Subjects -> HEALTH AND SAFETY (Total: 1464 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (686 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (358 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (112 journals)
    - PHYSICAL FITNESS AND HYGIENE (117 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH AND SAFETY (686 journals)                  1 2 3 4 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 1)
ACM Transactions on Computing for Healthcare     Hybrid Journal  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 2)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11)
Advances in Public Health     Open Access   (Followers: 30)
Adversity and Resilience Science : Journal of Research and Practice     Hybrid Journal   (Followers: 3)
African Health Sciences     Open Access   (Followers: 7)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 3)
Ageing & Society     Hybrid Journal   (Followers: 40)
Aging and Health Research     Open Access   (Followers: 3)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 10)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
Akademika     Open Access  
American Journal of Family Therapy     Hybrid Journal   (Followers: 6)
American Journal of Health Economics     Full-text available via subscription   (Followers: 25)
American Journal of Health Education     Hybrid Journal   (Followers: 36)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Sciences     Open Access   (Followers: 11)
American Journal of Health Studies     Full-text available via subscription   (Followers: 14)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 34)
American Journal of Public Health     Full-text available via subscription   (Followers: 208)
American Journal of Public Health Research     Open Access   (Followers: 31)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 9)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 10)
Annals of Health Law     Open Access   (Followers: 7)
Applied Biosafety     Hybrid Journal   (Followers: 2)
Applied Ergonomics     Hybrid Journal   (Followers: 18)
Apuntes Universitarios     Open Access   (Followers: 1)
Archives of Community Medicine and Public Health     Open Access   (Followers: 2)
Archives of Medicine and Health Sciences     Open Access   (Followers: 5)
Archives of Suicide Research     Hybrid Journal   (Followers: 11)
Archivos de Prevención de Riesgos Laborales     Open Access  
ASA Monitor     Full-text available via subscription   (Followers: 18)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 7)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 4)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 11)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 5)
Asian Journal of Medicine and Health     Open Access   (Followers: 1)
Asian Journal of Population Sciences     Open Access   (Followers: 9)
Asian Journal of Social Health and Behavior     Open Access   (Followers: 3)
Atención Primaria     Open Access   (Followers: 2)
Atención Primaria Práctica     Open Access  
Australasian Journal of Paramedicine     Open Access   (Followers: 8)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 15)
Bijzijn XL     Hybrid Journal  
Biograph-I : Journal of Biostatistics and Demographic Dynamic     Open Access   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 7)
Biosafety and Health     Open Access  
Biosalud     Open Access  
Birat Journal of Health Sciences     Open Access  
BLDE University Journal of Health Sciences     Open Access   (Followers: 1)
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
Brazilian Journal of Medicine and Human Health     Open Access  
British Journal of Health Psychology     Hybrid Journal   (Followers: 52)
Buletin Penelitian Kesehatan     Open Access  
Buletin Penelitian Sistem Kesehatan     Open Access  
Cadernos de Educação, Saúde e Fisioterapia     Open Access  
Cadernos de Saúde     Open Access  
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 13)
Canadian Family Physician     Partially Free   (Followers: 14)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 16)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 26)
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 1)
Carta Comunitaria     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
CASUS : Revista de Investigación y Casos en Salud     Open Access  
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
CES Salud Pública     Open Access  
Child and Adolescent Obesity     Open Access   (Followers: 3)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
Children     Open Access  
Chinese Journal of Physiology     Open Access   (Followers: 3)
CHRISMED Journal of Health and Research     Open Access   (Followers: 1)
Christian Journal for Global Health     Open Access   (Followers: 1)
Ciencia & Salud     Open Access  
Ciencia & Trabajo     Open Access  
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia y Salud     Open Access   (Followers: 1)
Ciencia, Tecnología y Salud     Open Access  
Cities & Health     Hybrid Journal   (Followers: 5)
Cleaner and Responsible Consumption     Open Access  
Clinical and Experimental Health Sciences     Open Access   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
Clocks & Sleep     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
Community Health     Open Access   (Followers: 6)
Conflict and Health     Open Access   (Followers: 8)
Contact (CTC)     Open Access  
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
Cuaderno de investigaciones: semilleros andina     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 10)
Current Opinion in Environmental Science & Health     Hybrid Journal  
D Y Patil Journal of Health Sciences     Open Access   (Followers: 4)
Das österreichische Gesundheitswesen ÖKZ     Hybrid Journal  
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Design for Health     Hybrid Journal   (Followers: 1)
Digital Health     Open Access   (Followers: 11)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 12)
Discover Social Science and Health     Open Access   (Followers: 5)
Diversity and Equality in Health and Care     Open Access   (Followers: 10)
Diversity of Research in Health Journal     Open Access   (Followers: 1)
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Open Access   (Followers: 2)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 23)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 25)
EcoHealth     Hybrid Journal   (Followers: 5)
Education for Health     Open Access   (Followers: 9)
electronic Journal of Health Informatics     Open Access   (Followers: 7)
ElectronicHealthcare     Full-text available via subscription   (Followers: 2)
Emerging Trends in Drugs, Addictions, and Health     Open Access   (Followers: 1)
Ensaios e Ciência : Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 3)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 7)
EsSEX : Revista Científica     Open Access  
Estudios sociales : Revista de alimentación contemporánea y desarrollo regional     Open Access  
Ethics & Human Research     Hybrid Journal   (Followers: 4)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 7)
Ethiopian Journal of Health Development     Open Access   (Followers: 7)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 6)
Ethnicity & Health     Hybrid Journal   (Followers: 16)
Eurasian Journal of Health Technology Assessment     Open Access   (Followers: 1)
EUREKA : Health Sciences     Open Access  
European Journal of Health Communication     Open Access  
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 5)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 11)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Exploratory Research in Clinical and Social Pharmacy     Open Access  
Expressa Extensão     Open Access  
F&S Reports     Open Access  
Face à face     Open Access  
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Hybrid Journal   (Followers: 13)
Family Medicine and Community Health     Open Access   (Followers: 8)
Family Relations     Partially Free   (Followers: 11)
FASEB BioAdvances     Open Access  
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 3)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 10)
Food Hydrocolloids for Health     Open Access  
Food Quality and Safety     Open Access   (Followers: 2)
Frontiers in Digital Health     Open Access   (Followers: 4)
Frontiers in Neuroergonomics     Open Access  
Frontiers in Public Health     Open Access   (Followers: 8)
Frontiers of Health Services Management     Partially Free   (Followers: 6)
Gaceta Sanitaria     Open Access   (Followers: 2)
Galen Medical Journal     Open Access  
Ganesha Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access   (Followers: 1)
Gestão e Desenvolvimento     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 7)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Advances in Health and Medicine     Open Access  
Global Challenges     Open Access   (Followers: 2)
Global Health : Science and Practice     Open Access   (Followers: 7)
Global Health Annual Review     Open Access   (Followers: 2)
Global Health Innovation     Open Access   (Followers: 4)
Global Health Journal     Open Access   (Followers: 2)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 5)
Global Journal of Public Health     Open Access   (Followers: 16)
Global Medical & Health Communication     Open Access   (Followers: 1)
Global Mental Health     Open Access   (Followers: 13)
Global Reproductive Health     Open Access  
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Global Transitions     Open Access   (Followers: 1)
Global Transitions Proceedings     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 7)
Hacia la Promoción de la Salud     Open Access  
Hastane Öncesi Dergisi     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HCU Journal     Open Access  
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 22)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 19)
Health and Human Rights     Open Access   (Followers: 10)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 63)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 5)
Health Behavior Research     Open Access   (Followers: 2)
Health Care Analysis     Hybrid Journal   (Followers: 12)
Health Equity     Open Access   (Followers: 4)
Health Information : Jurnal Penelitian     Open Access  
Health Information Management Journal     Hybrid Journal   (Followers: 26)
Health Notions     Open Access  

        1 2 3 4 | Last

Similar Journals
Journal Cover
Digital Health
Number of Followers: 11  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2055-2076 - ISSN (Online) 2055-2076
Published by Sage Publications Homepage  [1175 journals]
  • The experience of family caregivers of ventilator-assisted individuals who
           participated in a pilot web-based peer support program: A qualitative
           study

    • Authors: Marina B. Wasilewski, Kristina M. Kokorelias, Mika Nonoyama, Craig Dale, Douglas A McKim, Jeremy Road, David Leasa, Anu Tandon, Roger Goldstein, Louise Rose
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionFamily caregivers play an important role supporting the day-to-day needs of ventilator-assisted individuals (VAIs) living at home. Peer-to-peer communication can help support these caregivers and help them sustain caregiving in the community. Online peer-support has been suggested as a way to help meet caregivers’ support needs.MethodsA qualitative descriptive approach was used to elicit the perspectives of support received from caregivers who participated in a pilot web-based peer support program from October to December 2018. Data were collected through the transcripts of weekly online peer-to-peer group chats. Data were analyzed using an integration of thematic and framework analysis.ResultsIn total, eight caregivers and five peer mentors participated in the pilot. All five mentors and four of the caregivers participated in the weekly chats. We identified three themes, a) The experience of caregivers is characterized by unique challenges related to the complexity of VAI care including technology; b) Mentors and caregiver participants reciprocally share support; c) Despite hardships, there are things that make caregiving easier and joyful.DiscussionOur results add to the growing body of evidence pointing to the importance of online communities for supporting vulnerable caregivers. The reciprocal element of peer support, where trained mentors and untrained participants both benefit from support, can help sustain peer-support interventions. Despite the challenges of providing care to a VAI, there are facilitators that may help ease the caregiving experience and caregivers can benefit from ongoing support that is tailored to their needs along the caregiving trajectory.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-25T08:06:27Z
      DOI: 10.1177/20552076221134964
      Issue No: Vol. 8 (2022)
       
  • Assessing medical students’ perceived stress levels by comparing a
           chatbot-based approach to the Perceived Stress Questionnaire (PSQ20) in a
           mixed-methods study

    • Authors: Julia-Astrid Moldt, Teresa Festl-Wietek, Amir Madany Mamlouk, Anne Herrmann-Werner
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveDigital transformation in higher education has presented medical students with new challenges, which has increased the difficulty of organising their own studies. The main objective of this study is to evaluate the effectiveness of a chatbot in assessing the stress levels of medical students in everyday conversations and to identify the main condition for accepting a chatbot as a conversational partner based on validated stress instruments, such as the Perceived Stress Questionnaire (PSQ20).MethodsIn this mixed-methods research design, medical-student stress level was assessed using a quantitative (digital- and paper-based versions of PSQ20) and qualitative (chatbot conversation) study design. PSQ20 items were also shortened to investigate whether medical students’ stress levels can be measured in everyday conversations. Therefore, items were integrated into the chat between medical students and a chatbot named Melinda.ResultsPSQ20 revealed increased stress levels in 43.4% of medical students who participated (N  =  136). The integrated PSQ20 items in the conversations with Melinda obtained similar subjective stress degree results in the statistical analysis of both PSQ20 versions. Qualitative analysis revealed that certain functional and technical requirements have a significant impact on the expected use and success of the chatbot.ConclusionThe results suggest that chatbots are promising as personal digital assistants for medical students; they can detect students’ stress factors during the conversation. Increasing the chatbot's technical and social capabilities could have a positive impact on user acceptance.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-23T05:57:58Z
      DOI: 10.1177/20552076221139092
      Issue No: Vol. 8 (2022)
       
  • The role of digital health in palliative care for people living with HIV
           in sub-Saharan Africa: A systematic review

