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    A care quality dashboard for general practitioners managing patients with diabetes mellitus type 2: user-centered design and prototype evaluation
    (Springer Science and Business Media LLC, 2026-05-09)
    Ackermann, Lola Jo
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    Principe, Marinja
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    Brändle, Michael
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    Jovanova, Mia
    Background Diabetes mellitus type 2 (T2D) is a growing burden in Switzerland, where general practitioners (GPs) face increasing workload. To evaluate the quality of T2D care, the Swiss Society of Endocrinology and Diabetology (SGED) developed the SGED score to help GPs overview aggregated patient parameters at the practice level. However, the practical use of the SGED score is hampered by paper-based workflows and fragmented documentation. Currently, no dashboard exists to specifically visualize the SGED score, which overviews aggregated population parameters such as HbA1c or blood pressure. To address this gap, this study examined: (1) what functional requirements healthcare professionals consider essential for such a potential SGED dashboard, and (2) how do healthcare professionals evaluate the usability and clinical relevance of an iteratively developed dashboard prototype. Methods We employed an iterative, user-centered three-step approach involving 10 semi-structured interviews with 14 Swiss T2D healthcare professionals. Step 1 involved defining the project scope, identifying predefined functional requirements, and developing an initial SGED score dashboard prototype. Step 2 collected user-generated requirements and prioritized all requirements using the “Must Have”, “Should Have”, “Could Have”, “Won’t Have” (MoSCoW) method. In step 3, the high-fidelity Figma dashboard prototype was iteratively refined based on the requirements and interviewee feedback. Results Key functional requirements of the digital SGED score included reminder and alert functions for missing or overdue SGED-relevant assessments, color-coded critical values such as low nephropathy screening rates, demographic overviews, trend analyses of SGED indicators at practice level, benchmarking within practice networks, and exportable reports. Additional needs emerged for patient-level views, integrated checklists, inclusion of comorbidities, and personal or practice-specific goal-setting features. Iterative refinements based on user feedback improved clarity, usability, and visual appeal. Some participants highlighted the dashboard’s intuitive design, clear and diverse visualizations, and benchmarking functionalities, describing it as both engaging and efficient. Others raised concerns about limited suitability for daily clinical workflows, potential integration challenges with existing systems, and the need for interactive, patient-centered features to support routine care. Conclusion The proposed SGED score dashboard could enhance T2D care through features like population overviews, long-term visualizations, and anonymized benchmarking, meaning the ability to compare a practice’s SGED performance with those of other practices. Successful clinical adoption will heavily depend on interoperability and seamless integration into existing workflows. The identified requirements provide a foundation for future digital T2D management systems.
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    Deep phenotyping of suicidal ideation after discharge from psychiatric inpatient care: study protocol for an interdisciplinary, multicentre prospective observational study in Psychiatric University Hospitals
    (BMJ, 2026-02)
    Anna Monn
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    Stephanie Homan
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    Jacopo Mocellin
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    Schwarna Maria Raja
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    Lara Kirchhofer
    Introduction Suicidal thoughts and behaviours (STB) are a critical public health concern, with 700 000 deaths by suicide each year. The period immediately following hospital discharge is associated with an elevated risk for suicide. Monitoring suicidal ideations throughout this period is therefore critical. However, its highly dynamic nature limits the utility of traditional risk assessments through infrequent outpatient visits. Recent advancements in ambulatory assessments and multimodal predictive approaches offer a promising new avenue. Hence, the present study aims to examine how psychological, linguistic, neurobiological and smartphone-based characteristics relate to suicidal ideation and to improve STB monitoring through a deep phenotyping approach. Methods and analysis In this interdisciplinary, multicentre, prospective observational study, we plan to recruit a total of 200 inpatients with current and/or past STB. The study comprises the following components: (1) a baseline assessment, conducted while participants are still in the hospital. This includes interviews, an electroencephalography recording, a video-recorded verbal task and self-report questionnaires; (2) data collection through a smartphone application during the first 4 weeks after hospital discharge with two active collection weeks of five daily ecological momentary assessments and two 1 min video diaries every other day, as well as smartphone passive sensing for 28 consecutive days and (3) two follow-up assessments, 4 weeks and 3 months after discharge. The primary outcome is self-reported suicidal ideation after hospital discharge. Ethics and dissemination The Ethics Committee of the Faculty of Arts and Social Sciences of the University of Zurich, Switzerland, approved the study for the Zurich and Basel sites (Ref: 22.09.19). Approval for the New York Site was granted by the Institutional Review Board of NYU Langone Health (i23-00366). Study findings will be disseminated via peer-reviewed, open-access publications, conference presentations, patient and public events, and dedicated social media outlets. Trial registration number CRSII5_205913.
