Multiple Reasons Research Articles

Cause and Effect: Can Large Language Models Truly Understand Causality?

With the rise of Large Language Models (LLMs), it has become crucial to understand their capabilities and limitations in deciphering and explaining the complex web of causal relationships that language entails. Current methods use either explicit or implicit causal reasoning, yet there is a strong need for a unified approach combining both to tackle a wide array of causal relationships more effectively. This research proposes a novel architecture called Context-Aware Reasoning Enhancement with Counterfactual Analysis (CARE-CA) to enhance causal reasoning and explainability. The proposed framework incorporates an explicit causal detection module with ConceptNet and counterfactual statements, as well as implicit causal detection through LLMs. Our framework goes one step further with a layer of counterfactual explanations to accentuate LLMs' understanding of causality. The knowledge from ConceptNet enhances the performance of multiple causal reasoning tasks such as causal discovery, causal identification, and counterfactual reasoning. The counterfactual sentences add explicit knowledge of `not caused by' scenarios. By combining these powerful modules, our model aims to provide a deeper understanding of causal relationships, enabling enhanced interpretability. Evaluation of benchmark datasets shows improved performance across all metrics, such as accuracy, precision, recall, and F1 scores. We also present CausalNet, a novel dataset specifically curated to benchmark and enhance the causal reasoning capabilities of LLMs. This dataset is accompanied by code designed to facilitate further research in this domain.

Scaffolding Fifth Graders’ Learning with a Digital Multi-Representation Applet: Design Research on Focusing Multiplicative Structures with Dynamic Dot Arrays

AbstractDigital multi-representation applets offer promising opportunities for promoting students’ conceptual understanding by dynamically converting graphical and symbolic representations and for promoting discoveries and justifications of mathematical properties. However, learning effects of open-ended multi-representation applets seem to depend on targeted scaffolds for students’ processes of conversions, treatments, and conversions of treatments. While these design challenges have come to be well-understood for dynamic geometry and functions, more design research is needed for multi-representation applets for multiplicative reasoning. We report on a design research study in Grade 5 in which the multi-representation applet of a dynamic dot array was integrated into a digital teaching–learning environment with sequenced tasks and more targeted scaffolds. The qualitative analysis of 30 students’ processes revealed multiple potentials of the dynamic array to (a) connect static representations by articulating the underlying multiplicative unit structures (conversions), (b) describe systematic variations (coordinated treatments), (c) explain systematic variations in representations by articulating unit structures (conversions of variations), (d) discover multiplicative commutativity (treatments), and (e) go towards justifying multiplicative commutativity by restructuring the array and its unit structures (conversions of treatments). Design experiment Cycle 1 revealed that all potentials were partially addressed by some students. To enable students to exploit more of these multiple potentials, attention scaffolds and language scaffolds were integrated. In Cycle 2, more potentials were exploited while still leaving room for improvements. In total, the study shows how design research can contribute to embed multi-representation applets into teaching–learning environments with well-sequenced tasks and targeted scaffolds.

Chat2Data: An Interactive Data Analysis System with RAG, Vector Databases and LLMs

Traditional data analysis methods require users to write programming codes or issue SQL queries to analyze the data, which are inconvenient for ordinary users. Large language models (LLMs) can alleviate these limitations by enabling users to interact with the data with natural language (NL), e.g., result retrieval and summarization for unstructured data and transforming the NL text to SQL queries or codes for structured data. However, existing LLMs have three limitations: hallucination (due to lacking domain knowledge for vertical domains), high cost for LLM reasoning, and low accuracy for complicated tasks. To address these problems, we propose a prototype, Chat2Data, to interactively analyze the data with natural language. Chat2Data adopts a three-layer method, where the first layer uses Retrieval-Augmented Generation (RAG) to embed domain knowledge in order to address the hallucination problem, the second layer utilizes vector databases to reduce the number of interactions with LLMs so as to improve the performance, and the third layer designs a pipeline agent to decompose a complex task to multiple subtasks and use multiple round reasoning to generate the results in order to improve the accuracy of LLMs. We demonstrate Chat2Data with two real scenarios, unstructured data retrieval and summarization, and natural language-based structured data analysis. The online demo is available at http://vdemo.dbmind.cn.