    • Authors: Christopher Mwase, Kennedy Nkhoma, Mathew J Allsop
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundIn 2018, 26.6 million people were living with HIV in sub-Saharan Africa. Palliative care services are recommended for people living with HIV at all stages from diagnosis through to end-of-life. However, the provision of palliative care in sub-Saharan Africa is limited, leading to little or no access for the majority of patients. Digital technologies in sub-Saharan Africa present an opportunity to improve access to palliative care for people living with HIV in the region. This review synthesised literature on digital health interventions for palliative care for people living with HIV in sub-Saharan Africa and assessed their effects on patient outcomes.MethodsLiterature searches were conducted in MEDLINE, Embase, PsycINFO and Global Health. Inclusion and exclusion criteria were applied. Two independent reviewers conducted study screening, data extraction and quality appraisal. A narrative synthesis was performed to draw together and report findings across heterogeneous studies. Reporting of this review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist.ResultsOut of 4117 records, 25 studies were included, covering 3592 people living with HIV, across 21 countries. Studies included three randomised controlled trials, three qualitative, three pre- and post-test, two observational, two case series, six cross-sectional and six mixed methods studies. Telemedicine was the most reported digital health intervention, with 12 studies demonstrating the effectiveness of digital health interventions.ConclusionEmerging evidence suggests digital health interventions can be effective in facilitating patient-provider communication and health professional decision-making as a part of palliative care for people living with HIV. There is a need for further development and evaluation of digital health interventions alongside determining optimal approaches to their implementation as a part of palliative care provision in sub-Saharan Africa.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-23T05:56:39Z
      DOI: 10.1177/20552076221133707
      Issue No: Vol. 8 (2022)
       
  • HRQoL and nutritional well-being dissimilarities between two different
           online collection methods: Value for digital health implementation

    • Authors: Andrea Higuera-Gomez, Rosa Ribot-Rodriguez, Rodrigo San-Cristobal, Roberto Martín-Hernández, Victor Mico, Isabel Espinosa-Salinas, Ana Ramirez de Molina, J Alfredo Martinez
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundOnline health data collection has gained a reputation over the last years to record and process information about health issues for implementing digital health.ObjectiveThe research aim was to appraise two online methods (open and rewarded) to collect information about HRQoL and nutritional well-being and to compare the results between both surveyed populations.MethodsThis cross-sectional study is framed on the NUTRiMDEA project. Online data through two different web-based methods (open survey and rewarded survey) were retrieved to assemble data related to sociodemographic, lifestyle (diet, physical activity and sleep patterns) and general health aspects, as well as HRQoL by an evidence-based form such as the SF-12 questionnaire, the IPAQ survey, and MEDAS-14, participants were adults (>18 years old).ResultsOverall, 17,332 participants responded to the open survey (OS, n = 11,883) or the rewarded survey (RS, n = 5449). About 65.1% of the participants were female, while the mean age was in the range of 40–70 years. There were significant differences (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-23T05:33:35Z
      DOI: 10.1177/20552076221138316
      Issue No: Vol. 8 (2022)
       
  • eHealth literacy of patients attending a primary care clinic in Malaysia
           and its associated factors: A cross-sectional study

    • Authors: Swee Shiuan Wong, Hooi Min Lim, Adrian Jian Zhi Chin, Felicia Wen Si Chang, Kah Chun Yip, Chin Hai Teo, Adina Abdullah, Chirk Jenn Ng
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPeople are overloaded with online health information (OHI) of variable quality. eHealth literacy is important for people to acquire and appraise reliable information to make health-related decisions. While eHealth literacy is widely studied in developed countries, few studies have been conducted among patients in low- and middle-income countries (LMICs).ObjectiveWe aimed to determine the level of eHealth literacy in patients attending a primary care clinic in Malaysia and its associated factors.MethodsA cross-sectional study using a self-administered questionnaire was conducted in an urban primary care clinic. We used a systematic random sampling method to select patients aged 18 years and above who attended the clinic. The eHealth literacy scale (eHEALS) was used to measure eHealth literacy.ResultsA total of 381 participants were included. The mean eHEALS was 24.4 ± 7.6. The eHEALS statements related to skills in appraising OHI were scored lower than statements related to looking for online resources. Higher education level of attending upper secondary school (AOR 2.53, 95% CI 1.05–6.11), tertiary education (AOR 4.05, 95% CI 1.60–10.25), higher monthly household income of>US$470 (AOR 1.95, 95% CI 1.07–3.56), and those who had sought OHI in the past month (AOR 1.95, 95% CI 1.13–3.36) were associated with a higher eHealth literacy level.ConclusionsThis study found a low eHealth literacy level among primary care patients in Malaysia. While the patients were confident in searching for OHI, they lacked skills in appraising them. Our findings inform the interventions for improving eHealth literacy in LMICs, especially educating the public about OHI appraisal.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-18T06:36:38Z
      DOI: 10.1177/20552076221135392
      Issue No: Vol. 8 (2022)
       
  • COVID-19 smart surveillance: Examination of Knowledge of Apps and mobile
           thermometer detectors (MTDs) in a high-risk society

    • Authors: Muhideen Sayibu, Jianxun Chu, Akintunde Tosin Yinka, Olayemi Hafeez Rufai, Riffat Shahani, MA Jin
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundTechnological innovations gained momentum and supported COVID-19 intelligence surveillance among high-risk populations globally. We examined technology surveillance using mobile thermometer detectors (MTDs), knowledge of App, and self-efficacy as a means of sensing body temperature as a measure of COVID-19 risk mitigation. In a cross-sectional survey, we explored COVID-19 risk mitigation, mobile temperature detectable by network syndromic surveillance mobility, detachable from clinicians, and laboratory diagnoses to elucidate the magnitude of community monitoring.Materials and MethodsIn a cross-sectional survey, we create in-depth comprehension of risk mitigation, mobile temperature Thermometer detector, and other variables for surveillance and monitoring among 850 university students and healthcare workers. An applied structural equation model was adopted for analysis with Amos v.24. We established that mobile usability knowledge of APP could effectively aid in COVID-19 intelligence risk mitigation. Moreover, both self-efficacy and mobile temperature positively strengthened data visualization for public health decision-making.ResultsThe algorithms utilize a validated point-of-center test to ascertain the HealthCode scanning system for a positive or negative COVID-19 notification. The MTD is an alternative personal self-testing procedure used to verify temperature rates based on previous SARS-CoV-2 and future mobility digital health. Personal self-care of MTD mobility and knowledge of mHealth apps can specifically manage COVID-19 mitigation in high or low terrestrial areas. We found mobile usability, mobile self-efficacy, and app knowledge were statistically significant to COVID-19 mitigation. Additionally, interaction strengthened the positive relationship between self-efficacy and COVID-19. Data aggregation is entrusted with government database agencies, using natural language processing and machine learning mechanisms to validate and analyze.ConclusionThe study shows that temperature thermometer detectors, mobile usability, and knowledge of App enhanced COVID-19 risk mitigation in a high or low-risk environment. The standardizing dataset is necessary to ensure privacy and security preservation of data ethics.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-18T06:35:41Z
      DOI: 10.1177/20552076221132092
      Issue No: Vol. 8 (2022)
       
  • ActiveHip+: A feasible mHealth system for the recovery of older adults
           after hip surgery during the COVID-19 pandemic

    • Authors: Rafael Prieto-Moreno, Fernando Estévez-López, Pablo Molina-Garcia, Marta Mora-Traverso, Kevin Deschamps, Kurt Claeys, Janou de Buyser, Patrocinio Ariza-Vega
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveHalf of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery.MethodsSixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery).ResultsThe ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app's perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness.ConclusionsThe ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-17T06:03:20Z
      DOI: 10.1177/20552076221139694
      Issue No: Vol. 8 (2022)
       
  • Technology implementation in care practices for community-dwelling older
           adults with mild cognitive decline: Perspectives of professional
           caregivers in Quebec and Brussels

    • Authors: S Dequanter, I Steenhout, M Fobelets, MP Gagnon, M Sasseville, A Bourbonnais, A Giguère, MA Ndiaye, A Lambert, E Gorus, R Buyl
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveAs worldwide population aging is accelerating, innovative technologies are being developed to support independent living among community-dwelling older adults with mild cognitive decline. However, the successful implementation of these interventions is often challenging. Until now, literature on implementation issues related to the specific context of older adults with mild cognitive decline is lacking and the few studies available do not focus specifically on the perspective of professional caregivers. Yet the perspective of these caregivers is important as they can be considered a key facilitator for technology implementation among this population. Therefore, this study was the first to examine technology implementation among community-dwelling older adults with mild cognitive decline from the broader perspective of professional caregivers.MethodsIn this qualitative study, two focus groups consisting of a heterogeneous pool of professional caregivers were conducted: one in Quebec (Canada, n = 6) and one in Brussels (Belgium, n = 8). Braun and Clarke’ method for thematic analysis, guided by a qualitative descriptive approach was applied to inductively identify themes from the data.ResultsWe identified factors influencing technology implementation in older adults with mild cognitive decline on three levels: an individual level (e.g., characteristics of older adults with mild cognitive decline and professional caregivers’ attitude), an organizational level (e.g., lack of training among professional caregivers) and a level referring to the broader context (e.g., ethical considerations).ConclusionsThis study contributes to the research gap in knowledge on the needs of professional caregivers to facilitate technology implementation among the population of older adults with cognitive decline. Future directions for research, practice, and policy are given, more specifically to improve knowledge among caregivers and on the development of decision support to retrieve safe and effective technologies that suit patient-centered care.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-17T06:02:22Z
      DOI: 10.1177/20552076221139693
      Issue No: Vol. 8 (2022)
       
  • Quality assessment of smartphone fitness apps used to increase physical
           activity level and improve general health in adults: A systematic review

    • Authors: Alexandher Negreiros, Roberto B T Maciel, Bianca Carvalho de Barros, Rosimeire Simprini Padula
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionMobile exercise apps for smartphones have been used with intervention measures to increase physical activity. This study aimed to identify and evaluate the quality of fitness apps for smartphones that were used to increase the level of physical activity and improve the overall health of healthy adults.MethodsThe systematic review was performed in five electronic databases EMBASE, MEDLINE, CINAHL, Academic Research Premier e Cochrane Reviews, and Trials. The search terms were grouped into three categories according to the principles of population, intervention, comparison, and outcomes. The following includes examples of the group terms: population (healthy adults), intervention (smartphone apps), and outcomes (physical activity level).ResultsOf the 3924 potential articles, 74 were read for full-text analysis. Only seven studies were included in the review. The methodological evaluation of the studies and the apps’ quality showed that only one study and one app were evaluated with good quality. All studies used a type of application to improve the level of physical activity (measured by the number of daily steps), reporting an increase and improvement in some general health indices (calorie expenditure, weight, BMI) in healthy adults, regardless of frequency and duration of intervention and applications.ConclusionWe cannot say that the use of smartphone applications improves the level of physical activity and general health. The low methodological quality of the studies and the possibility to evaluate the applications used (Mars Scale) due to the lack of technical standardization presented in the studies, despite the app used showing positive results in all studies.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-16T06:11:11Z
      DOI: 10.1177/20552076221138305
      Issue No: Vol. 8 (2022)
       
  • Application effect of Kolb's experiential learning theory in clinical
           nursing teaching of traditional Chinese medicine

    • Authors: Lu Chen, Wen-Juan Jiang, Ru-Ping Zhao
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study aimed to explore the practical application and effect of Kolb's experiential learning theory in the clinical nursing training of traditional Chinese medicine (TCM).MethodsThis study is a quasi-experimental study. Eighty clinical nurses from a class-III grade-A general hospital were enrolled in 2020 and 2021, respectively, as research subjects. The subjects in the control group were trained in “theory explanation, clinical practice, summary and Q&A, [and] centralized examination.” The subjects in the experimental group were first grouped according to Kolb's experiential learning style. The training followed a “problem–exploration–practice–exploration–theory–explanation–summary–centralized examination” structure based on Kolb's experiential learning cycle, the training place is Conference Room 1 of the hospital. The training time is from February to August 2020 and 2021. The application effect of the experiential learning theory was evaluated by analyzing course evaluation questionnaires and the final examination results.ResultsThe total score of the course evaluation questionnaire of the experimental group was 112.23  ±  5.88. The difference compared with the control group was statistically significant (P 
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-16T05:52:09Z
      DOI: 10.1177/20552076221138313
      Issue No: Vol. 8 (2022)
       
  • Understanding the use of telehealth in the context of the Family Nurse
           Partnership and other early years home visiting programmes: A rapid review
           

