Recruiting a National Sample of First Response Agencies to Participate in an Overdose Prevention Research Project: Randomized Controlled Trial and #feasibility Study Background: US overdose deaths continue to exceed 77,000 per year, the majority of which involve opioids. One evidence-based response to this crisis is overdose education and naloxone distribution (OEND). There is a large national (US) network of citizens and first response agencies connected through an app called , who are engaged in facilitating rapid layperson cardiopulmonary resuscitation administration in cases of public emergencies. Our goal is to recruit these first response agencies to provide targeted messaging about OEND to this large subpopulation of motivated layperson responders. This study focuses on the first step: the #feasibility of our national efforts to recruit first response agencies to participate in our project. Objective: This study aimed to determine whether more first response agencies were successfully recruited using materials that included preemptive correction of misperceptions about overdose and naloxone than with standard recruitment materials and to investigate the recruitment parameters observed when agencies were successfully recruited. Methods: The overall study was a randomized controlled trial in which we randomly sampled 180 first response agencies from the total set of agencies subscribing to (n=773). Agencies were randomly allocated to 3 study arms (1:1:1) with stratification for rural status. Arm 1 received standard recruitment materials, arm 2 received similar materials that directly addressed common misperceptions about overdose and naloxone, and arm 3 was recruited to serve as a control arm for later parts of the study. The primary analysis of recruitment approaches used logistic regression, contrasting arms 1 and 2. Exploratory analyses included descriptive statistics and other logistic regression models. Results: A total of 40 agencies signed memoranda of understanding to participate in the project (n=176, 22.7% of contacted agencies; n=151, 26.5% of the agencies where a point of contact had been established). We did not find evidence that the messaging contained in arm 2 significantly affected recruitment success (odds ratio 0.754, 95% CI 0.298‐1.904; =.55). Likewise, arm assignment (3-way comparison) did not significantly affect the likelihood of an agency agreeing to participate. The recruitment process took a mean of 159.08 (SD 104.74) days per agency and involved 8.38 emails, 1.98 voicemails, 0.83 phone calls, and 1.23 video calls. Conclusions: Recruiting first response agencies that subscribe to for participation in a national-level OEND project appears feasible, with an anticipated participation rate between 23% and 27% of agencies solicited. Successful recruitment timelines can be lengthy and involve extensive correspondence. Since the language used in our different study arms did not have a significant effect on agency recruitment, other factors (such as individual citizen responses to messaging) could reasonably be used to select the overall language used in subsequent project recruitment materials. Trial Registration: OSF Registries osf.io/egn3z; https://osf.io/egn3z International Registered Report Identifier (IRRID): RR2-10.2196/57280

JMIR Formative Res: Recruiting a National Sample of First Response Agencies to Participate in an Overdose Prevention Research Project: Randomized Controlled Trial and #feasibility Study #OverdosePrevention #Naloxone #OEND #FirstResponders #PublicHealth

A Conversational Platform (Okaya) for Multimodal Digital Biomarkers of Fatigue, Cognition, and Mental Health: #feasibility Observational Study Background: Collection of multimodal data (video, audio, and text) can yield digital biomarkers relevant to mental health, fatigue, and cognition. However, the #feasibility and signal characteristics in operational populations remain underexplored. Objective: The objectives of this study were to (1) extract an evidence-based library of vision, speech, and language features; (2) assess the #feasibility of a fully remote conversational platform (Okaya) for collecting analyzable multimodal data; and (3) conduct preliminary signal checks for depression, fatigue, and cognition. Methods: Participants were recruited from the US Air Force and US Space Force. All participants completed the Okaya check-in, which included a voice conversation with a large language model. A total of 66 visual, acoustic, and text features were extracted from each interaction between the participant and the large language model. For validation purposes, the study also collected measures of depression (Patient Health Questionnaire–9), fatigue (#Cancer Fatigue Scale), and cognition (trail making test). We evaluated the #feasibility of the platform and correlation between the extracted features and the validated assessments. Results: A total of 8 unique participants contributed with 62 sessions over a period from March 6, 2025, to August 6, 2025. The platform was deemed feasible as 6 of the 8 participants opted to complete more than one session, and the 3 participants who provided feedback reported high overall experience and #usability. From the data perspective, preliminary correlations produced significant results for multiple potential digital biomarkers, including (1) pitch (=.047), volume SD (=.04), volume slope (=.04), automated readability index complexity (=.047), Flesch-Kincaid complexity (=.04), and Gunning Fog complexity (=.04) for depression; (2) pitch (=.009), volume SD (=.007), volume slope (=.02), average F2 formant frequency (=.03), Gunning Fog complexity (=.049), and eyelid droop (=.047) for fatigue; and (3) shimmer (=.03) for cognition. We also observed how features varied over time among participants with multiple sessions. Conclusions: The conversational and artificial intelligence (#AI)–enabled platform was feasible among an operational sample as a method to collect multimodal data correlated with depression, fatigue, and cognition. These results align with those for previously discovered digital biomarkers of mental health, fatigue, and cognition and inform the development of personalized models for each user while detecting anomalies in a remote monitoring setting.

JMIR Formative Res: A Conversational Platform (Okaya) for Multimodal Digital Biomarkers of Fatigue, Cognition, and Mental Health: #feasibility Observational Study #MentalHealth #DigitalBiomarkers #Fatigue #Cognition #Research

#MissKitty is committed to ending #homelessness. I think a lot of people just virtually pat the kitty on the head and think that's nice. I get it. All I can offer are the onslaught of overwhelming #facts about the #need, #feasibility, and enormous #opportunity. And my organizational delivery.

Development and Evaluation of a Human-in-the-Loop Data Curation Training Program to Support a Digital Clinical Trial Platform: Descriptive #feasibility Study Background: LookUpTrials is a clinician-facing digital platform designed to support point-of-care navigation of institution-specific oncology clinical trials, incorporating artificial intelligence (#AI)–assisted summarization and search functionalities. While embedding curated trial knowledge tools in community oncology workflows is feasible, the human infrastructure required to sustain high-quality, up-to-date trial data over time remains underexplored. Objective: This study aimed to evaluate the #feasibility of a structured training program embedding trainees within a supervised human-in-the-loop workflow for oncology clinical trial data curation in support of the LookUpTrials digital platform. Methods: We conducted a descriptive #feasibility evaluation of a cohort-based training and workflow model. A total of 10 undergraduate trainees curated publicly available trial information from institutional portals and ClinicalTrials.gov across 5 academic medical centers. Trial throughput and participant experiences were summarized descriptively. Results: Over 10 months, trainees curated 2503 oncology clinical trial entries across 5 institutions, with processing rates increasing over time. Participants reported that structured onboarding and peer support facilitated engagement with data curation workflows. Conclusions: Standardized human-in-the-loop workflows for clinical trial data stewardship can be implemented with individuals without prior clinical trials or informatics experience when supported by structured training and quality assurance. This study complements prior #feasibility work on embedding trial knowledge tools in community oncology settings by focusing on the sustainability of the underlying content pipeline. Further evaluation is needed to assess scalability across institutions and durability over longer periods of platform maturation.