KFEX-N : A table-text data question-answering model based on knowledge-fusion encoder and EX-N tree decoder

Answering questions about hybrid data combining tables and text is challenging. Recent research has employed encoder-tree decoder frameworks to simulate the reasoning process of arithmetic expressions for generating answers. However, this approach overlooks the inherent diversity of expressions; there might be multiple valid reasoning paths, leading to a decrease in the accuracy of inferred expression trees. Moreover, encoders, lacking rich domain knowledge, struggle to capture deep relationships between questions and supporting evidence; this limitation results in models making errors when selecting operation units. In this paper, we propose a Knowledge-Fusion encoder and EX-N tree decoder table-text data question-answering model(KFEX-N). During the encoding process, the integration of traditional encoders with cross-fusion encoders forms a knowledge-fusion encoder, endowing the model with rich domain knowledge and enhancing its understanding of the operational units required to answer questions. Additionally, we propose an EX-N tree decoder. It reduces the diversity of inference paths through a constrained structure and mitigates the occurrence of final answer errors resulting from decoding errors. We validate our model using publicly available Table-Text QA datasets (TAT-QA and Fin-QA) and achieve state-of-the-art performance.

Firearm ownership and storage practices among United States firefighters and emergency medical services personnel.

Compared with the general U.S. population, firefighters (FF) and emergency medical services (EMS) workers (FF + EMS personnel) are at increased risk for firearm suicide. Although secure firearm storage is associated with reduced risk of firearm suicide, no study has examined the prevalence and sociodemographic correlates of firearm ownership and storage practices among U.S. FF + EMS personnel. A total of 141 U.S. FF + EMS personnel completed a structured, web-based self-report questionnaire. Overall, 76.6% (n = 108) of FF + EMS personnel in our sample reported owning a personal firearm, among whom 85.2% (n = 92) reported owning more than one firearm. Among firearm owners, 42.6% (n = 46) reported secure firearm storage (i.e., unloaded and locked) and 57.4% (n = 62) reported nonsecure firearm storage (i.e., loaded and/or unlocked). FF + EMS personnel who cited personal safety as the only reason for firearm ownership, as opposed to reporting other or multiple reasons for ownership (e.g., hunting), were at increased odds of reporting nonsecure storage practices (69.4% vs. 47.5%; OR = 2.51, 95% CI [1.14, 5.55], p = .023). Most FF + EMS personnel in our sample reported firearm ownership, and approximately half of the firearm owners reported nonsecure firearm storage practices. Promoting secure firearm storage practices among FF + EMS personnel might decrease risk of firearm suicide and other forms of firearm-related injuries. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Novel insights into tumorigenesis revealed by molecular analysis of Lynch syndrome cases with multiple colorectal tumors.

Lynch syndrome (LS) is an autosomal dominant multi-organ cancer syndrome with a high lifetime risk of cancer. The number of cumulative colorectal adenomas in LS does not generally exceed ten, and removal of adenomas via routine screening minimizes the cancer burden. However, abnormal phenotypes may mislead initial diagnosis and subsequently cause suboptimal treatment. Currently, there is no standard guide for the care of multiple colorectal adenomas in LS individuals. We aimed to shed insight into the molecular features and reasons for multiplicity of adenomas in LS patients. We applied whole exome sequencing on nine adenomas (ten samples) and three assumed primary carcinomas (five samples) of an LS patient developing the tumors during a 21-year follow-up period. We compared the findings to the tumor profiles of two additional LS cases ascertained through colorectal tumor multiplicity, as well as to ten adenomas and 15 carcinomas from 23 unrelated LS patients with no elevated adenoma burden from the same population. As LS associated cancers can arise via several molecular pathways, we also profiled the tumors for CpG Island Methylator Phenotype (CIMP), and LINE-1 methylation. All tumors were microsatellite unstable (MSI), and MSI was present in several samples derived from normal mucosa as well. Interestingly, frequent frameshift variants in RNF43 were shared among substantial number of the tumors of our primary case and the tumors of LS cases with multiple tumors but almost absent in our control LS cases. The RNF43 variants were completely absent in the normal tissue, indicating tumor-associated mutational hotspots. The RNF43 status correlated with the mutational signature SBS96. Contrary to LS tumors from the reference set with no elevated colorectal tumor burden, the somatic variants occurred significantly more frequently at C>T in the CpG context, irrespective of CIMP or LINE-1 status, potentially indicating other, yet unknown methylation-related mechanisms. There were no signs of somatic mosaicism affecting the MMR genes. Somatic variants in APC and CTNNB1 were unique to each tumor. Frequent somatic RNF43 hot spot variants combined with SBS96 signature and increased tendency to DNA methylation may contribute to tumor multiplicity in LS.