    • Authors: Kathleen Morrison, Thomas Hughes, Lawrence Doi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      OverviewThis rapid review sought to understand the use of telehealth in early parenthood programmes sharing similarities with the Family Nurse Partnership.MethodsA rapid review protocol was developed in accordance with Cochrane Rapid Reviews Methods Guidance. Medline, Cochrane Library, and CINAHL databases were searched. Inclusion criteria were developed using population, intervention, comparator, outcome, study design, and timeframe components. Two reviewers searched, screened, and extracted data. AMSTAR was used for critical appraisal. Results were synthesised narratively.ResultsSearches yielded 18 studies out of 881 for inclusion. Findings were identified across seven domains: acceptability and accessibility; therapeutic relationships; flexibility offered by telehealth; participation and engagement; confidentiality and privacy; equipment and technical considerations; and training and support.ConclusionTelehealth provides unique opportunities to improve access to early years health services for young mothers. However, considerable accessibility barriers remain in the form of connectivity issues, access to appropriate technology, and the acceptability of remote healthcare delivery. This review presents a timely overview of the opportunities and challenges associated with the use of telehealth in early parenthood and family-based programmes.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-15T07:49:58Z
      DOI: 10.1177/20552076221123711
      Issue No: Vol. 8 (2022)
       
  • The use of a smartphone application to improve stroke code workflow
           metrics: A pilot study in a comprehensive stroke centre

    • Authors: Raquel Gutiérrez-Zúñiga, Jorge Uclés, Juan Carlos Sánchez-Manso, Blanca Fuentes, Elena de Celis, Gerardo Ruiz-Ares, Jorge Rodríguez-Pardo, Ricardo Rigual, Laura Casado, Elisa Alonso, Andrés Fernández-Prieto, Pedro Navia, Alberto Álvarez-Muelas, Begoña Marín, Exuperio Díez Tejedor, María Alonso de Leciñana
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundTimely coordination between stroke team members is of relevance for stroke code management. We explore the feasibility and potential utility of a smartphone application for clinical and neuroimaging data sharing for improving workflow metrics of stroke code pathways, and professionals’ opinions about its use.MethodsWe performed an observational pilot study including stroke code activations at La Paz University Hospital in Madrid, from June 2019 to March 2020. Patients were classified according to the activation or not of the JOIN app by the attending physician. Clinical data and time-to-procedures were retrieved from the app or from the hospital records and the Madrid regional stroke registry as appropriate and compared between both groups. An anonymous survey collected professionals’ opinions about the app and its use.ResultsA total of 282 stroke code activations were registered. The JOIN app was activated in 111 (39%) cases. They had a significant reduction in imaging-to-thrombolysis (31 vs 20 min, p = .026) and in door-to-thrombolysis times (51 vs 36 min, p = .004), with more patients achieving a door-to-needle time below 45 min (68.8% vs 37.8%, p = .016). About 50% of the users found the app useful for facilitating the diagnosis and decision-making; interoperability with clinical files was considered an opportunity for improvement.ConclusionsThis pilot study suggests that JOIN helps improve and document workflow metrics in acute stroke management in a comprehensive stroke centre. These results support testing JOIN in a prospective randomised study to confirm its usefulness and the general applicability of the results.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-15T02:21:19Z
      DOI: 10.1177/20552076221137252
      Issue No: Vol. 8 (2022)
       
  • Use of mobile app to monitoring growth outcome of children: A systematic
           literature review

    • Authors: Theresia Chrisanthy Kustiawan, Siti Rahayu Nadhiroh, Roziana Ramli, Chaniphun Butryee
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Advances in knowledge and technology have created opportunities to help monitor child growth. Thus, we conducted a systematic review to determine if the use of mobile apps resulted in improved growth outcomes for children. We include articles published related to children's growth with poor nutritional status. The relevant articles were searched from PubMed, ScienceDirect, Scopus, ProQuest, and Google Scholar. Twelve studies were identified, which is the use of the mobile app to monitor growth in undernutrition and obesity in children. Six studies found that the use of mobile apps improved undernutrition child growth and improved parents’ and/or front health workers’ knowledge to prevent, treat, and monitor children with undernutrition. Six studies stated that the use of mobile app helps overweight/obese children lose weight and motivate them to achieve ideal body weight. Mobile apps for monitoring the growth of children with various standards are likely a promising means for early detection of growth failure and guiding overweight/obese children in gaining normal weight. Studies with large sample sizes and long-term interventions and follow-ups are needed to help assess the effectiveness of mobile app intervention programs and their impact on multiple growth outcomes more comprehensively and accurately.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-14T06:29:16Z
      DOI: 10.1177/20552076221138641
      Issue No: Vol. 8 (2022)
       
  • User experience reevaluation and diffusion of technology in the context of
           compulsory usage illustrated by the example of telepsychotherapy—a
           literature review

    • Authors: Benjamin Butz, Leonie Kloep, Bernd Kriegesmann
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveModels explaining technology acceptance fail to recognize the influence temporary, compulsory usage, meaning forced usage due to external factors, may have on user evaluation and continued diffusion. However, in context of the Covid-19 pandemic, a highly infectious respiratory disease, the significance of this factor is evident. Triggered by legal contact restrictions and extended reimbursement capacities, usage of telepsychotherapy increased drastically, thereby influencing therapists' attitude and increasing the technology's maturity. In this comprehensive literature review, we aim to outline the current state of research toward telepsychotherapy adoption and identify potential influences of the compulsory usage on the reevaluation of technology as well as barriers inhibiting and factors promoting future use.MethodsThe review was conducted on the five databases ScienceDirect, Web of Science, PubMed, PubPsych, and IEEE up to April 2022.ResultsOut of 685 identified references, a final selection was made of 22 papers, discussing experiences with telepsychotherapy in the context of the Covid-19 pandemic. Satisfaction and intention to use are universally high, further increasing with time and use experience, while perceived challenges decrease. Barriers include mostly contextual factors, such as technical issues, reimbursement issues, strict regulations, insufficient infrastructure, and lack of organizational support, but also concerns regarding efficacy. Promoting factors are training, guidelines, and organizational support.ConclusionsTelepsychohtherapy has become an integral part of psychotherapeutic care. A hybrid system in close coordination between provider and patient may prevail, addressing individual needs of both parties to achieve optimal care and provider well-being. This requires transparent regulations, guidelines, and standards.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-14T06:27:59Z
      DOI: 10.1177/20552076221134448
      Issue No: Vol. 8 (2022)
       
  • Defining covert recording: A qualitative study exploring the experiences
           of clinicians when a patient records a hospital clinical encounter using a
           smartphone without consent

    • Authors: Laura Ryan, Kelly A Weir, Jessica Maskell, Lily Bevan, Robyne Le Brocque
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPatients use their smartphones to covertly record their clinical encounters in hospital. However, this issue is poorly understood. Insight into the clinician perspective will help inform policies and practices that deliver safe environments for patients and clinicians.ObjectiveThis study aimed to gain a deep understanding of clinician attitudes and behaviours when a patient covertly records a hospital clinical encounter using a smartphone.MethodsSemi-structured interviews were undertaken with 20 hospital clinicians. Participants were recruited via purposive and snowball sampling. Interviews were conducted in person or via Microsoft Teams. Interviews were digitally audio recorded and transcribed. Data was analysed using thematic analysis.ResultsMost of the 20 participants reported they had either suspected or experienced a patient covertly recording a clinical encounter. Covert recordings occurred across a broad range of clinical disciplines and contexts. Themes were identified from participant perspectives, including discernment of patient intention, likeliness to consent to the recording if asked, anticipated risks and potential benefits associated with the covert recording. These themes have led to the categorisation of three forms of covert recording: (1) Intentional Covert Recording (2) Inadvertently – Covert Recording, and (3) Beneficial Covert Recording.ConclusionClinicians have varied experiences and responses when a patient covertly records a clinical encounter. Findings indicate that nuanced strategies may be required to support clinicians to manage covert recording, whilst balancing the needs of patients.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-11T04:29:20Z
      DOI: 10.1177/20552076221134388
      Issue No: Vol. 8 (2022)
       
  • Towards adaptive technology in routine mental health care

    • Authors: Yngve Lamo, Suresh K Mukhiya, Fazle Rabbi, Amin Aminifar, Svein I Lillehaug, Jim Tørresen, Minh H Pham, Ulysse Côtè-Allard, Farzan M Noori, Frode Guribye, Yavuz Inal, Eivind Flobakk, Jo D Wake, Sunniva Myklebost, Astri J Lundervold, Aasa Hammar, Emilie Nordby, Smiti Kahlon, Robin Kenter, Ragnhild JT Sekse, Kristine F Griffin, Petter Jakobsen, Ketil Joachim Ødegaard, Yngvar S Skar, Tine Nordgreen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients’ needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-11T04:27:50Z
      DOI: 10.1177/20552076221128678
      Issue No: Vol. 8 (2022)
       
  • Smartphone digital phenotyping, surveys, and cognitive assessments for
           global mental health: Initial data and clinical correlations from an
           international first episode psychosis study

    • Authors: Tanvi Lakhtakia, Ameya Bondre, Prabhat Kumar Chand, Nirmal Chaturvedi, Soumya Choudhary, Danielle Currey, Siddharth Dutt, Azaz Khan, Mohit Kumar, Snehil Gupta, Srilakshmi Nagendra, Preethi V Reddy, Abhijit Rozatkar, Luke Scheuer, Yogendra Sen, Ritu Shrivastava, Rahul Singh, Jagadisha Thirthalli, Deepak Kumar Tugnawat, Anant Bhan, John A Naslund, Vikram Patel, Matcheri Keshavan, Urvakhsh Meherwan Mehta, John Torous
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo examine feasibility and acceptability of smartphone mental health app use for symptom, cognitive, and digital phenotyping monitoring among people with schizophrenia in India and the United States.MethodsParticipants in Boston, USA and Bhopal and Bangalore, India used a smartphone app to monitor symptoms, play cognitive games, access relaxation and psychoeducation resources and for one month, with an initial clinical and cognitive assessment and a one-month follow-up clinical assessment. Engagement with the app was compared between study sites, by clinical symptom severity and by cognitive functioning. Digital phenotyping data collection was also compared between three sites.ResultsBy Kruskal-Wallis rank-sum test, we found no difference between app activities completed or digital phenotyping data collected across the three study sites. App use also did not correlate to clinical or cognitive assessment scores. When using the app for symptom monitoring, preliminary findings suggest app-based assessment correlate with standard cognitive and clinical assessments.ConclusionsSmartphone app for symptom monitoring and digital phenotyping for individuals with schizophrenia appears feasible and acceptable in a global context. Clinical utility of this app for real-time assessments is promising, but further research is necessary to determine the long-term efficacy and generalizability for serious mental illness.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-09T06:25:17Z
      DOI: 10.1177/20552076221133758
      Issue No: Vol. 8 (2022)
       
  • Evaluating the sustainability of smart technology applications in
           healthcare after the COVID-19 pandemic: A hybridising subjective and
           objective fuzzy group decision-making approach with explainable artificial
           intelligence

    • Authors: Tin-Chih Toly Chen, Min-Chi Chiu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      During the COVID-19 pandemic, some smart technology applications were more effective than had been expected, whereas some others did not achieve satisfactory performance. Consequently, whether smart technology applications in healthcare are sustainable is a question that warrants investigation. To address this question, a hybridising subjective and objective fuzzy group decision-making approach with explainable artificial intelligence was proposed in this study and then used to evaluate the sustainability of smart technology applications in healthcare. The contribution of this research is its subjective evaluation of the sustainability of smart technology applications followed by correction of the evaluation outcome on the basis of the applications’ objective performance during the COVID-19 pandemic. To this end, a fuzzy nonlinear programming model was formulated and optimised. In addition, the impact of several major global events that occurred during the pandemic on the sustainability of smart technology applications was considered. The proposed methodology was applied to evaluate the sustainability levels of eight smart technology applications in healthcare. According to the experimental results, three applications—namely healthcare apps, smartwatches, and remote temperature scanners—are expected to be highly sustainable in healthcare, whereas one application, namely smart clothing, is not.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-08T01:29:16Z
      DOI: 10.1177/20552076221136381
      Issue No: Vol. 8 (2022)
       
  • Care providers’ experiences with and attitudes towards virtual antenatal
           care: Findings from a qualitative study in British Columbia

