{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:06:48Z","timestamp":1782846408880,"version":"3.54.5"},"reference-count":80,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The targeted application and design of digital health interventions (DHIs) require an understanding of usage determinants. Usage includes uptake (initial use) and frequency (extent of use), but it is unclear whether both components are driven by the same determinants.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to examine the determinants of uptake and frequency of use and assess whether they differ.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The investigated DHI was a web portal provided in an intervention for improving disease-related self-management. This study is a secondary analysis of intervention group data from a parallel-group randomized controlled trial. Eligibility criteria were being an adult and being diagnosed with type 2 diabetes and\/or coronary heart disease. Sociodemographic, psychological, and health-related variables were examined as determinants. Determinants were analyzed using simple and multiple regression models. Uptake was analyzed using logistic regression, and frequency was analyzed using negative binomial regression with robust SEs. Frequency was analyzed for those who used the DHI at least once. Except for sociodemographic variables, all other variables were standardized to a range from 0 to 1. For simple regression, inflation of the \u03b1 error due to multiple testing was controlled via the approach of Benjamini and Hochberg, and for multiple regression, it was controlled via the significance of the complete multiple regression model.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 462 intervention group members, 199 (43.1%) used the web portal at least once. After controlling for inflation of the \u03b1 error, simple regression for uptake yielded significant effects for higher education (B=0.56, 95% CI 0.18-0.95;\n P<\/jats:italic>\n =.004), openness (B=1.08, 95% CI 0.33-1.83;\n P<\/jats:italic>\n =.005), intention regarding physical activity (B=2.28, 95% CI 1.30-3.26;\n P<\/jats:italic>\n <.001), and intention regarding healthy nutrition (B=2.30, 95% CI 1.30-3.31;\n P<\/jats:italic>\n <.001). The multiple regression model for uptake was highly significant (\n P<\/jats:italic>\n <.001), with significant positive associations for intentions regarding physical activity (B=1.86, 95% CI 0.74-2.97;\n P<\/jats:italic>\n =.001) and healthy nutrition (B=2.22, 95% CI 1.00-3.44;\n P<\/jats:italic>\n <.001), as well as a significant negative association for patient activation (B=\u22123.20, 95% CI \u22124.95 to \u22121.46;\n P<\/jats:italic>\n <.001). After controlling for inflation of the \u03b1 error, simple regression for frequency yielded no statistically significant effect, and the multiple regression model for frequency was not significant (\n P<\/jats:italic>\n =.07).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study is innovative in jointly examining determinants of the uptake and frequency of use of the same DHI within a single context and sample. By demonstrating that factors driving uptake do not necessarily increase the frequency of use, it advances existing research. The study contributes to a more differentiated understanding of DHI use and shows that distinct strategies are required to promote adoption versus sustained engagement. Applying this approach to other DHIs and settings may support more targeted and equitable digital health implementation in real-world contexts, thereby optimizing digital health deployment strategies overall.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/80895","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T08:15:08Z","timestamp":1771056908000},"page":"e80895-e80895","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of the Uptake and Frequency of Use of a Web Portal Digital Health Intervention in Patients With Type 2 Diabetes and\/or Coronary Heart Disease: Secondary Analysis of a Randomized Controlled