JMIR Formative Res: Development and Evaluation of a Human-in-the-Loop Data Curation Training Program to Support a Digital Clinical Trial Platform: Descriptive #feasibility Study #ClinicalTrials #Oncology #HealthcareInnovation #DataCuration #AI

Virtual Reality–Based Avatar Intervention for Eating Disorders: Mixed Methods #feasibility Study Background: There is a growing interest in developing novel psychological interventions for eating disorders, with an emphasis on targeting maintaining factors. One hypothesized mechanism underlying illness maintenance is the experience of an “inner eating disorder voice,” which reinforces maladaptive thoughts, emotions, and behaviors. Preliminary studies suggest that the eating disorder voice is common among patients and is linked to greater illness severity. Objective: This single-arm, mixed methods pilot #feasibility study aimed to evaluate a novel virtual reality (VR)–based therapy targeting the eating disorder voice. The intervention was adapted from AVATAR therapy for psychosis and was examined as an adjunct to treatment as usual in individuals with eating disorders. In this adaptation, participants engaged with a therapist-controlled avatar representing their inner eating disorder voice in VR. The primary objectives were to assess the #feasibility, acceptability, and safety of the intervention and to provide preliminary estimates of its clinical efficacy. Methods: Adults with anorexia nervosa (9/10, 90%) or bulimia nervosa (1/10, 10%) took part in a 7-session VR-based therapy course at the Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark, alongside their treatment as usual. Quantitative measures of #feasibility (recruitment, retention rates, and satisfaction scores), safety, and eating disorder–related outcomes were collected at baseline and after treatment between June 2023 and January 2024. Qualitative interviews conducted after the intervention (October 2023 to November 2023) explored participants’ experiences. Descriptive statistics, paired t tests, and thematic analysis were conducted, and the analyses were finalized in October 2025. Results: Recruitment targets were met: 14 individuals were referred, and 11 provided consent well within the prespecified time frame. Treatment completion rate was 80% (8/10; 95% CI 44%-97%), and no serious adverse events occurred. Participants reported high satisfaction (7/10, 70%; mean 9, SD 1.15 on a 10-point Likert scale; median 9, IQR 8.5-10.0; range 7-10), and qualitative data (8/10, 80%) suggested that they valued the immersive virtual representation of their eating disorder voice. Exploratory analyses indicated improvements in eating disorder symptoms (Hedges g=−0.99, 95% CI −1.74 to −0.24; P=.01), power dynamics associated with the eating disorder voice (Hedges g=−1.63, 95% CI −2.59 to −0.67; P=.002), and emotion regulation via cognitive reappraisal (Hedges g=0.87, 95% CI 0.08-1.66; P=.04). Conclusions: The VR-based avatar intervention for eating disorders was feasible, acceptable, and safe, with preliminary signals of clinical improvement. These findings support further development and evaluation of the intervention in a randomized clinical trial.

JMIR Formative Res: Virtual Reality–Based Avatar Intervention for Eating Disorders: Mixed Methods #feasibility Study #VirtualReality #EatingDisorders #MentalHealth #Therapy #PsychologicalIntervention

#feasibility and Engagement of a Peer-Driven Mobile Intervention for Adolescent E-Cigarette Cessation: Cluster Randomized Pilot Study Background: E-cigarette use remains prevalent among US adolescents, with many reporting daily use and high nicotine dependence. Few evidence-based mobile health interventions focus specifically on adolescents. Objective: This study aimed to evaluate the #feasibility, engagement, and preliminary efficacy of vaper-to-vaper (V2V)—a multicomponent, peer-driven texting intervention supporting adolescent e-cigarette cessation. Methods: A cluster randomized pilot study was conducted in 5 Massachusetts high schools, with schools randomized to either the V2V texting intervention (n=3) or a control group (n=2) that received a link to the National #Cancer Institute’s Smokefree.gov Quit Vaping website. The V2V intervention included four components: (1) peer-written messages provided motivation, tips, and strategies to support adolescents in quitting vaping, sent daily in the first 30 days; (2) peer videos featuring adolescents sharing their experiences with e-cigarettes and motivations to quit, sent regularly as links aligned with related peer message topics; (3) peer coaches—university students aged younger than 22 years who had successfully quit vaping—trained to provide support, encouragement and answers to participants’ questions through the texting platform; and (4) a fictional, gamified mystery story integrated into the texting platform to promote engagement. Each gamified message included a short story segment and a question, with the next segment unlocked after a response or automatically after 3 days. The intervention was mainly delivered over 30 days, but adolescents could message the peer coach over the 3 months. Eligible participants (grades 9‐12, current e-cigarette users) were followed for 3 months. We assessed the #feasibility of recruitment and retention (target: 80 participants, ≥85% retention), engagement with intervention components, and participant satisfaction. The secondary outcomes included improvements from baseline in confidence to quit, self-efficacy to resist vaping in specific high-risk situations, and fewer days vaped. E-cigarette cessation was biochemically verified using the Abbott iScreen cotinine test. Results: Seventy-one adolescents enrolled (intervention: 39/71, 55% ; control: 32/71, 45%), with a 96% follow-up rate at 3 months. Among intervention participants who responded to engagement items (N=37), high engagement—defined as self-reported use always, usually, or about half the time—was highest for peer messaging (n=29, 78%), followed by gamification (n=18, 49%), peer coaching (n=18, 49%), and peer video (n=13, 35%). The intervention group showed nonsignificant improvements in confidence to quit (n=17, 46%, vs n=9, 24%, moved from not at all, somewhat, or moderately confident to very or extremely confident) and in the number of days vaped in the past 30 days (−3.6 vs −2.9), while self-efficacy scores (adapted smoking self-efficacy scale range 12‐60) were slightly lower compared to the control group (mean −0.21, SD 1.14, vs mean 0.06, SD 1.39). Cotinine-validated 7-day point prevalence abstinence was similar between groups (intervention: 21.6% vs control: 22.6%). Conclusions: The V2V intervention demonstrated #feasibility and acceptability, with strong engagement and high satisfaction. Although differences between groups were not statistically significant, findings suggest that peer-driven mobile interventions are a promising approach to support adolescent e-cigarette cessation. Trial Registration: ClinicalTrials.gov NCT05140915 https://clinicaltrials.gov/study/NCT05140915