    • Authors: Jude Kornelsen, Daria Nowaczek, Robin Johnson, Mona Mattei, Shiraz Moola
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundVirtual care has emerged as an adjunctive response to challenges in rural health care, including maternity care, and use has accelerated during the coronavirus disease 2019 (COVID-19) pandemic. This gives rise to the need for a strategic plan for post-COVID-19 virtual maternity care in rural communities. To date, no provincial initiative has focused on understanding and documenting the needs of maternity care practitioners to provide virtual care.MethodsQualitative study, including virtual interviews and focus groups with rural primary maternity care providers and urban and rural specialists on perceptions of the utility of virtual maternity care pre- and post-COVID-19, and benefits and barriers of virtual care. Data were thematically analysed.ResultsIn total, 82 health care providers participated in the study. Health care provider responses fell into three categories: Attributes of virtual care, barriers to virtual care and system interventions needed to optimize the provision of virtual perinatal care. Participants expressed a desire for use of virtual communication tools post-COVID-19, continued ability to use fee codes for virtual care and a need for more secure texting options. The benefits of tripartite consultations were noted by many participants; impacts of the transition to virtual care included additional workload and interrupted workflow. Concerns over the lack of physical examinations and challenges in building relationships with patients when providing virtual care were frequently noted.ConclusionAdapting the current implementation of virtual maternity care in British Columbia may be enhanced through several provider- and evidence-derived strategies, many of which are currently underway in BC. The results from this provincial survey will be used to focus further discussion on the characteristics of an optimal system to meet patient and provider needs within a rural context.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-08T01:27:20Z
      DOI: 10.1177/20552076221131458
      Issue No: Vol. 8 (2022)
       
  • What goes on in digital behaviour change interventions for weight loss
           maintenance targeting physical activity: A scoping review

    • Authors: Jorge Encantado, António L Palmeira, Carolina Silva, Falko F Sniehotta, R James Stubbs, Maria João Gouveia, Pedro J Teixeira, Berit L Heitmann, Marta M Marques
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo identify the core components of digital behaviour change interventions for weight loss maintenance targeting physical activity, in terms of: (i) behaviour change techniques, (ii) mechanisms of action, (iii) modes of delivery, (iv) dose and (v) tailoring/personalization. In addition, the links between these components were investigated.MethodsA literature search was performed in five electronic databases: PubMed, Embase, CINHAL, PsycINFO and Web of Science. Two reviewers independently screened the identified articles and extracted data related with the study characteristics and behaviour change techniques, mechanism of action, mode of delivery, dose, and tailoring, using standardized classifications whenever available (e.g. behaviour change techniques taxonomy).ResultsSeventeen articles reporting 11 original studies were selected. Two studies were protocols, 9 studies presented results for weight change and all but one showed no significant differences between the intervention and control groups. Eight studies (73%) provided adequate information on behaviour change techniques. Five studies (45%) provided partial information about how the behaviour change techniques were linked to mechanisms of action, and only one study (0.9%) described these links for all the techniques. Around half of the studies reported the modes through which behaviour change techniques were delivered. Descriptions of dose were present in most studies, but with minimal information. The use of tailoring or personalization approaches was mentioned in eight studies (73%), but descriptions of what was tailored and how were minimal.ConclusionsThe compilation of information regarding intervention components was difficult due to the lack of information and systematization in reporting across papers. This is particularly true for the reporting of the links between behaviour change techniques and the other core intervention components. This information is crucial to help us understand in the context of behaviour change interventions what works or does not work, how it works and why.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-07T06:51:14Z
      DOI: 10.1177/20552076221129089
      Issue No: Vol. 8 (2022)
       
  • Effect of health literacy and shared decision-making on choice of
           weight-loss plan among overweight or obese participants receiving a
           prototype artificial intelligence robot intervention facilitating
           weight-loss management decisions

    • Authors: Yi-Tang Chu, Ru-Yi Huang, Tara Tai-Wen Chen, Wei-Hsuan Lin, James TaoQian Tang, Chi-Wei Lin, Chi-Hsien Huang, Chung-Ying Lin, Jung-Sheng Chen, Sabrina Kurtz-Rossi, Kristine Sørensen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Implementation of artificial intelligence (AI) in medical decision-making is still in early development. We developed an AI robot intervention prototype with a health literacy-friendly interface that uses interactive voice response (IVR) surveying to assist in decision-making for weight loss. The weight-specific health literacy instrument (WSHLI) and Shared Decision-Making Questionnaire (SDMQ) were used to measure factors influencing weight-loss decisions. Factors associated with participants choosing to lose weight were analyzed using logistic regression, and factors influencing the selection of specific weight-loss plans were examined with one-way analysis of variance. Our study recruited 144 overweight or obese adults (69.4% women, 58.3% with body mass index (BMI) ≥ 24). After interacting with the AI robot, 78% of the study population made the decision to lose weight. SDMQ score was a significant factor positively influencing the decision for weight-loss (odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.09–4.29, p = 0.027). Individuals who selected self-monitored lifestyle modification (mean ± SD: 11.52 ± 1.95) had significantly higher health literacy than those who selected dietician-assisted plan (9.92 ± 2.30) and physician-guided treatment (9.60 ± 1.52) (both p = 0.001). The study results demonstrated that our prototype AI robot can effectively encourage individuals to make decisions regarding weight management and that both WSHLI and SDMQ scores affect the choice of weight-loss plans.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-04T07:50:52Z
      DOI: 10.1177/20552076221136372
      Issue No: Vol. 8 (2022)
       
  • The use of social media to search for weight reduction information:
           Assessment of the perception among a sample of Saudi adults

    • Authors: Abeer S Alzaben, Khawlah I Alzaidy, Mona A Alghamdi, Raghad A Alanzi, Rawan T Aljohari, Reema A Alahaideb, Nada Benajiba
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo assess the patterns, prevalence, and perceptions of the benefits and risks of using social media as a source of weight loss information among Saudi adults.MethodsIn this cross-sectional study, convenient snowball sampling was used to recruit Saudi adults. A self-report questionnaire containing the following five sections was distributed: sociodemographic information, the pattern of social media use, use of social media to obtain weight loss information, perception of benefits, and perception of risks of using social media. A Chi-square test was used to identify differences according to participants' demographics.ResultsA total of 420 Saudi adults were included in the study. Most Saudi adults (43.3%) used social media for more than four hours a day, and 88.6% used WhatsApp. The prevalence of social media use for weight loss information was 89.2% among Saudi adults. Significant associations were found between the use of social media for weight loss information and age (
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-04T07:19:51Z
      DOI: 10.1177/20552076221136939
      Issue No: Vol. 8 (2022)
       
  • Applications of deep learning methods in digital biomarker research using
           noninvasive sensing data

    • Authors: Hoyeon Jeong, Yong W Jeong, Yeonjae Park, Kise Kim, Junghwan Park, Dae R Kang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Introduction: Noninvasive digital biomarkers are critical elements in digital healthcare in terms of not only the ease of measurement but also their use of raw data. In recent years, deep learning methods have been put to use to analyze these diverse heterogeneous data; these methods include representation learning for feature extraction and supervised learning for the prediction of these biomarkers. Methods: We introduce clinical cases of digital biomarkers and various deep-learning methods applied according to each data type. In addition, deep learning methods for the integrated analysis of multidimensional heterogeneous data are introduced, and the utility of these data as an integrated digital biomarker is presented. The current status of digital biomarker research is examined by surveying research cases applied to various types of data as well as modeling methods. Results: We present a future research direction for using data from heterogeneous sources together by introducing deep learning methods for dimensionality reduction and mode integration from multimodal digital biomarker studies covering related domains. The integration of multimodality has led to advances in research through the improvement of performance and complementarity between modes. Discussion: The integrative digital biomarker will be more useful for research on diseases that require data from multiple sources to be treated together. Since delicate signals from patients are not missed and the interaction effects between signals are also considered, it will be helpful for immediate detection and more accurate prediction of symptoms.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-04T07:18:51Z
      DOI: 10.1177/20552076221136642
      Issue No: Vol. 8 (2022)
       
  • Feasibility of a smartphone app to monitor patient reported outcomes in
           multiple sclerosis: The haMSter interventional trial

    • Authors: Patrick Altmann, Markus Ponleitner, Tobias Monschein, Nik Krajnc, Gudrun Zulehner, Tobias Zrzavy, Fritz Leutmezer, Paulus Stefan Rommer, Barbara Kornek, Thomas Berger, Gabriel Bsteh
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundMonitoring of patient outcomes in multiple sclerosis (MS) is fundamental for individualized treatment decisions. So far, these decisions have been motivated by conventional outcomes, i.e., relapses or clinical disability supported by radiological disease activity. Complementing this concept, patient reported outcomes (PROs) assess individual health-related quality of life, among other constructs. Their inclusion in clinical routine, however, has been challenging as assessing them requires resources of time and personnel.ObjectiveThis interventional feasibility study investigated the haMSter app, a mobile health solution for remote and longitudinal monitoring of PROs in a sample of people with MS (pwMS).MethodsThe core feature of haMSter is the provision of three PRO questionnaires relevant to MS (anxiety/depression, MS-related quality of life, and fatigue) that patients can fill out once a month. For this feasibility trial, we offered 50 volunteers to use the haMSter app over six months and to take part in a haMSter study visit. This consultation concluded the study and participants had the opportunity to discuss their graphically plotted PRO results with their treating physician.ResultsThe main outcome was overall patient adherence to monthly completion of the PRO questionnaires, which remained high up to 4 months (98%) and dropped over time (months 5: 83% and 6: 66%). Exploratory outcomes included patient satisfaction as estimated on the Telemedicine Perception Questionnaire (TMPQ, 17–85 points). The mean TMPQ score was 64 (95%CI: 62–66) points, indicating a high degree of approval. Ancillary tests included subgroup analyses of participants with particularly high or low satisfaction and upper extremity disability as a potential obstacle to utility or acceptance. We found no distinct characteristics separating participants with high or low satisfaction.ConclusionsIn this first feasibility trial, the haMSter app for longitudinal PRO monitoring was well received in terms of adherence and satisfaction. ClinicalTrials.gov identifier: NCT04555863.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-04T07:18:11Z
      DOI: 10.1177/20552076221135387
      Issue No: Vol. 8 (2022)
       
  • Smartphones and telemedicine for older people in China: Opportunities and
           challenges

    • Authors: Chi Zhang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The development of 5G technology has brought major advances and diverse challenges in healthcare services for older people, and access to equitable telemedicine is a high priority. Smartphones are most commonly used device to access the internet and bring the convenience of telemedicine to the user's fingertips. In the period where aging and informatization coexist in China, the role of smartphones in their daily lives, long-term care, and future opportunities and challenges needs serious reconsideration. We provide the latest evidence of smartphone use among the older adults of China and expound on issues about fairness in accessing mobile health, the substantial digital divide, and potential drawbacks of problematic smartphone use.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-04T07:17:33Z
      DOI: 10.1177/20552076221133695
      Issue No: Vol. 8 (2022)
       
  • RAFF-Net: An improved tongue segmentation algorithm based on residual
           attention network and multiscale feature fusion

    • Authors: Haibei Song, Zonghai Huang, Li Feng, Yanmei Zhong, Chuanbiao Wen, Jinhong Guo
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveDue to the complexity of face images, tongue segmentation is susceptible to interference from uneven tongue texture, lips and face, resulting in traditional methods failing to segment the tongue accurately. To address this problem, RAFF-Net, an automatic tongue region segmentation network based on residual attention network and multiscale feature fusion, was proposed. It aims to improve tongue segmentation accuracy and achieve end-to-end automated segmentation.MethodsBased on the UNet backbone network, different numbers of ResBlocks combined with the Squeeze-and-Excitation (SE) block was used as an encoder to extract image layered features. The decoder structure of UNet was simplified and the number of parameters of the network model was reduced. Meanwhile, the multiscale feature fusion module was designed to optimize the network parameters by combining a custom loss function instead of the common cross-entropy loss function to further improve the detection accuracy.ResultsThe RAFF-Net network structure achieved Mean Intersection over Union (MIoU) and F1-score of 97.85% and 97.73%, respectively, which improved 0.56% and 0.46%, respectively, compared with the original UNet; ablation experiments demonstrated that the improved algorithm could contribute to the enhancement of tongue segmentation effect.ConclusionThis study combined the residual attention network with multiscale feature fusion to effectively improve the segmentation accuracy of the tongue region, and optimized the input and output of the UNet network using different numbers of ResBlocks, SE block, multiscale feature fusion and weighted loss function, increased the stability of the network and improved the overall effect of the network.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-03T07:16:21Z
      DOI: 10.1177/20552076221136362
      Issue No: Vol. 8 (2022)
       