Reasoning with Two Types of Multiplicative Units Structures in Solving Middle-Grade Mathematics Problems

ABSTRACT In the present study, we illuminate students’ multiplicative reasoning in the context of their units-coordinating activity. Of particular interest is to investigate students’ use of three levels ofunits as given material for problem-solving activity, which we regard as supporting a more advanced level of multiplicative reasoning. Among 13 middle school students with whom we have conducted clinical interviews, this study focuses on eight students who conceived fractions with three levels of units and reports their units-coordinating activities in solving diverse middle-grade level problems. The result of the study indicates that the ability to coordinate two multiplicative units structures was an evident characteristic by which we classified them into two distinctive groups. Specifically, two students outperformed the other students in solving advanced equal sharing and bar transformation problems by the coordination of two explicitly multiplicative units structures and in representing a multiplicative relationship between two unknown quantities by the coordination of two implicitly multiplicative units structures. The findings suggest that the ability to use the coordinated result of two multiplicative units structures needs to be attended to as a sophisticated form of multiplicative reasoning, which we believe potentially undergirds students’ advanced mathematical learning beyond elementary school.

(151) Knowledge, Attitude, and Practice of Nursing and Midwifery Students Regarding Sexually Transmitted Infections

Abstract Introduction Sexually transmitted infections (STIs) are a global health problem. Nursing and obstetrics students are the future workers whose role in health education and promotion is undeniable. Hence we became interested in evaluating their knowledge of STIs. Objective The aim of our study was to assess the knowledge, attitude, and practice of nursing and midwifery students regarding sexually transmitted diseases. Methods This was a prospective, cross-sectional, quantitative, and descriptive study, conducted in the Higher Institute of Nursing Sciences of Tunis (ISSIT) and the Higher Institute of Health Sciences and Techniques of Tunis (ESSTST) over the period of to months (March 1st, 2022 to April 30, 2022). The target population of our study included 568 students. The information was collected via a self-administered questionnaire. Results Our study population sample was mainly composed of women (72%) versus 28% men. The average age of our sample was 21 years old. The majority of students (95%) have already heard of STIs. The main source of information was the academic background of these students (79%), followed by the media (15%) and only 1% comes from the family circle. Students rated their knowledge as fairly good and good in 37% and 34% of cases, respectively. Only 5% admitted having very good knowledge and 2% with zero knowledge. For their knowledge of the modes of transmission of STIs: 98.4% retained vaginal penetration, 69.1% for anal penetration against 40.7% for oral sex. The best-known germ was the human immunodeficiency virus (HIV) (87.8%) followed closely by syphilis (82.9%). The least known agent was Neisseria Gonorrhoeae (Gonococcus), identified only in 28.4% of cases. 65% of the students recognized syphilis as a bacterial infection. However, 34.1% of students in the sample did not know that it can be associated with HIV infection. Most students (52.8%) had no information regarding HPV infection and only a minority of 18.7% knew that there is an HPV vaccine. 7% already had sex and the medium age of their first sexual intercourse was 18, With an average of 1.33 partners during the last 12 months. Only 2% of them had used a condom during their first sexual intercourse with a new partner. 43%had justified the nonuse of condoms with decreased feelings of pleasure, 29% get embarrassed to purchase it, 14%had some difficulties using it, and 14% did not use a condom because they simply wanted to get pregnant. 75%had the intention to use a condom during their first sexual intercourse while 25% did not. Conclusions The knowledge of health students regarding sexually transmitted infections needs a boost in order to improve the involvement of awareness of the whole population. Besides, they are not taking the necessary measures to avoid sexually transmitted infections for multiple reasons and the lack of knowledge might be the main cause. Disclosure No.

Reasons for past abortions among women in treatment for opioid use disorder.

