024 %7 17.1.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38231548 %R 10.2196/48175 %U https://www.jmir.org/2024/1/e48175 %U https://doi.org/10.2196/48175 %U http://www.ncbi.nlm.nih.gov/pubmed/38231548 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49253 %T The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study %A Pang,Mingli %A Wang,Jieru %A Zhao,Mingyue %A Chen,Rui %A Liu,Hui %A Xu,Xixing %A Li,Shixue %A Kong,Fanlei %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhau Road, Jinan, 250012, China, kongfanlei@sdu.edu.cn %K loneliness %K social support %K sleep disturbance %K older adults %K migrant-local difference %K structural equation modeling %D 2024 %7 9.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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.11). However, we observed significantly greater intention to cope with loneliness after exposure to an animated video when compared with the control (β=4.14; t248=1.74; 1-tailed P=.04). Conclusions: Our results provide meaningful evidence for the feasibility of a full-scale study. Our study sheds light on the intention to cope with loneliness and explores the potential for creative digital interventions to enhance this psychological precursor, which is integral to overcoming loneliness. Trial Registration: German Clinical Trials Register DRKS00027116; https://drks.de/search/en/trial/DRKS00027116 %M 37285206 %R 10.2196/43036 %U https://formative.jmir.org/2023/1/e43036 %U https://doi.org/10.2196/43036 %U http://www.ncbi.nlm.nih.gov/pubmed/37285206 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44862 %T The Effectiveness of a Smartphone Intervention Targeting Suicidal Ideation in Young Adults: Randomized Controlled Trial Examining the Influence of Loneliness %A McGillivray,Lauren %A Keng-Meng Hui,Nicholas %A Wong,Quincy J J %A Han,Jin %A Qian,Jiahui %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Rd, Sydney, 2031, Australia, 61 2 9065 9133, m.torok@unsw.edu.au %K loneliness %K suicidal ideation %K suicide prevention %K digital therapeutics %K smartphone intervention %K apps %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While a smartphone intervention (LifeBuoy) has been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes. Objective: This study aims to determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone intervention (LifeBuoy). Methods: A total of 455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomized to use a dialectical behavioral therapy–based smartphone intervention (LifeBuoy) or an attention-matched control app (LifeBuoy-C) for 6 weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), post intervention (T1), and 3 months post intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether app engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time. Results: Loneliness was positively associated with higher levels of overall suicidal ideation (B=0.75, 95% CI 0.08-1.42; P=.03) and depression (B=0.88, 95% CI 0.45-1.32; P<.001), regardless of time point or allocated condition. However, loneliness did not affect suicidal ideation scores across time (time 1: B=1.10, 95% CI –0.25 to 2.46; P=.11; time 2: B=0.43, 95% CI –1.25 to 2.12; P=.61) and depression scores across time (time 1: B=0.00, 95% CI –0.67 to 0.66; P=.99; time 2: B=0.41, 95% CI –0.37 to 1.18; P=.30) in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation (B=0.00, 95% CI –0.17 to 0.18; P=.98) or depression (B=–0.08, 95% CI –0.19 to 0.03; P=.14). Conclusions: Loneliness was not found to affect young adults’ engagement with a smartphone intervention (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://tinyurl.com/yvpvn5n8 International Registered Report Identifier (IRRID): RR2-10.2196/23655 %M 36995752 %R 10.2196/44862 %U https://mental.jmir.org/2023/1/e44862 %U https://doi.org/10.2196/44862 %U http://www.ncbi.nlm.nih.gov/pubmed/36995752 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e41304 %T Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study %A Marston,Hannah Ramsden %A Ko,Pei-Chun %A Girishan Prabhu,Vishnunarayan %A Freeman,Shannon %A Ross,Christopher %A Sharaievska,Iryna %A Browning,Matthew HEM %A Earle,Sarah %A Ivan,Loredana %A Kanozia,Rubal %A Öztürk Çalıkoğlu,Halime %A Arslan,Hasan %A Bilir-Koca,Burcu %A Alexandra Silva,Paula %A Buttigieg,Sandra C %A Großschädl,Franziska %A Schüttengruber,Gerhilde %+ School of Health, Wellbeing and Social Care, The Open University, Horlock Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 7815507547, Hannah.Marston@open.ac.uk %K COVID-19 %K communication %K gerontology %K community living %K technology %K social media %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic brought digital practices and engagement to the forefront of society, which were based on behavioral changes associated with adhering to different government mandates. Further behavioral changes included transitioning from working in the office to working from home, with the use of various social media and communication platforms to maintain a level of social connectedness, especially given that many people who were living in different types of communities, such as rural, urban, and city spaces, were socially isolated from friends, family members, and community groups. Although there is a growing body of research exploring how technology is being used by people, there is limited information and insight about the digital practices employed across different age cohorts living in different physical spaces and residing in different countries. Objective: This paper presents the findings from an international multisite study exploring the impact of social media and the internet on the health and well-being of individuals in different countries during the COVID-19 pandemic. Methods: Data were collected via a series of online surveys deployed between April 4, 2020, and September 30, 2021. The age of respondents varied from 18 years to over 60 years across the 3 regions of Europe, Asia, and North America. On exploring the associations of technology use, social connectedness, and sociodemographic factors with loneliness and well-being through bivariate and multivariate analyses, significant differences were observed. Results: The levels of loneliness were higher among respondents who used social media messengers or many social media apps than among those who did not use social media messengers or used ≤1 social media app. Additionally, the levels of loneliness were higher among respondents who were not members of an online community support group than among those who were members of an online community support group. Psychological well-being was significantly lower and loneliness was significantly higher among people living in small towns and rural areas than among those living in suburban and urban communities. Younger respondents (18-29 years old), single adults, unemployed individuals, and those with lower levels of education were more likely to experience loneliness. Conclusions: From an international and interdisciplinary perspective, policymakers and stakeholders should extend and explore interventions targeting loneliness experienced by single young adults and further examine how this may vary across geographies. The study findings have implications across the fields of gerontechnology, health sciences, social sciences, media communication, computers, and information technology. International Registered Report Identifier (IRRID): RR2-10.3389/fsoc.2020.574811 %M 36877558 %R 10.2196/41304 %U https://mental.jmir.org/2023/1/e41304 %U https://doi.org/10.2196/41304 %U http://www.ncbi.nlm.nih.gov/pubmed/36877558 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e38593 %T Use of Digital Technologies to Maintain Older Adults’ Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review %A Lemaire,Célia %A Humbert,Christophe %A Sueur,Cédric %A Racin,Céline %+ Magellan (EA 3713), iaelyon, Université Jean Moulin Lyon 3, 1C, avenue des Frères Lumière - CS 78242, Lyon, 69372, CEDEX 08, France, 33 0649054213, celia.lemaire@univ-lyon3.fr %K social isolation %K COVID-19 pandemic %K remote care %K nursing homes %K social ties %K digital devices %K older adults %D 2023 %7 10.2.2023 %9 Review %J JMIR Aging %G English %X Background: Digital technologies were implemented to address the disruption of long-term care facility residents’ socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents’ social ties. Objective: Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. Results: Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. Conclusions: The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents’ perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. Trial Registration: OSF Registries osf.io/yhpx3; https://osf.io/yhpx3 %M 36599164 %R 10.2196/38593 %U https://aging.jmir.org/2023/1/e38593 %U https://doi.org/10.2196/38593 %U http://www.ncbi.nlm.nih.gov/pubmed/36599164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42172 %T Digital Intervention in Loneliness in Older Adults: Qualitative Analysis of User Studies %A Stuart,Avelie %A Yan,Ronnie Jieru %A Harkin,Lydia Jo %A Katz,Dmitri %A Stevenson,Clifford %A Mehta,Vikram %A Giles,Emilie %A Talbot,Catherine %A Gooch,Daniel %A Bennasar,Mohamed %A Self,Tara %A Nuseibeh,Bashar %A Price,Blaine %+ Computing and Communications, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908653545, blaine.price@open.ac.uk %K loneliness %K older adults %K digital connections %K reflection %K social identity %K user-centered design %K social network %K well-being apps %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Loneliness is a significant well-being issue that affects older adults. Existing, commonly used social connection platforms do not contain facilities to break the cognitive cycle of loneliness, and loneliness interventions implemented without due processes could have detrimental effects on well-being. There is also a lack of digital technology designed with older adults. Objective: We aimed to iteratively design a user-centered smartphone app that can address loneliness in older adults. The aim of this study was to investigate the loneliness-related psychological processes that our conceptual smartphone app promotes. We also identified the emergent needs and concerns that older adults raised regarding the potential benefits and detriments of the app. Methods: We used technology probes to elicit older adults’ reflections on the concept of using the app in 2 studies as follows: concept focus groups (n=33) and concept interviews (n=10). We then conducted a prototype trial with 1 week of use and follow-up interviews (n=12). Results: Thematic analysis explored the experiences and emergent challenges of our app through the design process. This led to the development of 4 themes as follows occurring in all 3 qualitative data sets: reflection on a digital social map is reassuring; app features encourage socializing; the risk of compounding loneliness; and individuals feel more control with mutual, socially beneficial activities. Conclusions: Smartphone apps have the potential to increase older adults’ awareness of the richness of their social connections, which may support loneliness reduction. Our qualitative approach to app design enabled the inclusion of older adults’ experiences in technology design. Thus, we conclude that the older adults in our study most desired functionalities that can support mutual activities and maintain or find new connections rather than enable them to share an emotional state. They were wary of the app replacing their preferred in-person social interaction. Participants also raised concerns about making the user aware of the lack of support in their social network and wanted specific means of addressing their needs. Further user-centered design work could identify how the app can support mutual activities and socializing. %M 36705962 %R 10.2196/42172 %U https://formative.jmir.org/2023/1/e42172 %U https://doi.org/10.2196/42172 %U http://www.ncbi.nlm.nih.gov/pubmed/36705962 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e39848 %T Digital Intergenerational Program to Reduce Loneliness and Social Isolation Among Older Adults: Realist Review %A Phang,Jie Kie %A Kwan,Yu Heng %A Yoon,Sungwon %A Goh,Hendra %A Yee,Wan Qi %A Tan,Chuen Seng %A Low,Lian Leng %+ Health Systems and Services Research, Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore, 65 90231226, phakyh@nus.edu.sg %K aged %K loneliness %K older people %K review %K social isolation %D 2023 %7 4.1.2023 %9 Review %J JMIR Aging %G English %X Background: There is a compelling need for an innovative and creative approach to promote social connectedness among older adults to optimize their well-being and quality of life. One possible solution may be through a digital intergenerational program. Objective: This realist review aimed to identify existing digital intergenerational programs that were used to reduce loneliness or social isolation among older adults and analyze them in terms of strategy, context, mechanisms, and outcomes. Methods: We performed a realist review with an extensive search of published and gray literature. For scholarly literature, we searched PubMed, Embase, CINAHL, PsycINFO (Ovid), and Social Sciences Citation Index databases for articles published between January 2000 to August 2020. A grey literature search was performed using the Google search engine, and the search was completed in May 2021. We included programs that evaluated digital intergenerational programs for older adults, which described outcomes of loneliness or social isolation. We