Trial"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1180-2416","authenticated-orcid":false,"given":"Maximilian","family":"Scholl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4299-4739","authenticated-orcid":false,"given":"Claas","family":"Lendt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4674-2486","authenticated-orcid":false,"given":"Sebastian","family":"Appelbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3026-5857","authenticated-orcid":false,"given":"Bianca","family":"Biallas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7664-8087","authenticated-orcid":false,"given":"Katja","family":"Brenk-Franz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5999-0868","authenticated-orcid":false,"given":"Chlo\u00e9","family":"Chermette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3404-3112","authenticated-orcid":false,"given":"Friederike","family":"Frank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5493-6785","authenticated-orcid":false,"given":"Angeli","family":"Gawlik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1900-5480","authenticated-orcid":false,"given":"Lisa","family":"Giesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5975-4331","authenticated-orcid":false,"given":"Martina","family":"He\u00dfbr\u00fcgge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9253-3020","authenticated-orcid":false,"given":"Lucas","family":"K\u00fcppers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6410-1642","authenticated-orcid":false,"given":"Larisa","family":"Pilic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8830-1999","authenticated-orcid":false,"given":"Marcus","family":"Reda\u00e8lli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4949-8452","authenticated-orcid":false,"given":"Lara","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4685-4189","authenticated-orcid":false,"given":"Frank","family":"Vitinius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1266-5064","authenticated-orcid":false,"given":"Stefan","family":"Wilm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6993-5977","authenticated-orcid":false,"given":"Uwe","family":"Konerding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2018.10.008","article-title":"The global burden of multiple chronic conditions: a narrative review","volume":"12","author":"Hajat","journal-title":"Prev Med Rep"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1161\/CIRCRESAHA.117.308903","article-title":"Reducing the global burden of cardiovascular disease, part 1: the epidemiology and risk factors","volume":"121","author":"Joseph","journal-title":"Circ Res"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.dsx.2020.12.030","article-title":"Effect of diabetes self-management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: systematic review and meta-analysis of randomized controlled trials","volume":"15","author":"Bekele","journal-title":"Diabetes Metab Syndr"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-017-0692-3","article-title":"A systematic review of chronic disease management interventions in primary care","volume":"19","author":"Reynolds","journal-title":"BMC Fam Pract"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.2196\/38447","article-title":"Patient portals as facilitators of engagement in patients with diabetes and chronic heart disease: scoping review of usage and usability","volume":"25","author":"Scheckel","journal-title":"J Med Internet Res"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.2196\/49055","article-title":"Mobile apps for common noncommunicable disease management: systematic search in app stores and evaluation using the mobile app rating scale","volume":"12","author":"Cheah","journal-title":"JMIR Mhealth Uhealth"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","DOI":"10.2196\/37315","article-title":"Web-based interventions to promote healthy lifestyles for older adults: scoping review","volume":"11","author":"Lavoie","journal-title":"Interact J Med Res"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.787135","article-title":"The cost-effectiveness of digital health interventions: a systematic review of the literature","volume":"10","author":"Gentili","journal-title":"Front Public Health"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1377\/hlthaff.2013.0992","article-title":"Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth","volume":"33","author":"Kvedar","journal-title":"Health Aff (Millwood)"},{"issue":"15","key":"R10","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1136\/heartjnl-2015-308966","article-title":"Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis","volume":"102","author":"Rawstorn","journal-title":"Heart"},{"issue":"e1","key":"R11","doi-asserted-by":"publisher","first-page":"e177","DOI":"10.1093\/jamia\/ocu047","article-title":"Technology-mediated interventions for enhancing medication adherence","volume":"22","author":"Mistry","journal-title":"J Am Med Inform Assoc"},{"issue":"12","key":"R12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-024262","article-title":"Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews","volume":"8","author":"Captieux","journal-title":"BMJ Open"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1177\/1932296817713506","article-title":"A systematic review of reviews evaluating technology-enabled diabetes self-management education and support","volume":"11","author":"Greenwood","journal-title":"J Diabetes Sci