  • Homogeneous ensemble models for predicting infection levels and mortality
           of COVID-19 patients: Evidence from China

    • Authors: Jiafeng Wang, Xianlong Zhou, Zhitian Hou, Xiaoya Xu, Yueyue Zhao, Shanshan Chen, Jun Zhang, Lina Shao, Rong Yan, Mingshan Wang, Minghua Ge, Tianyong Hao, Yuexing Tu, Haijun Huang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPersistence of long-term COVID-19 pandemic is putting high pressure on healthcare services worldwide for several years. This article aims to establish models to predict infection levels and mortality of COVID-19 patients in China.MethodsMachine learning models and deep learning models have been built based on the clinical features of COVID-19 patients. The best models are selected by area under the receiver operating characteristic curve (AUC) scores to construct two homogeneous ensemble models for predicting infection levels and mortality, respectively. The first-hand clinical data of 760 patients are collected from Zhongnan Hospital of Wuhan University between 3 January and 8 March 2020. We preprocess data with cleaning, imputation, and normalization.ResultsOur models obtain AUC = 0.7059 and Recall (Weighted avg) = 0.7248 in predicting infection level, while AUC=0.8436 and Recall (Weighted avg) = 0.8486 in predicting mortality ratio. This study also identifies two sets of essential clinical features. One is C-reactive protein (CRP) or high sensitivity C-reactive protein (hs-CRP) and the other is chest tightness, age, and pleural effusion.ConclusionsTwo homogeneous ensemble models are proposed to predict infection levels and mortality of COVID-19 patients in China. New findings of clinical features for benefiting the machine learning models are reported. The evaluation of an actual dataset collected from January 3 to March 8, 2020 demonstrates the effectiveness of the models by comparing them with state-of-the-art models in prediction.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-02T06:06:21Z
      DOI: 10.1177/20552076221133692
      Issue No: Vol. 8 (2022)
       
  • Evaluating a serious game to improve childhood cancer patients' treatment
           adherence

    • Authors: Carmen Wang Er Chai, Bee Theng Lau, Mark Kit Tsun Tee, Abdullah Al Mahmud
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveChildhood cancer patients need to have good treatment adherence. Unfortunately, treatment non-adherence often occurs due to high side-effect burdens of treatment and the lack of knowledge of one's illness and treatment. Therefore, a serious game intervention based on the Protection Motivation Theory (PMT) was designed and developed to motivate childhood cancer patients to undergo treatment and to motivate them to undergo treatment, perform daily self-care and educate them about their illness.MethodsChildhood cancer patients (6–17 years old) and their caregivers were recruited in a multi-centre, single-arm intervention in Malaysia. A total of 24 child-caregiver dyads have completed the study. This study used PMT-based surveys to collect quantitative data regarding children's motivation to adhere to treatment and perform daily self-care. Additionally, a 20-question multiple-choice quiz was used to determine children's knowledge levels. These surveys were conducted pre-test and post-test. Children's and caregivers' feedback were also gathered post-test as qualitative data.ResultsThe results showed that overall, the children's intention to undergo cancer treatment had increased significantly. A significant increase in the intention to perform daily self-care was found among younger children, while older children showed significant improvement in their cancer knowledge levels. The post-test feedback suggested that the game was liked by both children and caregivers and it provided various benefits to children with cancer.ConclusionsFindings suggest that the intervention has the potential to improve childhood cancer patients’ motivation for treatment adherence and daily self-care, in addition to educating them about cancer and treatment.
      Citation: DIGITAL HEALTH
      PubDate: 2022-11-02T05:41:03Z
      DOI: 10.1177/20552076221134457
      Issue No: Vol. 8 (2022)
       
  • Virtual and augmented reality applications to improve older adults’
           quality of life: A systematic mapping review and future directions

    • Authors: Reem Sulaiman Baragash, Hanan Aldowah, Samar Ghazal
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.MethodsTo reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.ResultsThe findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.ConclusionThis mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-31T12:33:42Z
      DOI: 10.1177/20552076221132099
      Issue No: Vol. 8 (2022)
       
  • A topic trend analysis on COVID-19 literature

    • Authors: Sara Urru, Veronica Sciannameo, Corrado Lanera, Silvano Salaris, Dario Gregori, Paola Berchialla
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveIn the past 2 years, the number of scientific publications has grown exponentially. The COVID-19 outbreak hugely contributed to this dramatic increase in the volume of published research. Currently, text mining of the volume of SARS-CoV-2 and COVID-19 publications is limited to the first months of the outbreak. We aim to identify the major topics in COVID-19 literature collected from several citational sources and analyze the temporal trend from November 2019 to December 2021.MethodsWe performed an extensive literature search on SARS-Cov-2 and COVID-19 publications on PubMed, Scopus, and Web of Science (WoS) and a structural topic modelling on the retrieved abstracts. The temporal trend of the recognized topics was analyzed. Furthermore, a comparison between our corpus and the COVID-19 Open Research Dataset (CORD-19) repository was performed.ResultsWe collected 269,186 publications and identified 10 topics. The most popular topic was related to the clinical pictures of the COVID-19 outbreak, which has a constant trend, and the least popular includes studies on COVID-19 literature and databases. “Telemedicine”, “Vaccine development”, and “Epidemiology” were popular topics in the early phase of the pandemic; increasing topics in the last period are “COVID-19 impact on mental health”, “Forecasting”, and “Molecular Biology”. “Education” was the second most popular topic, which emerged in September 2020.ConclusionsWe identified 10 topics for classifying COVID-19 research publications and estimated a nonlinear temporal trend that gives an overview of their unfolding over time. Several citational databases must be searched to retrieve a complete set of studies despite the efforts to build repositories for COVID-19 literature. Our collected data can help build a more focused literature search between November 2019 and December 2021 when carrying out systematic and rapid reviews and our findings can give a complete picture on the topic.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-28T06:52:07Z
      DOI: 10.1177/20552076221133696
      Issue No: Vol. 8 (2022)
       
  • Federated learning for preserving data privacy in collaborative healthcare
           research

    • Authors: Tyler J Loftus, Matthew M Ruppert, Benjamin Shickel, Tezcan Ozrazgat-Baslanti, Jeremy A Balch, Philip A Efron, Gilbert R Upchurch, Parisa Rashidi, Christopher Tignanelli, Jiang Bian, Azra Bihorac
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Generalizability, external validity, and reproducibility are high priorities for artificial intelligence applications in healthcare. Traditional approaches to addressing these elements involve sharing patient data between institutions or practice settings, which can compromise data privacy (individuals’ right to prevent the sharing and disclosure of information about themselves) and data security (simultaneously preserving confidentiality, accuracy, fidelity, and availability of data). This article describes insights from real-world implementation of federated learning techniques that offer opportunities to maintain both data privacy and availability via collaborative machine learning that shares knowledge, not data. Local models are trained separately on local data. As they train, they send local model updates (e.g. coefficients or gradients) for consolidation into a global model. In some use cases, global models outperform local models on new, previously unseen local datasets, suggesting that collaborative learning from a greater number of examples, including a greater number of rare cases, may improve predictive performance. Even when sharing model updates rather than data, privacy leakage can occur when adversaries perform property or membership inference attacks which can be used to ascertain information about the training set. Emerging techniques mitigate risk from adversarial attacks, allowing investigators to maintain both data privacy and availability in collaborative healthcare research. When data heterogeneity between participating centers is high, personalized algorithms may offer greater generalizability by improving performance on data from centers with proportionately smaller training sample sizes. Properly applied, federated learning has the potential to optimize the reproducibility and performance of collaborative learning while preserving data security and privacy.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-28T06:38:30Z
      DOI: 10.1177/20552076221134455
      Issue No: Vol. 8 (2022)
       
  • A pragmatic methodical framework for the user-centred development of an
           electronic process support for the sleep laboratory patients’ management
           

    • Authors: Maria Zerlik, Ian-C. Jung, Tony Sehr, Fabian Hennings, Christian Kamann, Moritz D. Brandt, Martin Sedlmayr, Brita Sedlmayr
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveLimited capacities and ineffective care pathways result in long waiting times for patients and sporadic treatment controls in sleep medicine. As one objective of the ‘Telesleep Medicine’ project, a portal should be developed, which supports sleep specialists in an efficient and resource-saving patient management. On account of the limited project timeframe, the ‘classical’ user-centred design and evaluation methods could not be comprehensively implemented. Therefore, a pragmatic methodical framework was developed.MethodsFor the iterative development of the portal, a combination of low-cost and quick-to-implement methods was used. In chronological order, these were: context interviews, personas, the development of an as-is model, a web search of design standards and good design aspects of similar systems, the development of a to-be model, the creation of an overarching mind map, and the iterative creation of mockups with simplified usability walkthroughs.ResultsThe feasibility of the pragmatic methodological framework for the development of a prototype for the portal was demonstrated. The used method combination resulted in a prototype based on the needs and requirements of the sleep specialists, taking into account their specific workflow and the technical implementation conditions.ConclusionsThe presented pragmatic methodological framework can be a valuable resource for developers of comparable projects. The combination of methods worked well together regarding the limited timeframe and resources for concept development. For the future, we plan to implement and test the portal in the clinical field and thus enrich our framework with additional methods.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-27T06:30:49Z
      DOI: 10.1177/20552076221134437
      Issue No: Vol. 8 (2022)
       
  • Big data and ICT solutions in the European Union and in China: A
           comparative analysis of policies in personalized medicine

    • Authors: Francesco Andrea Causio, Ilda Hoxhaj, Flavia Beccia, Marzia di Marcantonio, Timo Strohäker, Chiara Cadeddu, Walter Ricciardi, Stefania Boccia
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionSeveral countries are either planning or implementing national strategies for the development and integration of Personalized Medicine (PM) into their healthcare systems. Personalized Medicine is an undisputed priority of the European Commission (EC), which has funded the project “Integrating China into the International Consortium for Personalized Medicine” (IC2PerMed), in order to ensure a common basis for Sino-European collaborations. By mapping the current PM landscape in the European Union (EU) and in China, IC2PerMed aims to provide key solutions toward a synergistic and coordinated approach in the field of PM.MethodsAn extensive desk research was conducted, aimed at identifying documents on PM-related policies, programs, and action plans in the EU and in China, published up to November 2020. The search was conducted by exploring scientific and gray literature, and official institutional repositories. A descriptive summary condensed the information retrieved for both.ResultsSince 2013, the year of publication of the first PM policy by the EC “Use of omics technologies in PM development,” several documents have been published. PM is a key element of the policy agenda also in China, which in 2016 integrated PM into the 13th National Five-Year Plan, followed by the publication of several policies on technology infrastructure and big data. Both in the EU and China, especially in recent years, these policies addressed in detail the issues of big data, data interoperability and exchange, while defining the standards of information and communication infrastructures.ConclusionsIn order to allow optimal collaboration, it is essential to understand similarities and differences between the respective policy strategies, with particular attention to data management and adopted infrastructures. The results of this project may enable the development of joint Sino-European research and innovation initiatives, promoting developments in the field of PM.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-27T05:43:50Z
      DOI: 10.1177/20552076221129060
      Issue No: Vol. 8 (2022)
       
  • Feasibility, acceptability and effects of a group pelvic floor muscle
           telerehabilitation program to treat urinary incontinence in older women

