{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:48:20Z","timestamp":1782841700862,"version":"3.54.5"},"reference-count":65,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Bipolar disorder (BD) affects approximately 40 million people worldwide and is a chronic, potentially disabling mood disorder. Although effective treatments exist, access to evidence-informed psychosocial care remains limited, particularly for culturally and linguistically diverse populations, contributing to persistent global treatment gaps. Digital mental health interventions (DMHIs), such as smartphone apps, offer a promising means to improve access to self-management support and quality of life (QoL), an outcome prioritized by people with BD and in clinical guidelines. However, most apps for BD lack quality and are not culturally adapted or co-designed with people with BD, limiting relevance and engagement. PolarUs (mobile app) is an evidence-informed DMHI developed using co-design with people with BD. The app is structured on the core 14 domains from the Quality of Life in BD scale, the only BD-tailored scale, combined with psychoeducation on self-management strategies and QoL. A recent pilot study demonstrated promising QoL, clinical, and feasibility outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to culturally and linguistically adapt the PolarUs app into French, Chinese, and Spanish for the North American context using qualitative and co-design methods.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Guided by community-based participatory research principles, whereby end users are engaged throughout the research process, and the Ecological Validity Framework of Bernal et al, we will engage advisory groups of people with lived experience from each linguistic community throughout the cultural adaptation process. Semimonthly virtual meetings will support systematic cultural adaptation of the self-management strategies, affirmations, and resources while maintaining fidelity to core evidence-based components. This will include cultural tailoring of app content and the identification of culturally appropriate resources. Advisory groups will also contribute to the cointerpretation of findings and the co-design of culturally appropriate recruitment and implementation strategies of PolarUs for a future clinical trial. Meetings will be recorded and coanalyzed as research data with advisory groups using qualitative reflexive thematic analysis to capture advisory group perspectives and experiences.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n This study was funded in October 2024. As of January 31, 2026, we enrolled 7 participants, and the results are expected to be published in the fall of 2026.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The findings will support the development of a culturally appropriate DMHI for BD for additional linguistic communities, advance cultural adaptation methodologies, and inform preparation for a future clinical trial. This study will produce the first culturally adapted, BD-specific DMHI developed through co-design using a community-based participatory research approach with multilingual end users from traditionally underserved communities, advancing equitable access, engagement, and scalability of DMHIs for BD and digital health care more broadly.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/92600","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T08:10:07Z","timestamp":1772784607000},"page":"e92600-e92600","source":"Crossref","is-referenced-by-count":0,"title":["Cultural Adaptation of a Digital Mobile App for Bipolar Disorder (PolarUs): Protocol for a Qualitative Co-Design Study"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8557-3542","authenticated-orcid":false,"given":"Leena W","family":"Chau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8613-4429","authenticated-orcid":false,"given":"Jill K","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6179-1983","authenticated-orcid":false,"given":"Emma","family":"Morton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6045-2119","authenticated-orcid":false,"given":"Martin D","family":"Provencher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5663-4454","authenticated-orcid":false,"given":"Delphine","family":"Raucher-Chene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8953-3011","authenticated-orcid":false,"given":"Steven J","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0812-6527","authenticated-orcid":false,"given":"Erin E","family":"Michalak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"R1","unstructured":"Bipolar disorder. World Health Organization. Sep 8, 2025. URL: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/bipolar-disorder [Accessed 20-03-2026]"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1001\/archgenpsychiatry.2011.12","article-title":"Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative","volume":"68","author":"Merikangas","journal-title":"Arch Gen Psychiatry"},{"issue":"4","key":"R3","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1111\/bdi.13016","article-title":"Bipolar disorder: trimodal age-at-onset distribution","volume":"23","author":"Bolton","journal-title":"Bipolar Disord"},{"key":"R4","unstructured":"Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association; 2022. URL: https:\/\/psychiatryonline.org\/doi\/book\/10.1176\/appi.books.9780890425787 [Accessed 12-09-2014] ISBN: 