The main reasons women in the general population seek abortion are financial, timing, and partner-related reasons. While women with opioid use disorder (OUD) appear to use abortion services more than women in the general population, reasons for abortion in this group have not been examined to our knowledge. Female patients aged 18-50 years in OUD treatment at 22 randomly selected facilities in Michigan were surveyed. The survey included items assessing reproductive health history. Women who reported having one or more abortions were asked to think back to that time and their reasons for choosing abortion. Twenty potential reasons and a write-in option were offered; women could endorse as many as applied. Of 260 women surveyed, 84 reported having an abortion. Of these, most (77.4%) reported multiple reasons for having an abortion. The most common reasons for having an abortion were not having money to take care of a baby (54.8%), feeling too young to have a child and not feeling ready to be a mother (both 42.9%), not loving the father and other partner-related concerns (25.0%-32.1%), and having concerns about the effects of their drug use (28.6%). No combination of reasons for abortion emerged as more prevalent than any other. Like women in the general population, women in treatment for OUD had not only abortions because of financial, timing, and partner-related reasons but also concerns about the effects of their drug use. These results underscore the multiple and often interrelated reasons that lead women to seek abortion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Muscle-building supplement β-hydroxy β-methylbutyrate stimulates the maturation of oligodendroglial progenitor cells to oligodendrocytes.

Oligodendrocytes are the myelinating cells in the CNS and multiple sclerosis (MS) is a demyelinating disorder that is characterized by progressive loss of myelin. Although oligodendroglial progenitor cells (OPCs) should be differentiated into oligodendrocytes, for multiple reasons, OPCs fail to differentiate into oligodendrocytes in MS. Therefore, increasing the maturation of OPCs to oligodendrocytes may be of therapeutic benefit for MS. The β-hydroxy β-methylbutyrate (HMB) is a muscle-building supplement in humans and this study underlines the importance of HMB in stimulating the maturation of OPCs to oligodendrocytes. HMB treatment upregulated the expression of different maturation markers including PLP, MBP, and MOG in cultured OPCs. Double-label immunofluorescence followed by immunoblot analyses confirmed the upregulation of OPC maturation by HMB. While investigating mechanisms, we found that HMB increased the maturation of OPCs isolated from peroxisome proliferator-activated receptor β-/- (PPARβ-/-) mice, but not PPARα-/- mice. Similarly, GW6471 (an antagonist of PPARα), but not GSK0660 (an antagonist of PPARβ), inhibited HMB-induced maturation of OPCs. GW9662, a specific inhibitor of PPARγ, also could not inhibit HMB-mediated stimulation of OPC maturation. Furthermore, PPARα agonist GW7647, but neither PPARβ agonist GW0742 nor PPARγ agonist GW1929, alone increased the maturation of OPCs. Finally, HMB treatment of OPCs led to the recruitment of PPARα, but neither PPARβ nor PPARγ, to the PLP gene promoter. These results suggest that HMB stimulates the maturation of OPCs via PPARα and that HMB may have therapeutic prospects in remyelination.

Research activity among diagnostic and therapeutic radiographers: An international survey

IntroductionVarious national solutions have been considered and implemented to address the factors which limit radiographer engagement in conducting research. Nevertheless, national literature continues to suggest that radiographer engagement in research remains low. The aim of this study was to extend the existing evidence base by conducting an international survey to assess diagnostic radiographers and therapeutic radiographers involvement with, barriers to and support mechanisms for research. MethodsData collection was obtained via an online questionnaire which was distributed by the International Society of Radiographers and Radiologic Technologists (ISRRT). The study population included an international sample of qualified diagnostic radiographers and therapeutic radiographers across clinical and academic contexts in a variety of different roles such as clinical practice, management, education and research. ResultsIn total, 420 diagnostic radiographers and therapeutic radiographers completed the survey. Multiple reasons were identified that were considered to inhibit respondents from conducting research. 69.3% indicated a combination of reasons for lack of engagement with research, rather than one single issue. Examples of reasons include: lack of time, insufficient research funding, limited research expertise, and lack of a suitable mentorship scheme. ConclusionA minor segment of survey respondents indicated involvement in research activity. Lack of dedicated time to research, mentors, and funding were among the main barriers to conduct research. Further research is required to explore what solutions are available to overcoming the barriers.

