TY - JOUR AU - Kim, Minjin AU - Kim, Ellie AU - Lee, Hyeongsuk AU - Piao, Meihua AU - Rosen, Brittany AU - Allison, J. Jeroan AU - Zai, H. Adrian AU - Nguyen, L. Hoa AU - Shin, Dong-Soo AU - Kahn, A. Jessica PY - 2025/4/7 TI - A Culturally Tailored Artificial Intelligence Chatbot (K-Bot) to Promote Human Papillomavirus Vaccination Among Korean Americans: Development and Usability Study JO - Asian Pac Isl Nurs J SP - e71865 VL - 9 KW - human papillomavirus KW - HPV vaccination KW - artificial intelligence KW - AI KW - chatbot intervention KW - Korean Americans KW - usability testing KW - culturally tailored intervention N2 - Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is associated with various cancers, including cervical and oropharyngeal cancers. Despite the availability of effective vaccines, significant disparities in HPV vaccination rates persist, particularly among racial and ethnic minorities, such as Korean Americans. Cultural stigma, language barriers, and limited access to tailored health information contribute to these disparities. Objective: This study aimed to develop and evaluate the usability of K-Bot, an artificial intelligence (AI)?powered, culturally tailored, bilingual (Korean and English) chatbot designed to provide culturally sensitive health information about HPV vaccination to Korean immigrants and Korean Americans. Methods: K-Bot was developed using CloudTuring and Google Dialogflow. Its dialogues were created using Centers for Disease Control and Prevention (CDC) evidence-based HPV information and tailored to the Korean American population based on findings from previous studies. The evaluation and refinement process for K-Bot was organized into 3 phases: (1) expert evaluation by a multidisciplinary panel, (2) usability testing, and (3) iterative refinement based on feedback. An online survey collected demographics, HPV awareness, and vaccination status before 6 focus groups (N=21) sessions using semistructured questions guided by Peter Morville?s usability framework. Quantitative data were analyzed descriptively, and thematic analysis assessed usability, cultural relevance, and content clarity across 6 dimensions: desirability, accessibility, findability, credibility, usability, and usefulness. Results: Participants had a mean age of 23.7 (SD 4.7) years, with most being female (n=12, 57.1%), second-generation individuals (n=13, 61.9%), and single (n=20, 95.2%). HPV awareness was high (n=19, 90.5%), vaccine knowledge was also high (n=18, 81.8%), but only 11 (52.4%) participants were vaccinated. Feedback-driven refinements addressed usability challenges, including simplifying navigation and adding visual elements. Participants described K-Bot as a promising tool for promoting HPV vaccination among Korean and Korean American users, citing its bilingual functionality and culturally tailored content as key strengths. Evidence-based information was valued, but participants recommended visuals to improve engagement and reduce cognitive load. Accessibility concerns included broken links, and participants proposed enhancements, such as animations, demographic-specific resources, and interactive features, to improve usability and engagement further. Conclusions: Usability testing of K-Bot revealed its potential as a culturally tailored, bilingual tool for promoting HPV vaccination among Korean immigrants and Korean Americans. Participants valued its evidence-based information, cultural relevance, and bilingual functionality but recommended improvements, such as enhanced navigation, visual elements, and interactive features, to boost engagement and usability. These findings support the potential of AI-driven tools to improve health care access by addressing key barriers to care. Further research is needed to evaluate their broader impact and optimize their design and implementation for individuals with diverse health care needs. UR - https://apinj.jmir.org/2025/1/e71865 UR - http://dx.doi.org/10.2196/71865 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/71865 ER - TY - JOUR AU - Mundada, Pallavi AU - Makhija, Deepa AU - Mata, Sunita AU - Kachare, Kalpana AU - Manathottathil, Aparna AU - Sharma, Abha AU - Rao, Sekhara Bhogavalli Chandra AU - Rana, Rakesh AU - Tripathi, Arunabh AU - Rana, Kiran AU - Joshi, Vandana AU - Raturi, Ashish AU - Singh, Anukampa AU - Srikanth, N. AU - Acharya, Rabinarayan PY - 2024/11/11 TI - Effectiveness of Ayush Rasayana A and B on the Quality of Life of Older Adults: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e58186 VL - 13 KW - Ayush Rasayana A KW - Ayush Rasayana B KW - cluster-randomized trial KW - geriatrics KW - Ayurveda KW - quality of life KW - complementary and alternative medicine N2 - Background: With advancing age among older adults, the associated debilities increase, indicating a deteriorating health status as there is a gradual loss of muscle mass, strength, and functionality. Ayush Rasayana A and B are coded Ayurvedic medicines developed from herbal extracts. This study has been planned to prevent debilitating conditions and improve the quality of life (QOL) in older adults. Objective: This study aimed to assess the effectiveness of Ayush Rasayana A and B on the QOL, quality of sleep, and functionality of older adults, along with the tolerability of the intervention. Methods: This was a multicenter, open-label, cluster randomized controlled trial conducted with 720 participants aged 60 to 75 years. The participants were divided into 2 groups (intervention and control), with both receiving Ayurvedic ancillary treatment for 3 months. The intervention group additionally received 10 g of Ayush Rasayana A orally once daily at bedtime for 6 days, followed by 1.5 g of Ayush Rasayana B orally twice daily before food for the remaining 84 days. The assessment criteria included the Older People?s Quality of Life Questionnaire Brief, Katz Index of Independence in Activities of Daily Living, Pittsburgh Sleep Quality Index, Five Times Sit-to-Stand Test, and shoulder and scapular movements. Any change in hematological and biochemical parameters and occurrence of treatment-emergent adverse events were also assessed during the study period. Results: The recruitment of the participants started