José Côté

Background and aims: Cannabis use is highly prevalent among young adults with first‐episode psychosis (FEP) and is associated with poorer clinical and functional outcomes. Mobile health interventions may help address structural barriers to delivering cannabis‐focused psychosocial interventions within early intervention services (EIS), yet little is known about how such tools are experienced and integrated into routine care. This study explored young adults with FEP and clinician experiences of two cannabis‐focused mobile interventions, iCanChange (iCC) and Cannabis Harm‐reducing App to Manage Practices Safely (CHAMPS), with a particular focus on implementation within EIS. Design: Qualitative exploratory study using semi‐structured individual interviews. Data were analysed using a reflexive thematic approach informed by the integrated Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework. Setting: Six EIS programs in Canada (five in Quebec and one in Nova Scotia). Participants: Twenty‐eight young adults aged 18–35 years with FEP who participated in the intervention arms of the iCC or CHAMPS pilot randomized controlled trials, and 17 EIS clinicians from multiple professional backgrounds. Measurements: Semi‐structured interviews explored experiences of app use, perceived benefits and challenges, contextual influences, clinician involvement and factors affecting engagement and integration within EIS. Themes were mapped to the i‐PARIHS domains of innovation, recipients, context and facilitation. Findings: Participants generally perceived both mobile interventions as acceptable, relevant and well aligned with the daily realities of young adults with FEP. The apps' accessibility, flexibility and non‐judgmental approach supported self‐reflection, autonomy and increased awareness of cannabis use. However, engagement was shaped by individual motivation, psychosis‐related symptoms, competing life and treatment priorities and, for some, app‐related challenges, including content‐related concerns and technical issues that interfered with use. Clinician involvement was widely viewed as beneficial for sustaining engagement and supporting reflection, yet was inconsistently implemented due to time constraints, limited familiarity with app content and uncertainty regarding clinicians' roles. Conclusions: Cannabis‐focused mobile interventions appear to be acceptable and relevant complements to standard early intervention service care for psychosis. Their successful implementation depends not only on usability, but also on active facilitation, clear clinician role definitions and adaptive integration strategies that align with real‐world constraints within early intervention services.

Background: Continued cannabis use among young people with first-episode psychosis (FEP) has been linked to poorer clinical and functional outcomes (eg, increased symptom severity and higher relapse rates). Digital harm-reduction interventions may represent a promising, person-centered approach to reduce at-risk cannabis use behaviors in this population. However, evidence remains limited regarding which subgroups are more likely to engage with these interventions and whether specific levels of engagement are required to achieve more favorable cannabis-related outcomes. Objective: This exploratory, hypothesis-generating analysis of the CHAMPS (Cannabis Harm-Reducing App to Manage Practices Safely) pilot randomized controlled trial (RCT) evaluated a cannabis harm-reduction mobile app for youth with FEP in early intervention services (EIS). The objectives of this study were to assess engagement by examining associations between selected sociodemographic factors and module completion and to determine whether achieving specific completion thresholds was associated with improvements in cannabis-related outcomes. Methods: Cannabis-related outcomes (Marijuana Problems Scale [MPS], Protective Behavioral Strategies for Marijuana [PBSM] scores, and days of cannabis use) were self-assessed at baseline and at week 6 (primary end point), week 12, and week 18 (postrandomization). Participants were categorized into low to moderate (0‐4 modules) and high (5‐6 modules) completion groups, and selected sociodemographic factors were compared between groups using bivariate analyses. Mixed-effects models, adjusted for baseline values and the covariates sex and cannabis use disorder (CUD) status, were fitted to evaluate whether module thresholds were associated with improvements in cannabis-related outcomes. Results: Data from 96 participants, including 46 in the CHAMPS+EIS arm and 50 in the EIS-only arm (1:1 ratio), were analyzed under a modified intention-to-treat principle. Individuals in the high-engagement group reported higher baseline social support and higher educational level ( P =.005 and P =.01). No statistically significant associations were observed between specific module completion thresholds and cannabis-related outcomes in adjusted mixed-effects models. Conclusions: Participants with higher social support and higher education were more likely to engage with CHAMPS. Although descriptive analyses suggested a potential gradient of improvement with increasing module completion, no specific completion threshold was robustly associated with improvements in outcomes. Given the multifactorial nature of engagement, supporting subgroups at risk of lower app use and examining metrics beyond module completion may enhance the impact of CHAMPS. These findings are hypothesis-generating, given their exploratory nature, and require replication in a future efficacy trial.