JMIR Formative Res: #feasibility and Engagement of a Peer-Driven Mobile Intervention for Adolescent E-Cigarette Cessation: Cluster Randomized Pilot Study #AdolescentHealth #ECigaretteUse #VapingPrevention #PeerSupport #MobileHealth

Examination of the Acceptability and #feasibility of a Virtually Delivered Facilitator-Led and Self-Directed Cognitive Behavioral Skills Intervention in a Sample of Physicians and Medical Learners: Mixed Methods Evaluation Background: The prevalence of various mental health conditions is higher among physicians and medical learners. One common barrier to receiving adequate care includes a lack of time to see a provider and follow treatment plans. As such, virtual forms of cognitive behaviour therapy with mindfulness (CBTm) were introduced to mitigate these barriers and provide care in an efficient and effective manner. Objective: The objective of this study was to determine the acceptability and #feasibility of a 5-session CBTm program, delivered in 2 virtual formats within a population of medical learners and physicians. Methods: Participants signed up to the program using an online link and were able to choose a preferred format to participate in the CBTm program. One option was a virtual, facilitator-led class that was held once a week for 5 weeks, in a group setting (CBTm facilitator-led). Another option included a self-directed course that had identical content to the live classes but was independently completed by the participant using an online platform (CBTm self-directed). Feedback forms were collected from participants after every class and analyzed using quantitative and qualitative methods. Thematic analysis was used to qualitatively analyze open-ended questions from participant feedback forms. In addition, the mean values of questionnaire items were used to determine participant satisfaction with the program. Results: The results indicated a good level of interest in both CBTm facilitator-led (n=15) and CBTm self-directed (n=94) groups. Of those who registered for the program, 13.8% (15/109) registered for CBTm facilitator-led and 86.2% (94/109) chose the self-directed version. The percentage of participants who participated in the majority of classes was 80% (12/15) for the CBTm facilitator-led group and 45.7% (43/94) for the CBTm self-directed group. The mean age of participants was 44.86 (SD 12.15 years), and the highest rate of uptake was among female physicians. Quantitative mean scores of participant feedback forms also showed a high level of satisfaction. For example, the Client Satisfaction Questionnaire 8 (CSQ-8) was analyzed, and the results indicated mean total scores of 28.00 (SD 3.24) and 26.46 (SD 3.55) for CBTm facilitator-led and CBTm self-directed, respectively. In addition, many themes emerged from thematic analysis and were subsequently categorized into 3 major categories. This included perceived strengths, perceived weaknesses, and suggested revisions to improve the program. Perceived strengths included improved mental health, helpful course content, and improved patient care. Perceived weaknesses included individual barriers to participation, content downfalls, and format-specific barriers. Suggested revisions included improving adherence to homework and virtual delivery of the program. Conclusions: In conclusion, the results indicate that the self-directed and facilitator-led versions of CBTm were acceptable and feasible in this population of physicians and medical learners.

JMIR Formative Res: Examination of the Acceptability and #feasibility of a Virtually Delivered Facilitator-Led and Self-Directed Cognitive Behavioral Skills Intervention in a Sample of Physicians and Medical Learners:… #MentalHealth #CognitiveBehavioralTherapy #CBT #Telehealth #HealthcareInnovation

Comparing 3 Goal-Setting Techniques to Promote Adherence to National Physical Activity Guidelines in Midlife Adults: #feasibility Trial of a Mechanistic Study Design Background: Engaging in regular aerobic physical activity (PA) during midlife is associated with reduced risk for Alzheimer disease and related dementias. Yet, most midlife adults fail to meet national PA guidelines. Goal setting is a commonly used behavior change technique to increase PA, but limited empirical evidence exists regarding whether certain types of goal setting are more effective than others. This study served as an initial step toward understanding how different goal-setting strategies may enhance PA and promote adherence to national PA guidelines among insufficiently active midlife adults with obesity. Objective: This study aimed to establish the #feasibility and acceptability of a 4-arm mechanistic trial design comparing 3 different PA goal-setting techniques with a non–goal-setting comparison condition. Methods: This study was a 6-month stage IA mechanistic trial (based on National Institute on Aging’s Stage Model) that randomized insufficiently active midlife adults with obesity to 1 of 4 study groups: (1) Static Goal-Setting Group (weekly moderate to vigorous physical activity [MVPA] goal of 150 minutes), (2) Self-Selected Goal-Setting Group (participants self-selected a weekly MVPA goal), (3) Incremental Goal-Setting Group (weekly MVPA goal 20% greater than the previous week), and (4) Non–Goal-Setting Comparison Group (encouraged to increase MVPA without specific reference to a weekly goal). All participants (n=24) received a standardized, Social Cognitive Theory–based PA promotion intervention, which consisted of structured action planning sessions and a Fitbit activity monitor for self-monitoring of MVPA. The only difference across study groups was the goal-setting technique implemented. Primary outcomes included #feasibility of study implementation, as assessed by recruitment, retention, and engagement rates; the ability to deliver the intervention as planned and collect outcomes necessary for evaluating the effects of different goal-setting techniques in a subsequent larger-scale trial; and participant acceptability of the intervention, as assessed by participant perceptions of and satisfaction with the intervention. Results: The sample (n=24; mean age 54.1, SD 5.8 years; mean BMI 36.3, SD 5.0 kg/m) was recruited in approximately 4 months, equating to an enrollment rate of 6 participants per month. Retention at 6 months was 87.5% (21/24). Participants completing the intervention attended 85.9% of action planning sessions and wore the Fitbit for >10 hours per day on 87.1% of intervention days. Data collection rates for outcome measures ranged from 96% to 100%. Most participants expressed satisfaction with the intervention, with 86% (18/21) reporting gaining knowledge about PA and 90% (19/21) reporting that they would recommend the study to a friend. Conclusions: The next step in this research is to build on these findings by conducting a larger-scale phase 1B proof-of-concept trial to examine the preliminary effects of the goal-setting techniques for increasing MVPA and promoting adherence to national aerobic PA guidelines. Trial Registration: ClinicalTrials.gov NCT05980052; https://clinicaltrials.gov/study/NCT05980052