Technol"},{"issue":"4","key":"R14","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.1097\/JCN.0000000000000392","article-title":"Internet-delivered self-management support for improving coronary heart disease and self-management-related outcomes: a systematic review","volume":"32","author":"Palacios","journal-title":"J Cardiovasc Nurs"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2016.04.019","article-title":"Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials","volume":"116","author":"Su","journal-title":"Diabetes Res Clin Pract"},{"issue":"11","key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4836","article-title":"Mobile phone apps to promote weight loss and increase physical activity: a systematic review and meta-analysis","volume":"17","author":"Flores Mateo","journal-title":"J Med Internet Res"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-014-0097-9","article-title":"Apps to promote physical activity among adults: a review and content analysis","volume":"11","author":"Middelweerd","journal-title":"Int J Behav Nutr Phys Act"},{"issue":"11","key":"R18","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.2337\/dc16-0346","article-title":"Do mobile phone applications improve glycemic control (HbA1c) in the self-management of diabetes? A systematic review, meta-analysis, and GRADE of 14 randomized trials","volume":"39","author":"Hou","journal-title":"Diabetes Care"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008776.pub2","article-title":"Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus","volume":"2013","author":"Pal","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1376","article-title":"Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy","volume":"12","author":"Webb","journal-title":"J Med Internet Res"},{"issue":"3","key":"R21","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1772","article-title":"A systematic review of the impact of adherence on the effectiveness of e-therapies","volume":"13","author":"Donkin","journal-title":"J Med Internet Res"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-016-0454-y","article-title":"Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review","volume":"13","author":"Schoeppe","journal-title":"Int J Behav Nutr Phys Act"},{"issue":"11","key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/22212","article-title":"Real-world evidence of user engagement with mobile health for diabetes management: longitudinal observational study","volume":"8","author":"B\u00f6hm","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.4730","article-title":"Uptake of a consumer-focused mHealth application for the assessment and prevention of heart disease: the <30 days study","volume":"4","author":"Goyal","journal-title":"JMIR Mhealth Uhealth"},{"issue":"4","key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/10925","article-title":"Crossing the digital divide in online self-management support: analysis of usage data from HeLP-Diabetes","volume":"3","author":"Poduval","journal-title":"JMIR Diabetes"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/\/formative.6585","article-title":"The impact of participant characteristics on use and satisfaction of a web-based computer-tailored chronic obstructive pulmonary disease self-management intervention: a process evaluation","volume":"1","author":"Voncken-Brewster","journal-title":"JMIR Form Res"},{"issue":"12","key":"R27","doi-asserted-by":"publisher","DOI":"10.2196\/19150","article-title":"A mobile- and web-based health intervention program for diabetes and prediabetes self-management (BetaMe\/Melon): process evaluation following a randomized controlled trial","volume":"22","author":"Signal","journal-title":"J Med Internet Res"},{"issue":"4","key":"R28","doi-asserted-by":"publisher","DOI":"10.2196\/25333","article-title":"An internet-based intervention for cardiovascular disease management integrated with primary care electronic health records: mixed methods evaluation of implementation fidelity and user engagement","volume":"23","author":"Coorey","journal-title":"J Med Internet Res"},{"issue":"8","key":"R29","doi-asserted-by":"publisher","DOI":"10.2196\/17709","article-title":"Influence of personality on mHealth use in patients with diabetes: prospective pilot study","volume":"8","author":"Su","journal-title":"JMIR Mhealth Uhealth"},{"key":"R30","doi-asserted-by":"crossref","unstructured":"Ruotsalainen I Valtanen M K\u00e4rs\u00e4m\u00e4 R et al. Influencing factors in digital health intervention uptake: the interplay of education, lifestyle, and digital literacy. In: S\u00e4rest\u00f6niemi M Keikhosrokiani P Singh D Harjula E Tiulpin A Jansson M , editors. Digital Health and Wireless Solutions NCDHWS 2024 Communications in Computer and Information