Background: Cannabis use (CU) among young adults continues to be an important public health issue. Interventions to support lower-risk CU during young adulthood can improve health outcomes. Mobile applications constitute a promising mode of service delivery. However, there is a lack of evidence-based apps specifically developed for young adult cannabis users. Objective: This study aimed to evaluate the acceptability of a novel mobile app intervention (Joint Effort) and to assess the feasibility and outcome responsiveness of the study procedures used. Methods: A pilot study with a parallel-group randomized trial design was conducted with Canadian-based university students aged 18‐30 years reporting using cannabis ≥1 day in the past month. Participants were randomly assigned on a 1:1 ratio to either an experimental group (EG) involving the use of the Joint Effort mobile app or to a control group (CG) involving a web-based brief normative feedback message. The Joint Effort mobile app was designed to support CU self-management. This theory-informed behavior change intervention aims to reinforce the use of protective behavioral strategies by targeting intention, attitude, social norms, and self-efficacy. The app’s acceptability was assessed via uptake, engagement, and appreciation. The feasibility of study procedures was assessed via recruitment time, recruitment rate, and attrition rate. Outcome responsiveness was informed by participant-reported outcomes: CU frequency, intention to take action on CU, protective behavioral strategies use, severity of dependence, and psychological distress. All data were collected using a web-based survey at baseline, one-month (T1), and 2-month (T2) postbaseline. Descriptive analyses were carried out on all outcomes. Results: The recruitment period lasted 124 days, and the recruitment rate was 56% (99/178). The final dataset analyzed included 80 participants (39 in EG and 41 in CG). Mean age was 23.4 (SD 2.6) years, and 66% (53/80) self-identified as women. Study attrition was 18% (14/80). User uptake of the Joint Effort app (ie, proportion of participants in the EG who downloaded the app) was estimated at 59% (23/39), and the average time spent on it per participant was 8.2 minutes (SD 7.3; median 7.5, IQR 5.7). The app obtained a mean total score on the User Engagement Scale-Short Form of 3.8/5 (SD 0.5) and a mean app quality total score of 4.2/5 (SD 0.5) on the end user version of the Mobile App Rating Scale. The proportion of participants who reported daily CU in the past month decreased from 13% (5/39) at baseline to 4% (1/24) at T2 in the EG and from 7% (3/41) to 6% (2/36) in the CG. Conclusions: Joint Effort appears to be a promising, acceptable, and scalable mobile app to help young adult cannabis users who wish to better manage their CU. Findings should inform future randomized controlled trials to assess the efficacy of this mobile-based intervention for cannabis users.

BACKGROUND Comprehensive sexuality education (CSE) is essential to the health and well-being of young people. In the Democratic Republic of Congo, where 65% of the population is under the age of 25, access to interpersonal CSE remains limited owing to sociocultural and structural barriers. This exposes young people to persistent social and health vulnerabilities. In this context, mobile health apps (MHAs) constitute a promising solution, supported by the growing use of smartphones among young Congolese. However, this group’s intention to use MHAs for CSE has been the subject of little research to date. OBJECTIVE The aim of this study was to identify predictors of intention to use MHAs for CSE among school-attending young people in Bukavu, Democratic Republic of Congo, based on an adapted version of the extended Unified Theory of Acceptance and Use of Technology (UTAUT2). METHODS A predictive correlational study was conducted in 8 public secondary schools in Bukavu, Democratic Republic of Congo, with a stratified random sample of 859 students. Predictors of intention to use—performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), and perceived risk (PR)—and moderators—age, sex, and past MHA experience—were measured from data collected through a self-administered UTAUT questionnaire. Descriptive and multivariate analyses were performed using SPSS software (version 28; IBM Corp). RESULTS The mean age of participants was 16.3 years (SD 1.5). Male students represented 55.1% (473/859) of the sample. Overall, 51.0% (438/859) of participants owned a smartphone; among smartphone owners, 62.3% (273/438) reported having easy access to mobile data, and 16.2% (139/859) of the total sample were already using MHAs to learn about sexual health. Intention to use MHAs for CSE was positively associated with PE (β=.412; B=0.428, 95% CI 0.342-0.513; P<.001), EE (β=.098; B=0.078, 95% CI 0.028-0.128; P=.002), and SI (β=.131; B=0.100, 95% CI 0.052-0.149; P<.001). FC (P=.289) and PR (P=.682) were not significantly associated with intention to use MHAs for CSE. Age (β=–.063; P=.044) and sex (β=.101; P=.009) moderated the relationship between PE and intention to use MHAs for CSE. The final model explained 44.7% of the variance. CONCLUSIONS Intention to use digital CSE among school-attending young people was explained primarily by PE, EE, and SI, while the relationship between PE and intention was moderated by age and sex. To strengthen this intention, stakeholders should promote digital health behavior change interventions for CSE that are useful, easy to use, socially valued, and tailored to school-attending young people’s needs and the local context.