JMIR Formative Res: Comparing 3 Goal-Setting Techniques to Promote Adherence to National Physical Activity Guidelines in Midlife Adults: #feasibility Trial of a Mechanistic Study Design #PhysicalActivity #GoalSetting #HealthResearch #MidlifeHealth #AlzheimerAwareness

#feasibility and Preliminary Efficacy of Empowered Relief in Patients With Chronic Pain Taking Methadone or Buprenorphine: Single-Arm National Pilot Study Background: Approximately 45% of individuals taking methadone or buprenorphine have chronic pain. These medications are commonly prescribed for chronic pain or opioid use disorder (OUD). To optimize pain management as well as reduce opioid-related symptoms (eg, craving) and risks (misuse and overdose), there is a critical need for a brief, effective, and accessible pain skills intervention for this population. Objective: This single-arm study aimed to examine the #feasibility and preliminary efficacy of online Empowered Relief (ER), a 1-session pain relief skills class, for individuals with chronic pain taking methadone or buprenorphine for chronic pain or OUD. Methods: A priori #feasibility criteria were defined as at least 75% of enrolled participants attending the ER class and the mean satisfaction rating of at least 8 on a 0‐10 scale. Participants were recruited nationally across the United States. Out of the 69 enrolled participants, 55 attended the ER class. Self-report measures were collected at baseline, immediately post class, and at follow-up points of 2 weeks and months 1‐3. Additionally, qualitative interviews were conducted in a small sample (n=14) to obtain in-depth participant feedback. Among the class attendees, 51 participants (27/51, 52.9% female; mean age 48.6, SD 12.2, range 28‐71 years) completed at least one follow-up survey, and treatment outcomes were analyzed using repeated measures ANOVA, with missing data imputed using linear regression. This analytic sample consisted of 24 participants taking methadone and 27 participants taking buprenorphine; 43.1% (22/51) endorsed at least≥2 OUD symptoms within the past 12 months, meeting the ( [Fifth Edition]) diagnostic criteria for current OUD. Results: #feasibility was achieved with 79.7% (55/74) attendance and mean 8.6 (SD 2) ratings of treatment appraisal and satisfaction. Qualitative feedback demonstrated high acceptability of the class content and delivery, with suggestions for refinements. Repeated-measures ANOVAs and FDR-corrected post hoc tests revealed significant reductions at 1 month post-ER class (primary endpoint) in pain intensity (Cohen =0.71), pain bothersomeness (Cohen =0.54), and pain interference (Cohen =0.61). At 3 months post-ER class, efficacy was maintained for pain intensity, pain bothersomeness, and pain interference (Cohen =0.28, 0.44, and 0.48, respectively). No significant time effects were observed for pain catastrophizing, sleep disturbance, physical function, fatigue, depression, anxiety, social isolation, and opioid craving. Conclusions: This study is the first to test ER in patients taking methadone or buprenorphine for pain or OUD. Findings showed #feasibility, acceptability, and preliminary evidence of treatment efficacy. Participant feedback will inform future study designs. These findings support a randomized trial to fully evaluate the efficacy and scalability of ER in this population. Trial Registration: ClinicalTrials.gov NCT05057988; https://clinicaltrials.gov/study/NCT05057988 International Registered Report Identifier (IRRID): RR2-10.2196/53784

JMIR Formative Res: #feasibility and Preliminary Efficacy of Empowered Relief in Patients With Chronic Pain Taking Methadone or Buprenorphine: Single-Arm National Pilot Study #ChronicPain #PainManagement #OpioidCrisis #EmpoweredRelief #Methadone

Using Semiautomated WhatsApp Messages for Daily Stress Measurements: Integrated #usability and #feasibility Study Background: Stress is a key determinant of health outcomes and may influence work performance. Questionnaire-based assessments of stress are typically broad and retrospective. Daily stress measurements via smartphones offer more granular, real-time data but have adherence issues. Using an already established communication medium (WhatsApp) and a more conversational style assessment might improve adherence and help collect more detailed insights into (work) stress, underlying stressors, and countering energy sources. Objective: This study focuses on the #usability and #feasibility of semiautomated voice- and text-messages (with and without emojis) via WhatsApp as a method to collect daily data on experienced work stress, stressors, and energy sources. Methods: A sample of 210 workers was recruited via social media and participated in a 10-workday diary study using semiautomated WhatsApp messages to rate daily stress, stressors, and energy sources. Questions (with and without emojis) were presented by a chatbot as text messages with clickable buttons (multiple-choice questions; MC) or with instructions to answer with either a voice or a text message. The study used an experimental design with 4 groups: (1) week 1 voice, week 2 text/MC with emojis; (2) week 1 voice, week 2 text/MC without emojis; (3) week 1 text/MC, week 2 voice with emojis; (4) week 1 text/MC, week 2 voice without emojis. Pre- and poststudy web-based questionnaires assessed demographics, familiarity with voice messages, and #usability, including participants’ preference for research studies. Open answers were coded using artificial intelligence (#AI), and the number of stressors or energy sources was compared across the 3 collection methods (MC, voice, and text messages) to determine if the amount and quality of information collected differ per method within participants. Results: A total of 158 workers completed at least 80% of scheduled conversations. The sample was predominantly women(170/210, 81%), highly educated (173/210, 82%), and a slight majority worked part-time (109/210, 52%). Mean adherence to the daily schedule was very high (mean of 95%). The postquestionnaire revealed a strong preference for MC and text over voice messages, mostly due to ease and convenience in a variety of situations. The number of stressors per week was approximately 3 times higher in the MC-condition than in the voice condition, even though average stress levels per week did not differ significantly within participants. The number of energy sources was comparable between open answers in the voice and text conditions, but voice messages consisted of more words. Conclusions: Collecting (work) stress data via semiautomatic WhatsApp messages is a feasible method with low effort for participants. #usability ratings indicated a strong preference among participants for MC and text messages over voice messages. Future research should explore #usability in more diverse samples and in direct comparison to traditional assessment methods.

