{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:10:10Z","timestamp":1788228610756,"version":"build-2803163510"},"reference-count":74,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Stress among health care workers (HCWs) contributes to burnout, workforce attrition, and adverse patient outcomes. Although virtual reality (VR), psychoeducation, ecological momentary assessments (EMAs), and wearables have independently shown promise in stress research, no integrated digital suite has combined controlled stress induction, intervention delivery, and longitudinal real-world monitoring in HCWs.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate the feasibility, engagement, and preliminary effectiveness of a multimodal Digital Health Monitoring and Intervention suite for Stress framework integrating VR simulation, psychoeducation, EMAs, and wearable biometrics. We examined (1) the impact of VR simulation and psychoeducation on stress outcomes and (2) associations between physiological and self-reported mental health outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Ninety-nine nurses (mean age 33.7, SD 8.9 yr, 87% female) were enrolled in 2023. We conducted a single-arm prospective cohort study (NCT05923398). Using convenience sampling, participants were recruited from social media advertisements, flyers, and email notices distributed through professional listservs. Participants completed \u22652-week baseline monitoring, a single VR session (2 runs separated by a brief psychoeducation intervention), and 12-week follow-up. In-VR stress was assessed using the Subjective Units of Distress Scale (SUDS) and 4-item Moral Injury Outcome Scale (MIOS-4), with synchronous heart rate variability. Longitudinal outcomes included weekly and biweekly EMAs alongside 70 wearable-derived features. Paired\n t<\/jats:italic>\n tests, aligned rank transform ANOVA, and Pearson correlations informed study objectives, with P values adjusted for multiple comparisons. Qualitative content analysis classified emotional responses during and after VR.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n VR significantly increased subjective stress across checkpoints in both runs, with attenuation in Run B relative to Run A (all\n P<\/jats:italic>\n <.001). No significant heart rate variability differences were observed between runs (\n P=<\/jats:italic>\n .15). During VR, 92% (91\/99) of participants felt stressed, 36% (36\/99) reported anxiety or nervousness, and 51% (50\/99)\u201078% (77\/99) endorsed anger, guilt, shame, and\/or betrayal. Most (59\/99, 60%) HCWs returned to an emotional baseline post-VR, although 12% (12\/99) reported lingering distress. Immediate reliable improvements in anger, guilt, shame, and\/or betrayal occurred for 50% (50\/99)\u201075% (74\/99) of participants post intervention. Anxiety (mean \u22120.53, SD 2.34;\n P=<\/jats:italic>\n .03) and stress (mean \u22123.05, SD 11.35;\n P=<\/jats:italic>\n .01) decreased 2 weeks post intervention, but were not sustained at 12 weeks. Increased sleep restlessness was the only wearable feature showing significant changes (mean 2.46%, SD 5.43;\n \n P\n adj<\/jats:sub>\n <\/jats:italic>\n <.001). In-VR stress correlated with 12-week real-world stress (SUDS:\n r<\/jats:italic>\n =0.57\u20100.58; MIOS-4:\n r<\/jats:italic>\n =0.58\u20100.61; all\n P<<\/jats:italic>\n .01). Data completion exceeded 90%, with 71% achieving full compliance.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study moves beyond single-tool interventions to demonstrate the feasibility and preliminary effectiveness of an integrated, multimodal stress platform within a single coordinated framework. This trial demonstrates high engagement, short-term symptom responsiveness, ecological validity, and emotional safety. The framework provides a scalable model for proactive stress identification, skills training, and implementation in high-risk occupational settings. Randomized controlled trials are needed to establish sustained efficacy and optimize deployment for real-world implementation.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/77818","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T20:13:46Z","timestamp":1781208826000},"page":"e77818-e77818","source":"Crossref","is-referenced-by-count":1,"title":["Digital Health Monitoring and Intervention Suite for Stress in Frontline Nurses: Prospective Cohort Trial"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9977-9653","authenticated-orcid":false,"given":"Alice","family":"Rueda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5232-1513","authenticated-orcid":false,"given":"Josh","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5886-0228","authenticated-orcid":false,"given":"Karisa","family":"Parkington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0116-6922","authenticated-orcid":false,"given":"Argyrios","family":"Perivolaris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5325-9639","authenticated-orcid":false,"given":"Bazen Gashaw","family":"Teferra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6905-9528","authenticated-orcid":false,"given":"Gyu Hee","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9208-8809","authenticated-orcid":false,"given":"Vanessa