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    Development, Deployment, and Evaluation of DyMand: Wearable AI for In-Situ Detection and Capture of Couples’ Dyadic Interactions in Chronic Disease Management
    (Association for Computing Machinery (ACM), 2026-07-24)
    Boateng, George
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    Santhanam, Prabhakaran
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    Lüscher, Janina
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    Pauly, Theresa
    Dyadic interactions of couples are of interest as they provide insight into relationship quality and chronic disease management. Existing sensing systems primarily infer social structure within groups retrospectively, or capture couples’ interactions at random or scheduled times, which could miss meaningful interpersonal interactions between partners. In this work, we developed a smartwatch-based algorithm that detects interaction moments between partners and enables interaction-aware data capture in everyday settings. It uses the Bluetooth signal strength between two smartwatches, each worn by one partner, and a voice activity detection machine-learning model that we trained, to infer that the partners are interacting and then trigger data collection. We operationalized this sensing approach by developing, deploying, and evaluating DyMand, an open-source smartwatch and smartphone system that integrates multimodal sensor and self-report data collection in situ. We deployed the DyMand system in a 7-day field study and collected and analyzed data about social support and diabetes discussions from 13 (N=26) Swiss-based heterosexual couples managing diabetes mellitus type 2 of one partner. Our system evaluation showed that 77.6% of algorithm-triggered recordings contained partners’ conversation moments compared to 43.8% for scheduled triggers, and that DyMand was easy to use. Preliminary insights into disease management behavior revealed that 5.2% of couples’ conversation moments contained social support, and partners discussed diabetes management 2.4% of the time based on the audio data analyses. In contrast, the self-report data showed that patients received support in 67.7% of couples’ interactions and caregivers provided support in 71.8% of couples’ interactions. DyMand enables insights into dyadic behavior in-situ, and could be used by social, clinical, or health psychology researchers to understand the social dynamics of couples that are managing chronic diseases in everyday life to inform the development and delivery of behavioral interventions.
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    “Are You Okay, Honey?”: Recognizing Emotions Among Couples Managing Diabetes in Daily Life Using Multimodal Real-World Smartwatch Data
    (MDPI AG, 2026-05-15)
    Boateng, George
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    Zhao, Xiangyu
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    Speichert, Malgorzata
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    Lüscher, Janina
    Couples generally manage chronic diseases together and the management takes an emotional toll on both patients and their romantic partners. Consequently, recognizing the emotions of each partner in daily life could provide insight into their emotional well-being in chronic disease management. Currently, the process of assessing each partner’s emotions is manual, time-intensive, and costly. Despite the existence of works on emotion recognition among couples, none of these works have used data collected from couples’ interactions in daily life. In this work, we collected 85 h (1021 5-min samples) of real-world multimodal smartwatch sensor data (speech, heart rate, accelerometer, and gyroscope) and self-reported emotion data (n = 612) from 26 partners (13 couples) managing diabetes mellitus type 2 in daily life. We extracted physiological, movement, acoustic, and linguistic features, and trained machine learning models (support vector machine and random forest) to recognize each partner’s self-reported emotions (valence and arousal). Our results from the best models—balanced accuracies of 63.8% and 78.1% for arousal and valence respectively—are better than the results from (1) chance, (2) prior work that also used data from German-speaking, Swiss-based couples, and (3) partners’ perceptions of each other’s emotions. This work contributes toward building automated emotion recognition systems that would eventually enable partners to monitor their emotions in daily life and enable the delivery of interventions to improve their emotional well-being.
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    Perceived Value of Virtual Reality Simulations to Gain Insights into Delirium: A Pilot Study
    (European Delirium Association, 2026-05-04)
    Fontanesi, Laura
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    Coltekin, Arzu
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    Kunz, Thomas
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    Arrigoni, Sandro
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    Bourke, Steven
    Background Delirium affects one-in-four hospitalized individuals aged 65-years or older, and is associated with serious complications, including post-traumatic stress disorder, prolonged hospitalization, and increased mortality. Healthcare professionals often lack insight into the distress that patients experience; this is known to undermine empathic care and timely detection. Virtual reality (VR) is emerging as a promising tool to enhance empathy and understanding of the patient experience due to its inherent immersive, embodied, and experience-based characteristics. Objective To pilot and obtain preliminary subjective evidence on the usability, empathic impact, and educational value of a VR simulation grounded in qualitative evidence of patients’ delirium experiences. Methods 23 university students completed a 7-minute VR delirium simulation and an immediate 42-item survey. This included usability items adapted from the System Usability Scale, items conceptually informed by different validated questionnaires, and study-specific items. Full instruments were not administered to minimize respondent burden and target context-specific elements. Spearman correlations explored response patterns. Open-ended items were summarized descriptively. Results Twelve of 22 Likert items differed from neutrality (3) after correction. Participants found the simulation intuitive (M=4.30, SD=0.70, d=1.86) and its immersive nature engaging (M=4.22, SD=0.74, d=1.65), reporting increased empathy (M=4.39, SD=0.58, d= 2.39), improved understanding of delirium-related emotional distress (M=4.13, SD=0.81, d=1.48) and cognitive distortions (M=4.22, SD=0.60, d=1.81). They endorsed the integration of VR into health education and expressed interest in potential additional features. Qualitative responses highlighted VR’s value for empathy training and to improve doctor-patient communication, while calling for even greater realism and personalization. Conclusion This pilot study suggests that VR simulations are perceived as effective, engaging tools for enhancing empathy and insight in delirium-related education and care training.