in December 2023, and the final follow-up was completed in April 2024. Out of the total 720 enrolled participants, 686 (95.3%) completed the study up to the last follow-up. Conclusions: This study may provide evidence-based data to establish preventive treatment protocols for enhancing the QOL and functionality among older adults. The study results may also be helpful for the planning of interdisciplinary health policies for improving the health conditions of different populations International Registered Report Identifier (IRRID): DERR1-10.2196/58186 UR - https://www.researchprotocols.org/2024/1/e58186 UR - http://dx.doi.org/10.2196/58186 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58186 ER - TY - JOUR AU - Sun, Hui AU - Wu, Yanping AU - Sun, Jia AU - Zhou, Wu AU - Xu, Qian AU - Hu, Dandan PY - 2024/9/12 TI - Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality JO - JMIR Hum Factors SP - e56486 VL - 11 KW - nutrition management KW - WeChat mini-program KW - User Version of the Mobile Application Rating Scale KW - uMARS KW - function and quality evaluation N2 - Background: With the rise in people?s living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market. Objective: This study aimed to evaluate the functionality and quality of China?s WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS). Methods: This observational study involves quantitative methods. A keyword search for ?nutrition,? ?diet,? ?food,? and ?meal? in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS. Results: Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4% (19/27) provided resources for nutrition education and classroom instruction; 59.3% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67). Conclusions: Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future. UR - https://humanfactors.jmir.org/2024/1/e56486 UR - http://dx.doi.org/10.2196/56486 ID - info:doi/10.2196/56486 ER - TY - JOUR AU - Abdul Aziz, Fadzlina Amani AU - Ong, Tiffanie PY - 2024/9/10 TI - Real-World Outcomes of a Digital Behavioral Coaching Intervention to Improve Employee Health Status: Retrospective Observational Study JO - JMIR Mhealth Uhealth SP - e50356 VL - 12 KW - digital behavioral coaching KW - chronic disease management KW - digital health KW - mHealth KW - workplace interventions KW - mobile phone N2 - Background: Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees. Objective: This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees. Methods: This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up. Results: Significant time×group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=?0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=?11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group. Conclusions: This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors. UR - https://mhealth.jmir.org/2024/1/e50356 UR - http://dx.doi.org/10.2196/50356 UR - http://www.ncbi.nlm.nih.gov/pubmed/39255013 ID - info:doi/10.2196/50356 ER - TY - JOUR AU - Li, Wen-Wen AU - Toh, Prisca PY - 2023/7/27 TI - WeChat-Based Intervention for Chinese Immigrants With Hypertension: Development and Evaluation Study JO - Asian Pac Isl Nurs J SP - e45769 VL - 7 KW - social media KW - hypertension KW - medication adherence KW - Chinese immigrants KW - WeChat KW - blood pressure KW - BP N2 - Background: Despite Chinese immigrants having a higher or comparable proportion of hypertension (HTN) compared to non-Hispanic White and Hispanic individuals, there are no effective technology-based intervention studies that target HTN management in Chinese immigrants in the United States. Objective: The aim of this study was to develop and pilot-test the efficacy of a culturally and linguistically sensitive social media?based intervention (WeChat) for Chinese immigrants to improve blood pressure (BP) control, antihypertensive medication adherence, and self-efficacy. Methods: The study was conducted in 2020 with a pre- and posttest design (N=20). A WeChat-based intervention was implemented using one 20-minute video presentation plus one 20-minute nurse counseling session via WeChat at the baseline, followed by 4 biweekly 20-minute nurse counseling sessions via WeChat calls. The primary outcome (BP control) and secondary outcomes, including medication adherence and self-efficacy in HTN management, were measured at baseline and at 6 months. Results: The participants? mean age was 68.9 (SD 10.2; range: 51-86) years. The majority of the participants were female (n=13, 65%), had a high school degree or less (n=15, 75%), were married (n=16, 80%), not religious (n=13, 65%), and not employed (n=12, 60%). The results showed that the mean baseline systolic BP was 131.43 (SD 9.61) mmHg, and the mean diastolic BP was 79.79 (SD 9.62) mmHg. The 6-month outcome showed a reduction of systolic BP (?0.74, SD 9.18 mmHg; P=.05) and diastolic BP (?0.96, SD 6.92 mmHg; P=.001). The mean score for medication adherence at baseline was 4.50 (SD 1.70), and it significantly improved to 3.65 (SD 1.18) at 6 months (reversely scored; possible range was 1-5, with 1 being the best score; P=.001). Self-efficacy in HTN management had a trend in reduction from a baseline score of 8.28 (SD 1.25) decreasing to 7.93 (SD 1.48) at 6 months, with a mean difference of 0.34 (SD 2.02), with a score of 0 indicating the lowest self-efficacy and a score of 10 indicating the highest self-efficacy. Conclusions: Our WeChat-based HTN management program showed a significant improvement in diastolic BP and medication adherence as well as a trend of reduction for systolic BP and self-efficacy in managing HTN in Chinese immigrants. Compared to the traditional health care system, the proposed WeChat-based HTN management program has a low cost and is easy to implement. Thus, further investigation is recommended to generate further results. This intervention should be tested across different regions and clinical settings to verify the findings. The long-term goal is to implement the intervention in clinical settings to help Chinese immigrants at large achieve better HTN management. UR - https://apinj.jmir.org/2023/1/e45769 UR - http://dx.doi.org/10.2196/45769 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498663 ID - info:doi/10.2196/45769 ER -