K","family":"Tassone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1884-4973","authenticated-orcid":false,"given":"Qiaowei","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7050-1749","authenticated-orcid":false,"given":"Martin","family":"Ivanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3962-0544","authenticated-orcid":false,"given":"Benjamin","family":"Darnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8107-1227","authenticated-orcid":false,"given":"Lindsay","family":"Beavers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7046-0959","authenticated-orcid":false,"given":"Douglas M","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2334-1919","authenticated-orcid":false,"given":"Andrei","family":"Torres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5590-8719","authenticated-orcid":false,"given":"Wendy","family":"Lou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3288-7609","authenticated-orcid":false,"given":"Anthony","family":"Nazarov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8590-0136","authenticated-orcid":false,"given":"Andrea","family":"Ashbaugh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0434-3847","authenticated-orcid":false,"given":"Bill","family":"Kapralos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0479-8887","authenticated-orcid":false,"given":"Brett","family":"Litz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6610-9365","authenticated-orcid":false,"given":"Rakesh","family":"Jetly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2074-0933","authenticated-orcid":false,"given":"Adam","family":"Dubrowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1080-7372","authenticated-orcid":false,"given":"Gillian","family":"Strudwick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4659-564X","authenticated-orcid":false,"given":"Sridhar","family":"Krishnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8768-1173","authenticated-orcid":false,"given":"Venkat","family":"Bhat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"issue":"March","key":"R1","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.yfrne.2018.03.001","article-title":"More than a feeling: a unified view of stress measurement for population science","volume":"49","author":"Epel","journal-title":"Front Neuroendocrinol"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.17179\/excli2017-480","article-title":"The impact of stress on body function: a review","volume":"16","author":"Yaribeygi","journal-title":"EXCLI J"},{"issue":"January","key":"R3","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.neubiorev.2021.03.024","article-title":"Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis","volume":"126","author":"Marvaldi","journal-title":"Neurosci Biobehav Rev"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1037\/ocp0000069","article-title":"The cost of work-related stress to society: a systematic review","volume":"23","author":"Hassard","journal-title":"J Occup Health Psychol"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1177\/0969733019851548","article-title":"Empathy, compassion fatigue, guilt and secondary traumatic stress in nurses","volume":"27","author":"Mottaghi","journal-title":"Nurs Ethics"},{"issue":"10","key":"R6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0258866","article-title":"Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: a 6-month multi-centre prospective study","volume":"16","author":"Teo","journal-title":"PLoS One"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.36469","article-title":"Prevalence of and factors associated with nurse burnout in the US","volume":"4","author":"Shah","journal-title":"JAMA Netw Open"},{"issue":"6","key":"R8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2022-009316","article-title":"The global health workforce stock and distribution in 2020 and 2030: a threat to equity and \u201cuniversal\u201d health coverage?","volume":"7","author":"Boniol","journal-title":"BMJ Glob Health"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2021.113847","article-title":"Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19","volume":"299","author":"Buselli","journal-title":"Psychiatry Res"},{"issue":"5","key":"R10","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002892.pub6","article-title":"Individual-level interventions for reducing occupational stress in healthcare workers","volume":"5","author":"Tamminga","journal-title":"Cochrane Database Syst Rev"},{"issue":"18","key":"R11","doi-asserted-by":"publisher","first-page":"9110","DOI":"10.3390\/app12189110","article-title":"Psychoeducation on stress and anxiety using virtual reality: a mixed-methods study","volume":"12","author":"Pallavicini","journal-title":"Appl Sci (Basel)"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2021.648087","article-title":"A self-compassion and mindfulness-based cognitive mobile intervention (serene) for depression, anxiety, and stress: promoting adaptive emotional regulation and wisdom","volume":"12","author":"Al-Refae","journal-title":"Front Psychol"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"131","DOI":"10.11124\/jbisrir-2015-1898","article-title":"Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review","volume":"13","author":"Gillman","journal-title":"JBI Database System Rev Implement Rep"},{"issue":"2","key":"R14","doi-asserted-by":"publisher","DOI":"10.17533\/udea.iee.v37n2e05","article-title":"The effect of aerobic exercise on occupational stress of female nurses: a controlled clinical