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    Reminder Strategies to Improve Meal-Logging Adherence: Protocol for a Microrandomized Trial
    (JMIR Publications Inc., 2026-10-05)
    Fuchs, Magdalena
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    Jin, Qiuhan
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    Wirth, Benjamin
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    Bilz, Stefan
    Background Accurate measurement of lifestyle factors is central to understanding how daily behaviors act as risk factors or protective buffers to noncommunicable diseases. While wearable devices enable passive monitoring of physical activity or sleep, nutritional intake still depends on active participant input, such as manual dietary logs or image-based recordings. Adherence to such logging tasks often declines rapidly, impacting data completeness and clinical utility. Theory-based reminders drawing on loss-framing or logging consistency feedback (ie, tracking streaks) can improve adherence to lifestyle data collection, but the effects of these strategies on repeated dietary logging remain unclear. Objective The study aims to examine the effects of 2 theory-driven reminder strategies—loss-framing and logging consistency—on adherence to repeated, image-based meal logging. Methods We conducted a microrandomized trial embedded within a 4-week observational lifestyle phenotyping study in Switzerland (N=200, age ≥45 y, BMI ≥25 kg/m²). Participants photographed their meals at each mealtime (breakfast, lunch, and dinner) using a mobile app over 28 days. A decision point was scheduled prior to participant-defined habitual mealtimes. Participants were randomly assigned with equal probability to (1) a reminder emphasizing loss of a daily financial reward for not logging (“loss-framing”), (2) a reminder providing feedback on recent logging consistency (“logging consistency”), or (3) a neutral reminder (“active control”). The proximal outcome is whether the participant logs a meal within 2 hours of receiving a reminder. Participants earned a daily financial reward contingent on meal-logging completion. To estimate intervention effects, we will use marginal excursion effect models for binary outcomes, adjusting time-varying covariates (eg, day in study) and baseline covariates (eg, age and gender). Ethics approval for this study was granted by the Cantonal Ethics Committee of Eastern Switzerland (BASEC ID 2025‐00972). Results Enrollment began in November 2025, and the study was initiated on December 8, 2025. As of August 2026, 130 participants have been recruited, 120 have been enrolled, and 76 participants have completed the study, with an anticipated completion date of January 2027. Data analysis has not yet begun, and study results are expected to be published in Q2 2027. Conclusions By clarifying the proximal effects of loss-framed and consistency-based reminders, findings will inform the design of future digital health studies to improve meal-logging adherence in daily life. This work contributes to the development of scalable, theory-driven reminder strategies for enhancing dietary data quality in observational and interventional research.
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    Same Breath, Different Device: Comparing VR and Smartphone Biofeedback Breathing Training
    (ACM, 2026-04-13)
    Lola Jo Ackermann
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    Helen Galliker
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    Lukic Yanick Xavier
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    Slow breathing holds promise in strengthening mental resilience and reducing acute stress. Prior work presented distinct prototypes of smartphone and VR mobile biofeedback breathing trainings (MBBTs) but lacked direct comparisons. This study aimed to evaluate whether a VR MBBT offers advantages over smartphone MBBT in perceived (relaxation) effectiveness and intention to use, while maintaining non-inferiority in perceived breathing detection accuracy. A within-subject laboratory study with 67 participants was conducted. No evidence was found that the VR MBBT was perceived as more effective. The breathing detection algorithm, originally optimized for smartphones, was perceived as non-inferior in VR MBBT, indicating potential for cross-platform scalability. We found no evidence that intention to use was higher for VR, suggesting that practical considerations such as accessibility and cost may outweigh technology-based preferences. Although these findings are promising, future research must assess their applicability in the real world and ensure accessibility to VR for equitable use.