9780890425756"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.01.026","article-title":"What does quality of life refer to in bipolar disorders research? A systematic review of the construct\u2019s definition, usage and measurement","volume":"212","author":"Morton","journal-title":"J Affect Disord"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2024.101135","article-title":"Bipolar disorders: an update on critical aspects","volume":"48","author":"Oliva","journal-title":"Lancet Reg Health Eur"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s40271-015-0128-x","article-title":"Patient-important outcomes in the long-term treatment of bipolar disorder: a mixed-methods approach investigating relative preferences and a proposed taxonomy","volume":"9","author":"Eiring","journal-title":"Patient"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.06.057","article-title":"Effective self-management strategies for bipolar disorder: a community-engaged Delphi Consensus Consultation study","volume":"206","author":"Michalak","journal-title":"J Affect Disord"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/bdi.12609","article-title":"Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder","volume":"20","author":"Yatham","journal-title":"Bipolar Disord"},{"issue":"3","key":"R10","doi-asserted-by":"publisher","first-page":"350","DOI":"10.5498\/wjp.v14.i3.350","article-title":"Digital psychiatry in low-and-middle-income countries: new developments and the way forward","volume":"14","author":"Chakrabarti","journal-title":"World J Psychiatry"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.jaac.2025.02.018","article-title":"Racial and ethnic disparities in treatment of youth with bipolar disorders","volume":"65","author":"Fontanella","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"6","key":"R12","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1111\/bdi.12638","article-title":"Racial disparities in bipolar disorder treatment and research: a call to action","volume":"20","author":"Akinhanmi","journal-title":"Bipolar Disord"},{"issue":"11","key":"R13","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1177\/0004867416668790","article-title":"An ISBD perspective on the sociocultural challenges of managing bipolar disorder: a content analysis","volume":"50","author":"Oedegaard","journal-title":"Aust N Z J Psychiatry"},{"issue":"10027","key":"R14","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1016\/S0140-6736(15)00241-X","article-title":"Bipolar disorder","volume":"387","author":"Grande","journal-title":"Lancet"},{"issue":"10","key":"R15","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1001\/archgenpsychiatry.2011.113","article-title":"Absolute risk of suicide after first hospital contact in mental disorder","volume":"68","author":"Nordentoft","journal-title":"Arch Gen Psychiatry"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s40273-014-0250-y","article-title":"Cost-of-illness studies for bipolar disorder: systematic review of international studies","volume":"33","author":"Jin","journal-title":"Pharmacoeconomics"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.09.011","article-title":"The economic burden of bipolar I disorder in the United States in 2015","volume":"226","author":"Cloutier","journal-title":"J Affect Disord"},{"issue":"9","key":"R18","doi-asserted-by":"publisher","first-page":"399","DOI":"10.3928\/00485713-20190808-01","article-title":"Beyond pharmacotherapy for bipolar disorder: the role of adjunctive psychological treatments","volume":"49","author":"Fletcher","journal-title":"Psychiatr Ann"},{"issue":"6","key":"R19","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/S2215-0366(17)30096-2","article-title":"Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature","volume":"4","author":"Naslund","journal-title":"Lancet Psychiatry"},{"issue":"8","key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4581","article-title":"Mobile apps for bipolar disorder: a systematic review of features and content quality","volume":"17","author":"Nicholas","journal-title":"J Med Internet Res"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-022-00256-6","article-title":"Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management","volume":"10","author":"Morton","journal-title":"Int J Bipolar Disord"},{"issue":"8","key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/36213","article-title":"Supporting self-management and quality of life in bipolar disorder with the PolarUs App (Alpha): protocol for a mixed methods study","volume":"11","author":"Michalak","journal-title":"JMIR Res Protoc"},{"issue":"12","key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/27991","article-title":"The extent of user involvement in the design of self-tracking technology for bipolar disorder: literature review","volume":"8","author":"Majid","journal-title":"JMIR Ment Health"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/42719","article-title":"Barriers to and facilitators of digital health among culturally and linguistically diverse populations: qualitative systematic review","volume":"25","author":"Whitehead","journal-title":"J Med Internet Res"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-020-00202-4","article-title":"Digital health developments and drawbacks: a review and analysis of top-returned apps for bipolar disorder","volume":"8","author":"Lagan","journal-title":"Int J Bipolar