trial","volume":"37","author":"Mohebbi","journal-title":"Invest Educ Enferm"},{"issue":"9","key":"R15","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.11124\/JBISRIR-2017-003848","article-title":"Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review","volume":"17","author":"Hopper","journal-title":"JBI Database System Rev Implement Rep"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s10484-011-9174-x","article-title":"Validity of global physical and emotional SUDS","volume":"37","author":"Tanner","journal-title":"Appl Psychophysiol Biofeedback"},{"issue":"7","key":"R17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271996","article-title":"Physiological reactions to acute stressors and subjective stress during daily life: a systematic review on ecological momentary assessment (EMA) studies","volume":"17","author":"Weber","journal-title":"PLoS One"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2017.00258","article-title":"An overview of heart rate variability metrics and norms","volume":"5","author":"Shaffer","journal-title":"Front Public Health"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.3390\/s23010332","article-title":"Wearable-measured sleep and resting heart rate variability as an outcome of and predictor for subjective stress measures: a multiple N-of-1 observational study","volume":"23","author":"de Vries","journal-title":"Sensors (Basel)"},{"issue":"13","key":"R20","doi-asserted-by":"publisher","DOI":"10.3390\/s23135863","article-title":"On the reliability of wearable technology: a tutorial on measuring heart rate and heart rate variability in the wild","volume":"23","author":"Dudarev","journal-title":"Sensors (Basel)"},{"issue":"2","key":"R21","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1177\/17449871241226914","article-title":"The effectiveness of digital solutions in improving nurses\u2019 and healthcare professionals\u2019 mental well-being: a systematic review and meta-analysis","volume":"29","author":"Ilola","journal-title":"J Res Nurs"},{"issue":"2","key":"R22","doi-asserted-by":"publisher","first-page":"169","DOI":"10.31887\/DCNS.2020.22.2\/lvalmaggia","article-title":"Virtual reality as a clinical tool in mental health research and practice","volume":"22","author":"Bell","journal-title":"Dialogues Clin Neurosci"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.113359","article-title":"Ecological momentary assessment (EMA) of mental health outcomes in veterans and service members: a scoping review","volume":"292","author":"Gromatsky","journal-title":"Psychiatry Res"},{"issue":"11","key":"R24","doi-asserted-by":"publisher","first-page":"2907","DOI":"10.1007\/s40279-024-02077-2","article-title":"Keeping pace with wearables: a living umbrella review of systematic reviews evaluating the accuracy of consumer wearable technologies in health measurement","volume":"54","author":"Doherty","journal-title":"Sports Med"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2022.102213","article-title":"Virtual reality in the diagnostic and therapy for mental disorders: a systematic review","volume":"98","author":"Wiebe","journal-title":"Clin Psychol Rev"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1146\/annurev-clinpsy-081219-115923","article-title":"Virtual reality therapy in mental health","volume":"17","author":"Emmelkamp","journal-title":"Annu Rev Clin Psychol"},{"issue":"July 2018","key":"R27","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.janxdis.2018.08.003","article-title":"Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials","volume":"61","author":"Carl","journal-title":"J Anxiety Disord"},{"issue":"August","key":"R28","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.614539","article-title":"Effect of virtual reality on stress reduction and change of physiological parameters including heart rate variability in people with high stress: an open randomized crossover trial","volume":"12","author":"Kim","journal-title":"Front Psychiatry"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2018.02340","article-title":"Mindful self-compassion training reduces stress and burnout symptoms among practicing psychologists: a randomized controlled trial of a brief web-based intervention","volume":"9","author":"Eriksson","journal-title":"Front Psychol"},{"issue":"12","key":"R30","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20126109","article-title":"Self-compassion interventions to target secondary traumatic stress in healthcare workers: a systematic review","volume":"20","author":"Rushforth","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1136\/bmjinnov-2015-000098","article-title":"Conducting a fully mobile and randomised clinical trial for depression: access, engagement and expense","volume":"2","author":"Anguera","journal-title":"BMJ Innov"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1038\/s41746-020-0224-8","article-title":"Indicators of retention in remote digital health studies: a cross-study evaluation of 100,000 participants","volume":"3","author":"Pratap","journal-title":"NPJ Digit Med"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.2196\/42813","article-title":"Digital interventions for stress among frontline health care workers: results from a pilot feasibility cohort trial","volume":"12","author":"Espinola","journal-title":"JMIR Serious Games"},{"issue":"7676","key":"R34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1655","article-title":"Developing