included quantitative, mixed methods, and qualitative studies, as well as relevant theoretical papers, policy documents, and implementation documents. The studies were appraised based on their relevance and rigor. We synthesized the available evidence from the literature into Strategy-Context-Mechanism-Outcome (S-C-M-O) configurations to better understand what, when, and how programs work. Results: A total of 31 documents reporting 27 digital intergenerational programs were reviewed. Our final results identified 4 S-C-M-O configurations. For S-C-M-O configuration 1, we found that for community-dwelling older adults, provision of access to and training in digital technology may increase older adults’ self-efficacy in digital devices and therefore increase the use of digital communication with family. In S-C-M-O configuration 2, digital psychosocial support and educational interventions from nurses were found to be useful in reducing loneliness among community-dwelling older adults. In S-C-M-O configuration 3, a video call with a student or family was found to reduce loneliness among older adults residing in long-term residential care facilities. Finally, for S-C-M-O configuration 4, we found that behavioral activation provided through videoconferencing by a lay coach may be useful in reducing loneliness among older adults who are lonely. However, as almost half (11/27, 41%) of the included programs only reported quantitative results, this review focused on screening the discussion section of publications to identify author opinions or any qualitative information to elucidate the mechanisms of how programs work. Conclusions: This review identified the key strategy, context, and mechanism influencing the success of programs that promote intergenerational interaction through digital means. This review revealed that different strategies should be adopted for different groups of older adults (eg, older adults who are lonely, older adults who reside in long-term residential care facilities, and community-dwelling older adults). The S-C-M-O configurations should be considered when designing and implementing digital intergenerational programs for older adults. %M 36598801 %R 10.2196/39848 %U https://aging.jmir.org/2023/1/e39848 %U https://doi.org/10.2196/39848 %U http://www.ncbi.nlm.nih.gov/pubmed/36598801 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e39314 %T Dual Sensory Impairment as a Predictor of Loneliness and Isolation in Older Adults: National Cohort Study %A Wang,Qiong %A Zhang,Shimin %A Wang,Yi %A Zhao,Dan %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Number 44, Wen-hua-xi Road, Jinan, 250012, China, 86 0531 8838 1567, zhouchengchao@sdu.edu.cn %K loneliness %K social isolation %K dual sensory impairment %K vision impairment %K hearing impairment %K mental health %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults. Objective: This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China. Methods: This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults. Results: Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97% (2669/3069) reported VI, but only 27.11% (832/3069) and 9.45% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39% (2283/3069) in 2018, but only 0.72% (22/3069) were treated with a hearing aid. Conclusions: SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible. %M 36374533 %R 10.2196/39314 %U https://publichealth.jmir.org/2022/11/e39314 %U https://doi.org/10.2196/39314 %U http://www.ncbi.nlm.nih.gov/pubmed/36374533 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e31251 %T Factors Influencing Increased Use of Technology to Communicate With Others During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study %A Dawe-Lane,Erin %A Mutepua,Magano %A Morris,Daniel %A Odoi,Clarissa M %A Wilson,Emma %A Evans,Joanne %A Pinfold,Vanessa %A Wykes,Til %A Jilka,Sagar %A Simblett,Sara %+ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Henry Wellcome Building, London, SE5 8AF, United Kingdom, 44 2078480762, sara.simblett@kcl.ac.uk %K COVID-19 %K technology use %K communication %K demographics %K digital health %K mental health %K pandemic %K depression %K health technology %K psychosocial %K lockdown %K United Kingdom %K cross-sectional %K survey %K social interaction %K mental health %K social connection %K social connectivity %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Communication via technology is regarded as an effective way of maintaining social connection and helping individuals to cope with the psychological impact of social distancing measures during a pandemic. However, there is little information about which factors have influenced increased use of technology to communicate with others during lockdowns and whether this has changed over time. Objective: The aim of this study is to explore which psychosocial factors (eg, mental health and employment) and pandemic-related factors (eg, shielding and time) influenced an increase in communication via technology during the first lockdown in the United Kingdom. Methods: A cross-sectional, web-based survey was conducted between April and July 2020, examining thoughts, feelings, and behaviors associated with the pandemic, including communicating more using technology (eg, via messaging, phone, or video). We collected sociodemographic information, employment status, mental health service user status, and depression symptoms. We used hierarchical logistic regression to test which factors were associated with communicating more using technology during the lockdown. Results: Participants (N=1464) were on average 41.07 (SD 14.61) years old, and mostly women (n=1141; 77.9%), White (n=1265; 86.4%), and employed (n=1030; 70.4%). Participants reported a mild level of depression (mean 9.43, SD 7.02), and were communicating more using technology (n=1164; 79.5%). The hierarchical regression indicated that people who were employed and experiencing lower levels of depression were more likely to report increased communication using technology during a lockdown period of the COVID-19 pandemic, and over time, men communicated more using technology. Increased use of technology to communicate was related to greater communication and the inability to see others due to the social distancing measures enacted during the lockdown. It was not related to a general increase in technology use during the lockdown. Conclusions: Although most participants reported increased use of technology to communicate during a lockdown period of the COVID-19 pandemic, this was more apparent in the employed and those experiencing low levels of depression. Moving forward, we should continue to monitor groups who may have been excluded from the benefits of support and communication using technology. %M 35435852 %R 10.2196/31251 %U https://mental.jmir.org/2022/10/e31251 %U https://doi.org/10.2196/31251 %U http://www.ncbi.nlm.nih.gov/pubmed/35435852 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e40125 %T Effectiveness of Technology Interventions in Addressing Social Isolation, Connectedness, and Loneliness in Older Adults: Systematic Umbrella Review %A Balki,Eric %A Hayes,Niall %A Holland,Carol %+ Centre for Ageing Research, Faculty of Health and Medicine, Lancaster University, Furness Building, Hazelrigg Ln,, Lancaster, LA1 4YG, United Kingdom, 44 1524 592127, e.balkhi@lancaster.ac.uk %K information and communications technology %K interventions %K loneliness %K older adults %K social connectedness %K social isolation %K technology interventions %D 2022 %7 24.10.2022 %9 Review %J JMIR Aging %G English %X Background: The global population of older adults (aged >60 years) is expected to triple to 2 billion by 2050. Proportionate rises in older adults affected by loneliness and social isolation (or social connectedness) are expected. Rapid deployability and social changes have increased the availability of technological devices, creating new opportunities for older adults. Objective: This study aimed to identify, synthesize, and critically appraise the effectiveness of technology interventions improving social connectedness in older adults by assessing the quality of reviews, common observations, and derivable themes. Methods: Following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), 4 databases (PsycINFO, PubMed, Embase, and MEDLINE) were searched between February 2020 and March 2022. We identified reviews with adults aged ≥50 years in community and residential settings, reporting outcomes related to the impact of technologies on social disconnectedness with inclusion criteria based on the population, intervention, context, outcomes, and study schema—review-type articles (systematic, meta-analyses, integrative, and scoping)—and with digital interventions included. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to measure the strength of outcome recommendations including the risk of bias. The reviews covered 326 primary studies with 79,538 participants. Findings were extracted, synthesized, and organized according to emerging themes. Results: Overall, 972 publications met the initial search criteria, and 24 met our inclusion criteria. Revised Assessment of Multiple Systematic Reviews was used to assess the quality of the analysis. Eligible reviews (3/24, 12%) were excluded because of their low Revised Assessment of Multiple Systematic Reviews scores (<22). The included reviews were dedicated to information and communications technology (ICT; 11/24, 46%), videoconferencing (4/24, 17%), computer or internet training (3/24, 12%), telecare (2/24, 8%), social networking sites (2/24, 8%), and robotics (2/27, 8%). Although technology was found to improve social connectedness, its effectiveness depended on study design and is improved by shorter durations, longer training times, and the facilitation of existing relationships. ICT and videoconferencing showed the best results, followed by computer training. Social networking sites achieved mixed results. Robotics and augmented reality showed promising results but lacked sufficient data for informed conclusions. The overall quality of the studies based on GRADE was medium low to very low. Conclusions: Technology interventions can improve social connectedness in older adults. The specific effectiveness rates favor ICT and videoconferencing, but with limited evidence, as indicated by low GRADE ratings. Future intervention and study design guidelines should carefully assess the methodological quality of studies and the overall certainty of specific outcome measures. The lack of randomized controlled trials in underlying primary studies (<28%) and suboptimal methodologies limited our findings. Robotics and augmented or virtual reality warrant further research. Low GRADE scores highlight the need for high-quality research in these areas. Trial Registration: PROSPERO CRD42022363475; https://tinyurl.com/mdd6zds %M 36279155 %R 10.2196/40125 %U https://aging.jmir.org/2022/4/e40125 %U https://doi.org/10.2196/40125 %U http://www.ncbi.nlm.nih.gov/pubmed/36279155 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e38864 %T Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified Cluster Randomized Controlled Trial and Mixed Methods Study %A Bradwell,Hannah %A Edwards,Katie J %A Winnington,Rhona %A Thill,Serge %A Allgar,Victoria %A Jones,Ray B %+ Centre for Health Technology, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, United Kingdom, 44 7975927341, hannah.bradwell@plymouth.ac.uk %K social robots %K companion robots %K well-being %K older adults %K dementia %K robot pets %K COVID-19 %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs). Objective: We aimed to address the limited effectiveness research on JfA devices. Methods: We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection. Results: There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation. Conclusions: Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely. Trial Registration: ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463 %M 35830959 %R 10.2196/38864 %U https://aging.jmir.org/2022/3/e38864 %U https://doi.org/10.2196/38864 %U http://www.ncbi.nlm.nih.gov/pubmed/35830959 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36515 %T Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials %A Lippke,Sonia %A Ratz,Tiara %A Keller,Franziska Maria %A Juljugin,Dennis %A Peters,Manuela %A Pischke,Claudia %A Voelcker-Rehage,Claudia %+ Psychology & Methods, Jacobs University Bremen, Campus Ring 1, Bremen, 28759, Germany, 49 421200 ext 4730, s.lippke@jacobs-university.de %K physical activity %K older adults %K intervention %K loneliness %K depression %K eHealth %K mobile health %K mHealth %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. Objective: We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? Methods: Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. Results: The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=–1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; η2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; η2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; η2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; η2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c′ path −0.86, 95% CI −1.58 to −0.13, SE 0.38; print-based: c′ path −1.96, 95% CI −2.99 to −0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path −0.14, 95% CI −0.34 to −0.01; SE 0.09). Conclusions: Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. Trial Registration: German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy International Registered Report Identifier (IRRID): RR2-10.2196/15168 %M 35943790 %R 10.2196/36515 %U https://aging.jmir.org/2022/3/e36515 %U https://doi.org/10.2196/36515 %U http://www.ncbi.nlm.nih.gov/pubmed/35943790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34949 %T Communications Through Contemporary Tools of Information and Communication Technology: Cross-sectional Study Evaluating Health Among Separated Family Members %A Nishikitani,Mariko %A Ariyoshi,Mie %A Nohara,Yasunobu %A Umihara,Junko %+ Medical Information Center, Kyushu University Hospital, 3-1-1 Collabo 2-705, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan, 81 92 642 6475, nishikitani.mariko.585@m.kyushu-u.ac.jp %K family relations %K interpersonal communication %K internet use %K smartphone %K home environment %K psychosocial functioning %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of single-living workers separated from their spouses and families has been increasing due to the need to create a balance between life and work. Workers are assigned everywhere in globalized workplaces while also caring for their family members in the context of Japan’s aging society. At the same time, the mental and health status of persons living separately from their families is a matter of concern. The development of interpersonal communication means using information and communications technology (ICT) tools and the internet is remarkable, enabling simultaneous 2-way communication across distances and national borders. The easy accessibility to simultaneous communication is expected to improve the psychosocial status of isolated family members. Objective: This study aims to clarify the health benefits of ICT by using a psychosocial health assessment, the characteristics of ICT tools, and the frequency of communication among the workers and their families who live separately. Methods: This was a cross-sectional study planned and conducted in Japan. Study participants, including adults who live separately from other family members or have separately living family members due to work, were recruited to answer a web response survey about ICT usage status, health status, and life and society evaluation. This study recruited 73 participants divided into 2 groups by their communication tools and frequencies, and their separated life, health, and psychosocial status were statistically compared. Results: Among the 73 study participants, 15 were categorized in the high communication–skilled (HCS) group that used both types of ICT tools to communicate frequently: “live,” such as video chat and voice call, and “nonlive,” such as SMS text message service and email. A simple comparison between the HCS and reference groups showed significant differences in the cohesion with the neighborhood (P=.03), perceived social position (P=.01), and happiness (P<.001); however, there were no significant differences in the health (psychological distress, P=.08; self-rated health, P=.07), lifestyle (drinking, P>.99; current smoking, P=.37), and dyadic trust in family members living separately (P=.80). Further, in a multivariate regression analysis adjusted for confounding factors, such as educational history, age, gender, and job status, poor subjective health showed a prevalence odds ratio of less than 1 (OR 0.17, 95% CI 0.03-1.02). The HCS group showed significant positive relationships in the cohesion score with the neighborhood (P=.01; β=2.40, 95% CI 0.56-4.24), perceived social position (P=.03; β=1.17, 95% CI 0.11-2.23), and happiness score (P=.002; β=1.46, 95% CI 0.58-2.34) in the same multivariate regression models. Conclusions: This study suggested that people who frequently communicate with separated family members by taking advantage of various ICT tools can maintain a better mental state and better social relations among those who live alone and are separated from their families. %M 35921127 %R 10.2196/34949 %U https://formative.jmir.org/2022/8/e34949 %U https://doi.org/10.2196/34949 %U http://www.ncbi.nlm.nih.gov/pubmed/35921127 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e38896 %T The Effect of Cognitive Function Health Care Using Artificial Intelligence Robots for Older Adults: Systematic Review and Meta-analysis %A Lee,Hocheol %A Chung,Min Ah %A Kim,Hyeji %A Nam,Eun Woo %+ Department of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Unit 412, Chang-jo gwan, 1 Yonseidae-gil, Wonju, 26493, Republic of Korea, 82 33 760 2413, ewnam@yonsei.ac.kr %K older adult population %K older adults %K cognition %K cognitive function %K artificial intelligence %K socially assistive robots %K AI SAR %K social prescription %K dementia %K social support %K aging %K caregiver %K caregiving %K meta-analysis %K review %K Cochrane collaboration %K assistive robot %K assistive technology %D 2022 %7 28.6.2022 %9 Review %J JMIR Aging %G English %X Background: With rapidly aging populations in most parts of the world, it is only natural that the need for caregivers for older adults is going to increase in the near future. Therefore, most technologically proficient countries are in the process of using artificial intelligence (AI) to build socially assistive robots (SAR) to play the role of caregivers in enhancing interaction and social participation among older adults. Objective: This study aimed to examine the effect of intervention through AI SAR on the cognitive function of older adults through a systematic literature review. Methods: We conducted a meta-analysis of the various existing studies on the effect of AI SAR on the cognitive function of older adults to standardize the results and clarify the effect of each method and indicator. Cochrane collaboration and the systematic literature review flow of PRISMA (Preferred Reporting Item Systematic Reviews and Meta-Analyses) were used on original, peer-reviewed studies published from January 2010 to March 2022. The search words were derived by combining keywords including Population, Intervention, and Outcome—according to the Population, Intervention, Comparison, Outcome, Time, Setting, and Study Design principle—for the question “What is the effect of AI SAR on the cognitive function of older adults in comparison with a control group?” (Population: adults aged ≥65 years; Intervention: AI SAR; Comparison: comparison group; Outcome: popular function; and Study Design: prospective study). For any study, if one condition among subjects, intervention, comparison, or study design was different from those indicated, the study was excluded from the literature review. Results: In total, 9 studies were selected (6 randomized controlled trials and 3 quasi-experimental design studies) for the meta-analysis. Publication bias was examined using the contour-enhanced funnel plot method to confirm the reliability and validity of the 9 studies. The meta-analysis revealed that the average effect size of AI SAR was shown to be Hedges g=0.43 (95% CI –0.04 to 0.90), indicating that AI SAR are effective in reducing the Mini Mental State Examination scale, which reflects cognitive function. Conclusions: The 9 studies that were analyzed used SAR in the form of animals, robots, and humans. Among them, AI SAR in anthropomorphic form were able to improve cognitive function more effectively. The development and expansion of AI SAR programs to various functions including health notification, play therapy, counseling service, conversation, and dementia prevention programs are expected to improve the quality of care for older adults and prevent the overload of caregivers. AI SAR can be considered a representative, digital, and social prescription program and a nonpharmacological intervention program that communicates with older adults 24 hours a day. Despite its effectiveness, ethical issues, the digital literacy needs of older adults, social awareness and reliability, and technological advancement pose challenges in implementing AI SAR. Future research should include bigger sample sizes, pre-post studies, as well as studies using an older adult control group. %M 35672268 %R 10.2196/38896 %U https://aging.jmir.org/2022/2/e38896 %U https://doi.org/10.2196/38896 %U http://www.ncbi.nlm.nih.gov/pubmed/35672268 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e36269 %T Strengthening Social Capital to Address Isolation and Loneliness in Long-term Care Facilities During the COVID-19 Pandemic: Protocol for a Systematic Review of Research on Information and Communication Technologies %A Beogo,Idrissa %A Sia,Drissa %A Tchouaket Nguemeleu,Eric %A Zhao,Junqiang %A Gagnon,Marie-Pierre %A Etowa,Josephine %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smith road, Roger-Guindon Hall, Ottawa, ON, K1H 8M5, Canada, 1 6135625800 ext 8148, ibeogo@uottawa.ca %K ICT, long-term care facilities, COVID-19, social isolation, loneliness, pandemic, implementation sciences, protocol %K nursing home %K long-term care %K mental health %K aging %K older adults %K virtual communication %K virtual care %K information technology %K healthcare %K healthcare sector %K health care %D 2022 %7 24.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has had the greatest impact in long-term care facilities (LTCFs) by disproportionately harming older adults and heightening social isolation and loneliness (SIL). Living in close quarters with others and in need of around-the-clock assistance, interactions with older adults, which were previously in person, have been replaced by virtual chatting using information and communication technologies (ICTs). ICT applications such as FaceTime, Zoom, and Microsoft Teams video chatting have been overwhelmingly used by families to maintain residents’ social capital and subsequently reduce their SIL. Objective: Because of the lack of substantive knowledge on this ever-increasing form of social communication, this systematic review intends to synthesize the effects of ICT interventions to address SIL among residents in LTCFs during the COVID-19 period. Methods: We will include studies published in Chinese, English, and French from December 2019 onwards. Beyond the traditional search strategy approach, 4 of the 12 electronic databases to be queried will be in Chinese. We will include quantitative and intervention studies as well as qualitative and mixed methods designs. Using a 2-person approach, the principal investigator and one author will blindly screen eligible articles, extract data, and assess risk of bias. In order to improve the first round of screening, a pilot-tested algorithm will be used. Disagreements will be resolved through discussion with a third author. Results will be presented as structured summaries of the included studies. We plan to conduct a meta-analysis if sufficient data are available. Results: A total of 1803 articles have been retrieved to date. Queries of the Chinese databases are ongoing. The systematic review and subsequent manuscript will be completed by the fall of 2022. Conclusions: ICT applications have become a promising avenue to reduce SIL by providing a way to maintain communication between LTCF residents and their families and will certainly remain in the post–COVID-19 period. This review will investigate and describe context-pertinent and high-quality programs and initiatives to inform, at the macro level, policy makers and researchers, frontline managers, and families. These methods will remain relevant in the post–COVID-19 era. International Registered Report Identifier (IRRID): DERR1-10.2196/36269 %M 35275841 %R 10.2196/36269 %U https://www.researchprotocols.org/2022/3/e36269 %U https://doi.org/10.2196/36269 %U http://www.ncbi.nlm.nih.gov/pubmed/35275841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32598 %T The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis %A Haucke,Matthias %A Heinz,Andreas %A Liu,Shuyan %A Heinzel,Stephan %+ Department of Psychiatry and Neurosciences, Charité–Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin, 10117, Germany, 49 015155710318, matthias.haucke@fu-berlin.de %K COVID-19 %K mental health %K outbreak %K epidemic %K pandemic %K psychological response %K emotional well-being %K ecological momentary assessment %K risk %K protective factors %K lockdown measures %K loneliness %K mood inertia %K stressors %K mobile apps %K mHealth %K digital health %K EMA %K smartphone apps %K network model %K cognition %K stress %K temporal dynamic network %K permutation testing %K network comparison %K network characteristics %K multilevel vector autoregressive model %K mlVAR %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood. Objective: We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets. Methods: We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a “no-lockdown” and a “lockdown” stage. COVID-19–related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices. Results: We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage. Conclusions: The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions. %M 35191843 %R 10.2196/32598 %U https://www.jmir.org/2022/3/e32598 %U https://doi.org/10.2196/32598 %U http://www.ncbi.nlm.nih.gov/pubmed/35191843 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32694 %T The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study %A Sugaya,Nagisa %A Yamamoto,Tetsuya %A Suzuki,Naho %A Uchiumi,Chigusa %+ Graduate School of Technology, Industrial and Social Sciences, Tokushima University, 1-1, Minamijosanjima-cho, Tokushima, 770-8502, Japan, 81 88 656 7617, t.yamamoto@tokushima-u.ac.jp %K coronavirus disease 2019 %K mild lockdown %K social isolation %K longitudinal survey %K public health %K surveillance %K epidemiology %K COVID-19 %K pandemic %K lockdown %K psychological behavior %K social factors %K mental health %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a “mild” lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people’s lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes. Objective: This study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated. Methods: We collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables. Results: There were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants’ average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction. Conclusions: This study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic. %M 35107428 %R 10.2196/32694 %U https://publichealth.jmir.org/2022/3/e32694 %U https://doi.org/10.2196/32694 %U http://www.ncbi.nlm.nih.gov/pubmed/35107428 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34221 %T Customized Information and Communication Technology for Reducing Social Isolation and Loneliness Among Older Adults: Scoping Review %A Thangavel,Gomathi %A Memedi,Mevludin %A Hedström,Karin %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 70281, Sweden, 46 19 302471, gomathi.thangavel@oru.se %K social isolation %K loneliness %K review %K ICT %K older adults %K customization %K mobile phone %D 2022 %7 7.