    • Authors: Mélanie Le Berre, Johanne Filiatrault, Barbara Reichetzer, Chantale Dumoulin
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionUrinary incontinence (UI) is one of the most prevalent health concerns in women age 65 and over. The recommended first-line treatment for UI is individual pelvic floor muscle training (PFMT). However, healthcare systems worldwide are unable to meet the demand for this resource-intensive approach. Recently, the Group Rehabilitation Or IndividUal Physiotherapy (GROUP) trial showed that group-based PFMT was not inferior to individual PFMT to treat UI in older women, despite using fewer resources. This study aims to assess the feasibility, acceptability and effects on UI-related symptoms and associated quality of life (QoL) of an online adaptation of the GROUP program (teleGROUP) for UI in older women.Methods and analysisThis pilot study will involve the recruitment of 32 older women with UI. Participants’ attendance to online sessions, adherence to weekly home exercises, and side effects, in addition to the physiotherapist's fidelity to the program delivery will be collected to evaluate the program's feasibility. Participants’ dropout rates, reasons for dropout, satisfaction and usability scores will be collected to evaluate the program's acceptability for participants. A survey will evaluate the program's acceptability for the physiotherapists. Additionally, at the end of the study, qualitative semi-structured interviews and focus groups will investigate further feasibility and acceptability. To measure the effects of teleGROUP, number of weekly leakages and percentage reduction will be the primary outcomes.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-26T07:50:12Z
      DOI: 10.1177/20552076221123720
      Issue No: Vol. 8 (2022)
       
  • Investigating the mechanical effect of the sagittal angle of the cervical
           facet joint on the cervical intervertebral disc

    • Authors: Rui Weng, Xue-Cheng Huang, Lin-Qiang Ye, Ce-Kai Yang, Zhuo-Yan Cai, Yue-Rong Xu, Jian-Chao Cui, Sheng-Hui Yi, De Liang, Zhen-Song Yao
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundFacet tropism is defined as the asymmetry between the left and right facet joints relative to the sagittal plane. Published clinical studies have found that facet tropism is associated with cervical disc herniation. However, the relationship between the facet orientation and the side of cervical disc herniation remains controversial. Therefore, this study used the finite-element technique to investigate the biomechanical effects of the sagittal angle of the cervical facet joints on the cervical intervertebral disc.ObjectiveThe biomechanical effects of the sagittal angle of the cervical facet joint on the cervical disc and facet joint were investigated using the finite-element technique.MethodsThe finite-element model was constructed using computed tomography scans of a 26-year-old female volunteer. First, a cervical model was constructed from C3 to C7. The model was verified using data from previously published studies. Second, the facet orientation at the C5–C6 level was altered to simulate different sagittal angles of cervical facet joints. Five models, F70, F80, F90, F100, and F110, were simulated with different facet joint orientations (70°, 80°, 90°, 100°, and 110° facet joint angles at the left side, respectively, and 90° facet joint angles at the right side) at the C5–C6 facet joints. In each model, annular fibres stress and facet cartilage pressure were studied under six pure moments and two combined moments.ResultsComparing the stress of the annulus fibres in flexion combined with right axial rotation and in flexion combined with left axial rotation in the same model, no difference in the maximum stress of the annulus fibres was noted between these two different moments in the F90 model, whereas differences of 12.80%, 8.84%, 14.95% and 33.32% were noted in the F70, F80, F100 and F110 models, respectively. The same trend was observed when comparing the maximum stress of the annulus fibres in each model during left and right axial rotation. No differences in annular fibres stress and facet cartilage pressure were noted among the five models in flexion, extension, lateral bending, left axial rotation, and flexion combined with left axial rotation in this study. However, compared with the F70 model in flexion combined with right axial rotation, the annulus fibres stress of the F80, F90, F100, and F110 models increased by 5.53%, 13.03%, 35.04%, and 72.94%, respectively, and the pressure of the left facet joint of these models decreased by 5.65%, 12.10%, 18.41%, and 25.74%, respectively. The same trend was observed in the right axial moment.ConclusionFacet tropism leads to unbalanced stress distribution on the annulus fibres at the cervical intervertebral disc. The greater the sagittal angle of the facet joint, the greater the annular fibres stress on this side. We hypothesised that the side with the larger sagittal angle of the facet joint exhibits a greater risk of disc herniation.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-26T07:43:43Z
      DOI: 10.1177/20552076221134456
      Issue No: Vol. 8 (2022)
       
  • Exploring low-income migrant workers’ health information-seeking
           behavior during COVID-19 in Taiwan: A qualitative study

    • Authors: Tuan-he Lee, Weerachaya Jarupreechachan, Yuan-Chi Tseng
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundCOVID-19 pandemic is reported to exacerbate existing vulnerabilities of marginalized groups, and the lack of self-care can lead to the spread of the virus across society. Therefore, effective responses to the challenges imposed by the health crisis should consider the health information needs of migrant workers.ObjectiveWe aimed to explore how migrant low-income workers seek health information and how their health-related information needs were met during a health crisis. We also investigated migrant workers’ preferred information sources and types of content with the theoretical concept of health literacy to understand the development of health competencies among migrant workers.MethodsWe conducted semi-structured interviews with Thai low-income migrant workers. A total of 13 Thai migrant workers participated in the study, among whom five were undocumented. The interviews were audio-taped, transcribed, and analyzed with the thematic analysis approach.ResultsOur findings indicated that migrant workers’ health literacy and health information behavior could be improved through technology when facing a health crisis. We found that participants sought health information proactively to reduce their perceived risks. However, there is still space for design to support the ability to process jargon information and apply local policy, such as providing easy-to-understand, accurate, and timely information. The findings of this study provide some insights for the authority and technological design to respond to migrant workers’ health information needs.ConclusionsThis study acknowledges and understands the needs of vulnerable migrant workers in society. The findings of this study provide insights for the authority and technological design to respond to migrant workers’ health information needs. We also outline the areas worth further investigation, such as the communication between information seekers and providers, and the navigation of the healthcare system for migrants in the host country.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-26T07:09:29Z
      DOI: 10.1177/20552076221133764
      Issue No: Vol. 8 (2022)
       
  • Predicting non-initiation of care and dropout in a blended care CBT
           intervention: Impact of early digital engagement, sociodemographic, and
           clinical factors

    • Authors: Monica S. Wu, Shih-Yin Chen, Robert E. Wickham, Yan Leykin, Alethea Varra, Connie Chen, Anita Lungu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study examines predictors of non-initiation of care and dropout in a blended care CBT intervention, with a focus on early digital engagement and sociodemographic and clinical factors.MethodsThis retrospective cohort analysis included 3566 US-based individuals who presented with clinical levels of anxiety and depression and enrolled in a blended-care CBT (BC-CBT) program. The treatment program consisted of face-to-face therapy sessions via videoconference and provider-assigned digital activities that were personalized to the client's presentation. Multinomial logistic regression and Cox proportional hazard survival analysis were used to identify predictors of an increased likelihood of non-initiation of therapy and dropout.ResultsIndividuals were more likely to cancel and/or no-show to their first therapy session if they were female, did not disclose their ethnicity, reported poor financial status, did not have a college degree, endorsed more presenting issues during the onboarding triage assessment, reported taking antidepressants, and had a longer wait time to their first appointment. Of those who started care, clients were significantly more likely to drop out if they did not complete the digital activities assigned by their provider early in treatment, were female, reported more severe depressive symptoms at baseline, reported taking antidepressants, and did not disclose their ethnicity.ConclusionsVarious sociodemographic and clinical predictors emerged for both non-initiation of care and for dropout, suggesting that clients with these characteristics may benefit from additional attention and support (especially those with poor early digital engagement). Future research areas include targeted mitigation efforts to improve initiation rates and curb dropout.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-26T07:09:04Z
      DOI: 10.1177/20552076221133760
      Issue No: Vol. 8 (2022)
       
  • Evaluation of deep learning techniques for identification of
           sarcoma-causing carcinogenic mutations

    • Authors: Asghar Ali Shah, Fahad Alturise, Tamim Alkhalifah, Yaser Daanial Khan
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The abnormal growth of human healthy cells is called cancer. One of the major types of cancer is sarcoma, mostly found in human bones and soft tissue cells. It commonly occurs in children. According to a survey of the United States of America, there are more than 17,000 sarcoma patients registered each year which is 15% of all cancer cases. Recognition of cancer at its early stage saves many lives. The proposed study developed a framework for the early detection of human sarcoma cancer using deep learning Recurrent Neural Network (RNN) algorithms. The DNA of a human cell is made up of 25,000 to 30,000 genes. Each gene is represented by sequences of nucleotides. The nucleotides in a sequence of a driver gene can change which is termed as mutations. Some mutations can cause cancer. There are seven types of a gene whose mutation causes sarcoma cancer. The study uses the dataset which has been taken from more than 134 samples and includes 141 mutations in 8 driver genes. On these gene sequences RNN algorithms Long and Short-Term Memory (LSTM), Gated Recurrent Units and Bi-directional LSTM (Bi-LSTM) are used for training. Rigorous testing techniques such as Self-consistency testing, independent set testing, 10-fold cross-validation test are applied for the validation of results. These validation techniques yield several metrics such as Area Under the Curve (AUC), sensitivity, specificity, Mathew's correlation coefficient, loss, and accuracy. The proposed algorithm exhibits an accuracy of 99.6% with an AUC value of 1.00.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-23T02:32:21Z
      DOI: 10.1177/20552076221133703
      Issue No: Vol. 8 (2022)
       
  • Mutations in lysine methyltransferase 2C and PEG3 are associated with
           tumor mutation burden, prognosis, and antitumor immunity in pancreatic
           adenocarcinoma patients

    • Authors: Yili Huang, Jinsong Liu, Xiaole Zhu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAs a common cancer-related death worldwide, pancreatic adenocarcinoma (PAAD) has significantly increased mortality in recent years. In recent years, tumor mutation burden (TMB) has been regarded as the most popular biomarker for PAAD immunotherapy. However, it remains unclear which gene mutations affect TMB and immune response in pancreatic adenocarcinoma.MethodsThe somatic mutation images of PAAD samples were downloaded from The Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC). Based on the expression data of the TCGA and IGCC cohorts, various bioinformatics algorithms are used for evaluating the prognostic value and functional annotation of some frequently somatically mutated genes. Furthermore, the correlation between gene mutation and tumor immunity was also evaluated.ResultsThe results showed that lysine methyltransferase 2C (KMT2C) and paternally expressed 3 (PEG3) are frequently mutated genes in PAAD. Patients with KMT2C and PEG3 mutations have higher TMB severity and a lousy prognosis. In addition, the mutations of KMT2C and PEG3 genes positively regulate the metabolic and protein-related pathways in PAAD. Meanwhile, significant differences in the composition of the immune cells were observed for KMT2C and PEG3 mutations PAAD patients, for providing additional guidelines for antitumor treatments in various KMT2C and PEG3 mutation states in PAAD.ConclusionThis study reveals that KMT2C and PEG3 mutation may serve as biomarkers for predicting prognosis and guiding anti-PAAD immunotherapy for PAAD patients.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-21T05:25:31Z
      DOI: 10.1177/20552076221133699
      Issue No: Vol. 8 (2022)
       
  • A smart healthcare-based system for classification of dementia using deep
           learning

    • Authors: Jihye Lim
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesThis study aims to develop a deep learning-based classification model for early detection of dementia using a wearable device that can measure the electrical conductivity of the skin, temperature, and movement as factors related to dementia, interlocking them with an application, and analyzing the collected data.MethodsThis study was conducted on 18 elderly individuals (5 males, 13 females) aged 65 years or older who consented to the study. The Korean Mini-Mental State Examination survey for cognitive function tests was conducted by well-trained researchers. The subjects were first grouped into high- or low-risk group for dementia based on their Korean Mini-Mental State Examination score. Data obtained by wearable devices of each subject were then used for the classification of the high- and low-risk groups of dementia through a smart healthcare-based system implementing a deep neural network with scaled principal component analysis. The correlation coefficients between the Korean Mini-Mental State Examination score and the featured data were also investigated.ResultsOur study showed that the proposed system using a deep neural network with scaled principal component analysis was effective in detecting individuals at high risk for dementia with up to 99% accuracy and which performance was better compared with commonly used classification algorithms. In addition, it was found that the electrical conductivity of skin had the closest correlation with the results of the Korean Mini-Mental State Examination score among data collected through wearable devices in this study.ConclusionsOur proposed system can contribute to effective early detection of dementia for the elderly, using a non-invasive and easy-to-wear wearable device and classification algorithms with a simple cognitive function test. In the future, we intend to have more subjects participate in the experiment, to include more relevant variables in the wearable device, and to analyze the effectiveness of the smart healthcare-based dementia classification system over the long term.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-21T05:24:34Z
      DOI: 10.1177/20552076221131667
      Issue No: Vol. 8 (2022)
       