and evaluating complex interventions: the new Medical Research Council guidance","volume":"337","author":"Craig","journal-title":"BMJ"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","journal-title":"BMJ"},{"issue":"3","key":"R36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0150205","article-title":"Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework","volume":"11","author":"Eldridge","journal-title":"PLoS One"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2017.00874","article-title":"The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults","volume":"8","author":"Ma","journal-title":"Front Psychol"},{"issue":"4","key":"R38","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1086\/JCE200920406","article-title":"Moral distress, moral residue, and the crescendo effect","volume":"20","author":"Epstein","journal-title":"J Clin Ethics"},{"key":"R39","doi-asserted-by":"crossref","unstructured":"Meshkat S Edalatkhah M Di Luciano C et al. Virtual Reality and Stress Management: A Systematic Review. Cureus Springer Science and Business Media LLC; 2024. [doi: 10.7759\/cureus.64573]","DOI":"10.7759\/cureus.64573"},{"issue":"2","key":"R40","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1080\/15402002.2017.1300587","article-title":"The sleep of the ring: comparison of the \u014cURA Sleep tracker against polysomnography","volume":"17","author":"de Zambotti","journal-title":"Behav Sleep Med"},{"issue":"4","key":"R41","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0000473","article-title":"Predicting stress in first-year college students using sleep data from wearable devices","volume":"3","author":"Bloomfield","journal-title":"PLOS Digit Health"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2024.01.020","article-title":"Validity and reliability of the Oura Ring Generation 3 (Gen3) with Oura sleep staging algorithm 2.0 (OSSA 2.0) when compared to multi-night ambulatory polysomnography: a validation study of 96 participants and 421,045 epochs","volume":"115","author":"Svensson","journal-title":"Sleep Med"},{"issue":"16","key":"R43","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.70527","article-title":"Validation of nocturnal resting heart rate and heart rate variability in consumer wearables","volume":"13","author":"Dial","journal-title":"Physiol Rep"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2023.107645","article-title":"Development of a data-driven digital phenotype profile of distress experience of healthcare workers during COVID-19 pandemic","volume":"240","author":"Nguyen","journal-title":"Comput Methods Programs Biomed"},{"issue":"3","key":"R45","doi-asserted-by":"publisher","DOI":"10.2196\/54180","article-title":"Digital interventions to understand and mitigate stress response: protocol for process and content evaluation of a cohort study","volume":"13","author":"Martin","journal-title":"JMIR Res Protoc"},{"key":"R46","unstructured":"The future of mental health care, now. Greenspace. URL: https:\/\/greenspacehealth.com\/ [Accessed 05-05-2026]"},{"issue":"2","key":"R47","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1097\/ACM.0000000000002035","article-title":"The PEARLS healthcare debriefing tool","volume":"93","author":"Bajaj","journal-title":"Acad Med"},{"issue":"10","key":"R48","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","journal-title":"PLoS Med"},{"issue":"404","key":"R49","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1080\/01621459.1988.10478722","article-title":"A test of missing completely at random for multivariate data with missing values","volume":"83","author":"Little","journal-title":"J Am Stat Assoc"},{"issue":"3","key":"R50","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1109\/TBME.1985.325532","article-title":"A real-time QRS detection algorithm","volume":"32","author":"Pan","journal-title":"IEEE Trans Biomed Eng"},{"key":"R51","doi-asserted-by":"publisher","DOI":"10.1080\/13645579.2025.2585286","article-title":"Improving the reliability of the Reliable Change Index","author":"Crenshaw","journal-title":"Int J Soc Res Methodol"},{"key":"R52","doi-asserted-by":"publisher","DOI":"10.1017\/S1754470X22000484","article-title":"Reliable change and the reliable change index: still useful after all these years?","volume":"15","author":"Blampied","journal-title":"tCBT"},{"key":"R53","unstructured":"Dresing T Pehl T Schmieder C . Manual (on) Transcription Transcription Conventions, Software Guides and Practical Hints for Qualitative Researchers. 3rd ed. dr. dresing & pehl GmbH; 2015. URL: https:\/\/www.audiotranskription.de\/wp-content\/uploads\/2020\/11\/manual-on-transcription.pdf [Accessed 05-05-2026] ISBN: 978-3-8185-0497-7"},{"issue":"8","key":"R54","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1111\/papr.12695","article-title":"The relationship between heart rate variability, psychological flexibility, and pain in neurofibromatosis type 1","volume":"18","author":"Allen","journal-title":"Pain Pract"},{"issue":"5","key":"R55","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1089\/tmj.2014.0104","article-title":"Reliability of ultra-short-term analysis as a surrogate of standard 5-min analysis of heart rate variability","volume":"21","author":"Baek","journal-title":"Telemed J E Health"},{"issue":"4","key":"R56","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1159\/000530376","article-title":"Heart