{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:43:26Z","timestamp":1785545006060,"version":"3.56.0"},"reference-count":19,"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 Endometriosis is a chronic gynecological condition affecting approximately 10% of women of reproductive age worldwide and is associated with chronic pelvic pain, infertility, and reduced quality of life. In Brazil\u2019s Unified Health System (Sistema \u00danico de Sa\u00fade [SUS]), diagnostic delays frequently range from 7 to 10 years and disproportionately affect socially vulnerable populations, including rural, low-income, Black, and Indigenous women. Digital health interventions have been proposed as scalable solutions; however, most available applications are developed in high-income settings and do not align with the structural and operational realities of low- and middle-income countries (LMICs).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate feasibility, usability, acceptability, and user engagement associated with the real-world implementation of EndoConnect Alpha in primary health care settings, and to explore preliminary patterns of change in symptom burden, knowledge, and care navigation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A single-arm, prospective, formative implementation study was conducted in 10 primary health care units in Cear\u00e1, Brazil. A convenience sample of 60 participants, including women with suspected or confirmed endometriosis and primary care professionals, used the platform over an 8-week period under real-world conditions. Usability (assessed using the System Usability Scale), acceptability (assessed using the Technology Acceptance Model), engagement metrics, and exploratory outcomes were assessed. All analyses were exploratory, with no control group and no causal inference.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n High usability and acceptability were observed, with strong user engagement, including a 79% completion rate of educational modules and consistent platform use. Observed decreases in pelvic pain and anxiety were identified, alongside increases in disease-related knowledge, self-reported therapy adherence, and reported gynecological referrals. A positive association between usability and acceptability was also observed. These findings should be interpreted as exploratory signals given the study design. Descriptive subgroup analyses suggested more pronounced trends among rural participants and those with a lower education level.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The real-world implementation of EndoConnect Alpha demonstrated high feasibility, usability, and acceptability within a public primary care setting in a middle-income country. Observed trends suggest potential benefits, particularly among underserved populations; however, causal inference cannot be established. These findings support further controlled evaluation and highlight the relevance of equity-oriented digital health strategies tailored to LMIC contexts.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/89464","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T12:25:07Z","timestamp":1775305507000},"page":"e89464-e89464","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Implementation of EndoConnect in Brazilian Primary Care: Formative Study of Usability, Engagement, and Equity in Digital Endometriosis Care"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5656-6754","authenticated-orcid":false,"given":"Kelnner Portela","family":"Luz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9916-013X","authenticated-orcid":false,"given":"Danilo Lopes","family":"Ferreira Lima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"issue":"13","key":"R1","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","journal-title":"N Engl J Med"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: Endometriosis","volume":"2022","author":"Becker","journal-title":"Hum Reprod Open"},{"issue":"9","key":"R3","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14092975","article-title":"New evidence about malignant transformation of endometriosis-a systematic review","volume":"14","author":"Ioannidou","journal-title":"J Clin Med"},{"key":"R4","unstructured":"Ethics and governance of artificial intelligence for health. World Health Organization; 2021."},{"key":"R5","unstructured":"Brasil. Minist\u00e9rio da sa\u00fade. In: Pol\u00edtica Nacional de Aten\u00e7\u00e3o Integral \u00e0 Sa\u00fade Da Mulher. Minist\u00e9rio da Sa\u00fade; 2020."},{"key":"R6","unstructured":"Brasil. Minist\u00e9rio da sa\u00fade. In: Estrat\u00e9gia de Sa\u00fade Digital Para o Brasil 2020\u20132028. Minist\u00e9rio da Sa\u00fade; 2020."},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001363","article-title":"The effectiveness of mobile-health technologies to improve health care service delivery processes: A systematic review and meta-analysis","volume":"10","author":"Free","journal-title":"PLoS Med"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12525","article-title":"Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review","author":"Agarwal","journal-title":"Trop Med Int Health"},{"key":"R9","unstructured":"Recommendations on digital interventions for health system strengthening. World Health Organization; 2019."},{"key":"R10","unstructured":"Global strategy on digital health 2020\u20132025. World Health Organization; 2020."},{"issue":"1","key":"R11","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: The convergence of human and artificial intelligence","volume":"25","author":"Topol","journal-title":"Nat Med"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1038\/s41591-018-0316-z","article-title":"A guide to deep learning in healthcare","volume":"25","author":"Esteva","journal-title":"Nat Med"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1426-2","article-title":"Key challenges for delivering clinical impact with artificial intelligence","volume":"17","author":"Kelly","journal-title":"BMC Med"},{"issue":"21","key":"R14","doi-asserted-by":"publisher","first-page":"2199","DOI":"10.1001\/jama.2018.17163","article-title":"Clinical decision support in the era of artificial intelligence","volume":"320","author":"Shortliffe","journal-title":"JAMA"},{"key":"R15","unstructured":"WMA declaration of helsinki \u2013 ethical principles for medical research involving human participants. World Medical Association. URL: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki\/ [Accessed 26-05-2026]"},{"key":"R16","unstructured":"Brazilian General Data Protection Law (Lei Geral de Prote\u00e7\u00e3o de Dados \u2013 Law No. 13.709\/2018). Presid\u00eancia da Rep\u00fablica - Secretaria-Geral - Subchefia para Assuntos Jur\u00eddicos. URL: https:\/\/www.planalto.gov.br\/ccivil_03\/_ato2015-2018\/2018\/lei\/l13709.htm [Accessed 26-05-2026]"},{"key":"R17","unstructured":"National health council resolution no. 466\/2012. Minist\u00e9rio da Sa\u00fade. URL: https:\/\/www.gov.br\/conselho-nacional-de-saude\/pt-br [Accessed 26-05-2026]"},{"key":"R18","unstructured":"Continuous PNAD - continuous national household sample survey. Instituto Brasileiro de Geografia e Estat\u00edstica. URL: https:\/\/www.ibge.gov.br\/en\/statistics\/social\/population\/18083-annual-dissemination-pnadc3.html [Accessed 27-04-2026]"},{"issue":"8","key":"R19","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.67655","article-title":"Influence of app-based self-management on the quality of life of women with endometriosis","volume":"16","author":"Rohloff","journal-title":"Cureus"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e89464","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:24:38Z","timestamp":1785536678000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e89464"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":19,"URL":"https:\/\/doi.org\/10.2196\/89464","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]},"article-number":"v10i13e89464"}}