Kayoko Takahashi

Occupation-based practice (OBP) is central to occupational therapy, yet its implementation remains inconsistent. This study translated and culturally adapted the OBP Measure into Japanese and evaluated its psychometric properties in 351 occupational therapists. Content validity, structural validity, internal consistency, test–retest reliability, measurement error, and measurement invariance were examined. Content validity was excellent (S-CVI = .97). Confirmatory factor analysis of the revised 33-item model showed mixed fit. Internal consistency was acceptable for four subscales, whereas Interest in OBP showed inadequate internal consistency and relatively weak test–retest reliability. Total-score test–retest reliability was high (ICC = 0.87), with an MDC ₉₅ of 1.94. Configural and metric invariance were supported across career stages, whereas scalar invariance was not fully supported. Overall, the OBPM-J showed promising psychometric properties, although its structural validity, Interest in OBP subscale, total-score interpretation, and comparability across career stages require further investigation.

In client-centred occupational therapy, enabling clients to set personally meaningful goals is considered critical to the success of interventions [1,2]. Goal setting has been shown to enhance clie...

Background: Completion rates for smoking cessation treatments under Japan’s national health insurance system remain suboptimal. A workplace cessation program, combining nicotine gum or patches with a group-based digital peer-supported app, has reported high cessation success rates. Although nicotine dependence is generally associated with lower cessation success, and self-confidence is generally associated with higher success, these associations may differ by tobacco product type. Evidence on these relationships in app-based cessation programs remains limited. Objective: This study aimed to examine the independent and combined associations of nicotine dependence and self-confidence in quitting with smoking cessation success among cigarette-only smokers, heated tobacco product–only users, and dual users. Methods: This retrospective cohort study used data from a workplace cessation program in Japan. Participants were eligible if they were employed, owned a smartphone, and self-enrolled in the program. Recruitment was conducted through workplace promotion and individual outreach, primarily via email from companies. The program combined a digital peer-support app with nicotine gum or patches, adjusted according to cigarette consumption. The app included anonymous peer-support group chats of up to 5 participants, where participants shared progress, photos, and comments. Nicotine dependence was assessed by the time to the first cigarette after waking (high: ≤30 min; low: >30 min). Self-confidence for quitting was rated on a 0‐10 scale and dichotomized at the median. A 4-level variable combined nicotine dependence and self-confidence for quitting. Logistic regression analyses were conducted by tobacco product type, and odds ratios (ORs) and 95% CIs were estimated. Results: A total of 2143 participants were included in the analysis. Their mean age was 46.5 (SD 10.9) years, and approximately 90% were men. Overall cessation success was 53.8% (1152/2143). Participants with high self-confidence had a higher cessation success rate than those with low self-confidence (529/834, 63.4% vs 623/1309, 47.6%), with an OR of 1.81 (95% CI 1.55‐2.12). Nicotine dependence was significantly associated with cessation success only among cigarette-only smokers; those with low nicotine dependence had a higher OR than those with high dependence (OR 1.59, 95% CI 1.07‐2.37). Across all tobacco product types, the subgroup with low nicotine dependence and high self-confidence showed the highest cessation success, followed by the subgroup with high nicotine dependence but high self-confidence. Conclusions: By distinguishing cigarette-only smokers, heated tobacco product–only users, and dual users in a workplace cessation program, this study provides novel, product-specific evidence regarding nicotine dependence and self-confidence related to cessation success. This study extends prior research beyond cigarette-only smokers by examining tobacco user groups and suggests that self-confidence may predict cessation across tobacco product types, whereas the role of nicotine dependence may be product-specific. These findings may inform tailored, scalable smoking-cessation support in workplaces; however, they should be interpreted with caution because cessation outcomes were self-reported.