Science, Vol 2084. Springer; 2024:322-332. [doi: 10.1007\/978-3-031-59091-7_21]","DOI":"10.1007\/978-3-031-59091-7_21"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.2196\/66804","article-title":"Analysis of factors influencing the willingness of Chinese older adults to use mHealth devices: nationwide cross-sectional survey study","volume":"27","author":"Yan","journal-title":"J Med Internet Res"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1177\/0272989X13498156","article-title":"Understanding who benefits at each step in an internet-based diabetes self-management program: application of a recursive partitioning approach","volume":"34","author":"Glasgow","journal-title":"Med Decis Making"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-022-01711-0","article-title":"Attachment and patient activation as predictors of the interest and use of telemedical health applications -results of an observational study in primary health care","volume":"23","author":"Brenk-Franz","journal-title":"BMC Prim Care"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2024.105537","article-title":"Determinants of the intention to use mHealth in the future: evidence from an intervention study of patients with chronic diseases in Slovenia","volume":"190","author":"Dolni\u010dar","journal-title":"Int J Med Inform"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-55910-z","article-title":"eHealth tools use and mental health: a cross-sectional network analysis in a representative sample","volume":"14","author":"Ochnik","journal-title":"Sci Rep"},{"issue":"3","key":"R36","doi-asserted-by":"publisher","first-page":"254","DOI":"10.3109\/17538157.2014.908200","article-title":"Patient activation and use of an electronic patient portal","volume":"40","author":"Ancker","journal-title":"Inform Health Soc Care"},{"issue":"4","key":"R37","first-page":"788","volume":"1","author":"Hibbard","journal-title":"Int J Pers Cent Med"},{"issue":"11","key":"R38","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.9397","article-title":"Measuring engagement in eHealth and mHealth behavior change interventions: viewpoint of methodologies","volume":"20","author":"Short","journal-title":"J Med Internet Res"},{"issue":"3","key":"R39","doi-asserted-by":"publisher","DOI":"10.2196\/34925","article-title":"The influencing contexts and potential mechanisms behind the use of web-based self-management support interventions: realistic evaluation","volume":"9","author":"Engelen","journal-title":"JMIR Hum Factors"},{"issue":"1","key":"R40","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-021-05636-4","article-title":"A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and\/or for coronary heart disease","volume":"22","author":"Konerding","journal-title":"Trials"},{"issue":"13","key":"R41","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20136271","article-title":"Theoretical derivation of a telephone-based health coaching intervention for promoting physical activity and healthy nutrition","volume":"20","author":"Gawlik","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"R42","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1377\/hlthaff.23.3.56","article-title":"Disease management programs in Germany\u2019s statutory health insurance system","volume":"23","author":"Busse","journal-title":"Health Aff (Millwood)"},{"key":"R43","unstructured":"Ryan RM Deci EL . Overview of self-determination theory: an organismic-dialectical perspective. In: Handbook of Self-Determination Research. University of Rochester Press; 2002:3-33. ISBN: 9781580461085"},{"issue":"12","key":"R44","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.5927","article-title":"IDEAS (integrate, design, assess, and share): a framework and toolkit of strategies for the development of more effective digital interventions to change health behavior","volume":"18","author":"Mummah","journal-title":"J Med Internet Res"},{"key":"R45","unstructured":"Lendt C Gawlik A Chermette C Biallas B Kleinert J . Entwicklung einer webbasierten intervention zur aktivit\u00e4tsf\u00f6rderung bei patient:innen mit typ-2 diabetes mellitus und koronarer herzkrankheit [Article in German]. Presented at: 31 Rehabilitationswissenschaftliches Kolloquium: Deutscher Kongress f\u00fcr Rehabilitationsforschung Rehabilitation: Neue Wege, neue Chancen; Mar 7-9, 2022; M\u00fcnster, Germany. URL: https:\/\/fis.dshs-koeln.de\/de\/publications\/entwicklung-einer-webbasierten-intervention-zur-aktivit%C3%A4tsf%C3%B6rderu\/ [Accessed 08-03-2026]"},{"key":"R46","unstructured":"Reck C Lendt C Biallas B . User engagement and usability of a digital behavior change intervention to promote physical activity in older patients with type-2 diabetes and coronary heart disease. Presented