Wound care in hard-to-reach populations: rough sleepers.

People sleeping rough commonly develop wounds and other skin disorders. Wounds vary and develop for multiple reasons. They include acute wounds such as burns, infected injection sites, abscesses and cellulitis, as well as chronic wounds such as pressure ulcers; rough sleepers have a high prevalence of lower limb wounds. Skin and soft tissue infections are common, especially in people who inject drugs via subcutaneous or intramuscular routes. Emergency departments are often the pathways into healthcare for homeless people as traditional health and care systems often fail to meet their needs. Across England, initiatives have been developed to improve access to wound care for those who sleep rough. A case study illustrates the care of a homeless man presenting with a lower limb wound.

Semantic and style based multiple reference learning for artistic and general image aesthetic assessment

Artistic Image Aesthetic Assessment (AIAA) is an emerging paradigm that predicts the aesthetic score as the popular aesthetic taste for an artistic image. Previous AIAA takes a single image as input to predict the aesthetic score of the image. However, most existing AIAA methods fail dramatically to predict the artistic images with a large variance of artistic subjective voting with only a single image. People are good at employing multiple similar references for making relative comparisons. Motivated by the practice that people considers similar semantics and specific artistic style to keep the consistency of the voting result, we present a novel Semantic and Style based Multiple Reference learning (SSMR) to mimic this natural process. Our novelty is mainly two-fold: (a) Similar Reference Index Generation (SRIG) module that considers artistic attribution of semantics and style to generate the index of reference images; (b) Multiple Reference Graph Reasoning (MRGR) module that employs graph convolutional network (GCN) to initialize and reason by adjusting the weight of edges with intrinsic relationships among multiple images. Our evaluation with the benchmark BAID, VAPS and TAD66K artistic aesthetic datasets demonstrates that the proposed SSMR outperforms state-of-the-art AIAA methods, and verifies the comparable to the SOTA IAA methods on the AVA general aesthetic dataset.

Super-additive cooperation

Repeated interactions provide an evolutionary explanation for one-shot human cooperation that is counterintuitive but orthodox1–3. Intergroup competition4–7 provides an explanation that is intuitive but heterodox. Here, using models and a behavioural experiment, we show that neither mechanism reliably supports cooperation. Ambiguous reciprocity, a class of strategies that is generally ignored in models of reciprocal altruism, undermines cooperation under repeated interactions. This finding challenges repeated interactions as an evolutionary explanation for cooperation in general, which further challenges the claim that repeated interactions in the past can explain one-shot cooperation in the present. Intergroup competitions also do not reliably support cooperation because groups quickly become extremely similar, which limits scope for group selection. Moreover, even if groups vary, group competitions may generate little group selection for multiple reasons. Cooperative groups, for example, may tend to compete against each other8. Whereas repeated interactions and group competitions do not support cooperation by themselves, combining them triggers powerful synergies because group competitions constrain the corrosive effect of ambiguous reciprocity. Evolved strategies often consist of cooperative reciprocity with ingroup partners and uncooperative reciprocity with outgroup partners. Results from a behavioural experiment in Papua New Guinea fit exactly this pattern. They thus suggest neither an evolutionary history of repeated interactions without group competition nor a history of group competition without repeated interactions. Instead, our results suggest social motives that evolved under the joint influence of both mechanisms.

Ten tips to make difficult conversations easier

Academia offers plenty of rewarding pleasures; consider commencement, award ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less rewarding academic duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

Ten tips to make difficult conversations easier

Academia offers plenty of rewarding pleasures, including commencement, awards ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less rewarding academic duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

10 tips to make difficult conversations easier

Academia offers plenty of rewarding pleasures; consider commencement, award ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less rewarding academic duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

Barcoding Fails to Delimit Species in Mongolian Oedipodinae (Orthoptera, Acrididae).