Background: In recent years, artificial intelligence (AI) systems have increasingly been used to assess emotional states in health care. AI offers a safe, quick, user-friendly, and objective emotional evaluation method. However, evidence supporting its implementation in health care remains limited. Objective: This study aimed to explore the concurrent validity and test-retest reliability of emotion recognition AI based on facial expressions. Methods: In this study, we used the Kokoro Sensor, an accurate and widely recognized automated facial expression recognition system. The Japanese version of the Profile of Mood States–Short Form was used to screen the potential influence of mental states on facial expressions. The study participants made positive, negative, and neutral expressions, which were analyzed by the emotion recognition AI. Agreement between the results of the AI and subjective evaluations was assessed by participants and a researcher using a 4-point Likert-type scale. The facial expressions and emotion analysis process were repeated after a 30-minute interval to investigate reliability. Concurrent validity was evaluated using the content validity index (CVI) and κ coefficient, and test-retest reliability was determined using the κ coefficient. Results: The study participants were 40 individuals whose mental states did not deviate from the reference range of the Profile of Mood States manual. Among the participants, the CVI values for positive, neutral, and negative expressions were 95%, 98%, and 85%, respectively. Among the researchers, the corresponding CVI values were 100%, 100%, and 70%, respectively. The overall weighted κ coefficient was 0.55 (CI 0.44‐0.67), indicating moderate agreement. The agreement was almost perfect for distinguishing positive from neutral expressions (κ=0.83, 95% CI 0.70‐0.95) but not statistically significant for distinguishing negative from neutral expressions (κ=0.15, 95% CI –0.07 to 0.37). Test-retest reliability analysis showed an overall weighted κ coefficient of 0.66, reflecting substantial reliability. Almost perfect agreement was observed for distinguishing positive from neutral expressions (κ=0.85, 95% CI 0.73‐0.97), while distinguishing negative from neutral expressions showed limited reliability (κ=0.36, 95% CI 0.16‐0.57). Conclusions: Our findings suggest that the Kokoro Sensor may be useful for identifying positive affect, given its acceptable concurrent validity for overall valence estimation and its high agreement for distinguishing positive from neutral expressions. However, concurrent validity for negative expressions did not meet the prespecified benchmark based on the researcher’s ratings, and agreement for distinguishing negative from neutral expressions was limited, which may constrain clinical utility for detecting negative affect. Therefore, in clinical settings, the Kokoro Sensor should be used as an assistive tool rather than a stand-alone method.

Background: Physical activity is a simple, low-risk intervention that could be integrated into daily life to improve glycemic control in individuals with prediabetes and early-stage type 2 diabetes mellitus (T2DM). However, maintaining physical activity remains challenging, even when its benefits are well understood. Although digital peer support has the potential to promote and maintain physical activity, its effectiveness has not yet been sufficiently established. Objective: This study examined the impact of a digital peer-supported app on daily step goal achievement and average daily step counts among individuals with prediabetes and early-stage T2DM. Methods: This 3-month, prospective, nonrandomized controlled trial recruited participants aged 40-79 years with prediabetes or early-stage T2DM. The participants were divided into a digital peer-supported app group and a control group. The digital peer-supported app group tracked their daily steps, shared their progress with small peer groups, and received real-time feedback and support within the app. The control group tracked their steps individually using a pedometer. The primary outcome was the achievement rate of daily step goals. Secondary outcomes included the average daily step count, BMI, glycosylated hemoglobin A1c level, blood pressure, and self-reported lifestyle behaviors. Results: A total of 32 participants (digital peer-supported app group: n=18 and control group: n=14) completed the study. The digital peer-supported app group reported a significantly higher median daily step goal achievement rate (57.2%, IQR 32.2%-90% vs 26.7%, IQR 10%-64.4%; P=.04) and daily step count (6854, IQR 4846-10388 steps vs 3946, IQR 3176-6832 steps; P<.03) compared to the control group. No significant differences were observed in glycosylated hemoglobin A1c levels, blood pressure, BMI, or lifestyle behaviors. Conclusions: Our findings inform research in this field by suggesting that a digital peer-supported app may support daily step goal achievement and increase step counts among individuals with prediabetes and early-stage T2DM over the 3-month study period. The digital peer-supported app facilitated real-time feedback, peer approval, and continuous engagement to support participation in light physical activity. Trial Registration: UMIN-CTR UMIN000039466; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044999