JMIR Formative Res: Using Semiautomated WhatsApp Messages for Daily Stress Measurements: Integrated #usability and #feasibility Study #StressManagement #MentalHealth #Wellbeing #WorkplaceWellness #WhatsApp

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"The cost of building something new has fallen through the floor over the last decade. Developer tools have become more powerful, numerous, and freely available.

Enter #AI. Almost without warning, AI-enabled tools dramatically expanded what a resource-strapped team can create. It’s a genuine […]

Integrating GPT-4o Into Data Mining in Neurosurgery: #feasibility and Proof-of-Concept Study Background: Large language models offer new possibilities for transforming unstructured clinical text into structured datasets. However, their performance in specialized and complex documentation environments, such as neurosurgery, remains insufficiently characterized. GPT-4o is a large language model with enhanced natural language capabilities, but its accuracy in extracting structured data from neurosurgical reports has not been systematically assessed. Objective: This proof-of-concept study evaluated the #feasibility and accuracy of GPT-4o for extracting predefined structured variables from unstructured neurosurgical reports of patients with vestibular schwannoma. Specific aims were to measure accuracy across variable types, assess the impact of prompt refinement, and explore the model’s potential utility for research-oriented data mining. Methods: In this retrospective single-center study, 10 consecutive patients with histologically confirmed vestibular schwannoma who underwent surgery between August and December 2023 were included. Four anonymized German-language documents per patient (discharge, surgical, histopathology, and 3-month follow-up reports) were processed using GPT-4o. Seventeen variables were extracted using a standardized zero-shot prompt. Targeted prompt refinements were subsequently applied for variables with low baseline accuracy. Two board-certified neurosurgeons independently validated all outputs, with discrepancies resolved by a senior neurosurgeon. Accuracy metrics, 95% CIs (Wilson method), and descriptive comparisons between variable types were calculated. Results: GPT-4o achieved 100% accuracy for structured variables requiring minimal interpretation, including patient ID, date of birth, date of surgery, histopathological diagnosis, and World Health Organization grade. Several interpretative variables, such as symptoms at presentation, symptom type, symptom duration, extent of resection, and permanence of postoperative deficits, were also extracted with 100% accuracy. In contrast, intraoperative complications and new postoperative deficits were correctly identified in only 50% (5/10) of cases using the zero-shot prompt. After targeted prompt refinement, accuracy for these variables improved substantially, reaching 90% to 100% in most cases. The mean accuracy was highest for structured categorical variables (97.5%, SD 4.6%), intermediate for binary variables (80%, SD 27.4%), and lowest for conditional text variables (66.7%, SD 28.9%), without statistically significant differences (=.25). Conclusions: GPT-4o demonstrated strong #feasibility for structured data extraction from standardized neurosurgical reports, particularly for variables with limited semantic complexity. However, the high accuracy observed reflects a narrow and highly controlled context and should not be interpreted as evidence of general reliability across diverse clinical settings. Larger, multi-institutional, and multilingual studies are needed to determine broader applicability and potential clinical integration.

JMIR Formative Res: Integrating GPT-4o Into Data Mining in Neurosurgery: #feasibility and Proof-of-Concept Study #Neurosurgery #DataMining #MachineLearning #GPT4 #ArtificialIntelligence

#feasibility and Acceptability of Just Breathe, A Novel Handheld Mindful Breathing Device, for Postpartum Stress: Pilot, Single-Arm Pre-Post Study Among newly postpartum people, the novel Just Breathe guided breathing device showed high user satisfaction scores and self-perceived reductions in stress, although the Cohen d effect on heart rate variability and stress or anxiety symptoms as measured by validated psychometric scales was minimal.

JMIR Formative Res: #feasibility and Acceptability of Just Breathe, A Novel Handheld Mindful Breathing Device, for Postpartum Stress: Pilot, Single-Arm Pre-Post Study #MentalHealth #PostpartumCare #Mindfulness #BreathingTech #StressRelief

Orbital datacenters are a pie-in-the-sky idea: Gartner : Analyst firm bemoans ‘peak insanity’ among those who think circling servers can replace down-to-earth server farms

Gartner has a strong view about orbital datacenters ... Logistics, operational and cyber security costs are indeed likely to have a massive impact!
www.theregister.com/2026/02/25/g... #OrbitalDataCenters #Feasibility #logistics #operations #cybersecurity

Co-Designed Mental Health Screening App (Here for You) for University Students: Pilot #feasibility Mixed Methods Study Background: Mental health disorders are a growing public health concern among university students globally and in India, exacerbated by stigma and limited access to care. Mobile health (mHealth) apps offer a potential solution, but user engagement and cultural relevance remain key challenges. This pilot study evaluated Here for You, a mental health screening app co-designed with Indian university students to provide accessible, nonstigmatizing support. Objective: This mixed methods study aimed to (1) describe the user-centered codevelopment and pilot testing process of the Here for You app; (2) evaluate the app’s #feasibility, user acceptability, and engagement; and (3) assess the concurrent validity of the app’s screening tool, the Depression, Anxiety, and Stress Scale-21 (DASS-21) against established clinical measures (Hamilton Depression Rating Scale [HAM-D], Hamilton Anxiety Rating Scale [HAM-A], and Perceived Stress Scale [PSS]). Methods: This study used a 4-phase user-centered design involving students with lived mental health experience, clinicians, and developers. A purposive sample of 30 university students (mean age 21, SD 1.8 years; n=15, 50% female) diagnosed with depression, anxiety, or stress participated. Participants completed the DASS-21 via the app and underwent clinical assessments using the HAM-D, HAM-A, and PSS scales. User experience was evaluated using the User Mobile App Rating Scale and qualitative feedback. Data analysis included Pearson correlation coefficients and thematic analysis. Results: App-based DASS-21 scores showed strong correlations with clinician-administered scales: HAM-D (r=0.819; P

JMIR Formative Res: Co-Designed Mental Health Screening App (Here for You) for University Students: Pilot #feasibility Mixed Methods Study #MentalHealth #UniversityStudents #MobileHealth #MentalHealthApp #UserEngagement