Mongolia, a country in central Asia, with its vast grassland areas represents a hotspot for Orthoptera diversity, especially for the Acrididae. For Mongolia, 128 Acrididae species have been documented so far, of which 41 belong to the subfamily Oedipodinae (band-winged grasshoppers). Yet, few studies concerning the distribution and diversity of Oedipodinae have been conducted in this country. Molecular genetic data is almost completely absent, despite its value for species identification and discovery. Even, the simplest and most used data, DNA barcodes, so far have not been generated for the local fauna. Therefore, we generated the first DNA barcode data for Mongolian band-winged grasshoppers and investigated the resolution of this marker for species delimitation. We were able to assemble 105 DNA barcode (COI) sequences of 35 Oedipodinae species from Mongolia and adjacent countries. Based on this data, we reconstructed maximum likelihood and Bayesian inference phylogenies. We, furthermore, conducted automatic barcode gap discovery and used the Poisson tree process (PTP) for species delimitation. Some resolution was achieved at the tribe and genus level, but all delimitation methods failed to differentiate species by using the COI region. This lack of resolution may have multiple possible reasons, which likely differ between taxa: the lack of resolution in the Bryodemini may be partially explained by their massive genomes, implying the potential presence of large numbers of pseudogenes, while within the Sphingonotini incomplete lineage sorting and incorrect taxonomy are more likely explanations for the lack of signal. Further studies based on a larger number of gene fragments, including nuclear DNA, are needed to distinguish the species also at the molecular level.

Stimuli-responsive magnetic silica-poly-lactic-co-glycolic acid hybrid nanoparticles for targeted cancer chemo-immunotherapy.

Chemotherapy and immunotherapy are two important modalities in cancer management. However, due to multiple reasons, a monotherapy is only partially effective. Hence, if used concurrently in targeted and stimuli-responsive manner, it could have been superior therapeutically. To facilitate co-delivery of chemotherapeutic and immunotherapeutic agent to the target cancer cells, engineered nanoparticles, i.e., a pH-responsive polymer PLGA-coated magnetic silica nanoparticles (Fe3O4-SiO2-PLGA-PDA-PTX-siRNA NPs) encapsulating paclitaxel (PTX) and siRNA against programmed cell death ligand-1 (PD-L1) are synthesized and characterized. Developed nanoparticles demonstrated pH-sensitive sustained drug release up to 10 days. In vitro 4T1 cell line studies showed efficient cellular uptake, PD-L1 gene downregulation, and apoptosis. Further, in vivo efficacy studies carried out in the mice model demonstrated a significant reduction of tumor growth following treatment with dual-Fe3O4-SiO2-PLGA-PDA-PTX-siRNA NPs as compared with monotherapy with Fe3O4-SiO2-PLGA-PDA-PTX NPs. The high therapeutic efficacy observed with dual-Fe3O4-SiO2-PLGA-PDA-PTX-siRNA NPs was mainly due to the cytotoxic effect of PTX combined with targeted silencing of the gene of interest, i.e., PD-L1, which in turn improve CD8+ T cell-mediated cancer cell death as evident with increased proliferation of CD8+ T cells in co-culture experiments. Thereby, dual-Fe3O4-SiO2-PLGA-PDA-PTX-siRNA NPs may have a promising anti-cancer treatment potential against breast cancer; however, the beneficial effects of dual loading of PTX + PD-L1 siRNA may be corroborated against other cancer models such as lung and colorectal cancer models as well as in clinical trials.

Between Rhetoric and Reality: Real-world Barriers to Uptake and Early Engagement in Digital Mental Health Interventions

Digital mental health interventions (DMHIs) have potential to provide effective and accessible care to entire populations, but low client uptake and engagement are significant problems. Few prior studies explore the lived experiences of non-engagers, because reaching this population is inherently difficult. We present an observational inquiry into the barriers to sign-up and early use of a DMHI, along with reasons for initial interest in the DMHI. We collected 205 online questionnaire responses and 20 interviews from self-referring participants across four healthcare ecosystems in the UK and US. Questionnaire results revealed that uncertainty about DMHI usefulness and usability were the main barriers to uptake, whereas forgetting about it, not finding time for it and not finding it useful were the main barriers to early engagement. Participants reported multiple reasons for considering the DMHI, reflecting the contextual, subjective nature of mental health. Our thematic analysis generated themes around (1) the need for human connection, (2) the impact of self-stigma on help-seeking, (3) the lack of knowledge around DMHIs and psychological therapy, (4) the desire for personally relevant care, and (5) the fluctuating, perennial nature of mental health. We discuss implications for DMHI design, implementation and future research, as well as transdisciplinary opportunities.