Background: Occupational therapy has highlighted the necessity for planning and executing interventions in collaboration with clients, families, and caregivers to facilitate their progress. Thus, in pediatric occupational therapy, it is essential to position the family as a primary client and to actively involve them in the intervention process. These interventions often incorporate tools that facilitate parental engagement in home-based activities. However, no tools have been specifically designed to support parents comprehensively in achieving their parenting goals in everyday situations. To address this gap, we developed a mobile app called the Children’s Occupation Support Mobile System (COSMO) to support occupational therapists, children, and parents in a collaborative manner to achieve intervention goals in daily life. Objective: The aim of the study is to develop the COSMO and validate its content in terms of legibility, visibility, and accessibility. Methods: This study was conducted in two stages: (1) designing a prototype of COSMO and (2) validating its content using the Delphi method. The prototype was developed based on a conceptual model of parenting strategies, which was derived from interviews with mothers raising children with developmental disabilities. This study included 10 Japanese pediatric occupational therapists, who were selected using convenience sampling to ensure diversity and heterogeneity in attributes. The Delphi survey was conducted entirely through a web-based questionnaire emailed to the experts. Participants rated their agreement with each item on a 5-point Likert scale. A mean item score of ≥3.75 (75%) indicated consensus. Results: The prototype was designed through a series of 13 one-hour meetings held monthly. The functional framework of COSMO was structured into four core components based on previous research: (1) collaborative goal setting, (2) home strategy—an action plan to achieve goals, (3) self-reflection—a record of implemented strategies, and (4) progress reports—data storage for tracking outcomes. For validating the content, the 2 Delphi rounds resulted in a total mean score of 4.44 for legibility, 4.86 for visibility, and 4.84 for accessibility. In the free-text responses, there were references to improvements in the wording and to the burden of writing the reflections. Therefore, the wording was revised to avoid jargon and use plain language. The burden of COSMO use was reduced by simplifying the use process by incorporating optional inputs for some of its functions. Conclusions: COSMO was developed as a comprehensive tool to integrate functions while aiming to reduce the burden on parents. This may reduce resistance to app use and make it easier for more parents to use it. Future studies should evaluate the generalizability and effectiveness of the prototype as an intervention. Limitations of this study include the absence of end-user testing, a geographically limited expert panel, and a limited discussion of implementation challenges across diverse health care settings.

Background: Smoking cessation has become a global priority, with peer support interventions shown to improve abstinence rates. However, no studies have examined the effectiveness of a group-based digital peer-supported app combined with nicotine gum for smoking cessation among working populations. Objective: This study aimed to assess whether adding a digital peer-supported app to standard nicotine gums improves 12-week smoking abstinence rates among current working smokers in employment-based settings. Methods: A nonrandomized comparison trial was conducted with current working smokers in Japan. Eligible participants smoked at least 1 cigarette per day, owned a smartphone (iOS or Android), and were enrolled in their company’s health insurance program. Participants were self-selected into one of the two intervention groups (digital peer-supported app + nicotine gums) or a control group (nicotine gums only). The digital peer-supported app creates a group chat for up to 5 people aimed at smoking cessation, where participants can anonymously post counts, photos, and comments daily. Logistic regression analyses adjusted for demographic and smoking-related variables were used to estimate the odds ratios for smoking cessation. Engagement with the app (usage days and posting frequency) was analyzed within the intervention groups. Results: A total of 451 participants were included in the per-protocol analysis (260 in the intervention groups and 191 in the control group). The 12-week abstinence rate was significantly higher in the digital peer-supported app + nicotine gum group compared to the gum-only group (59.2% [154/260] vs 38.7% [74/191]). The adjusted odds ratio of smoking cessation was 2.41 (95% CI 2.07‐2.81), indicating a significant impact of digital peer support. Both higher duration of digital peer-supported app usage and increased posting frequency were positively associated with cessation success (P for trend <.001). Conclusions: The addition of a digital peer-supported app to nicotine gum use significantly improved smoking cessation outcomes among working smokers. These findings provide preliminary evidence for the feasibility and effectiveness of integrating group-based digital peer support into smoking cessation interventions.

Background: Smoking cessation plans under Japan’s national health insurance system are hindered by low completion and success rates. A small-group intervention combining nicotine replacement therapy with digital peer support demonstrated improved smoking cessation success outcomes. However, the extent to which the type of tobacco products used affects the program’s efficacy remains unclear. Objective: This study aimed to evaluate the differences in smoking cessation success rates among cigarette-only smokers, heated tobacco product (HTP)–only users, and individuals who use both (dual smokers), following a group-based intervention combining nicotine replacement therapy and a digital peer–supported app. Methods: A prospective study involved smokers from Japanese workplaces who owned smartphones. Participants received free nicotine replacement therapy (either patches or gum) and access to a digital peer support app. This app facilitated anonymous group chats (up to 5 participants) to encourage interactions and smoking cessation efforts by sharing activity reports, including photos and comments. Participants were classified into 3 groups: cigarette-only smokers, HTP-only users, and dual smokers. Logistic regression analysis was conducted to compare cessation success rates, with cigarette-only smokers being the reference group (odds ratios [ORs] and 95% CIs). Results: A total of 435 participants were included in the final analysis, comprising 163 cigarette-only smokers (37.5%), 218 HTP-only users (50.1%), and 54 dual smokers (12.4%). The participants had a mean age of 46.6 (SD 10.1) years, with a predominant male representation (416/435, 95.6%) and a significant proportion (296/435, 68.1%) having more than 20 years of smoking history. The smoking cessation success rate was significantly higher among HTP-only users than among cigarette-only smokers (63.3% vs 52.8%; adjusted OR 1.84, 95% CI 1.57‐2.16). Conversely, dual smokers exhibited a nonsignificantly lower success rate than cigarette-only smokers (48.1% vs 52.8%; adjusted OR 0.96, 95% CI 0.79‐1.16). Conclusions: A group-based smoking cessation program using a digital peer support app yielded higher success rates among HTP-only users than among cigarette-only smokers. However, no significant differences were found in dual smokers. These findings highlight the importance of considering tobacco product type in workplace cessation programs.

