%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58976 %T Improving Pre-Exposure Prophylaxis Provision as Part of Routine Gynecologic Care Among Black Cisgender Women (Project PrEP4Her): Protocol for the Implementation of an Intervention %A Sohail,Maira %A Matthews,Lynn %A Williams,Audra %A Kempf,Mirjam-Colette %A Phillips,Desiree %A Goymer,Hannah %A Johnson,,Bernadette %A Mugavero,Michael %A Elopre,Latesha %+ Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, BBRB 206, Birmingham, AL, 35205, United States, 1 205 975 2457, lelopre@uabmc.edu %K Black %K cis-Gender women %K PrEP %K pre-exposure prophylaxis %K South %K HIV %K gynecology %D 2025 %7 14.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although HIV pre-exposure prophylaxis (PrEP) has been proven to be an effective prevention tool in decreasing HIV transmission, achieving adequate PrEP uptake has remained a challenge among Black cisgender women living in the Southern United States. Gynecology clinics, which provide primary health care services for many cisgender women, have the potential to be an ideal setting for the integration of PrEP services. Objective: We designed an intervention, PrEP4Her, which aims to implement PrEP service delivery at gynecology clinics in Alabama, the United States, as part of routine reproductive and sexual health care visits to improve PrEP engagement rates among Black cisgender women. Methods: Guided by the information gathered on (1) factors impacting PrEP implementation at gynecology clinics, including key barriers and facilitators to PrEP implementation and potential strategies to address the identified barriers (in-depth interviews with the gynecology care team), (2) structural barriers and provider-level barriers to PrEP implementation (cross-sectional study among gynecologists), and (3) implementation strategies on how to integrate PrEP services into routine gynecology care (in-depth interviews and focus groups with Black cisgender women), a multicomponent implementation strategy, tailored for Black cisgender women, was developed to integrate PrEP in routine women’s health visits (ie, PrEP4Her). To determine the efficacy of the program, we will measure implementation outcomes, reach (increase in the absolute number of Black cisgender women receiving PrEP prescriptions), effectiveness (increase in the proportion of PrEP prescriptions over time), and adoption (proportion of team members willing to implement PrEP4Her) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. In addition, acceptability (the extent to which providers and Black cisgender women feel PrEP4Her to be acceptable—in-depth interviews); Feasibility (appropriateness of PrEP4Her for a larger, full-scale trial—the Feasibility of Intervention Measure scale); and fidelity (the degree to which PrEP4Her program was implemented as designed—electronic survey with patients) will also be assessed. Results: The qualitative and quantitative data from the gynecology care team and the qualitative data from Black cisgender women were collected from August 9, 2022, to April 19, 2023, and were integrated through joint displays to identify major themes. The combined findings provided a comprehensive understanding of factors that were fundamental in the development and refinement of PrEP4Her implementation. The PrEP4Her was implemented from January 29, 2024, to August 16, 2024. The information gathered is being used to assess PrEP4Her efficacy (based on reach, effectiveness, adoption, acceptability, feasibility, and fidelity). Conclusions: Upon completion of our research, our interdisciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research, and psychology, will be primed to lead a multisite type III implementation trial for PrEP service delivery at gynecology clinics across the Southern United States. International Registered Report Identifier (IRRID): DERR1-10.2196/58976 %M 40085134 %R 10.2196/58976 %U https://www.researchprotocols.org/2025/1/e58976 %U https://doi.org/10.2196/58976 %U http://www.ncbi.nlm.nih.gov/pubmed/40085134 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e56667 %T Pediatric Sleep Quality and Parental Stress in Neuromuscular Disorders: Descriptive Analytical Study %A Khaksar,Sajjad %A Jafari-Oori,Mehdi %A Sarhangi,Forogh %A Moayed,Malihe Sadat %K spinal muscular atrophy %K neuromuscular disorders %K sleep quality %K pediatrics %K parental stress %K children %K parents %K muscular atrophy %K muscular disorders %D 2025 %7 28.1.2025 %9 %J Asian Pac Isl Nurs J %G English %X Background: Neuromuscular disorders (NMDs) constitute a heterogeneous group of disorders that affect motor neurons, neuromuscular junctions, and muscle fibers, resulting in symptoms such as muscle weakness, fatigue, and reduced mobility. These conditions significantly affect patients’ quality of life and impose a substantial burden on caregivers. Spinal muscular atrophy (SMA) is a relatively common NMD in children that presents in various types with varying degrees of severity. Objective: This study aimed to evaluate the sleep quality of children with