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Advancements in science and various technologies have resulted in people having access to better health care, a good quality of life, and better economic situations, enabling humans to live longer than ever before. Research shows that the problems of loneliness and social isolation are common among older adults, affecting psychological and physical health. Information and communication technology (ICT) plays an important role in alleviating social isolation and loneliness. Objective: The aim of this review is to explore ICT solutions for reducing social isolation or loneliness among older adults, the purpose of ICT solutions, and the evaluation focus of these solutions. This study particularly focuses on customized ICT solutions that either are designed from scratch or are modifications of existing off-the-shelf products that cater to the needs of older adults. Methods: A scoping literature review was conducted. A search across 7 databases, including ScienceDirect, Association for Computing Machinery, PubMed, IEEE Xplore, PsycINFO, Scopus, and Web of Science, was performed, targeting ICT solutions for reducing and managing social isolation and loneliness among older adults. Articles published in English from 2010 to 2020 were extracted and analyzed. Results: From the review of 39 articles, we identified 5 different purposes of customized ICT solutions focusing on reducing social isolation and loneliness. These were social communication, social participation, a sense of belonging, companionship, and feelings of being seen. The mapping of purposes of ICT solutions with problems found among older adults indicates that increasing social communication and social participation can help reduce social isolation problems, whereas fulfilling emotional relationships and feeling valued can reduce feelings of loneliness. In terms of customized ICT solution types, we found the following seven different categories: social network, messaging services, video chat, virtual spaces or classrooms with messaging capabilities, robotics, games, and content creation and management. Most of the included studies (30/39, 77%) evaluated the usability and acceptance aspects, and few studies (11/39, 28%) focused on loneliness or social isolation outcomes. Conclusions: This review highlights the importance of discussing and managing social isolation and loneliness as different but related concepts and emphasizes the need for future research to use suitable outcome measures for evaluating ICT solutions based on the problem. Even though a wide range of customized ICT solutions have been developed, future studies need to explore the recent emerging technologies, such as the Internet of Things and augmented or virtual reality, to tackle social isolation and loneliness among older adults. Furthermore, future studies should consider evaluating social isolation or loneliness while developing customized ICT solutions to provide more robust data on the effectiveness of the solutions. %M 35254273 %R 10.2196/34221 %U https://mental.jmir.org/2022/3/e34221 %U https://doi.org/10.2196/34221 %U http://www.ncbi.nlm.nih.gov/pubmed/35254273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30598 %T The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study %A Dura-Perez,Elena %A Goodman-Casanova,Jessica Marian %A Vega-Nuñez,Amanda %A Guerrero-Pertiñez,Gloria %A Varela-Moreno,Esperanza %A Garolera,Maite %A Quintana,Maria %A Cuesta-Vargas,Antonio I %A Barnestein-Fonseca,Pilar %A Gómez Sánchez-Lafuente,Carlos %A Mayoral-Cleries,Fermin %A Guzman-Parra,Jose %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital, s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K COVID-19 %K cognition %K quality of life %K social isolation %K mental health %K social support %K technology %K physical distancing %K leisure activities %K nursing %D 2022 %7 22.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people. Objective: This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak. Methods: This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout. Results: The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization. Conclusions: Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): RR2-10.2196/26431 %M 35049505 %R 10.2196/30598 %U https://www.jmir.org/2022/2/e30598 %U https://doi.org/10.2196/30598 %U http://www.ncbi.nlm.nih.gov/pubmed/35049505 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32442 %T COVID-19’s Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators %A Schuster,Amy M %A Cotten,Shelia R %+ Department of Sociology, Anthropology, and Criminal Justice, Clemson University, 132 Brackett Hall, Clemson, SC, 29634, United States, 1 904 294 7893, amschus@clemson.edu %K COVID-19 %K pandemic %K socioemotional needs %K long-term care %K nursing home facility %K assisted living facility %K elderly %K older adults %K information and communication technologies %K support %K emotion %K needs %K access %K connection %K communication %K engagement %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. Objective: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. Methods: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. Results: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents’ use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents’ use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. Conclusions: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents’ engagement and communication opportunities, such as another pandemic. %M 34878989 %R 10.2196/32442 %U https://aging.jmir.org/2022/1/e32442 %U https://doi.org/10.2196/32442 %U http://www.ncbi.nlm.nih.gov/pubmed/34878989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31175 %T Examining Tweet Content and Engagement of Users With Tweets About Hikikomori in Japanese: Mixed Methods Study of Social Withdrawal %A Pereira-Sanchez,Victor %A Alvarez-Mon,Miguel Angel %A Horinouchi,Toru %A Kawagishi,Ryo %A Tan,Marcus P J %A Hooker,Elizabeth R %A Alvarez-Mon,Melchor %A Teo,Alan R %+ Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Campus Universitario – C/ 19, Av, de Madrid, Km 33,600, Alcala de Henares, Spain, 34 91 885 4505, maalvarezdemon@icloud.com %K hikikomori %K loneliness %K social isolation %K social withdrawal %K Twitter %K hidden youth %K mobile phone %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Hikikomori is a form of severe social withdrawal that is particularly prevalent in Japan. Social media posts offer insight into public perceptions of mental health conditions and may also inform strategies to identify, engage, and support hard-to-reach patient populations such as individuals affected by hikikomori. Objective: In this study, we seek to identify the types of content on Twitter related to hikikomori in the Japanese language and to assess Twitter users’ engagement with that content. Methods: We conducted a mixed methods analysis of a random sample of 4940 Japanese tweets from February to August 2018 using a hashtag (#hikikomori). Qualitative content analysis included examination of the text of each tweet, development of a codebook, and categorization of tweets into relevant codes. For quantitative analysis (n=4859 tweets), we used bivariate and multivariate logistic regression models, adjusted for multiple comparisons, and estimated the predicted probabilities of tweets receiving engagement (likes or retweets). Results: Our content analysis identified 9 codes relevant to tweets about hikikomori: personal anecdotes, social support, marketing, advice, stigma, educational opportunities, refuge (ibasho), employment opportunities, and medicine and science. Tweets about personal anecdotes were the most common (present in 2747/4859, 56.53% of the tweets), followed by social support (902/4859, 18.56%) and marketing (624/4859, 12.84%). In the adjusted models, tweets coded as stigma had a lower predicted probability of likes (−33 percentage points, 95% CI −42 to −23 percentage points; P<.001) and retweets (−11 percentage points, 95% CI −18 to −4 percentage points; P<.001), personal anecdotes had a lower predicted probability of retweets (−8 percentage points, 95% CI −14 to −3 percentage points; P=.002), marketing had a lower predicted probability of likes (−13 percentage points, 95% CI −21 to −6 percentage points; P<.001), and social support had a higher predicted probability of retweets (+15 percentage points, 95% CI 6-24 percentage points; P=.001), compared with all tweets without each of these codes. Conclusions: Japanese tweets about hikikomori reflect a unique array of topics, many of which have not been identified in prior research and vary in their likelihood of receiving engagement. Tweets often contain personal stories of hikikomori, suggesting the potential to identify individuals with hikikomori through Twitter. %M 35014971 %R 10.2196/31175 %U https://www.jmir.org/2022/1/e31175 %U https://doi.org/10.2196/31175 %U http://www.ncbi.nlm.nih.gov/pubmed/35014971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30286 %T Implications and Preventions of Cyberbullying and Social Exclusion in Social Media: Systematic Review %A Ademiluyi,Adesoji %A Li,Chuqin %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte Charlotte, Woodward 310H, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 704 687 8668, apark11@uncc.edu %K cyberbullying %K cybervictimization %K cyberaggression %K bullying %K mental health %K social isolation %K social media %K mobile phone %D 2022 %7 4.1.2022 %9 Review %J JMIR Form Res %G English %X Background: The growth of social networking has created a paradigm in which many forms of personal communication are being replaced by internet communication technologies, such as social media. This has led to social issues, such as cyberbullying. In response, researchers are investigating cyberbullying to determine its implications in various life sectors. Objective: This manuscript reviews the methods, results, and limitations of the current cyberbullying research and discusses the physical and mental repercussions of cyberbullying and social exclusion as well as methods of predicting and counteracting these events. On the basis of the findings, we discuss future research directions. Methods: Using ScienceDirect, ACM Digital Library, and PubMed, 34 research articles were used in this review. A review was conducted using the selected articles with the goal of understanding the current landscape of cyberbullying research. Results: Studies have analyzed correlations between depressive and suicidal ideations in subjects as well as relationships in the social, educational, and financial status of the perpetrators. Studies have explored detection methods for monitoring cyberbullying. Automated detection has yet to become effective and accurate; however, several factors, such as personal background and physical appearance, have been identified to correlate with the likelihood that a person becomes a survivor or perpetrator of web-based cybervictimization. Social support is currently common in recovery efforts but may require diversification for specific applications in web-based incidents. Conclusions: Relations between social status, age, gender, and behaviors have been discovered that offer new insights into the origins and likeliness of cyberbullying events. Rehabilitation from such events is possible; however, automatic detection is not yet a viable solution for prevention of cyberbullying incidents. Effects such as social exclusion and suicidal ideations are closely tied to incidents of cyberbullying and require further study across various social and demographical populations. New studies should be conducted to explore the experiences of survivors and perpetrators and identify causal links. The breadth of research includes demographics from China, Canada, Taiwan, Iran, the United States, and Namibia. Wider ranges of national populations should be considered in future studies for accurate assessments, given global internet communication technology activity. The studies emphasize the need for formal classification terminology. With formal classification, researchers will have a more definite scope, allowing specific research on a single definable topic rather than on general bullying events and symptoms. Of all the studies, 2 used a longitudinal design for their research methodology. The low number of longitudinal studies leaves gaps between causation and correlation, and further research is required to understand the effects of cyberbullying. Research addressing ongoing victimization is required for the various forms of cyberbullying; social support offers the most effective current standard for prevention. %M 34982712 %R 10.2196/30286 %U https://formative.jmir.org/2022/1/e30286 %U https://doi.org/10.2196/30286 %U http://www.ncbi.nlm.nih.gov/pubmed/34982712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e20466 %T The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe %A Silva,Patrícia %A Delerue Matos,Alice %A Martinez-Pecino,Roberto %+ Communication and Society Research Centre, University of Minho, Campus Gualtar, Social Sciences Institute, Braga, 4710-057, Portugal, 351 253604212, patriciasilva@ics.uminho.pt %K social isolation %K internet %K 50+ individuals %K e-inclusion %K SHARE %D 2022 %7 3.