Introduction: A growing body of literature suggests that medication errors (MEs) result from a complex interaction of factors related to inadequate medication management systems or from human factors and staffing shortages. Research has identified several significant associations between MEs and nurse staffing indicators, but the evidence is moderate and varies considerably across studies. Most of this research has been conducted in the United States. Few studies have been undertaken in Canada. Objective: The purpose of this study was to demonstrate the feasibility of using an innovative data warehouse to assess the association of nurse staffing indicators with MEs in a Canadian context. Methods: A correlational design was used to examine retrospective data (2019–2021) from an innovative data warehouse (LEPSI) located in a university hospital center in a metropolitan area. Specifically, 94,145 patient files, 8368 employee profiles, and 2813 MEs were analyzed. A generalized linear mixed model was used to model the relationship between nurse staffing indicators and MEs, with confounding variables controlled. Results: A significant association emerged between lower odds of ME occurrence and, respectively, higher ratios of clinical nurse (bachelor’s degree) and nurse technician (professional/vocational diploma) hours to overall care team member hours (OR: 0.46, 95% CI: 0.32–0.66, p < 0.001) and higher ratios of clinical nurse hours to care team hours (OR: 0.41, 95% CI: 0.31–0.54, p < 0.001). No evidence emerged to support an association between MEs and, respectively, higher ratios of overall care team hours to overall patient hours (OR: 1.01, 95% CI: 0.83–1.24, p = 0.890) and higher ratios of care team overtime hours to care team hours (OR: 0.71, 95% CI: 0.47–1.06, p = 0.097). Conclusions: Results proved consistent with the literature, thus confirming the feasibility of using the LEPSI data warehouse for nursing performance measurement. The use of a data warehouse to assess the association between nurse staffing indicators and MEs constitutes a promising approach for generating evidence to inform decision making related to patient safety.

Introduction: Young adults (aged 18–39) diagnosed with cancer often turn to cannabis to manage symptoms such as pain, anxiety, or cachexia. However, few educational interventions exist to train oncology nurses in supporting the safe use of cannabis in this population. Methods: We conducted a two-arm pilot randomized controlled trial (1:1) to evaluate the feasibility and preliminary effects of a digital educational intervention grounded in the Theory of Planned Behavior. Nurses were randomized to either the intervention group ( n = 35) or an active control group ( n = 35). Feasibility outcomes included recruitment and retention rates, intervention uptake, module completion, participant engagement (eg, log-ins, time spent), and questionnaire completion. Nurses' knowledge, attitudes, self-efficacy, and intention to support safe cannabis use were measured at baseline and 1 month after randomization. Descriptive statistics summarized feasibility outcomes and sociodemographics; outcome changes were assessed using linear mixed effects models. Results: Participants were mostly over 40 years old (60%) and 74% held a bachelor's degree. Of 70 participants enrolled, 57 completed the 1-month follow-up. In the intervention group, 89% (31/35) completed the full intervention. The intention to support safe cannabis use significantly increased in the intervention group compared to controls ( P = .016). Discussion: This digital educational intervention demonstrated strong feasibility and preliminary effectiveness in enhancing nurses' intention to support safe cannabis use. Findings support the value of tailored, theory-informed educational strategies in oncology nursing and suggest the potential for scaling up in a larger trial.