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    The Impact of a Reward-and-Progression Loop on Engagement with a Mobile Breathing Training: Preliminary Findings from a 15-day Field Study
    (ACM, 2026-04-13)
    Lola Jo Ackermann
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    Sarah Wehrli
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    Helen Galliker
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    Engagement with digital health interventions (DHIs) often declines over time, with many users discontinuing use after initial adoption. Gamification has been proposed to address this challenge, yet evidence on its effectiveness remains mixed. This exploratory study examines whether a reward-and-progression loop (RPL), linking performance to daily-constrained collectible coins and unlockable visual features, is associated with differences in engagement in a mobile biofeedback breathing training (MBBT). Twenty participants were randomly assigned to a control or an RPL condition and used the application over 15 days. Engagement was operationalized using two metrics: the number of active days and median session duration per user. Participants in the RPL condition showed more active days than those in the control condition (median = 7 vs. 2). Session duration was comparable across conditions, though more variable in the RPL condition. These preliminary findings suggest that RPLs may support more frequent engagement in DHIs and warrant further investigation.
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    Evaluating Cross-Study Generalization of Receptivity Models for Just-in-Time Adaptive Interventions
    (Association for Computing Machinery (ACM), 2026-09-30)
    Negi, Samarth
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    Keller, Roman
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    Mair, Jacqueline L.
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    Kleim, Birgit
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    Allemand, Mathias
    Just-in-Time Adaptive Interventions (JITAIs) offer a promising paradigm for delivering personalized mobile health support. Receptivity, i.e., the user's ability to receive the intervention plays a critical role in the effectiveness of JITAIs. While prior work has shown that receptivity can be inferred from mobile sensing data, the generalizability of these models across interventions, populations, and sensing configurations remains largely unexplored. Developing a new model for each intervention is burdensome and costly, whereas transferring models across studies is complicated by heterogeneity in populations, sensors, and data collection protocols. This paper presents the first systematic evaluation of cross-study generalization in receptivity detection. Using data from four diverse studies (yielding seven distinct datasets), we establish within-study performance benchmarks (median AUCs = 0.687-0.844) and quantify the performance drop when models transfer using only shared features (mean generalization AUCs of up to 0.676). We evaluate strategies that leverage the full feature union, employing imputation-based methods, correlation alignment (Deep CORAL), and a missingness-aware neural network. These approaches close the generalization gap, improving mean generalization AUCs of up to 0.722. In two target datasets, cross-study models matched or exceeded within-study baselines. These findings demonstrate the feasibility of robust, generalizable “warm-start” receptivity models, offering a practical pathway for deploying effective JITAIs without a costly “cold-start” learning phase.
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    Scopus© Citations 1
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    Beyond the Binary: Operationalizing Receptivity to Digital Health Interventions as a Time-to-Event Spectrum
    (Association for Computing Machinery (ACM), 2026-09-30)
    Negi, Samarth
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    Mishra, Varun
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    Kum Chai Yin
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    Castro, Oscar
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    Just-In-Time Adaptive Interventions (JITAIs) aim to support health behavior by providing the right support at the right time. A critical determinant of JITAI efficacy is timing delivery such that the user is receptive, defined as the cognitive and behavioral capacity to receive, process, and use support. While prior work has explored context sensing to predict receptivity, standard approaches typically operationalize this construct as a binary outcome within a fixed window, despite theoretical definitions characterizing availability as a continuous, time-varying state. Modeling receptivity at this granularity increases learning complexity, and deep sequence models are further constrained by the scarcity of labeled interaction data in mHealth settings. To address these challenges, we propose PRISM, a deep learning framework for modeling receptivity as a probabilistic time-to-event distribution from longitudinal mobile sensing data. PRISM combines a Channel-Independent Transformer (PatchTST) encoder with a discrete-time survival objective and employs self-supervised pre-training on unlabeled sensor traces via Masked Patch Reconstruction to mitigate label scarcity.; AB@We evaluate PRISM on the LvL UP intervention dataset, leveraging data from preliminary studies for pre-training and a large-scale efficacy trial for evaluation. Our results demonstrate competitive performance with established receptivity benchmarks, with self-supervised initialization yielding up to 15.5% improvement in median AUC across heterogeneous user groups. Beyond single-window evaluation, PRISM remains stable across multiple decision horizons from a single trained model, in contrast to binary baselines that degrade or require retraining at each cutoff. A follow-up evaluation on an independent dataset with variable prompt timing provides preliminary evidence that the learned representations transfer across cohorts and schedules. These findings suggest that PRISM provides a data-efficient pathway for deploying resilient, time-aware receptivity models in real-world mHealth systems.
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    Scopus© Citations 1