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation. Objective: This study specifically aims to clarify the relationship between internet use and social isolation of individuals aged ≥50 years, for which other surveys present contradictory results. Methods: We performed logistic regression analysis with social isolation as the dependent variable, internet use as the interest variable, and several other sociodemographic, economic, and health characteristics of the individuals as control variables. The sample size was 67,173 individuals aged 50 years and older from 17 European countries (Portugal, Greece, Italy, Spain, Denmark, Sweden, Austria, Belgium, France, Germany, Switzerland, Luxemburg, Poland, Czech Republic, Slovenia, Estonia, and Croatia) plus Israel, who were interviewed in the Survey of Health, Ageing and Retirement in Europe (SHARE), wave 6. Results: The results show that countries differ in the level of social isolation and rate of internet use by individuals aged 50 years and older. They also evidence that in most of the countries analyzed, social isolation of internet users was lower compared to that of nonusers after controlling for a set of sociodemographic, economic, and health characteristics of the individuals that have been previously described in the literature as determinants of social isolation. Indeed, on average, although 31.4% of individuals in the nonuser group experienced high social isolation, only 12.9% of individuals who used the internet experienced this condition. Conclusions: Internet users show lower social isolation. This result underlines the importance of promoting e-inclusion in Europe as a way to counter social isolation of individuals aged 50 years and older. %M 34982040 %R 10.2196/20466 %U https://www.jmir.org/2022/1/e20466 %U https://doi.org/10.2196/20466 %U http://www.ncbi.nlm.nih.gov/pubmed/34982040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28022 %T Older Adults’ Loneliness, Social Isolation, and Physical Information and Communication Technology in the Era of Ambient Assisted Living: A Systematic Literature Review %A Latikka,Rita %A Rubio-Hernández,Rosana %A Lohan,Elena Simona %A Rantala,Juho %A Nieto Fernández,Fernando %A Laitinen,Arto %A Oksanen,Atte %+ Faculty of Social Sciences, Tampere University, Kalevantie 4, Tampere, 33100, Finland, 358 504313178, rita.latikka@tuni.fi %K loneliness %K social isolation %K older adults %K physical information and communication technology %K systematic literature review %D 2021 %7 30.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Loneliness and social isolation can have severe effects on human health and well-being. Partial solutions to combat these circumstances in demographically aging societies have been sought from the field of information and communication technology (ICT). Objective: This systematic literature review investigates the research conducted on older adults’ loneliness and social isolation, and physical ICTs, namely robots, wearables, and smart homes, in the era of ambient assisted living (AAL). The aim is to gain insight into how technology can help overcome loneliness and social isolation other than by fostering social communication with people and what the main open-ended challenges according to the reviewed studies are. Methods: The data were collected from 7 bibliographic databases. A preliminary search resulted in 1271 entries that were screened based on predefined inclusion criteria. The characteristics of the selected studies were coded, and the results were summarized to answer our research questions. Results: The final data set consisted of 23 empirical studies. We found out that ICT solutions such as smart homes can help detect and predict loneliness and social isolation, and technologies such as robotic pets and some other social robots can help alleviate loneliness to some extent. The main open-ended challenges across studies relate to the need for more robust study samples and study designs. Further, the reviewed studies report technology- and topic-specific open-ended challenges. Conclusions: Technology can help assess older adults’ loneliness and social isolation, and alleviate loneliness without direct interaction with other people. The results are highly relevant in the COVID-19 era, where various social restrictions have been introduced all over the world, and the amount of research literature in this regard has increased recently. %M 34967760 %R 10.2196/28022 %U https://www.jmir.org/2021/12/e28022 %U https://doi.org/10.2196/28022 %U http://www.ncbi.nlm.nih.gov/pubmed/34967760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33123 %T A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study %A Hijab,Mohamad Hassan Fadi %A Al-Thani,Dena %A Banire,Bilikis %+ Division of Information and Computer Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, 34110, Qatar, 974 50677321, mhhijab@hbku.edu.qa %K autism %K assistive technology %K mobile app %K social and communication skills %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD. Objective: This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD. Methods: Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants’ interactions with the app were collected. Additionally, 6 participants’ parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app’s usability. Following the study, interviews were conducted with participants to discuss their experiences with the app. Results: The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=−2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=−0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations. Conclusions: This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD. %M 34878998 %R 10.2196/33123 %U https://formative.jmir.org/2021/12/e33123 %U https://doi.org/10.2196/33123 %U http://www.ncbi.nlm.nih.gov/pubmed/34878998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30624 %T Effects of Emotional Expressiveness of a Female Digital Human on Loneliness, Stress, Perceived Support, and Closeness Across Genders: Randomized Controlled Trial %A Loveys,Kate %A Sagar,Mark %A Zhang,Xueyuan %A Fricchione,Gregory %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Auckland, 1023, New Zealand, 64 9 923 6756, e.broadbent@auckland.ac.nz %K computer agent %K digital human %K emotional expressiveness %K loneliness %K closeness %K social support %K stress %K human-computer interaction %K voice %K face %K physiology %D 2021 %7 25.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Loneliness is a growing public health problem that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Social support interventions have been shown to reduce loneliness, including when delivered through technology. Digital humans are a new type of computer agent that show promise as supportive peers in health care. For digital humans to be effective and engaging support persons, it is important that they develop closeness with people. Closeness can be increased by emotional expressiveness, particularly in female relationships. However, it is unknown whether emotional expressiveness improves relationships with digital humans and affects physiological responses. Objective: The aim of this study is to investigate whether emotional expression by a digital human can affect psychological and physiological outcomes and whether the effects are moderated by the user’s gender. Methods: A community sample of 198 adults (101 women, 95 men, and 2 gender-diverse individuals) was block-randomized by gender to complete a 15-minute self-disclosure conversation with a female digital human in 1 of 6 conditions. In these conditions, the digital human varied in modality richness and emotional expression on the face and in the voice (emotional, neutral, or no face; emotional or neutral voice). Perceived loneliness, closeness, social support, caring perceptions, and stress were measured after each interaction. Heart rate, skin temperature, and electrodermal activity were assessed during each interaction. 3-way factorial analyses of variance with post hoc tests were conducted. Results: Emotional expression in the voice was associated with greater perceptions of caring and physiological arousal during the interaction, and unexpectedly, with lower feelings of support. User gender moderated the effect of emotional expressiveness on several outcomes. For women, an emotional voice was associated with increased closeness, social support, and caring perceptions, whereas for men, a neutral voice increased these outcomes. For women, interacting with a neutral face was associated with lower loneliness and subjective stress compared with no face. Interacting with no face (ie, a voice-only black screen) resulted in lower loneliness and subjective stress for men, compared with a neutral or emotional face. No significant results were found for heart rate or skin temperature. However, average electrodermal activity was significantly higher for men while interacting with an emotional voice. Conclusions: Emotional expressiveness in a female digital human has different effects on loneliness, social, and physiological outcomes for men and women. The results inform the design of digital human support persons and have theoretical implications. Further research is needed to evaluate how more pronounced emotional facial expressions in a digital human might affect the results. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000865819; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381816&isReview %M 34842540 %R 10.2196/30624 %U https://www.jmir.org/2021/11/e30624 %U https://doi.org/10.2196/30624 %U http://www.ncbi.nlm.nih.gov/pubmed/34842540 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31586 %T A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial %A Loveys,Kate %A Sagar,Mark %A Pickering,Isabella %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 0003, e.broadbent@auckland.ac.nz %K COVID-19 %K loneliness %K stress %K well-being %K eHealth %K digital human %K conversational agent %K older adults %K chronic illness %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human’s design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 %M 34596572 %R 10.2196/31586 %U https://mental.jmir.org/2021/11/e31586 %U https://doi.org/10.2196/31586 %U http://www.ncbi.nlm.nih.gov/pubmed/34596572 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29896 %T Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study %A Joshi,Megha %A Shah,Aangi %A Trivedi,Bhavi %A Trivedi,Jaahnavee %A Patel,Viral %A Parghi,Devam %A Thakkar,Manini %A Barot,Kanan %A Jadawala,Vivek %+ Department of Psychiatry, Shrimati Nathiba Hargovandas Lakhamichand Municipal Medical College, Gujarat University, Pritamrai cross road,, Ellisbridge, Paldi, Ahmedabad, 380006, India, 91 9909896196, joshimegha1@gmail.com %K COVID-19 %K mental health %K India %K lockdown %K isolation %K social isolation %K behavior %K psychology %K psychosocial effects %D 2021 %7 5.