Digital phenotyping of depression during pregnancy using self-report data.

Background: Depression is a common pregnancy complication yet is often under-detected and, subsequently, undertreated. Data collected through mobile health tools may be used to support the identification of depression symptoms in pregnancy.

Methods: An observational cohort study of 2062 pregnancies collected self-reports of patient history, mood, pregnancy-specific symptoms, and written language using a prenatal support app.

A Model for Engaging Citizen Scientists: A Community-Partnered Research Collaboration to Address Inequities for Black Birthing People.

Purpose: Co-creation of a citizen-science research initiative with a collaborative team of community members and university-based scientists to address regional disparities in maternal and fetal health outcomes for Black birthing people.

Description: Citizen scientist-led projects, where community members actively contribute to each discovery step, from setting a research agenda to collecting data and disseminating results, can extend community participatory research initiatives and help reconceptualize traditional research processes. The Pregnancy Collaborative is a citizen-science research initiative and one of nine scientific committees of The Pittsburgh Study-a longitudinal, community-partnered study designed to bring together collaborators to improve child thriving.

Predicting first time depression onset in pregnancy: applying machine learning methods to patient-reported data.

Purpose: To develop a machine learning algorithm, using patient-reported data from early pregnancy, to predict later onset of first time moderate-to-severe depression.

Methods: A sample of 944 U.S.

Benefits, Harms, and Stakeholder Perspectives Regarding Opioid Therapy for Pain in Individuals With Metastatic Cancer: Protocol for a Descriptive Cohort Study.

Background: Opioids are a key component of pain management among patients with metastatic cancer pain. However, the evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Patients with advanced cancer or cancer that is unlikely to be cured frequently experience pain.

Decision-making and Treatment Preferences Surrounding Bacteriuria in Nonpregnant Women: A Qualitative Investigation.

Introduction And Hypothesis: Best practices suggest nontreatment for asymptomatic bacteriuria in a nonpregnant population, yet there is little literature on patient preference or understanding of asymptomatic bacteriuria treatment. We hypothesize that there might be core factors that affect antibiotic preferences and care-seeking decisions for urinary tract infection and asymptomatic bacteriuria in a postmenopausal population.

Methods: We performed semi-structured interviews with postmenopausal individuals who had been previously treated for at least one patient-reported urinary tract infection.

Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study.

Background: Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs).

Objective: This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine.

Collection and Analysis of Adherence Information for Software as a Medical Device Clinical Trials: Systematic Review.

Background: The rapid growth of digital health apps has necessitated new regulatory approaches to ensure compliance with safety and effectiveness standards. Nonadherence and heterogeneous user engagement with digital health apps can lead to trial estimates that overestimate or underestimate an app's effectiveness. However, there are no current standards for how researchers should measure adherence or address the risk of bias imposed by nonadherence through efficacy analyses.

Indirect Identification of Perinatal Psychosocial Risks from Natural Language.

During the perinatal period, psychosocial health risks, including depression and intimate partner violence, are associated with serious adverse health outcomes for birth parents and children. To appropriately intervene, healthcare professionals must first identify those at risk, yet stigma often prevents people from directly disclosing the information needed to prompt an assessment. In this research we use short diary entries to indirectly elicit information that could indicate psychosocial risks, then examine patterns that emerge in the language of those at risk.

Parent Care-Seeking Decisions for Pediatric Acute Respiratory Tract Infections in the United States: A Mental Models Approach.

Objective: To understand US parent health care-seeking decisions in the context of multiple in-person and telehealth care options. As the health care landscape evolves, new research is needed to explain how parents now decide when and where to seek acute pediatric health care.

Methods: We applied a mental models approach, focusing on the archetypal example of care-seeking for pediatric acute respiratory tract infections (ARTIs), by first reviewing pediatric ARTI guidelines with 16 health care professionals to inform 40 subsequent semi-structured interviews with parents of young children in 2021.

Using natural language from a smartphone pregnancy app to identify maternal depression.

Depression is highly prevalent in pregnancy, yet it often goes undiagnosed and untreated. Language can be an indicator of psychological well-being. This longitudinal, observational cohort study of 1,274 pregnancies examined written language shared in a prenatal smartphone app.

Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study.

Background: Telemedicine delivered from primary care practices became widely available for children during the COVID-19 pandemic.

Objective: Focusing on children with a usual source of care, we aimed to examine factors associated with use of primary care telemedicine.

Methods: In February 2022, we surveyed parents of children aged ≤17 years on the AmeriSpeak panel, a probability-based panel of representative US households, about their children's telemedicine use.

Identification of maternal depression risk from natural language collected in a mobile health app.

Depression is one of the most common pregnancy complications, affecting approximately 15% of pregnant people. While valid psychometric measures of depression risk exist, they are not consistently administered at routine prenatal care, exacerbating the problem of adequate detection. The language we use in daily life offers a window into our psychological wellbeing.

The Role of Confidence and Knowledge in Intentions to (Not) Seek Care for Hypertension: Evidence From a National Survey.