#feasibility of a Noncontact Photoplethysmography–Based Mobile App for Noninvasive Hemoglobin Monitoring: Exploratory Observational Study Background: Anemia is a widespread global health issue. Hemoglobin (Hb) concentration measurement remains the most common method for anemia screening and diagnosis. In recent years, there has been growing interest in the development of noninvasive point-of-care technologies that eliminate the need for blood sampling. Objective: This pilot study explores the #feasibility of using a noncontact photoplethysmography–based mobile app for Hb monitoring. Methods: Adult volunteers aged 18 years and older, of both sexes, were consecutively recruited. Participants were seated and allowed a 2-minute rest before measurements. During testing, they faced a smartphone running comestai.app which used the front-facing camera to capture facial videos. Simultaneous readings were collected for Hb over approximately 90 seconds using the app. Ambient lighting was standardized for all remote photoplethysmography recordings. No medical decisions were made based on the app-generated data. A complete blood count, including Hb levels, was used as a reference for comparison with the data collected using comestai.app. Results: A total of 555 (female: n=313, 56.4%; male: n=242, 43.6%) individuals participated in the study. The app achieved a mean absolute error of 1.46, a mean absolute percentage error of 11.26, a mean error of −0.67, and a root mean square error of 1.88. The Bland-Altman plot evaluated the agreement between the app-based and laboratory-based Hb measurements, with the mean difference between the 2 methods being −0.70 g/dL. The method demonstrated an overall accuracy of 75%. The area under the curve was 0.701 (95% CI 0.655-0.745). Conclusions: Comestai.app offers an innovative approach to wellness monitoring by providing noninvasive Hb estimation using the smartphone’s front-facing camera. Continued development, including algorithmic refinement and larger-scale validation in diverse populations, will be key to enhancing accuracy and broadening its utility. By leveraging the ubiquity of smartphones, comestai.app contributes meaningfully to the democratization of health monitoring and the promotion of proactive self-care. Trial Registration: ClinicalTrials.gov NCT06427564; https://clinicaltrials.gov/study/NCT06427564

JMIR Formative Res: #feasibility of a Noncontact Photoplethysmography–Based Mobile App for Noninvasive Hemoglobin Monitoring: Exploratory Observational Study #NoninvasiveMonitoring #Hemoglobin #AnemiaAwareness #MobileHealth #HealthTech

Insights on Recruitment, Implementation, and Movement Pattern Detection by Exploring the #feasibility of Sensor-Based Insole Technology in Long-Term Care: Mixed Methods #feasibility Study Background: Sensor-based footwear is increasingly discussed as a promising tool for mobility monitoring and fall-risk assessment, yet its applicability in long-term care remains largely unexamined. In particular, little is known about whether such systems and the study procedures needed to evaluate them can be feasibly integrated into dementia care settings. This #feasibility study provides practice-based evidence of using a sensor-equipped insole system with cognitively impaired residents. Objective: The study examines recruitment #feasibility, integration of the device into daily care routines, and the operationalization of the study design under everyday institutional conditions. Furthermore, it explores whether movement patterns, including agitation-related behaviors, can be detected in situ, acknowledging the exploratory nature of this aim due to the rarity and unpredictability of natural agitation episodes. Methods: An exploratory #feasibility study was conducted in 2 long-term care facilities in Eastern Switzerland. Six residents with mild-to-moderate cognitive impairment and increased fall risk were recruited through a multistep, staff-supported process, offering rare documentation of real-world recruitment constraints. The insole system recorded continuous gait and movement data during daily activities and weekly walking tests. Controlled simulations of agitation-related patterns were conducted to generate reference data, as natural agitation events were infrequent and difficult to capture systematically. #feasibility outcomes were informed focusing on recruitment capability, acceptability and adherence, #feasibility of continuous data acquisition, and the practicality of integrating the system into daily care routines. Results: The study identified substantial #feasibility constraints, including contextual limitations posed by sedation practices, fluctuating health status, and consent-related barriers. Practical challenges such as inconsistent battery charging, communication gaps across rotating staff, and difficulties achieving adequate shoe fit directly affected protocol adherence and data yield. Continuous sensor-based data collection was technically feasible when the shoes were worn, and machine-learning models consistently classified predefined agitation-related patterns under controlled conditions. Natural agitation episodes were rare, making simulated reference data essential for establishing fundamental detectability. Resident acceptance varied, with some individuals reporting increased perceived stability due to the shoe’s firm construction rather than its vibration feature. Conclusions: This #feasibility study demonstrates that sensor-based footwear is technically feasible and shows situational acceptability in long-term care, while also highlighting key contextual constraints related to recruitment, workflow integration, device handling, and adherence. The findings provide early empirical evidence on what is practically achievable in this population and setting, clarifying the exploratory nature and methodological necessity of using simulated agitation patterns, and underscoring the need for context-sensitive, participatory strategies when introducing sensor-based technologies into dementia care.

JMIR Formative Res: Insights on Recruitment, Implementation, and Movement Pattern Detection by Exploring the #feasibility of Sensor-Based Insole Technology in Long-Term Care: Mixed Methods #feasibility Study #Recruitment #MobilityMonitoring #FallRiskAssessment #DementiaCare #SensorTechnology

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A Better Fundraising Feasibility Study Method: How to Plan and Ensure a Successful Campaign Join Andrea Kihlstedt to debunk prevailing myths about feasibility studies. Learn how you can leverage this critical, early campaign planning tool to truly build relationships with the philanthropists in your community and get a jumpstart on your campaign.

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Evaluating a Wearable-Based Pain Monitoring System in Palliative #Cancer Care: #usability and #feasibility Study Background: Effective pain management is a cornerstone of #Cancer palliative care, yet it remains challenging in low- and middle-income countries (LMICs) due to limited resources, regulatory constraints, and a lack of objective tools. While wearable technologies offer promise for augmenting pain-related patient-reported outcomes (PROs) with physiological data, their #usability in LMIC palliative settings is underexplored. Objective: This article presents an evaluation on technology #usability and implementation #feasibility of the NEST system, a low-cost, smartwatch-based pain monitoring solution for palliative #Cancer care co-designed with health care staff from a #Cancer hospital in Ecuador. Methods: An observational #usability study was conducted with seven #Cancer patients receiving palliative care treatment, combining hospital- and home-based monitoring phases. We used a qualitative and quantitative approach to assess the #usability of the NEST system and to identify sociotechnical factors affecting #feasibility using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. Results: Quantitative results showed strong preference for the smartwatch over the mobile phone for submitting PROs (83%), with wear-time adherence of the smartwatch ranging from 36% to 92% of the time. Qualitative feedback from patients and healthcare staff indicated good #usability and perceived clinical value, though technical and organizational challenges such as charging habits, training needs, and dashboard integration into daily workflow of healthcare staff were noted. As for #feasibility, most of the complexity was found on the dynamics of the health condition while the technology shows clear promising signs of having value to patients and healthcare staff. Conclusions: Our findings suggest that the commonly reported #usability hurdles of a smartwatch-based sociotechnical health solution are surmountable given fluid communication between stakeholders during all stages of design and deployment. The primary threats to #feasibility in our context seem to lie in the highly complex and dynamic environment of palliative #Cancer care, regulatory ambiguity regarding use of medical devices, and the workload burden on healthcare staff.