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 %M 34519652 %R 10.2196/29896 %U https://www.researchprotocols.org/2021/11/e29896 %U https://doi.org/10.2196/29896 %U http://www.ncbi.nlm.nih.gov/pubmed/34519652 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e25298 %T A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study %A Aguilera,Adrian %A Hernandez-Ramos,Rosa %A Haro-Ramos,Alein Y %A Boone,Claire Elizabeth %A Luo,Tiffany Christina %A Xu,Jing %A Chakraborty,Bibhas %A Karr,Chris %A Darrow,Sabrina %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC7400, School of Social Welfare, Berkeley, CA, 94720, United States, 1 (510) 642 8564, aguila@berkeley.edu %K mobile health %K COVID-19 %K text messaging %K cognitive behavioral therapy %K anxiety %K depression %K microrandomized trials %K mHealth %K intervention %K mental health %K SMS %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 %M 34543230 %R 10.2196/25298 %U https://mental.jmir.org/2021/11/e25298 %U https://doi.org/10.2196/25298 %U http://www.ncbi.nlm.nih.gov/pubmed/34543230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32353 %T Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19–Related Stress: Pilot Feasibility Study %A Gordon,Judith S %A Sbarra,David %A Armin,Julie %A Pace,Thaddeus W W %A Gniady,Chris %A Barraza,Yessenya %+ College of Nursing, University of Arizona, 1305 North Martin Avenue, Tucson, AZ, 85721, United States, 1 5206264970, judithg@email.arizona.edu %K COVID-19 %K stress %K anxiety %K isolation %K intervention %K guided imagery %K mobile app %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in 2 phases: (1) development and internal testing of the app; and (2) feasibility and pilot testing with participants recruited online through earned media (eg, news stories), presentations at a university campus, and social media (eg, online sharing of earned media and presentations). The feasibility study employed a mixed methods, within-subjects, pre-/posttest design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva samples for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% [90/99] of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% [84/99] of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app, with 87% (78/90) rating the app as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences (P=.41) in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is a need for evidence-based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. %M 34546941 %R 10.2196/32353 %U https://formative.jmir.org/2021/10/e32353 %U https://doi.org/10.2196/32353 %U http://www.ncbi.nlm.nih.gov/pubmed/34546941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28002 %T “Skip the Small Talk” Virtual Event Intended to Promote Social Connection During a Global Pandemic: Online Survey Study %A Mote,Jasmine %A Gill,Kathryn %A Fulford,Daniel %+ Department of Occupational Therapy, Tufts University, 574 Boston Ave, Medford, MA, 02155, United States, 1 617 627 3781, jasmine.mote@tufts.edu %K COVID-19 %K depression %K digital group %K loneliness %K social connection %K virtual social interaction %K community %K mental health %K connection %K virtual health %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing measures meant to prevent the spread of COVID-19 in the past year have exacerbated loneliness and depression in the United States. While virtual tools exist to improve social connections, there have been limited attempts to assess community-based, virtual methods to promote new social connections. Objective: In this proof-of-concept study, we examined the extent to which Skip the Small Talk (STST)—a business dedicated to hosting events to facilitate structured, vulnerable conversations between strangers—helped reduce loneliness in a virtual format in the early months of the 2020 COVID-19 pandemic. We predicted that participants who attended STST virtual events would show a reduction in loneliness, improvement in positive affect, and reduction in negative affect after attending an event. We were also interested in exploring the role of depression symptoms on these results as well as the types of goals participants accomplished by attending STST events. Methods: Adult participants who registered for an STST virtual event between March 25 and June 30, 2020, completed a survey before attending the event (pre-event survey; N=64) and a separate survey after attending the event (postevent survey; n=25). Participants reported on their depression symptoms, loneliness, and positive and negative affect. Additionally, participants reported the goals they wished to accomplish as well as those they actually accomplished by attending the STST event. Results: The four most cited goals that participants hoped to accomplish before attending the STST event included the following: “to make new friends,” “to have deeper/better conversations with other people,” “to feel less lonely,” and “to practice social skills.” A total of 34% (20/58) of participants who completed the pre-event survey reported depression symptoms that indicated a high risk of a major depressive episode in the preceding 2 weeks. Of the 25 participants who completed the pre- and postevent surveys, participants reported a significant reduction in loneliness (P=.03, Cohen d=0.48) and negative affect (P<.001, Cohen d=1.52) after attending the STST event compared to before the event. Additionally, depressive symptoms were significantly positively correlated with change in negative affect (P=.03), suggesting that the higher the depression score was prior to attending the STST event, the higher the reduction in negative affect was following the event. Finally, 100% of the participants who wished to reduce their loneliness (11/11) or feel less socially anxious (5/5) prior to attending the STST event reported that they accomplished those goals after the event. Conclusions: Our preliminary assessment suggests that the virtual format of STST was helpful for reducing loneliness and negative affect for participants, including those experiencing depression symptoms, during the COVID-19 pandemic. While encouraging, additional research is necessary to demonstrate whether STST has benefits when compared to other social events and interventions and whether such benefits persist beyond the events themselves. %M 34468326 %R 10.2196/28002 %U https://formative.jmir.org/2021/9/e28002 %U https://doi.org/10.2196/28002 %U http://www.ncbi.nlm.nih.gov/pubmed/34468326 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30802 %T Co-Development of a Web-Based Hub (eSocial-hub) to Combat Social Isolation and Loneliness in Francophone and Anglophone Older People in the Linguistic Minority Context (Quebec, Manitoba, and New Brunswick): Protocol for a Mixed Methods Interventional Study %A Beogo,Idrissa %A Ramdé,Jean %A Nguemeleu Tchouaket,Eric %A Sia,Drissa %A Bationo,Nebila Jean-Claude %A Collin,Stephanie %A Anne,Abdoulaye %A Gagnon,Marie-Pierre %+ École des sciences infirmières, Faculté des sciences de la santé, Université d'Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada, 1 6135625432, ibeogo@uottawa.ca %K older people %K nursing facility %K nursing home %K long-term care home %K linguistic minority %K digital health %K COVID-19 %K social isolation %K loneliness %K older adults %K development %K isolation %K minority %K community %D 2021 %7 15.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The first wave of the COVID-19 pandemic has severely hit Canadian nursing facilities (81% of deaths). To this toll, public health measures (eg, visitation restriction) have subsequently deepened the social isolation and loneliness of residents in nursing facilities (NFs), especially those in linguistic minority settings: Anglophone institutions in Quebec and Francophone institutions outside Quebec. However, very few COVID-19 initiatives targeting these populations specifically have been documented. Given the limited number of NFs serving linguistic minorities in Canadian populations, families and loved ones often live far from these facilities, sometimes even in other provinces. This context places the digital solutions as particularly relevant for the present COVID-19 pandemic as well as in the post–COVID-19 era. Objective: This project aims to co-develop a virtual community of practice through a web-based platform (eSocial-hub) to combat social isolation and loneliness among the older people in linguistic minority settings in Canada. Methods: An interventional study using a sequential mixed methods design will be conducted. Four purposely selected NFs will be included, 2 among facilities in Manitoba and 2 in New Brunswick; and 2 Anglophone NFs in Quebec will serve as knowledge users. The development of eSocial-hub will include an experimental 4-month phase involving the following end users: (1) older people (n=3 per NF), (2) families of the participating older people (n=3 per NF), and (3) frontline staff (nurse and health care aid; n=2 per NF). Results: Activities and solutions aiming at reducing social isolation and loneliness will be implemented and then evaluated with the project stakeholders, and the best practices generated. The assessment will be conducted using indicators derived from the 5 domains of the Consolidated Framework for Implementation Research. The project will be led by an interdisciplinary team and will involve a multisectoral partnership. Conclusions: The project will develop a promising and generalizable solution that uses virtual technology to help reduce social isolation and loneliness among the older people. International Registered Report Identifier (IRRID): PRR1-10.2196/30802 %M 34464326 %R 10.2196/30802 %U https://www.researchprotocols.org/2021/9/e30802 %U https://doi.org/10.2196/30802 %U http://www.ncbi.nlm.nih.gov/pubmed/34464326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24624 %T Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh %A Rashid Soron,Tanjir %A Ashiq,Md Ashiqur Rahman %A Al-Hakeem,Marzia %A Chowdhury,Zaid Farzan %A Uddin Ahmed,Helal %A Afrooz Chowdhury,Chaman %+ Telepsychiatry Research and Innovation Network Ltd, 3D, 2nd Floor, Rupayan Trade Center, Bangla Motor, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K domestic violence %K COVID-19 %K mental health %K violence %K Bangladesh %K lockdown %K isolation %K anxiety %K stress %K telemental health %K telepsychiatry %K web-based survey %D 2021 %7 13.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. %M 34346893 %R 10.2196/24624 %U https://formative.jmir.org/2021/9/e24624 %U https://doi.org/10.2196/24624 %U http://www.ncbi.nlm.nih.gov/pubmed/34346893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26513 %T Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study %A Tuck,Alison B %A Thompson,Renee J %+ Department of Psychological and Brain Sciences, Washington University in St Louis, Campus Box 1125, One Brookings Drive, St Louis, MO, 63130, United States, 1 (314) 935 3502, alison.tuck@wustl.edu %K social media %K social networking sites %K COVID-19 %K loneliness %K well-being %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing during the COVID-19 pandemic has reduced the frequency of in-person social interactions. College students were highly impacted, since many universities transferred curriculum from in-person to entirely online formats, physically separating students with little notice. With social distancing, their use of social networking sites (SNSs) likely changed during the COVID-19 pandemic, possibly holding implications for well-being. Objective: This study aimed to determine (1) how components of SNS use (ie, weekly frequency, time per day, habitual use, engagement, enjoyment, addiction, and emotional impact) changed from before to during COVID-19, (2) how these changes in SNS use were associated with pandemic-related social and emotional well-being, and (3) how SNS use and changes in use during the pandemic were associated with loneliness. Methods: College students (N=176) were surveyed during the time when their university campus in the United States was operating online. Participants completed the same SNS use questionnaires twice, once with regard to the month preceding the onset of COVID-19 and again with regard to the month since this time. They also reported the extent to which they experienced perceived change in social support resulting from the pandemic, pandemic-related stress, and general loneliness. Results: After the onset of COVID-19, participants showed an increase in daily time spent on SNSs (t169=5.53, d=0.42, P<.001), habitual use (t173=3.60, d=0.27, P<.001), and addiction (t173=4.96, d=0.38, P<.001); further, enjoyment on SNSs decreased (t173=–2.10, d=–0.16, P=.04) and the emotional impact of SNS activities became more negative (t172=–3.76, d=–0.29, P<.001). Increased perceived social support during COVID-19 was associated with changes in frequency of SNS use, time per day, addiction, and engagement (r>0.18 for all). Pandemic-related stress was associated with changes in SNS addiction and the extent to which one’s SNS content was related to the pandemic (r>0.20 for all). Loneliness was positively associated with SNS addiction (r=0.26) and negatively associated with SNS engagement (r=–0.19) during the pandemic. Loneliness was also negatively associated with changes in habit and engagement (r<–0.15 for all). Conclusions: Findings suggest that components of SNS use are associated with both positive and negative pandemic-related social outcomes, but largely negative pandemic-related emotional outcomes. Further, some components of SNS use are positively associated with loneliness (eg, addiction) while others show a negative association (eg, engagement). These findings provide a more nuanced picture of how SNS use is associated with social and emotional well-being during the time of a global health crisis when in-person interactions are scarce. %M 34313587 %R 10.2196/26513 %U https://formative.jmir.org/2021/9/e26513 %U https://doi.org/10.2196/26513 %U http://www.ncbi.nlm.nih.gov/pubmed/34313587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e30164 %T Association of COVID-19 Risk Misperceptions With Household Isolation in the United States: Survey Study %A Ladapo,Joseph A %A Rothwell,Jonathan T %A Ramirez,Christina M %+ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, United States, 1 3107942728, jladapo@mednet.ucla.edu %K COVID-19 %K pandemic %K mental health %K public health %K isolation %K loneliness %K guideline %K risk %K perception %K United States %K health risk %K well-being %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the COVID-19 pandemic. Objective: The goal of this study was to examine the association of COVID-19 risk misperceptions with self-reported household isolation, a potential risk factor for social isolation and loneliness. Methods: We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July to December 2020) of 24,649 US adults. We also analyzed data from the Gallup Panel (March 2020 to February 2021), which included 123,516 observations about loneliness. The primary outcome was self-reported household isolation, which we defined as a respondent having no contact or very little contact with people outside their household, analogous to quarantining. Results: From July to December 