at: 26th Annual Congress of the European College of Sport Science; Sep 8-10, 2021. URL: https:\/\/fis.dshs-koeln.de\/en\/publications\/user-engagement-and-usability-of-a-digital-behavior-change-interv\/ [Accessed 08-03-2026]"},{"issue":"3","key":"R47","doi-asserted-by":"publisher","first-page":"779","DOI":"10.4338\/ACI-2017-01-RA-0005","article-title":"Long-term patterns of patient portal use for pediatric patients at an academic medical center","volume":"8","author":"Steitz","journal-title":"Appl Clin Inform"},{"key":"R48","doi-asserted-by":"crossref","unstructured":"Halfaker A Keyes O Kluver D et al. User session identification based on strong regularities in inter-activity time. arXiv. Preprint posted online on Nov 11, 2014. [doi: 10.48550\/arXiv.1411.2878]","DOI":"10.1145\/2736277.2741117"},{"key":"R49","unstructured":"Rammstedt B Kemper CJ Klein MC Beierlein C Kovaleva A . Big Five Inventory (BFI-10). GESIS \u2013 Leibniz Institute for the Social Sciences - Zusammenstellung Sozialwissenschaftlicher Items Und Skalen (ZIS). 2014. URL: https:\/\/search.gesis.org\/instruments_tools\/zis76 [Accessed 08-03-2026]"},{"issue":"3","key":"R50","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1037\/\/0022-3514.39.3.472","article-title":"The revised UCLA loneliness scale: concurrent and discriminant validity evidence","volume":"39","author":"Russell","journal-title":"J Pers Soc Psychol"},{"issue":"2","key":"R51","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/bjhp.12404","article-title":"Development and validation of a 6-item revised UCLA loneliness scale (RULS-6) using Rasch analysis","volume":"25","author":"Wongpakaran","journal-title":"Br J Health Psychol"},{"issue":"1-2","key":"R52","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jad.2009.06.019","article-title":"A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population","volume":"122","author":"L\u00f6we","journal-title":"J Affect Disord"},{"issue":"1","key":"R53","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s11606-013-2568-0","article-title":"Psychometric properties of the brief health literacy screen in clinical practice","volume":"29","author":"Wallston","journal-title":"J Gen Intern Med"},{"issue":"9","key":"R54","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0074786","article-title":"Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients","volume":"8","author":"Brenk-Franz","journal-title":"PLoS ONE"},{"issue":"6 Pt 1","key":"R55","doi-asserted-by":"publisher","first-page":"1918","DOI":"10.1111\/j.1475-6773.2005.00438.x","article-title":"Development and testing of a short form of the patient activation measure","volume":"40","author":"Hibbard","journal-title":"Health Serv Res"},{"key":"R56","unstructured":"Brenk-Franz K Hibbard J Tiesler F Gensichen J . Manual Zur Deutschen Version Des PAM 13 [Book in German]. Institut f\u00fcr Allgemeinmedizin, Friedrich-Schiller-Universit\u00e4t Jena; 2014. ISBN: 9783981574937"},{"issue":"404","key":"R57","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"},{"key":"R58","doi-asserted-by":"crossref","unstructured":"van Buuren S . Flexible Imputation of Missing Data. 2nd ed. Chapman and Hall\/CRC; 2018. [doi: 10.1201\/9780429492259]","DOI":"10.1201\/9780429492259"},{"key":"R59","doi-asserted-by":"crossref","unstructured":"Hilbe JM . Modeling Count Data. Cambridge University Press; 2014. [doi: 10.1017\/cbo9781139236065] ISBN: 9781139236065","DOI":"10.1017\/CBO9781139236065"},{"issue":"1","key":"R60","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","journal-title":"J R Stat Soc Series B Stat Methodol"},{"key":"R61","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials","volume":"389","author":"Hopewell","journal-title":"BMJ"},{"issue":"2","key":"R62","first-page":"17","volume":"39","author":"Smith","journal-title":"Multiple Linear Regression Viewpoints"},{"issue":"1","key":"R63","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11567-y","article-title":"Analyzing health service employees\u2019 intention to use e-health systems in southwest Ethiopia: using UTAUT-2 model","volume":"24","author":"Admassu","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"R64","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","article-title":"The theory of planned behavior","volume":"50","author":"Ajzen","journal-title":"Organ Behav Hum Decis Process"},{"issue":"Suppl 10","key":"R65","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.5694\/mja2.51535","article-title":"Activating people to partner in health and self-care: use of the Patient Activation Measure","volume":"216 Suppl 10","author":"Janamian","journal-title":"Med J Aust"},{"key":"R66","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.973522","article-title":"Information adoption