rate variability for evaluating psychological stress changes in healthy adults: a scoping review","volume":"82","author":"Immanuel","journal-title":"Neuropsychobiology"},{"issue":"3","key":"R57","doi-asserted-by":"publisher","DOI":"10.1136\/gpsych-2023-101115","article-title":"Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis","volume":"37","author":"Ong","journal-title":"Gen Psychiatr"},{"issue":"2","key":"R58","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1177\/2515245919847202","article-title":"Evaluating effect size in psychological research: sense and nonsense","volume":"2","author":"Funder","journal-title":"Adv Methods Pract Psychol Sci"},{"issue":"1","key":"R59","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-016-1065-5","article-title":"Reactivity to smartphone-based ecological momentary assessment of depressive symptoms (MoodMonitor): protocol of a randomised controlled trial","volume":"16","author":"van Ballegooijen","journal-title":"BMC Psychiatry"},{"issue":"4","key":"R60","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0267534","article-title":"The effectiveness of incentives for research participation: a systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Abdelazeem","journal-title":"PLoS One"},{"key":"R61","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.963741","article-title":"Participant retention in a fully remote trial of digital psychotherapy: comparison of incentive types","volume":"4","author":"Griffith Fillipo","journal-title":"Front Digit Health"},{"issue":"11","key":"R62","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1037\/h0043424","article-title":"On the social psychology of the psychological experiment: with particular reference to demand characteristics and their implications","volume":"17","author":"Orne","journal-title":"Am Psychol"},{"issue":"1","key":"R63","doi-asserted-by":"publisher","DOI":"10.1038\/s41539-022-00147-6","article-title":"Enhancing learning and retention with distinctive virtual reality environments and mental context reinstatement","volume":"7","author":"Essoe","journal-title":"NPJ Sci Learn"},{"issue":"5","key":"R64","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","journal-title":"J Appl Psychol"},{"issue":"1","key":"R65","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/add.16001","article-title":"Emotion regulation in substance use disorders: a systematic review and meta\u2010analysis","volume":"118","author":"Stellern","journal-title":"Addiction"},{"key":"R66","doi-asserted-by":"publisher","DOI":"10.1016\/j.jrp.2024.104487","article-title":"Characterizing stress processes by linking big five personality states, traits, and day-to-day stressors","volume":"110","author":"Ringwald","journal-title":"J Res Pers"},{"issue":"3","key":"R67","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0092804","article-title":"Controlling social stress in virtual reality environments","volume":"9","author":"Hartanto","journal-title":"PLoS One"},{"key":"R68","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvp.2023.102107","article-title":"Inducing and measuring acute stress in virtual reality: evaluation of canonical physiological stress markers and measuring methods","volume":"94","author":"Hanshans","journal-title":"J Environ Psychol"},{"issue":"3","key":"R69","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s12144-000-1016-6","article-title":"Skills training in the long-term management of stress and occupational burnout","volume":"19","author":"Rowe","journal-title":"Curr Psychol"},{"key":"R70","doi-asserted-by":"crossref","unstructured":"Flick U . The SAGE Handbook of Qualitative Data Collection. SAGE Publications; 84-97. URL: https:\/\/sk.sagepub.com\/reference\/the-sage-handbook-of-qualitative-data-collection [Accessed 05-05-2026] [doi: 10.4135\/9781526416070.n6]","DOI":"10.4135\/9781526416070.n6"},{"issue":"2","key":"R71","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1037\/0022-3514.60.2.307","article-title":"Enhancement and denial in socially desirable responding","volume":"60","author":"Paulhus","journal-title":"J Pers Soc Psychol"},{"issue":"3","key":"R72","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1097\/MLR.0b013e3182408812","article-title":"Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact","volume":"50","author":"Curran","journal-title":"Med Care"},{"issue":"1","key":"R73","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1146\/annurev-publhealth-031816-044215","article-title":"An overview of research and evaluation designs for dissemination and implementation","volume":"38","author":"Brown","journal-title":"Annu Rev Public Health"},{"key":"R74","doi-asserted-by":"publisher","DOI":"10.2196\/45543","article-title":"Evaluating the modified Patient Health Questionnaire-2 and Insomnia Severity Index-2 for daily digital screening of depression and insomnia: validation study","volume":"10","author":"Oh","journal-title":"JMIR Ment Health"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e77818","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:26:56Z","timestamp":1785536816000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e77818"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":74,"URL":"https:\/\/doi.org\/10.2196\/77818","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"article-number":"v10iMarche77818"}}