JMIR Formative Res: Evaluating a Wearable-Based Pain Monitoring System in Palliative #Cancer Care: #usability and #feasibility Study #CancerCare #PalliativeCare #PainManagement #WearableTech #HealthInnovation

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Assessing the #feasibility, #usability, Acceptability, and Efficacy of an AI Chatbot for Sleep Promotion: Quasi-Experimental Study Background: Poor sleep is a concerning public health problem in the United States. Previous sleep interventions often face barriers such as high costs, limited accessibility, and low user engagement. Recent advancements in artificial intelligence (#AI) (AI) technologies offer a novel approach to overcoming these limitations. In response, our team developed a prototype AI sleep chatbot powered by a large language model to deliver personalized, accessible sleep support. Objective: This study aimed to examine the #feasibility, #usability, acceptability, and preliminary efficacy of the AI chatbot for sleep promotion. Methods: We conducted a quasi-experimental, single-group study with adults in the United States aged 18 to 75 years who self-reported poor sleep. The chatbot was integrated into a commercially available messaging app. Participants were asked to engage with a virtual sleep therapist via texting over 2 weeks. The chatbot provided ongoing, individualized sleep guidance and adapted recommendations based on participants’ prior conversations. #feasibility, #usability, and acceptability were descriptively summarized. Sleep was assessed using questionnaires before and after the intervention. Results: Of the 107 adults who enrolled in the study, 88 (82.2%) completed chatbot registration. Among these 88 participants, 65 (73.9%) initiated interactions, and 44 (50%) completed the 2-week intervention. The final analysis included 42 adults (mean age 36, SD 11 years; n=12, 28.6% male). On average, participants engaged with the chatbot for 58 (SD 42) minutes, with each chat session lasting approximately 9 (SD 6) minutes. Most reported favorable experiences with the chatbot. The average #usability score was 85.2 (SD 10.7) out of 100, which was well above the benchmark of 68. The chatbot was rated as highly acceptable, with a satisfaction score of 27.3 (SD 4.1) out of 32. All participants perceived the chatbot as effective, with ratings ranging from “slightly effective” to “extremely effective.” The preliminary evidence showed improved sleep outcomes after chatbot use: total sleep time increased by 1.4 hours (P

JMIR Formative Res: Assessing the #feasibility, #usability, Acceptability, and Efficacy of an AI Chatbot for Sleep Promotion: Quasi-Experimental Study #SleepHealth #AIChatbot #SleepSupport #PublicHealth #AIInHealthcare

Development of a Social Media Campaign to Support HIV Prevention and Care Among Transgender Latina Women: Community-Engaged Mixed Methods #feasibility Pilot Study Background: Transgender Latina women in the U.S. face disproportionate HIV risk due to intersecting social and structural vulnerabilities that limit access to care. While gender-affirming, culturally responsive, and eHealth strategies show promise for improving access, social media-based approaches remain underutilized despite their potential to reach marginalized groups at scale. Objective: This study aimed to develop and pilot a culturally tailored social media campaign to increase awareness of HIV prevention and care services offered by a community-based organization (CBO) in King County, Washington for transgender Latina women, and to assess the campaign’s #feasibility and acceptability. Methods: We conducted a community-engaged, mixed-methods pilot study using a multi-phase design. In Phase 1, we conducted cross-sectional, in-depth interviews with transgender Latina women (n=20) recruited by a CBO in King County, Washington. Interviews were analyzed using thematic analysis, guided by the Unified Theory of Behavior, to inform campaign messaging priorities. A subsequent focus group (n= 7) then reviewed and refined six draft campaign concepts according to the community preferences. In Phase 2, the finalized campaign was piloted on Facebook and Instagram. A cross-sectional REDCap survey was conducted with a subset (n=100) of transgender Latina women exposed to the campaign who voluntarily consented to complete the survey after being directed from the campaign, Survey data were summarized using descriptive statistics to assess campaign reach and #feasibility and acceptability outcomes. Results: In-depth interview participants were a mean age of 37.6 years (standard deviation [SD]: 9.5) and reported an average of 10.2 years (SD: 10.8) residing in the U.S. (n=20). Interviews revealed four key themes: (1) importance of HIV prevention and awareness; (2) accessibility of HIV services; (3) provision of culturally tailored care; and (4) need for confidentiality. Among survey respondents (mean age: 29.7, SD: 5.2), 97% (95% CI:91.5%-99.0%) had ever tested for HIV and 44% (95% CI:34.3%-53.7%) reported testing within the past six months. Three respondents were living with HIV, all on antiretroviral therapy. Nearly all (91%, 95% CI:84.3%-95.2%) reported campaign-motivated action, including HIV testing or seeking information or services. Conclusions: Findings demonstrate the #feasibility and acceptability of a culturally tailored campaign, co-created with community members, to promote HIV prevention and care among transgender Latina women. By integrating participatory methods with digital outreach, this study contributes an innovative model that centers community voices in campaign design while leveraging widely used platforms. The study has implications for providing CBOs with scalable, low-cost strategies to expand culturally responsive HIV services, reduce stigma and motivate health-seeking behaviors in populations often overlooked by mainstream public health messaging. This work underscores how co-designed social media campaigns can complement traditional outreach and inform future HIV prevention strategies for underserved populations.