behavior in online healthcare communities from the perspective of personality traits","volume":"13","author":"Zhu","journal-title":"Front Psychol"},{"issue":"22","key":"R67","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16224527","article-title":"Self-expressive creativity in the adolescent digital domain: personality, self-esteem, and emotions","volume":"16","author":"P\u00e9rez-Fuentes","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"R68","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004362","article-title":"The effectiveness of interventions used to improve general health check uptake by the older adult population: a systematic review and meta-analysis","volume":"5","author":"Lau","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"R69","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01510-8","article-title":"A systematic review of consumers\u2019 and healthcare professionals\u2019 trust in digital healthcare","volume":"8","author":"Catapan","journal-title":"NPJ Digit Med"},{"issue":"1","key":"R70","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1037\/0012-1649.33.1.176","article-title":"Developmental regulation across adulthood: primary and secondary control of age-related challenges","volume":"33","author":"Heckhausen","journal-title":"Dev Psychol"},{"issue":"2","key":"R71","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1037\/\/0882-7974.7.2.194","article-title":"Age differences in adults\u2019 control beliefs related to life goals and concerns","volume":"7","author":"Nurmi","journal-title":"Psychol Aging"},{"key":"R72","doi-asserted-by":"crossref","unstructured":"Baltes PB Baltes MM . Psychological perspectives on successful aging: the model of selective optimization with compensation. In: Baltes PB Baltes MM , editors. Successful Aging: Perspectives from the Behavioral Sciences. Cambridge University Press; 1990:1-34. [doi: 10.1017\/CBO9780511665684.003]","DOI":"10.1017\/CBO9780511665684.003"},{"issue":"11","key":"R73","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanhl.2024.08.007","article-title":"The views and experiences of older adults regarding digital mental health interventions: a systematic review of qualitative studies","volume":"5","author":"Yin","journal-title":"Lancet Healthy Longev"},{"key":"R74","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2023.105124","article-title":"Sociodemographic determinants of digital health literacy: a systematic review and meta-analysis","volume":"177","author":"Estrela","journal-title":"Int J Med Inform"},{"issue":"3","key":"R75","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1002\/tre.694","article-title":"Who self\u2010cares wins: an updated perspective on men and self\u2010care","volume":"10","author":"Baker","journal-title":"Trends Urol & Men\u2019s Health"},{"issue":"7","key":"R76","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1136\/jech-2019-213435","article-title":"Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark","volume":"74","author":"H\u00f6hn","journal-title":"J Epidemiol Community Health"},{"key":"R77","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2016.09.002","article-title":"The role of masculinity in men\u2019s help-seeking for depression: a systematic review","volume":"49","author":"Seidler","journal-title":"Clin Psychol Rev"},{"issue":"5","key":"R78","doi-asserted-by":"publisher","DOI":"10.2196\/16299","article-title":"Characterizing the US population by patterns of mobile health use for health and behavioral tracking: analysis of the National Cancer Institute\u2019s Health Information National Trends Survey data","volume":"22","author":"Rising","journal-title":"J Med Internet Res"},{"issue":"2","key":"R79","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8371","article-title":"A multidimensional tool based on the eHealth literacy framework: development and initial validity testing of the eHealth Literacy Questionnaire (eHLQ)","volume":"20","author":"Kayser","journal-title":"J Med Internet Res"},{"issue":"3","key":"R80","doi-asserted-by":"publisher","DOI":"10.1080\/08989621.2025.2544331","article-title":"GAIDeT (Generative AI Delegation Taxonomy): a taxonomy for humans to delegate tasks to generative artificial intelligence in scientific research and publishing","volume":"33","author":"Suchikova","journal-title":"Account Res"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2026\/1\/e80895","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:14:31Z","timestamp":1782843271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e80895"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":80,"URL":"https:\/\/doi.org\/10.2196\/80895","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]},"article-number":"v28i6e80895"}}