{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:25Z","timestamp":1785545065546,"version":"3.56.0"},"reference-count":50,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cancer survivors often experience declining engagement in digital health interventions (DHIs). However, predictors of engagement with provider-guided DHIs remain unclear. Nurse WRITE (Nurse Written Representational Intervention To Ease Symptoms), an effective 8-week nurse-directed symptom management DHI, offers an opportunity to identify factors influencing engagement and enhance intervention efficacy evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to (1) understand engagement phenomena (dimensions, influencing factors, and challenges), and (2) assess the relationship between engagement and patient symptom control in Nurse WRITE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this secondary analysis of the Nurse WRITE arm of a 3-arm symptom management trial, we examined data from 68 women with recurrent ovarian cancer to assess socioaffective and cognitive engagement through message board activity, as well as behavioral engagement through website usage data. Regression analyses examined patient characteristics, engagement, and symptom control perceptions. Through content analysis, we explored participant challenges and activities before disengagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Education was significantly associated with selected cognitive, socioaffective, and behavioral engagement indicators, including cognitive activity count, total word count, completion of symptom care plans, and plan reviews after false discovery rate correction. The most common engagement challenges included worsening health and treatment, busy family life, and website difficulties. Moderate and low engagers also experienced confusion about the intervention timeline and process. Among low engagers, 63.2% (24\/38) discontinued communication at specific intervention phases: introduction (8\/24, 33.3%), symptom representational assessment (5\/24, 20.8%), and goal setting and planning (5\/24, 20.8%). Improved symptom control at the end of the intervention was significantly associated with overall engagement, cognitive and socioaffective activity count, question completion percentage, total word count, and completed symptom care plans after false discovery rate correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Education was associated with selected cognitive, socioaffective, and behavioral engagement indicators in Nurse WRITE. Future provider-guided DHIs should consider strategies to support participants with lower educational attainment, address common engagement barriers, and reengage participants during critical intervention phases. Meaningful engagement across cognitive, socioaffective, and behavioral dimensions may be important for improving outcomes while balancing protocol adherence with flexibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/72784","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T10:35:09Z","timestamp":1780310109000},"page":"e72784-e72784","source":"Crossref","is-referenced-by-count":0,"title":["Patient Engagement and Symptom Outcomes in a Provider-Guided Online Symptom Management Intervention: Mixed Methods Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3136-3109","authenticated-orcid":false,"given":"Yan","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3325-435X","authenticated-orcid":false,"given":"Annette 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Development of standardized sociodemographic and co-morbidity questionnaires. Presented at: 17th International Nursing Research Congress Focusing on Evidence-Based Practice; Jul 19-22, 2006; Montreal, Quebec, Canada. URL: https:\/\/stti.confex.com\/stti\/congrs06\/techprogram\/paper_30321.htm [Accessed 01-07-2026]"},{"issue":"6","key":"R35","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1037\/\/0022-3514.67.6.1063","article-title":"Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test","volume":"67","author":"Scheier","journal-title":"J Pers Soc Psychol"},{"issue":"2","key":"R36","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1037\/a0035248","article-title":"Validation of interpersonal support evaluation list-12 (ISEL-12) scores among English- and Spanish-speaking Hispanics\/Latinos from the HCHS\/SOL Sociocultural Ancillary Study","volume":"26","author":"Merz","journal-title":"Psychol Assess"},{"issue":"6","key":"R37","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1097\/01.mlr.0000163658.65008.ec","article-title":"Use of a self-report-generated Charlson Comorbidity Index for predicting mortality","volume":"43","author":"Chaudhry","journal-title":"Med Care"},{"key":"R38","doi-asserted-by":"crossref","unstructured":"Spielberger CD Gorsuch RL Lushene R Vagg PR Jacobs GA . Manual for the State-Trait Anxiety Inventory. 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