Background: Hypertension (high blood pressure) is a modifiable risk factor for cardiovascular disease. However, patients may lack confidence in their understanding of what constitutes normal/healthy blood pressure, potentially affecting intentions to seek necessary care. The American Heart Association defines normal/healthy blood pressure as <120/80 mm Hg, with a 130/80 mm Hg threshold for hypertension diagnosis.

Using implementation science frameworks to translate and adapt a pregnancy app for an emerging Latino community.

Background: Digital mobile health (mHealth) applications are a popular form of prenatal education and care delivery in the U.S.; yet there are few Spanish language options for native speakers.

The value of adherence information during clinical pharmaceutical trials.

Background/aims: The quality of the evidence used to evaluate a drug's safety and efficacy depends, in part, on how well participants adhere to the prescribed drug-taking regime. There are multiple approaches to measure adherence in clinical trials, varying in their cost and accuracy. We demonstrate a method for evaluating the cost-effectiveness of common adherence monitoring methods, considering the costs and data quality for drugs that differ in how forgiving they are of nonadherence.

Decision-making tendencies and voucher spending independently support abstinence within contingency management for methamphetamine use disorder.

Decision-making tendencies and spending within cash voucher-based interventions have individually been shown to be related to future abstinence among participants with methamphetamine use disorder (MUD), but less is known of their independent contributions. This study of participants in a contingency management (CM) trial investigated whether decision-making and spending were each associated with future abstinence. Thirty-two outpatients with MUD, predominately male (68%) and mixed ancestry (94%) with a median age of 34 years, participated in an 8-week cash voucher-based CM pilot trial.

A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States.

The United States has abysmal reproductive health indices that, in part, reflect stark inequities experienced by people of color and those with preexisting medical conditions. The growth of "femtech," or technology-based solutions to women's health issues, in the public and private sectors is promising, yet these solutions are often geared toward health-literate, socioeconomically privileged, and/or relatively healthy white cis-women. In this viewpoint, we propose a set of guiding principles for building technologies that proactively identify and address these critical gaps in health care for people from socially and economically marginalized populations that are capable of pregnancy, as well as people with serious chronic medical conditions.

Barriers of Acceptance to Hospice Care: a Randomized Vignette-Based Experiment.

Background: The per diem financial structure of hospice care may lead agencies to consider patient-level factors when weighing admissions.

Objective: To investigate if treatment cost, disease complexity, and diagnosis are associated with hospice willingness to accept patients.

Design: In this 2019 online survey study, individuals involved in hospice admissions decisions were randomized to view one of six hypothetical patient vignettes: "high-cost, high-complexity," "low-cost, high-complexity," and "low-cost, low-complexity" within two diseases: heart failure and cystic fibrosis.

Assessing How Consumers Interpret and Act on Results From At-Home COVID-19 Self-test Kits: A Randomized Clinical Trial.

Importance: The US Food and Drug Administration (FDA) authorized SARS-CoV-2 rapid at-home self-test kits for individuals with and without symptoms. How appropriately users interpret and act on the results of at-home COVID-19 self-tests is unknown.

Objective: To assess how users of at-home COVID-19 self-test kits interpret and act on results when given instructions authorized by the FDA, instructions based on decision science principles, or no instructions.

Perceptions and knowledge of COVID-19 vaccine safety and efficacy among vaccinated and non-vaccinated obstetric healthcare workers.

The COVID-19 vaccines are highly effective in preventing COVID-19 illness; however, pregnant people were not included in the original COVID-19 vaccine trials, with resultant conflicting recommendations from health organizations regarding vaccinations for this high-risk population. Pregnant and lactating healthcare workers (HCWs), along with people planning a pregnancy, identified as "obstetric HCWs" in our study, were among the first to make decisions regarding vaccinating themselves against COVID-19. Given that HCWs are key sources of information and access to vaccinations, this study was conducted to understand the perceptions and knowledge of obstetric HCWs regarding the COVID-19 vaccine.

Physicians' cognitive approach to prognostication after cardiac arrest.

Objective: Elucidate how physicians formulate a neurological prognosis after cardiac arrest and compare differences between experts and general providers.

Methods: We performed semi-structured interviews with experts in post-arrest care and general physicians. We created an initial model and interview guide based on professional society guidelines.

COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey.

Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals' choice of specific protective health behaviors during pregnancy may be affected by information sources.

Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system.

Digital medicines for adherence support: A conceptual framework and qualitative study of adherence among chronically ill patients.

Digital medicine programs (DMPs) are emerging technologies that use sensor-enabled medicine to detect when patients have taken their medication and then provide feedback about adherence. We use qualitative methods to understand how patients change their behavioral patterns while participating in a DMP intervention. An influence diagram outlining the factors hypothesized to affect adherence in DMPs constructed from prior scientific research and expert input was created.

Use of a Smartphone App to Explore Potential Underuse of Prophylactic Aspirin for Preeclampsia.

Importance: Preeclampsia is a leading preventable cause of maternal morbidity and mortality. Initiation of low-dose aspirin (LDASA) treatment at or before 16 weeks' gestation may prevent preeclampsia onset for patients with specific risk factors.

Objective: To assess potential underuse of LDASA and reasons for underuse using data from a prenatal care smartphone app.