  • The role of mobile health technologies in promoting COVID-19 prevention: A
           narrative review of intervention effectiveness and adoption

    • Authors: Jane Katusiime, Wilson Tumuhimbise, Godfrey Rwambuka Mugyenyi, Phionah Kobutungi, Aaron Mugaba, Raphael Zender, Niels Pinkwart, Angella Musiimenta
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundResearchers have found innovative ways of using mobile health (mHealth) technologies to prevent the spread of coronavirus disease 2019 (COVID-19). However, fewer studies have been done to determine their adoption and effectiveness.ObjectiveThis review summarises the published evidence on the effect of mHealth technologies on the adoption of COVID-19 preventive measures, prevention knowledge acquisition and risk perception as well as technology adoption features for COVID-19 prevention.MethodsPubMed, IEEE and Google Scholar databases were searched for peer-reviewed literature from 1 January 2020 to 31 March 2022 for studies that evaluated the effect of mHealth technologies on COVID-19 preventive measures adoption, prevention knowledge acquisition and risk perception. Thirteen studies met the inclusion criteria and were included in this review. All the included studies were checked for quality using the mHealth evidence reporting and assessment (mERA) checklist.ResultsThe review found out that the utilisation of mHealth interventions such as alert text messages, tracing apps and social media platforms was associated with adherence behaviour such as wearing masks, washing hands and using sanitisers, maintaining social distance and avoiding crowded places. The use of contact tracing was linked to low-risk perception as users considered themselves well informed about their status and less likely to pose transmission risks compared to non-users. Privacy and security issues, message personalisation and frequency, technical issues and trust concerns were identified as technology adoption features that influence the use of mHealth technologies for promoting COVID-19 prevention.ConclusionUtilisation of mHealth may be a feasible and effective way to prevent the spread of COVID-19. However, the small study samples and short study periods prevent generalisation of the findings and calls for larger, longitudinal studies that encompass diverse study settings.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-20T07:13:21Z
      DOI: 10.1177/20552076221131146
      Issue No: Vol. 8 (2022)
       
  • Internet-facilitated interventions for informal caregivers of patients
           with neurodegenerative disorders: Systematic review and meta-analysis

    • Authors: Neil Boyt, Aileen K Ho, Hannah Morris-Bankole, Jacqueline Sin
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis systematic review explored the effectiveness of internet-delivered interventions in improving psychological outcomes of informal caregivers for neurodegenerative-disorder (ND) patients.MethodsWe searched seven databases for English-language papers published from 1999 to May 2021. Study-eligibility required that interventions used a minimum 50% internet-facilitation, targeting unpaid, adult informal caregivers of community-based ND-patients. We included randomised controlled trials (RCTs) and pre-post evaluative studies reporting outcomes for at least one-time point post-intervention. Independent quality checks on abstract and full-text screening were completed. Data extraction encompassed interventions’ features, approaches, theoretical bases and delivery-modes. The Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) framework assessed risk of bias. Alongside narrative synthesis, we calculated meta-analyses on post-intervention using outcome measures from at least two RCTs to assess effectiveness.ResultsSearches yielded 51 eligible studies with 3180 participants. In 48 studies, caregivers supported a dementia-diagnosed individual. Intervention-durations encompassed four weeks to 12 months, with usage-frequency either prescribed or participant-determined. The most frequently-used approach was education, followed by social support. We calculated meta-analyses using data from 16 RCTs. Internet-delivered interventions were superior in improving mastery (g  =  1.17 [95% CI; 0.1 to 2.24], p  =  0.03) and reducing anxiety (g = -1.29 [95% CI; −1.56 to −1.01], p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-20T07:12:25Z
      DOI: 10.1177/20552076221129069
      Issue No: Vol. 8 (2022)
       
  • Acceptance of information communication technology-based health
           information services: Exploring the culture in primary-level health care
           of South Ethiopia, using Utaut Model, Ethnographic Study

    • Authors: Senait Samuel Bramo, Amare Desta, Munavvar Syedda
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionIn sub-Saharan African countries including Ethiopia, the acceptance of Information Communication Technology (ICT) in health is at the proof-of-concept level with a few unsustainable piecemeal of pilot projects. Thus, a desirable willingness of acceptance among healthcare providers is a paramount.Material and MethodsEight months elapsed ethnographic study design was conducted using participant observation and key informant interviews. The data were entered on Qualitative Data Analysis mine software version 1.4. The quotes and field notes were thematized. The Unified Technology Acceptance and Use Theory (UTAUT) is validated and used to generate new meanings.ResultsThis study highlighted the different instances of technology acceptance. Although the primary-level healthcare (PLHC) providers displayed tendencies to accept ICTs-based health information services consistent with the UTAUT dimensions such as the degree of simplicity associated with performance expectancy, use/effort expectancy, facilitating conditions, social issue, individual variation, and organization culture there are instances that disputed acceptance. For instance, the gains in data quality and reporting secondary to the use of District Health Information System Two (DHIS-II) are not influenced by acceptance. Rather PLHC providers are burnt-out of additional clerical duties of filling data on the DHIS-2. Furthermore, ICT acceptance is influenced by individual variations and the unique culture of primary level facilities such as leadership commitment.ConclusionsOn this basis, we conclude that the willingness to accept ICT-based health information services at the primary level is not limited to those factors discussed in the UTAUT model.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-19T08:06:42Z
      DOI: 10.1177/20552076221131144
      Issue No: Vol. 8 (2022)
       
  • Study protocol of EMPOWER: A cluster randomized trial of a multimodal
           eHealth intervention for promoting mental health in the workplace
           following a stepped wedge trial design

    • Authors: Beatriz Olaya, Christina M. Van der Feltz-Cornelis, Leona Hakkaart-van Roijen, Dorota Merecz-Kot, Marjo Sinokki, Päivi Naumanen, Jessie Shepherd, Frédérique van Krugten, Marleen de Mul, Kaja Staszewska, Ellen Vorstenbosch, Carlota de Miquel, Rodrigo Antunes Lima, José Luis Ayuso-Mateos, Luis Salvador-Carulla, Oriol Borrega, Carla Sabariego, Renaldo M. Bernard, Christophe Vanroelen, Jessie Gevaert, Karen Van Aerden, Alberto Raggi, Francesco Seghezzi, Josep Maria Haro
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers’ and employees’ perspective.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-19T07:37:21Z
      DOI: 10.1177/20552076221131145
      Issue No: Vol. 8 (2022)
       
  • Interpretable modeling and discovery of key predictors for pneumonia
           diagnosis in children based on electronic medical records

    • Authors: Jing Li, Yingshuo Wang, Qiuyang Sheng, Xiaoqing Liu, Zijian Xing, Fenglei Sun, Yuqi Wang, Shuxian Li, Yiming Li, Yizhou Yu, Gang Yu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundCommunity-acquired pneumonia is one of the most common infectious diseases in children and is a leading cause of death among children under 5 years of age, resulting in high rates of antibiotic usage and hospitalization. It is of extremely practical significance to make full use of the existing electronic medical records to study pneumonia and to establish automatic diagnosis models for pneumonia.MethodsWe established pneumonia diagnosis models of Bayesian network using a total of 13,448 electronic medical records. We investigated learning network structure and parameter estimation and evaluated different structure learning strategies and various modeling methods. By identifying the key predictors of model, the pneumonia status was analyzed.ResultsThe performance of the proposed Bayesian network was evaluated using a set of 3361 cases with a precision of 0.7861, a recall of 0.9889, and an F1-score of 0.8759. On an independent external validation set containing 4925 cases, Bayesian network achieved a precision of 0.7382, a recall of 0.9947, and an F1-score of 0.8475. Our proposed Bayesian network outperformed all other methods, including CatBoost, XGBoost, LightGBM, logistic regression, and ridge classification.ConclusionThe appropriate feature selection improved the performance of Bayesian networks. The proposed Bayesian network had good generalizability and could be directly applied to clinical research centers. And the key predictors identified by the network demonstrated good clinical interpretability, allowing for a better understanding of pneumonia status and complications. This study had important clinical value and practical significance for the research and diagnosis of pediatric pneumonia.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-19T07:16:03Z
      DOI: 10.1177/20552076221131185
      Issue No: Vol. 8 (2022)
       
  • Remote patient monitoring of central retinal function with MACUSTAT®: A
           multi-modal macular function scan

    • Authors: Earnest Chen, Michael Mills, Tara Gallagher, Sean Ianchulev, Ranya Habash, Ronald C Gentile
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionThere is significant unmet need for patient-centric remote monitoring of visual function for chronic retinal diseases, as demonstrated by the COVID-19 pandemic. The Macustat® central retinal function scan is a novel cloud-based digital health application for remote monitoring. The aim of this study is to assess the efficacy of the Macustat® compared to traditional in-office retinal evaluations.Materials and methodsPatients with underlying macular pathology underwent office-based retinal and visual acuity examinations and OCT macula imaging followed by remote tele-monitoring assessment with the Macustat. Central visual function was assessed with the multi-modal Macustat test using dynamic virtual Amsler grid testing, hyperacuity perimetry and visual acuity testing. The results were compared to the findings of the in-office comprehensive retina exam and OCT evaluation.ResultsThe foveal acuity potential registered with the Macustat test showed high correlation with the office Snellen acuity potential 96% of eyes registered Macustat acuity within 0.2 LogMAR of office acuity measurement. In Wet AMD eyes with CNV pathology documented on OCT, the Macustat foveal function scan showed a corresponding abnormality in 89% of any CNV eyes and 100% of all visually significant CNV. In normal eyes without any visually significant edema or CNV, more than 92% showed corresponding normal retinal function scan.ConclusionThe Macustat demonstrates high concordance with clinical findings using traditional diagnostic devices. Home monitoring with the Macustat® may offer complementary clinical utility as a telehealth tool for the assessment of visual acuity and macular function in patients at high risk for macular disease.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-18T06:45:32Z
      DOI: 10.1177/20552076221132105
      Issue No: Vol. 8 (2022)
       
  • HYPO-CHEAT’s aggregated weekly visualisations of risk reduce real
           world hypoglycaemia

    • Authors: Chris Worth, Paul W Nutter, Mark J Dunne, Maria Salomon-Estebanez, Indraneel Banerjee, Simon Harper
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundChildren with congenital hyperinsulinism (CHI) are at constant risk of hypoglycaemia with the attendant risk of brain injury. Current hypoglycaemia prevention methods centre on the prediction of a continuous glucose variable using machine learning (ML) processing of continuous glucose monitoring (CGM). This approach ignores repetitive and predictable behavioural factors and is dependent upon ongoing CGM. Thus, there has been very limited success in reducing real-world hypoglycaemia with a ML approach in any condition.ObjectivesWe describe the development of HYPO-CHEAT (HYpoglycaemia-Prevention-thrOugh-CGM-HEatmap-Technology), which is designed to overcome these limitations by describing weekly hypoglycaemia risk. We tested HYPO-CHEAT in a real-world setting to evaluate change in hypoglycaemia.MethodsHYPO-CHEAT aggregates individual CGM data to identify weekly hypoglycaemia patterns. These are visualised via a hypoglycaemia heatmap along with actionable interpretations and targets. The algorithm is iterative and reacts to anticipated changing patterns of hypoglycaemia. HYPO-CHEAT was compared with Dexcom Clarity's pattern identification and Facebook Prophet's forecasting algorithm using data from 10 children with CHI using CGM for 12 weeks. HYPO-CHEAT's efficacy was assessed via change in time below range (TBR).ResultsHYPO-CHEAT identified hypoglycaemia patterns in all patients. Dexcom Clarity identified no patterns. Predictions from Facebook Prophet were inconsistent and difficult to interpret. Importantly, the patterns identified by HYPO-CHEAT matched the lived experience of all patients, generating new and actionable understanding of the cause of hypos. This facilitated patients to significantly reduce their time in hypoglycaemia from 7.1% to 5.4% even when real-time CGM data was removed.ConclusionsHYPO-CHEAT's personalised hypoglycaemia heatmaps reduced total and targeted TBR even when CGM was reblinded. HYPO-CHEAT offers a highly effective and immediately available personalised approach to prevent hypoglycaemia and empower patients to self-care.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-18T06:44:47Z
      DOI: 10.1177/20552076221129712
      Issue No: Vol. 8 (2022)
       