NMDs, particularly SMA types 1, 2, and 3 and assess the stress levels experienced by their parents. Methods: A descriptive analytical study was conducted from February to October 2023, in selected hospitals and dystrophy associations in Tehran and Isfahan, Iran. A total of 207 children aged 1‐14 years with various NMDs were included in the study. Data were collected using a web-based questionnaire with 3 parts: demographic information, the Children’s Sleep Habits Questionnaire to assess children’s sleep, and the Stress Response Inventory to measure parental stress. Statistical analyses were performed using SPSS version 22, with an α level of .05. Results: Significant differences in sleep quality were found among SMA types, with mean scores of 74.76 (SD 7.48) for SMA type 1, 76.4 (SD 7.29) for SMA type 2, 72.88 (SD 6.73) for SMA type 3, and 75.87 (SD 5.74) for other NMDs (P=.02). A correlation was found between sleep and length of hospital stay (r=0.234, P<.001)and between sleep and the child’s sex (r=−0.140, P=.04). Parental stress scores averaged 95.73 (SD 32.12). There was not a statistically significant difference in parental stress scores among the 4 groups (P=.78). This suggests that parental stress levels were similar across different NMD groups. Conclusions: Sleep disorders are prevalent among children with NMDs, especially SMA. Parents experience high levels of stress that can affect the care they provide. Therefore, interventions to improve children’s sleep and address parental stress are crucial. Regular screening, counseling, and tailored support are recommended to enhance the well-being of children with NMDs and their families. %R 10.2196/56667 %U https://apinj.jmir.org/2025/1/e56667 %U https://doi.org/10.2196/56667 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59308 %T Use of Machine Learning to Predict Individual Postprandial Glycemic Responses to Food Among Individuals With Type 2 Diabetes in India: Protocol for a Prospective Cohort Study %A Choudhry,Niteesh K %A Priyadarshini,Shweta %A Swamy,Jaganath %A Mehta,Mridul %+ Department of Medicine, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02115, United States, 1 617 278 0412, nkc@post.harvard.edu %K diabetes %K T2DM %K diabetes management %K food responsiveness %K postprandial glucose response %K food intake %K diet logs %K dietary intake %K machine learning %D 2025 %7 23.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Type 2 diabetes (T2D) is a leading cause of premature morbidity and mortality globally and affects more than 100 million people in the world’s most populous country, India. Nutrition is a critical and evidence-based component of effective blood glucose control and most dietary advice emphasizes carbohydrate and calorie reduction. Emerging global evidence demonstrates marked interindividual differences in postprandial glucose response (PPGR) although no such data exists in India and previous studies have primarily evaluated PPGR variation in individuals without diabetes. Objective: This prospective cohort study seeks to characterize the PPGR variability among individuals with diabetes living in India and to identify factors associated with these differences. Methods: Adults with T2D and a hemoglobin A1c of ≥7 are being enrolled from 14 sites around India. Participants wear a continuous glucose monitor, eat a series of standardized meals, and record all free-living foods, activities, and medication use for a 14-day period. The study’s primary outcome is PPGR, calculated as the incremental area under the curve 2 hours after each logged meal. Results: Data collection commenced in May 2022, and the results will be ready for publication by September 2025. Results from our study will generate data to facilitate the creation of machine learning models to predict individual PPGR responses and to facilitate the prescription of personalized diets for individuals with T2D. Conclusions: This study will provide the first large scale examination variability in blood glucose responses to food in India and will be among the first to estimate PPGR variability for individuals with T2D in any jurisdiction. Trial Registration: Clinical Trials Registry-India CTRI/2022/02/040619; https://tinyurl.com/mrywf6bf International Registered Report Identifier (IRRID): DERR1-10.2196/59308 %M 39847416 %R 10.2196/59308 %U https://www.researchprotocols.org/2025/1/e59308 %U https://doi.org/10.2196/59308 %U http://www.ncbi.nlm.nih.gov/pubmed/39847416 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55461 %T Racial Composition of Social Environments Over the Life Course Using the Pictorial Racial Composition Measure: Development and Validation Study %A Bather,Jemar R %A Kaphingst,Kimberly A %A Goodman,Melody S %+ Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, 9th Floor, 708 Broadway, New York, NY, 10003, United States, 1 212 992 5623, jemar.bather@nyu.edu %K racial residential segregation %K racial composition %K health equity %K social environment %K place %K neighborhood composition %K health inequities %K social determinants of health %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Studies investigating the impact of racial segregation on health have reported mixed findings and tended to focus on the racial composition of neighborhoods. These studies use varying racial composition measures, such as census data or investigator-adapted questions, which are currently limited to assessing one dimension of neighborhood racial composition. Objective: This study aims to develop and validate a novel racial segregation measure, the Pictorial Racial Composition Measure (PRCM). Methods: The PRCM is a 10-item questionnaire of pictures representing social environments across adolescence and adulthood: neighborhoods and blocks (adolescent and current), schools and classrooms (junior high and high school), workplace, and place of worship. Cognitive interviews (n=13) and surveys (N=549) were administered to medically underserved patients at a primary care clinic at the Barnes-Jewish Hospital. Development of the PRCM occurred across pilot and main phases. For each social environment and survey phase (pilot and main), we computed positive versus negative pairwise comparisons: mostly Black versus all other categories, half Black versus all other categories, and mostly White versus all other categories. We calculated the following validity metrics for each pairwise comparison: sensitivity, specificity, correct classification rate, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, false positive rate, and false negative rate. Results: For each social environment, the mostly Black and mostly White dichotomizations generated better validity metrics relative to the half Black dichotomization. Across all 10 social environments in the pilot and main phases, mostly Black and mostly White dichotomizations exhibited a moderate-to-high sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value. The positive likelihood ratio values were >1, and the negative likelihood ratio values were close to 0. The false positive and negative rates were low to moderate. Conclusions: These findings support that using either the mostly Black versus other categories or the mostly White versus other categories dichotomizations may provide accurate and reliable measures of racial composition across the 10 social environments. The PRCM can serve as a uniform measure across disciplines, capture multiple social environments over the life course, and be administered during one study visit. The PRCM also provides an added window into understanding how structural racism has impacted minoritized communities and may inform equitable intervention and prevention efforts to improve lives. %M 39115929 %R 10.2196/55461 %U https://publichealth.jmir.org/2024/1/e55461 %U https://doi.org/10.2196/55461 %U http://www.ncbi.nlm.nih.gov/pubmed/39115929 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51355 %T Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity %A Kepper,Maura M %A Fowler,Lauren A %A Kusters,Isabelle S %A Davis,Jean W %A Baqer,Manal %A Sagui-Henson,Sara %A Xiao,Yunyu %A Tarfa,Adati %A Yi,Jean C %A Gibson,Bryan %A Heron,Kristin E %A Alberts,Nicole M %A Burgermaster,Marissa %A Njie-Carr,Veronica PS %A Klesges,Lisa M %+ Prevention Research Center, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, United States, 1 3149350142, kepperm@wustl.edu %K digital health %K health equity %K mobile health %K mHealth %K health care access %K digital divide %K behavioral medicine %K implementation %K mobile phone %D 2024 %7 1.8.2024 %9 Viewpoint %J J Med Internet Res %G English %X The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science–based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity. %M 39088246 %R 10.2196/51355 %U https://www.jmir.org/2024/1/e51355 %U https://doi.org/10.2196/51355 %U http://www.ncbi.nlm.nih.gov/pubmed/39088246 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55418 %T Geographic Disparities in Access to Assisted Reproductive Technology Centers in China: Spatial-Statistical Study %A Zhou,Qingqing %A Zeng,Huatang %A Wu,Liqun %A Diao,Kaichuan %A He,Rongxin %A Zhu,Bin %+ School of Public Health and Emergency Management, Southern University of Science and Technology, No 1088 Xueyuan Avenue, Nanshan District, Shenzhen, 518055, China, 86 0755 8801 5610, zhub6@sustech.edu.cn %K assisted reproductive technology %K spatial accessibility %K travel time %K travel cost %K China %D 2024 %7 12.6.2024 %9 Research Letter %J JMIR Public Health Surveill %G English %X A study on infertility in China found that while 543 health care institutions are approved for assisted reproductive technology (ART), only 10.1% offer all ART services, with a significant skew toward the eastern regions, highlighting the accessibility challenges faced by rural and remote populations; this study recommends government measures including travel subsidies and education initiatives to improve ART access for economically disadvantaged individuals. %M 38865169 %R 10.2196/55418 %U https://publichealth.jmir.org/2024/1/e55418 %U https://doi.org/10.2196/55418 %U http://www.ncbi.nlm.nih.gov/pubmed/38865169