JMIR Formative Res: Development of a Social Media Campaign to Support HIV Prevention and Care Among Transgender Latina Women: Community-Engaged Mixed Methods #feasibility Pilot Study #HIVPrevention #TransgenderHealth #LatinaWomen #SocialMediaCampaign #CommunityEngagement

#feasibility and User Experience of an AI-Supported mHealth Intervention for Remote Life Goal Setting Based on Flow Theory: Exploratory Within-Participant Study Background: Life goal setting contributes substantially to well-being and quality of life, particularly among middle-aged and older adults. However, delivering remote goal-setting support remains challenging due to limited professional resources and accessibility barriers. Recent advancements in mobile health (mHealth) technologies, telemedicine, and generative artificial intelligence (#AI) (AI) present new opportunities for scalable, personalized health behavior interventions. Nevertheless, few studies have compared AI-driven life goal interventions with conventional human-facilitated approaches in real-world settings. Objective: This study aimed to evaluate the #feasibility and user experience of an AI-supported mHealth intervention for remote life goal setting based on flow theory. We compared the AI-supported approach to occupational therapist (OT)–facilitated support and explored the differential characteristics of AI-guided and human-guided interventions for self-management and motivation enhancement. Methods: An exploratory, within-participant, 2-condition comparison with a counterbalanced order was conducted among 28 community-dwelling adults (aged between 20 and 76 years) who were smartphone users. Each participant selected 2 personal life goals and completed remote adjusting the challenge-skill balance (R-ACS) sessions, a structured telemedicine process based on flow theory. One goal was supported by an OT, while the other was facilitated by a generative AI chatbot integrated into an mHealth platform. Following each session, participants completed a 4-item rubric-based questionnaire (5-point Likert scale), assessing the quantity and quality of questions, appropriateness of suggestions, and perceived contribution to goal attainment. Free-text feedback was also collected. Quantitative data were analyzed using Wilcoxon signed-rank tests with effect size calculations and Benjamini-Hochberg correction for multiple comparisons. Qualitative differences were explored using text mining (term frequency–inverse document frequency analysis) and sentiment evaluation. Results: Both AI-supported and OT-facilitated R-ACS sessions were feasible and successfully delivered tailored suggestions for all participants. AI-supported sessions received higher scores on all rubric items than OT-facilitated sessions, with a statistically significant difference in suggestion appropriateness (z score=3.13; P=.002; r=0.418; false discovery rate–adjusted P=.008). Term frequency–inverse document frequency analysis of free-text comments revealed that AI-supported sessions emphasized actionability, motivation, and immediacy, while OT-facilitated sessions highlighted reflection, self-understanding, and emotional safety. Participants expressed high acceptance of both intervention types, with AI-supported interactions perceived as particularly accessible and conducive to health behavior change. Conclusions: AI-supported mHealth interventions for remote life goal setting based on flow theory are feasible, well accepted, and offer potential advantages in immediacy, motivation enhancement, and action-oriented support. OT-facilitated support provides complementary strengths by fostering reflection and psychological safety. A hybrid R-ACS model that integrates both AI and human expertise may optimize personalized, scalable self-management support for life goal setting. Future randomized controlled trials are warranted to further investigate the long-term impact of AI-driven mHealth interventions on health behavior, well-being, and quality of life.

JMIR Formative Res: #feasibility and User Experience of an AI-Supported mHealth Intervention for Remote Life Goal Setting Based on Flow Theory: Exploratory Within-Participant Study #AI #mHealth #telemedicine #healthcare #digitalhealth

Why BRL is Essential for Sustainable Innovation TRL answers « Can we build it? » but BRL answers « Will it survive? » Discover why Business Readiness Levels (BRL) are the critical missing link in Chall…

Challenge-Driven #Innovation requires more than just technology—it requires a validated business model.

Learn how to map projects on the TRL/BRL matrix, #assess commercial #viability, and bridge the gap between engineering #feasibility and real-world #impact.

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Early Evaluation of IMAGINATOR 2.0 Intervention Targeting Self-Harm in Young People: Single-Arm #feasibility Trial Background: Self-harm (SH) affects around 20% of all young people in the United Kingdom. Treatment options for SH remain limited and those available are long and costly and may not suit all young people. There is an urgent need to develop new scalable interventions to address this gap. IMAGINATOR is a novel imagery-based intervention targeting SH initially developed for individuals aged 16 to 25 years. It is a blended digital intervention delivering functional imagery training via therapy sessions and a smartphone app. Objective: This study aimed to pilot a new version of the app, IMAGINATOR 2.0, extended to adolescents from the age of 12 years and coproduced with a diverse group of young people with lived experience. Our aim was also to test the #feasibility and acceptability of delivering IMAGINATOR 2.0 in secondary mental health services. Methods: A total of 4 co-design workshops were conducted online with UK-based lived-experience co-designers aged 14-25 years to develop the IMAGINATOR 2.0 app. The intervention was then piloted with participants recruited from West London NHS Trust Tier 2 Child and Adolescent Mental Health Services and adult Mental Health Integrated Network Teams. Participants received 3 face-to-face functional imagery training sessions in which the app was introduced and 5 brief phone support sessions. Outcome assessments were conducted after completing therapy, approximately 3 months post baseline. Two focus groups gathered the therapists’ perspectives on IMAGINATOR 2.0’s acceptability and means of improvement. For quantitative data, descriptives are reported. Qualitative data were analyzed using a coproduced thematic analysis method with young people with lived experiences. Results: Overall, 83 participants were referred, and 29 (gender: n=28 women, n=1 transgender; mean age 18.9, SD 3.74 years) were eligible and completed screening. Of the 27 participants who started, 59% (n=16) completed therapy per protocol, while only 15 (55.6%) completed the quantitative outcome assessment. There was an overall reduction in the number of SH episodes over 3 months from pre- to postintervention (baseline: median 7, IQR 3.5-21.5 months; postintervention: median 0, IQR 0-7 months; median difference=–6.5; r=0.69). Six themes were identified through thematic analysis of therapists’ feedback, including mental imagery’s potential and boundaries, therapy expectations, experience and effectiveness, accessibility of digital support, and adaptation of the IMAGINATOR 2.0 app to complement care pathways. The app was valued by therapists who highlighted the need for an intervention like IMAGINATOR 2.0 in their services. Conclusions: IMAGINATOR 2.0 shows initial promise as an acceptable brief intervention targeting SH in young people under adolescent and adult mental health services. Challenges with attrition need to be addressed for a definitive randomized controlled trial to test the intervention efficacy. Clinical Trial: ClinicalTrials.gov NCT06311084; https://clinicaltrials.gov/study/NCT06311084

JMIR Formative Res: Early Evaluation of IMAGINATOR 2.0 Intervention Targeting Self-Harm in Young People: Single-Arm #feasibility Trial #SelfHarm #MentalHealth #YouthWellness #DigitalIntervention #ImageryTraining