2020, 53% to 57% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years old accounted for 7% of total US deaths, respondents estimated that this population represented 43% of deaths. Overestimating COVID-19 health risks was associated with increased self-reported household isolation, with percentage differences ranging from 5.6 to 11.8 (P<.001 at each time point). Characteristics associated with self-reported household isolation from the July and August 2020 surveys and persisting in the December 2020 survey included younger age (18 to 39 years), having a serious medical condition, having a household member with a serious medical condition, and identifying as a Democrat. In the Gallup Panel, self-reported household isolation was associated with a higher prevalence of loneliness. Conclusions: Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines. %M 34253507 %R 10.2196/30164 %U https://formative.jmir.org/2021/8/e30164 %U https://doi.org/10.2196/30164 %U http://www.ncbi.nlm.nih.gov/pubmed/34253507 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e25801 %T Associations Between Psychosocial Measures and Digital Media Use Among Transgender Youth: Cross-sectional Study %A Allen,Brittany J %A Stratman,Zoe E %A Kerr,Bradley R %A Zhao,Qianqian %A Moreno,Megan A %+ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, 2870 University Avenue, Suite 200, Madison, WI, 53705, United States, 1 16082655835, bjallen@pediatrics.wisc.edu %K transgender person %K internet %K sex and gender minorities %K well-being %K adolescent %K mobile phone %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Transgender, nonbinary, and gender-diverse (TNG) youth encounter barriers to psychosocial wellness and also describe exploring identities and communities on the web. Studies of cisgender youth connect increased digital technology use with lower well-being, parent relationships, and body image scores as well as increased loneliness and fear of missing out (FOMO). However, little is known about the psychosocial factors associated with digital technology use among TNG compared with cisgender youth. Objective: This study aims to examine the associations between psychosocial measures and digital technology use and its importance for cisgender and TNG youth. Methods: We surveyed a nationally representative sample of adolescents (aged 13-18 years) about psychosocial wellness and digital technology use. Psychosocial measures included assessment of well-being, parental relationships, body image, loneliness, and FOMO. Digital media use assessments included the short Problematic and Risky Internet Use Screening Scale-3 and the Adolescent Digital Technology Interactions and Importance (ADTI) scale and subscales. We compared psychosocial measures between gender identity groups. We also compared stratified correlations for psychosocial measures (well-being, parent relationships, body image, loneliness, and FOMO) with ADTI and Problematic and Risky Internet Use Screening Scale-3 scores between gender identity groups. All comparisons were adjusted for age, race, and ethnicity. Results: Among 4575 adolescents, 53 (1.16%) self-identified as TNG youth. TNG youth had lower scores for well-being (23.76 vs 26.47; P<.001), parent relationships (19.29 vs 23.32; P<.001), and body image (13.50 vs 17.12; P<.001), and higher scores for loneliness (9.28 vs 6.55; P<.001) and FOMO (27.93 vs 23.89; P=.004), compared with cisgender peers. In a pattern different from that of their cisgender peers, better well-being scores and body image for TNG youth predicted higher problematic internet use (PIU) scores (correlation coefficients of 0.32 vs −0.07; P=.004 and 0.26 vs −0.21; P=.002, respectively). FOMO was a stronger positive predictor of higher ADTI total and subscale scores for cisgender youth compared with TNG youth. Conclusions: Overall, this study supports previously demonstrated disparities in the psychosocial wellness of TNG youth and adds that these disparities include loneliness and FOMO. This study shows prediction of PIU by both higher well-being and better body image, indicating that PIU may not be unilaterally driven by problematic factors among TNG youth. We suggest that this may be because of the specific digital media functions that TNG youth engage with as a disenfranchised population. %M 34398792 %R 10.2196/25801 %U https://pediatrics.jmir.org/2021/3/e25801 %U https://doi.org/10.2196/25801 %U http://www.ncbi.nlm.nih.gov/pubmed/34398792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e28738 %T Studying How Individuals Who Express the Feeling of Loneliness in an Online Loneliness Forum Communicate in a Nonloneliness Forum: Observational Study %A Andy,Anietie %+ Penn Medicine, 3400 Civic Blvd, Philadelphia, PA, , United States, 1 202 486 4095, andyanietie@gmail.com %K loneliness %K Reddit %K nonloneliness %K mental health %K eHealth %K forum %K online forum %K communication %K natural language processing %K language %K linguistics %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Loneliness is a public health concern, and increasingly, individuals experiencing loneliness are seeking support on online forums, some of which focus on discussions around loneliness (loneliness forums). Some of these individuals may also seek support around loneliness on online forums not related to loneliness or well-being (nonloneliness forums). Hence, to design and implement appropriate and efficient online loneliness interventions, it is important to understand how individuals who express and seek support around loneliness on online loneliness forums communicate in nonloneliness forums; this could provide further insights into the support needs and concerns of these users. Objective: This study aims to explore how users who express the feeling of loneliness and seek support around loneliness on an online loneliness forum communicate in an online nonloneliness forum. Methods: A total of 2401 users who expressed loneliness in posts published on a loneliness forum on Reddit and had published posts in a nonloneliness forum were identified. Using latent Dirichlet allocation (a natural language processing algorithm); Linguistic Inquiry and Word Count (a psycholinguistic dictionary); and the word score–based language features valence, arousal, and dominance, the language use differences in posts published in the nonloneliness forum by these users compared to a control group of users who did not belong to any loneliness forum on Reddit were determined. Results: It was found that in posts published in the nonloneliness forum, users who expressed loneliness tend to use more words associated with the Linguistic Inquiry and Word Count categories on sadness (Cohen d=0.10) and seeking to socialize (Cohen d=0.114), and use words associated with valence (Cohen d=0.364) and dominance (Cohen d=0.117). In addition, they tend to publish posts related to latent Dirichlet allocation topics such as relationships (Cohen d=0.105) and family and friends and mental health (Cohen d=0.10). Conclusions: There are clear distinctions in language use in nonloneliness forum posts by users who express loneliness compared to a control group of users. These findings can help with the design and implementation of online interventions around loneliness. %M 34283026 %R 10.2196/28738 %U https://formative.jmir.org/2021/7/e28738 %U https://doi.org/10.2196/28738 %U http://www.ncbi.nlm.nih.gov/pubmed/34283026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23471 %T Needs and Preferences of Middle-Aged and Older Adults in Taiwan for Companion Robots and Pets: Survey Study %A Chiu,Ching-Ju %A Hsieh,Shiuan %A Li,Chia-Wei %+ Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 70101, Taiwan, 886 6 2353535 ext 5739, cjchiu@mail.ncku.edu.tw %K middle-aged adults %K older adults %K companionship demand %K robot %K pet %K acceptance %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, robots have been considered a new tech industry that can be used to solve the shortage in human resources in the field of health care. Also, animal-assisted therapy has been used to provide assistance, companionship, and interaction among the elderly and has been shown to have a positive impact on their emotional and psychological well-being. Both pets and robots can provide dynamic communication and positive interaction patterns. However, preferences for middle-aged and older adults in this regard are not clear. Objective: This study explored the degree of acceptance of robots and pets as partners in later life and to determine the needs and preferences of elderly individuals related to companion robots. Methods: A total of 273 middle-aged and older adults aged ≥45 years and living in the community were invited to answer a structured questionnaire after watching a companion robot video. Sociodemographic data, physical health status and activities, experience with technology, eHealth literacy, and acceptance and attitude toward robots and pets were recorded and analyzed using multinomial logistic regression analysis. Results: Age, level of education, type of dwelling, occupation, retirement status, number of comorbidities, experience with pets, experience using apps, and eHealth literacy were significantly associated with acceptance of robots and pets. Middle-aged and older women preferred robots with an animal-like appearance, while men preferred robots that resembled a human adult. In terms of robot functions, participants preferred a companion robot with dancing, singing, storytelling, or news-reporting functions. Participants’ marital status and whether or not they lived alone affected their preference of functions in the companion robot. Conclusions: Findings from this study inform the development of social robots with regard to their appearance and functions to address loneliness in later life in fast-aging societies. %M 34347621 %R 10.2196/23471 %U https://www.jmir.org/2021/6/e23471/ %U https://doi.org/10.2196/23471 %U http://www.ncbi.nlm.nih.gov/pubmed/34347621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24712 %T Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis %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 1865221262, sarwar.shah@ouh.nhs.uk %K loneliness %K older people %K digital technology %K effectiveness %K efficacy %K evidence %K systematic review %K meta-analysis %D 2021 %7 4.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Loneliness is a serious public health issue, and its burden is increasing in many countries. Loneliness affects social, physical, and mental health, and it is associated with multimorbidity and premature mortality. In addition to social interventions, a range of digital technology interventions (DTIs) are being used to tackle loneliness. However, there is limited evidence on the effectiveness of DTIs in reducing loneliness, especially in adults. The effectiveness of DTIs in reducing loneliness needs to be systematically assessed. Objective: The objective of this study is to assess the effectiveness of DTIs in reducing loneliness in older adults. Methods: We conducted electronic searches in PubMed, MEDLINE, CINAHL, Embase, and Web of Science for empirical studies published in English from January 1, 2010, to July 31, 2019. The study selection criteria included interventional studies that used any type of DTIs to reduce loneliness in adults (aged ≥18 years) with a minimum intervention duration of 3 months and follow-up measurements at least 3 months after the intervention. Two researchers independently screened articles and extracted data using the PICO (participant, intervention, comparator, and outcome) framework. The primary outcome measure was loneliness. Loneliness scores in both the intervention and control groups at baseline and at follow-up at 3, 4, 6, and 12 months after the intervention were extracted. Data were analyzed via narrative synthesis and meta-analysis using RevMan (The Cochrane Collaboration) software. Results: A total of 6 studies were selected from 4939 screened articles. These studies included 1 before and after study and 5 clinical trials (4 randomized clinical trials and 1 quasi-experimental study). All of these studies enrolled a total of 646 participants (men: n=154, 23.8%; women: n=427, 66.1%; no gender information: n=65, 10.1%) with an average age of 73-78 years (SD 6-11). Five clinical trials were included in the meta-analysis, and by using the random effects model, standardized mean differences (SMDs) were calculated for each trial and pooled across studies at the 3-, 4-, and 6-month follow-ups. The overall effect estimates showed no statistically significant difference in the effectiveness of DTIs compared with that of usual care or non-DTIs at follow-up at 3 months (SMD 0.02; 95% CI −0.36 to 0.40; P=.92), 4 months (SMD −1.11; 95% CI −2.60 to 0.38; P=.14), and 6 months (SMD −0.11; 95% CI −0.54 to 0.32; P=.61). The quality of evidence was very low to moderate in these trials. Conclusions: Our meta-analysis shows no evidence supporting the effectiveness of DTIs in reducing loneliness in older adults. Future research may consider randomized controlled trials with larger sample sizes and longer durations for both the interventions and follow-ups. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-032455 %M 34085942 %R 10.2196/24712 %U https://www.jmir.org/2021/6/e24712 %U https://doi.org/10.2196/24712 %U http://www.ncbi.nlm.nih.gov/pubmed/34085942 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e24623 %T The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study %A Yang,Xue %A Yip,Benjamin H K %A Mak,Arthur D P %A Zhang,Dexing %A Lee,Eric K P %A Wong,Samuel Y S %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong, 852 2252 8488, yeungshanwong@cuhk.edu.hk %K social media %K depression %K suicidal ideation %K social loneliness %K posttraumatic stress %K suicide %K mental health %K COVID-19 %K loneliness %K age %K mediation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. Objective: This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. Methods: We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. Results: The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (β=–.07; P=.04) but not among younger people (β=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (β=.09; P=.02) and older people (β=.10; P=.01). The indirect effect via social loneliness was significant among older people (β=–.01; P=.04) but not among younger people (β=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (β=.02; P=.04) and older people (β=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). Conclusions: Social media may be a “double-edged sword” for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic. %M 33835937 %R 10.2196/24623 %U https://publichealth.jmir.org/2021/5/e24623 %U https://doi.org/10.2196/24623 %U http://www.ncbi.nlm.nih.gov/pubmed/33835937 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e23591 %T An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform: Development and Validation Study %A Anderberg,Peter %A Abrahamsson,Linda %A Berglund,Johan Sanmartin %+ Department of Health, Blekinge Institute of Technology, Blekinge Tekniska Högskola (BTH), Karlskrona, 37179, Sweden, 46 46 73 422 3736, pan@bth.se %K internet %K older people %K social participation %K aging %K instrument %K elderly %K social platform %K perception %K connectedness %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Older people’s use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people’s internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective: The aim of this study was to create an instrument to measure an older person’s perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193). Results: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach α coefficient was .92. The 1-factor solution explained 55% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model (χ26=13.985; χ2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025). Conclusions: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected. %M 33999004 %R 10.2196/23591 %U https://aging.jmir.org/2021/2/e23591 %U https://doi.org/10.2196/23591 %U http://www.ncbi.nlm.nih.gov/pubmed/33999004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e21864 %T COVID-19, Social Isolation, and Mental Health Among Older Adults: A Digital Catch-22 %A Cosco,Theodore D %A Fortuna,Karen %A Wister,Andrew %A Riadi,Indira %A Wagner,Kevin %A Sixsmith,Andrew %+ Gerontology Research Center, Simon Fraser University, 2800 Harbour Centre, 515 West Hastings Street, Vancouver, BC, , Canada, 1 778 782 5065, tdcosco@cantab.net %K social isolation %K mental health %K COVID-19 %K technology %K older adult %K psychology %K digital health %D 2021 %7 6.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X One of the most at-risk groups during the COVID-19 crisis is older adults, especially those who live in congregate living settings and seniors’ care facilities, are immune-compromised, and/or have other underlying illnesses. Measures undertaken to contain the spread of the virus are far-reaching, and older adults were among the first groups to experience restrictions on face-to-face contact. Although reducing viral transmission is critical, physical distancing is associated with negative psychosocial implications, such as increased rates of depression and anxiety. Promising evidence suggests that participatory digital co-design, defined as the combination of user-centered design and community engagement models, is associated with increased levels of engagement with mobile technologies among individuals with mental health conditions. The COVID-19 pandemic has highlighted shortcomings of existing technologies and challenges in their uptake and usage; however, strategies such as co-design may be leveraged to address these challenges both in the adaptation of existing technologies and the development of new technologies. By incorporating these strategies, it is hoped that we can offset some of the negative mental health implications for older adults in the context of physical distancing both during and beyond the current pandemic. %M 33891557 %R 10.2196/21864 %U https://www.jmir.org/2021/5/e21864 %U https://doi.org/10.2196/21864 %U http://www.ncbi.nlm.nih.gov/pubmed/33891557 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26474 %T Impact of the COVID-19 Pandemic on Older Adults: Rapid Review %A Lebrasseur,Audrey %A Fortin-Bédard,Noémie %A Lettre,Josiane %A Raymond,Emilie %A Bussières,Eve-Line %A Lapierre,Nolwenn %A Faieta,Julie %A Vincent,Claude %A Duchesne,Louise %A Ouellet,Marie-Christine %A Gagnon,Eric %A Tourigny,André %A Lamontagne,Marie-Ève %A Routhier,François %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525 Hamel est, Québec, QC, G1M 2S8, Canada, 1 4185299141 ext 6256, francois.routhier@rea.ulaval.ca %K COVID-19 %K impact %K rapid review %K older adults %K aged individuals %K review %D 2021 %7 12.4.2021 %9 Review %J JMIR Aging %G English %X Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers. %M 33720839 %R 10.2196/26474 %U https://aging.jmir.org/2021/2/e26474 %U https://doi.org/10.2196/26474 %U http://www.ncbi.nlm.nih.gov/pubmed/33720839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23588 %T The Effect of Information and Communication Technology and Social Networking Site Use on Older People’s Well-Being in Relation to Loneliness: Review of Experimental Studies %A Casanova,Georgia %A Zaccaria,Daniele %A Rolandi,Elena %A Guaita,Antonio %+ Centre for Socio-Economic Research on Ageing, National Institute of Health & Science on Ageing, Istituto di Ricovero e Cura a Carattere Scientifico, Via Santa Margherita 5, Ancona, Italy, 39 347 0836007, g.casanova@inrca.it %K review %K aging %K loneliness %K older people’s well-being %K ICTs %K social network sites %D 2021 %7 1.3.2021 %9 Review %J J Med Internet Res %G English %X Background: In the last decades, the relationship between social networking sites (SNSs) and older people’s loneliness is gaining specific relevance. Studies in this field are often based on qualitative methods to study in-depth self-perceived issues, including loneliness and well-being, or quantitative surveys to report the links between information and communication technologies (ICTs) and older people’s well-being or loneliness. However, these nonexperimental methods are unable to deeply analyze the causal relationship. Moreover, the research on older people’s SNS use is still scant, especially regarding its impact on health and well-being. In recent years, the existing review studies have separately focused their attention on loneliness and social isolation of older people or on the use of ICTs and SNSs in elderly populations without addressing the relationship between the former and the latter. This thorough qualitative review provides an analysis of research performed using an experimental or quasi-experimental design that investigates the causal effect of ICT and SNS use on elderly people’s well-being related to loneliness. Objective: The aims of this review are to contrast and compare research designs (sampling and recruitment, evaluation tools, interventions) and the findings of these studies and highlight their limitations. Methods: Using an approach that integrates the methodological framework for scoping studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews, we identified 11 articles that met our inclusion criteria. A thematic and content analysis was performed based on the ex post categorization of the data on the selected studies, and the data were summarized in tables. Results: The analysis of the selected articles showed that: (1) ICT use is positively but weakly related to the different measures of older people’s well-being and loneliness, (2) overall, the studies under review lack a sound experimental design, (3) the main limitations of these studies lie in the lack of rigor in the sampling method and in the recruitment strategy. Conclusions: The analysis of the reviewed studies confirms the existence of a beneficial effect of ICT use on the well-being of older people in terms of reduced loneliness. However, the causal relationship is often found to be weak. This review highlights the need to study these issues further with adequate methodological rigor. %M 33439127 %R 10.2196/23588 %U https://www.jmir.org/2021/3/e23588 %U https://doi.org/10.2196/23588 %U http://www.ncbi.nlm.nih.gov/pubmed/33439127 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23767 %T Evaluation of an Intergenerational and Technological Intervention for Loneliness: Protocol for a Feasibility Randomized Controlled Trial %A Hoang,Peter %A Whaley,Colin %A Thompson,Karen %A Ho,Venus %A Rehman,Uzma %A Boluk,Karla %A Grindrod,Kelly A %+ School of Pharmacy, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 21392, colin.whaley@uwaterloo.ca %K seniors %K communication technology %K social isolation %K computers %K intergenerational %K older adults %K mobile phone %D 2021 %7 17.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social integration and mental health are vital aspects of healthy aging. However, close to half of Canadians older than 80 years report feeling socially isolated. Research has shown that social isolation leads to increased mortality and morbidity, and various interventions have been studied to alleviate loneliness among older adults. This proposal presents an evaluation of an intervention that provides one-on-one coaching, is intergenerational, provides both educational and socialization experiences, and increases technology literacy of older adults to overcome loneliness. Objective: This paper describes the protocol of a randomized, mixed-methods study that will take place in Ontario, Canada. The purpose of this study is to evaluate if an intergenerational technology literacy program can reduce social isolation and depression in older adults via quantitative and qualitative outcome measures. Methods: This study is a randomized, mixed-methods, feasibility trial with 2 conditions. Older adults in the intervention condition will receive 1 hour of weekly technological assistance to send an email to a family member, for 8 weeks, with the assistance of a volunteer. Participants in the control condition will not receive any intervention. The primary outcomes are loneliness, measured using the University of California, Los Angeles Loneliness Scale, and depression, measured using the Center for Epidemiologic Studies Depression scale, both of which are measured weekly. Secondary outcomes are quality of life, as assessed using the Older People’s Quality of Life-Brief version, and technological literacy, evaluated using the Computer Proficiency Questionnaire-12, both of which will be administered before and after the intervention. Semistructured interviews will be completed before and after the intervention to assess participants’ social connectedness, familiarity with technology, and their experience with the intervention. The study will be completed in a long-term care facility in Southwestern Ontario, Canada. Significance was set at P<.05. Results: This study was funded in April 2019 and ethical approval was obtained in August 2019. Recruitment for the study started in November 2019. The intervention began in February 2020 but was halted due to the COVID-19 pandemic. The trial will be restarted when safe. As of March 2020, 8 participants were recruited. Conclusions: Information and communication technology interventions have shown varying results in reducing loneliness and improving mental health among older adults. Few studies have examined the role of one-on-one coaching for older adults in addition to technology education in such interventions. Data from this study may have the potential to provide evidence for other groups to disseminate similar interventions in their respective communities. International Registered Report Identifier (IRRID): DERR1-10.2196/23767 %M 33595443 %R 10.2196/23767 %U http://www.researchprotocols.org/2021/2/e23767/ %U https://doi.org/10.2196/23767 %U http://www.ncbi.nlm.nih.gov/pubmed/33595443 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e26617 %T The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group %A Boucher,Eliane M %A McNaughton,Emily C %A Harake,Nicole %A Stafford,Julia L %A Parks,Acacia C %+ Happify Health, 51 East 12th Street, New York, NY, 10003, United States, 1 432 258 5233, eliane@happify.com %K loneliness %K digital interventions %K COVID-19 %K qualitative research %K perspective %K impact %K intervention %K lonely %K mental health %K e-mental health %K digital health %K focus group %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common. Objective: Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness. Methods: A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020. Results: Participants’ responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic. Conclusions: The heterogeneity in participants’ experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely. %M 33498011 %R 10.2196/26617 %U http://mental.jmir.org/2021/2/e26617/ %U https://doi.org/10.2196/26617 %U http://www.ncbi.nlm.nih.gov/pubmed/33498011 %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