Background: Controlling glycated hemoglobin (HbA_1c) levels can be challenging for patients with type 2 diabetes mellitus (T2DM). Peer support promotes HbA_1c control, and a digital peer-supported app designed for group interactions may enable patients with T2DM to encourage one another to achieve better HbA_1c outcomes. However, no studies have investigated the use of digital peer-supported apps to control HbA_1c levels in patients with T2DM. Objective: This pilot study aimed to explore the effects of a digital peer-supported app on HbA_1c control in patients with T2DM. Methods: This prospective single-arm pilot study enrolled patients with T2DM who owned smartphones and visited medical institutions in Japan. During the 3-month intervention, participants used a digital peer-supported app in addition to receiving standard care. This app allowed participants to share activity logs and concerns via a chat function to improve HbA_1c levels through mutual engagement and encouragement. The primary outcome was the change in HbA_1c levels, measured at health care facilities at baseline and after 3 months. The secondary outcomes were body weight and blood pressure, with the most recent data obtained from hospitals and clinics. Physical activity (≥1 hour/day) was assessed at the same time points using a self-reported questionnaire. Results: The study included 21 participants with a median age of 56 (IQR 51‐61) years, of which 13 (61.9%) were female. After using the digital peer-supported app for 3 months, the participants’ HbA_1c levels significantly decreased from 7.1% (SD 0.6%) at baseline to 6.9% (SD 0.1%) (P=.04). Similarly, participants’ body weight decreased from 70.7 (SD 12.7) kg to 69.9 (SD 12.4) kg (P =.004) through app use. Although blood pressure decreased slightly from 128.2 (SD 12.5) mm Hg to 126.0 (SD 12.9) mm Hg, this change was not statistically significant (P=.20). Additionally, the proportion of participants engaged in ≥1 hour of daily physical activity significantly increased from 23.5% (n=4) to 58.5% (n=10) (P=.03). Conclusions: In addition to receiving standard clinical care, the use of a digital peer-supported app may significantly lower HbA_1c levels in patients with T2DM by promoting healthy behaviors.

BACKGROUND Physical activity is a simple, low-risk intervention that could be integrated into daily life to improve glycemic control in individuals with prediabetes and early-stage type 2 diabetes mellitus (T2DM). However, maintaining physical activity remains challenging, even when its benefits are well understood. Although digital peer support has the potential to promote and maintain physical activity, its effectiveness has not yet been sufficiently established. OBJECTIVE This study examined the impact of a digital peer-supported app on daily step goal achievement and average daily step counts among individuals with prediabetes and early-stage T2DM. METHODS This 3-month, prospective, nonrandomized controlled trial recruited participants aged 40-79 years with prediabetes or early-stage T2DM. The participants were divided into a digital peer-supported app group and a control group. The digital peer-supported app group tracked their daily steps, shared their progress with small peer groups, and received real-time feedback and support within the app. The control group tracked their steps individually using a pedometer. The primary outcome was the achievement rate of daily step goals. Secondary outcomes included the average daily step count, BMI, glycosylated hemoglobin A1c level, blood pressure, and self-reported lifestyle behaviors. RESULTS A total of 32 participants (digital peer-supported app group: n=18 and control group: n=14) completed the study. The digital peer-supported app group reported a significantly higher median daily step goal achievement rate (57.2%, IQR 32.2%-90% vs 26.7%, IQR 10%-64.4%; P=.04) and daily step count (6854, IQR 4846-10388 steps vs 3946, IQR 3176-6832 steps; P<.03) compared to the control group. No significant differences were observed in glycosylated hemoglobin A1c levels, blood pressure, BMI, or lifestyle behaviors. CONCLUSIONS Our findings inform research in this field by suggesting that a digital peer-supported app may support daily step goal achievement and increase step counts among individuals with prediabetes and early-stage T2DM over the 3-month study period. The digital peer-supported app facilitated real-time feedback, peer approval, and continuous engagement to support participation in light physical activity. CLINICALTRIAL UMIN-CTR UMIN000039466; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044999