Disord"},{"issue":"3","key":"R26","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1136\/eb-2018-102891","article-title":"Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements","volume":"21","author":"Torous","journal-title":"Evid Based Ment Health"},{"issue":"7","key":"R27","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1111\/j.1399-5618.2010.00865.x","article-title":"Development of the QoL.BD: a disorder-specific scale to assess quality of life in bipolar disorder","volume":"12","author":"Michalak","journal-title":"Bipolar Disord"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.70096","article-title":"Empowering quality of life monitoring and self-management in bipolar disorder: pilot evaluation of the PolarUs app","volume":"28","author":"Michalak","journal-title":"Bipolar Disord"},{"issue":"10","key":"R29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0001017","article-title":"What influences engagement with a bipolar disorder self-management app? A qualitative investigation of use of the PolarUs app","volume":"4","author":"Morton","journal-title":"PLOS Digit Health"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.04.107","article-title":"The experience of self-monitoring using the PolarUs bipolar disorder self-management app: a qualitative report of impacts and unmet needs","volume":"383","author":"Morton","journal-title":"J Affect Disord"},{"issue":"4","key":"R31","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1037\/a0016401","article-title":"Cultural adaptation of treatments: a resource for considering culture in evidence-based practice","volume":"40","author":"Bernal","journal-title":"Prof Psychol Res Pr"},{"key":"R32","unstructured":"WHOQOL: measuring quality of life. World Health Organization. URL: https:\/\/www.who.int\/toolkits\/whoqol [Accessed 20-01-2026]"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-2-40","article-title":"A conceptual framework for implementation fidelity","volume":"2","author":"Carroll","journal-title":"Implement Sci"},{"issue":"6","key":"R34","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1002\/cpp.1804","article-title":"What do service users with bipolar disorder want from a web-based self-management intervention? A qualitative focus group study","volume":"20","author":"Todd","journal-title":"Clin Psychol Psychother"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","DOI":"10.2196\/45409","article-title":"Cultural responsivity in technology-enabled services: integrating culture into technology and service components","volume":"25","author":"Eustis","journal-title":"J Med Internet Res"},{"issue":"4","key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/resprot.8810","article-title":"Cultural and contextual adaptation of an eHealth intervention for youth receiving services for first-episode psychosis: adaptation framework and protocol for Horyzons-Canada Phase 1","volume":"7","author":"Lal","journal-title":"JMIR Res Protoc"},{"issue":"3","key":"R37","doi-asserted-by":"publisher","DOI":"10.2196\/18848","article-title":"Digital mental health and COVID-19: using technology today to accelerate the curve on access and quality tomorrow","volume":"7","author":"Torous","journal-title":"JMIR Ment Health"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","DOI":"10.2196\/25456","article-title":"It Is Time to REACT: opportunities for digital mental health apps to reduce mental health disparities in racially and ethnically minoritized groups","volume":"8","author":"Friis-Healy","journal-title":"JMIR Ment Health"},{"key":"R39","unstructured":"What languages do we speak in the United States? United States Census Bureau. 2022. URL: https:\/\/www.census.gov\/library\/stories\/2022\/12\/languages-we-speak-in-united-states.html?utm_source=chatgpt.com [Accessed 20-01-2026]"},{"key":"R40","unstructured":"The great Canadian language mash-up. Statistics Canada. 2025. URL: https:\/\/www.statcan.gc.ca\/o1\/en\/plus\/7869-great-canadian-language-mash?utm_source=chatgpt.com [Accessed 20-01-2026]"},{"issue":"7","key":"R41","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1037\/amp0000167","article-title":"Community-based participatory research (CBPR): towards equitable involvement of community in psychology research","volume":"73","author":"Collins","journal-title":"Am Psychol"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-016-0045-5","article-title":"Harnessing the potential of community-based participatory research approaches in bipolar disorder","volume":"4","author":"Michalak","journal-title":"Int J Bipolar Disord"},{"issue":"4","key":"R43","doi-asserted-by":"publisher","DOI":"10.2196\/13493","article-title":"Supporting self-management in bipolar disorder: mixed-methods knowledge translation study","volume":"6","author":"Michalak","journal-title":"JMIR Ment Health"},{"issue":"1","key":"R44","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/BF01447045","article-title":"Ecological validity and cultural sensitivity for outcome research: issues for the cultural adaptation and development of psychosocial treatments with Hispanics","volume":"23","author":"Bernal","journal-title":"J Abnorm Child Psychol"},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.1186\/s13031-020-00290-0","article-title":"No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings","volume":"14","author":"Perera","journal-title":"Confl Health"},{"key":"R46","doi-asserted-by":"publisher","DOI":"10.2196\/39206","article-title":"\u201cI haven\u2019t been diagnosed, but I should be\u201d\u2014Insight into self-diagnoses of common mental health disorders: cross-sectional study","volume":"7","author":"Rutter","journal-title":"JMIR Form Res"},{"key":"R47","unstructured":"UBC survey tool. The University of British Columbia. URL: https:\/\/it.ubc.ca\/services\/teaching-learning-tools\/survey-tool [Accessed 20-03-2026]"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/26895269.2022.2129597","article-title":"Toward good practice in thematic analysis: avoiding common problems and be(com)ing a researcher","volume":"24","author":"Braun","journal-title":"Int J Transgend Health"},{"issue":"3","key":"R49","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s11135-021-01182-y","article-title":"A worked example of Braun and Clarke\u2019s approach to reflexive thematic analysis","volume":"56","author":"Byrne","journal-title":"Qual Quant"},{"issue":"3","key":"R50","doi-asserted-by":"publisher","first-page":"214","DOI":"10.5014\/ajot.45.3.214","article-title":"Rigor in qualitative research: the assessment of trustworthiness","volume":"45","author":"Krefting","journal-title":"Am J Occup Ther"},{"key":"R51","unstructured":"Lincoln YS Guba EG . Naturalistic Inquiry. Sage Publications; 1985. URL: https:\/\/books.google.co.in\/books?id=2oA9aWlNeooC [Accessed 20-03-2026] ISBN: 9780803924314"},{"key":"R52","unstructured":"NVivo. Lumivero. URL: https:\/\/lumivero.com\/products\/nvivo\/ [Accessed 07-11-2025]"},{"key":"R53","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2020.12.016","article-title":"The emergence of digital mental health in low-income and middle-income countries: a review of recent advances and implications for the treatment and prevention of mental disorders","volume":"133","author":"Carter","journal-title":"J Psychiatr Res"},{"key":"R54","unstructured":"World mental health report: transforming mental health for all. World Health Organization; 2022. URL: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/40e5a13a-fe50-4efa-b56d-6e8cf00d5bfa\/content [Accessed 11-11-2025]"},{"issue":"2","key":"R55","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1002\/wps.21299","article-title":"The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality","volume":"24","author":"Torous","journal-title":"World Psychiatry"},{"issue":"1","key":"R56","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1017\/S0033291714000129","article-title":"What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies","volume":"45","author":"Clement","journal-title":"Psychol Med"},{"issue":"3","key":"R57","doi-asserted-by":"publisher","first-page":"127","DOI":"10.3928\/00485713-20230215-02","article-title":"Deconstructing cultural aspects of mental health care in Hispanic\/Latinx people","volume":"53","author":"Forc\u00e9n","journal-title":"Psychiatr Ann"},{"issue":"1","key":"R58","doi-asserted-by":"publisher","DOI":"10.1080\/20008066.2025.2514327","article-title":"Mental health help-seeking behaviours of East Asian immigrants: a scoping review","volume":"16","author":"Park","journal-title":"Eur J Psychotraumatol"},{"issue":"1","key":"R59","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1177\/2374373518769008","article-title":"Impact of language barriers on quality of care and patient safety for official language minority Francophones in Canada","volume":"6","author":"de Moissac","journal-title":"J Patient Exp"},{"issue":"10","key":"R60","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1037\/ccp0000759","article-title":"Culturally adapted digital mental health interventions for ethnic\/racial minorities: a systematic review and meta-analysis","volume":"90","author":"Ellis","journal-title":"J Consult Clin Psychol"},{"key":"R61","doi-asserted-by":"publisher","DOI":"10.1038\/s44184-023-00025-y","article-title":"Examining equity in access and utilization of a freely available meditation app","volume":"2","author":"Jiwani","journal-title":"NPJ Ment Health Res"},{"issue":"2","key":"R62","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.jaac.2024.02.017","article-title":"Scoping review: digital mental health interventions for children and adolescents affected by war","volume":"64","author":"Danese","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"10","key":"R63","doi-asserted-by":"publisher","DOI":"10.2196\/35538","article-title":"User behavior of a publicly available, free-to-use, self-guided mHealth app for depression: observational study in a global sample","volume":"6","author":"Su","journal-title":"JMIR Form Res"},{"key":"R64","doi-asserted-by":"publisher","DOI":"10.2196\/59965","article-title":"Current practice and expert perspectives on cultural adaptations of digital health interventions: qualitative study","volume":"13","author":"Nittas","journal-title":"JMIR mHealth uHealth"},{"issue":"2","key":"R65","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1111\/j.1524-4733.2005.04054.x","article-title":"Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation","volume":"8","author":"Wild","journal-title":"Value Health"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e92600","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:15:55Z","timestamp":1782839755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e92600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":65,"URL":"https:\/\/doi.org\/10.2196\/92600","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]},"article-number":"v15i3e92600"}}