  • Exploring the sociocultural contexts in which healthcare staff respond to
           and use online patient feedback in practice: In-depth case studies of
           three NHS Trusts

    • Authors: Lauren Ramsey, Rebecca Lawton, Laura Sheard, Jane O’Hara
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesPatients are increasingly reporting about their healthcare experiences online and NHS Trusts are adopting different approaches to responding. However, the sociocultural contexts underpinning these organisational approaches remain unclear. Therefore, we aimed to explore the sociocultural contexts underpinning three organisations who adopted different approaches to responding to online patient feedback.MethodsRecruitment of three NHS Trusts was theoretically guided, and determined based on their different approaches to responding to online patient feedback (a nonresponding organisation, a generic responding organisation and an organisation providing transparent, conversational responses). Ethnographic methods were used during a year of fieldwork involving staff interviews, observations of practice and documentary analysis. Three in-depth case studies are presented.FindingsThe first organisation did not respond to or use online patient feedback as staff were busy firefighting volumes of concerns received in other ways. The second organisation adopted a generic responding style due to resource constraints, fears of public engagement and focus on resolving known issues raised via more traditional feedback sources. The final organisation provided transparent, conversational responses to patients online and described a 10-year journey enabling their desired culture to be embedded.ConclusionsWe identified a range of barriers facing organisations who ignore or provide generic responses to patient feedback online. We also demonstrated the sociocultural context in which online interactions between staff and patients can be embraced to inform improvement. However, this represented a slow and difficult organisational journey. Further research is needed to better establish how organisations can recognise and overcome barriers to engaging with online patient feedback, and at pace.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-18T06:43:19Z
      DOI: 10.1177/20552076221129085
      Issue No: Vol. 8 (2022)
       
  • Public perceptions of a healthy lifestyle change conversational agent in
           Singapore: A qualitative study

    • Authors: Dhakshenya Ardhithy Dhinagaran, Lorainne Tudor Car
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveConversational agents (CAs) are increasingly used for the delivery of healthy lifestyle behaviour interventions. This qualitative study aimed to explore the barriers and facilitators to participants’ usage of a healthy lifestyle change CA and collect their views on areas for its improvement.MethodsTwenty participants were recruited from a convenience sample of users interacting with a CA promoting healthy lifestyle changes to the general population in Singapore. This CA, Precilla, educated users on healthy living, specifically: diet, exercise, sleep and stress; for four weeks. The volunteers participated in semi-structured interviews where an interview guide was used, with questions on acceptability, satisfaction and critical appraisal of the CA. Interviews were transcribed and analysed in parallel by two researchers using thematic content analysis.ResultsFour main themes were identified: (1) enjoyable and acceptable experiences, (2) suboptimal experience(s), (3) alterations to Precilla for enhanced interaction and (4) suggestions for the future. Enjoyable experiences referenced the CA's friendly personality and important content that motivated a positive change to their lifestyle. Some participants were less satisfied and found the content to be too simple or sometimes, the messages too lengthy.ConclusionsParticipants suggested that in the future, CAs should provide regularly updated content on healthy living, specifically pre-diabetes. Multiple answer options should also be provided for more personalisation along with links to external resources to help improve users’ health literacy. Further recommendations include a necessity for a user-centered approach in CA development, employment of engagement strategies, use of a delivery platform most familiar to the target population and stratified message timings to suit the population and purpose of CA. Translating the health CAs to languages relevant to the target group could also enable wider reach and applicability.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-17T06:38:27Z
      DOI: 10.1177/20552076221131190
      Issue No: Vol. 8 (2022)
       
  • Demonstration experiment of telemedicine using ultrasonography and
           telerehabilitation with 5G communication system in aging and depopulated
           mountainous area

    • Authors: Masaomi Saeki, Shintaro Oyama, Hidemasa Yoneda, Shingo Shimoda, Tsukasa Agata, Yutaka Handa, Satoshi Kaneda, Hitoshi Hirata
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe challenges of an aging population worldwide are the increased number of people needing medical and nursing care and inadequate medical resources. Information and communication technologies have progressed remarkably, leading to innovations in various areas. 5G communication systems are capable of high-capacity, high-speed communication with low latency and are expected to transform medicine. We aimed to report a demonstration experiment of telerehabilitation and telemedicine using a mobile ultrasound system in a depopulated area in a mountainous terrain, where 32% of the population are 65 years or older.MethodsAt the core hospital, a physician or physical therapist remotely performed ultrasonography or rehabilitation on a subject in a clinic. Five general residents participated in the telerehabilitation as subjects. The delay time and video quality transmitted with 5G and long-term evolution (LTE) communication systems were compared. The physician or physical therapist subjectively evaluated the quality and delay of the transmitted images and subject acceptability.ResultsOf seven physical therapists, six and three responded that the video quality was “good” for telerehabilitation with 5G/4K resolution and LTE, respectively. Five physical therapists and one physical therapist reported that the delay time was “acceptable” with 5G/4K resolution and LTE, respectively. For telemedicine using a mobile ultrasound system, the responses for 5G were “the delay was acceptable” and “rather acceptable.” In contrast, both respondents’ responses for LTE were “not acceptable.”ConclusionsMultiple high-definition images can be transmitted with lower latency in telerehabilitation and telemedicine using mobile ultrasound imaging systems with a 5G communication system. These differences affected the subjective evaluation of the doctors and physical therapists.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-13T07:13:02Z
      DOI: 10.1177/20552076221129074
      Issue No: Vol. 8 (2022)
       
  • A scoping review of feasibility, cost, access to rehabilitation services
           and implementation of telerehabilitation: Implications for low- and
           middle-income countries

    • Authors: Eugene Nizeyimana, Conran Joseph, Nicola Plastow, Gouwa Dawood, Quinette A Louw
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo scope all published information reporting on the feasibility, cost, access to rehabilitation services, implementation processes including barriers and facilitators of telerehabilitation (TR) in low- and middle-income countries (LMICs) and high-income countries (HICs).MethodsA comprehensive electronic search of PubMed, Scopus, PEDro, Cochrane library, EBSCOhost (Academic search premier, Africa-wide information, CINAHL, Eric, MEDLINE, Health sources - Nursing/Academic edition), Africa online, as well as ProQuest databases were conducted. To maximise the coverage of the literature, the reference lists of included articles identified through the search were also screened. The analysis included both descriptive summary and inductive thematic analysis.ResultsTwenty-nine studies were included. TR was reported to be feasible, cost-saving and improved access to rehabilitation services in both HICs and LMICs settings. Asynchronous methods using different mobile apps (Skype, WhatsApp, Google meet, Facebook messenger, Viber, Face time and Emails) were the most common mode of TR delivery. Barriers to the implementation were identified and categorised in terms of human, organisational, technical and clinical practice related factors. Facilitators for health professionals and patients/caregivers’ dyads were also identified.ConclusionTR could be considered a feasible service delivery mode in both HICs and LMICs. However, the mitigation of barriers such as lack of knowledge and technical skills among TR providers and service users, lack of secure platform dedicated for TR, lack of resources and connectivity issues which are particularly prevalent in LMICs will be important to optimise the benefits of TR.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-12T06:37:02Z
      DOI: 10.1177/20552076221131670
      Issue No: Vol. 8 (2022)
       
  • Beliefs, emotions, and usage of information and communication technologies
           in distance learning during the COVID-19 pandemic: Health sciences
           students’ perspectives

    • Authors: Gizell Green, Tali Shorer
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesFirst, to examine Health Sciences students’ discipline, educational level, number of online courses taken, and emotions regarding distance learning; second, to explore a model in which information and communication technologies' (ICT) beliefs serve as mediators among ICT's emotions and ICT usage.MethodsThis is a cross-sectional study. Participants consisted of 210 students from the School of Health Sciences at the University. Perceptions toward ICTs in Teaching-Learning Process Scale and Computer Emotion Scale were used.ResultsNursing students report significantly more ICT-related negative emotions than Management of Health Systems students. Students who took a low or medium number of online courses report significantly more ICT-related positive emotions than students who took a high number of online courses. In addition, ICT-related beliefs did not mediate the effects of ICT-related positive emotions and ICT usage but did mediate ICT-related negative emotions and ICT usage.ConclusionsThe digital tools in online courses should be appropriately combined with the learning method, and course content. It requires not only a solid technical foundation but also an educational mentality, as well as an adjustment period.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-12T06:35:42Z
      DOI: 10.1177/20552076221131188
      Issue No: Vol. 8 (2022)
       
  • Identifying essential factors that influence user engagement with digital
           mental health tools in clinical care settings: Protocol for a Delphi study
           

    • Authors: Brian Lo, Quynh Pham, Sanjeev Sockalingam, David Wiljer, Gillian Strudwick
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionImproving effective user engagement with digital mental health tools has become a priority in enabling the value of digital health. With increased interest from the mental health community in embedding digital health tools as part of care delivery, there is a need to examine and identify the essential factors in influencing user engagement with digital mental health tools in clinical care. The current study will use a Delphi approach to gain consensus from individuals with relevant experience and expertise (e.g. patients, clinicians and healthcare administrators) on factors that influence user engagement (i.e. an essential factor).MethodsParticipants will be invited to complete up to four rounds of online surveys. The first round of the Delphi study comprises of reviewing existing factors identified in literature and commenting on whether any factors they believe are important are missing from the list. Subsequent rounds will involve asking participants to rate the perceived impact of each factor in influencing user engagement with digital mental health tools in clinical care contexts. This work is expected to consolidate the perspectives from relevant stakeholders and the academic literature to identify a core set of factors considered essential in influencing user engagement with digital mental health tools in clinical care contexts.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-12T06:33:04Z
      DOI: 10.1177/20552076221129059
      Issue No: Vol. 8 (2022)
       
  • Commercial smartwatch with pulse oximeter detects short-time hypoxemia as
           well as standard medical-grade device: Validation study

    • Authors: Jakub Rafl, Thomas E Bachman, Veronika Rafl-Huttova, Simon Walzel, Martin Rozanek
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveWe investigated how a commercially available smartwatch that measures peripheral blood oxygen saturation (SpO2) can detect hypoxemia compared to a medical-grade pulse oximeter.MethodsWe recruited 24 healthy participants. Each participant wore a smartwatch (Apple Watch Series 6) on the left wrist and a pulse oximeter sensor (Masimo Radical-7) on the left middle finger. The participants breathed via a breathing circuit with a three-way non-rebreathing valve in three phases. First, in the 2-minute initial stabilization phase, the participants inhaled the ambient air. Then in the 5-minute desaturation phase, the participants breathed the oxygen-reduced gas mixture (12% O2), which temporarily reduced their blood oxygen saturation. In the final stabilization phase, the participants inhaled the ambient air again until SpO2 returned to normal values. Measurements of SpO2 were taken from the smartwatch and the pulse oximeter simultaneously in 30-s intervals.ResultsThere were 642 individual pairs of SpO2 measurements. The bias in SpO2 between the smartwatch and the oximeter was 0.0% for all the data points. The bias for SpO2 less than 90% was 1.2%. The differences in individual measurements between the smartwatch and oximeter within 6% SpO2 can be expected for SpO2 readings 90%–100% and up to 8% for SpO2 readings less than 90%.ConclusionsApple Watch Series 6 can reliably detect states of reduced blood oxygen saturation with SpO2 below 90% when compared to a medical-grade pulse oximeter. The technology used in this smartwatch is sufficiently advanced for the indicative measurement of SpO2 outside the clinic.Trial RegistrationClinicalTrials.gov NCT04780724
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-11T07:16:42Z
      DOI: 10.1177/20552076221132127
      Issue No: Vol. 8 (2022)
       
  • Level of implementation of district health information system 2 at public
           health facilities in Eastern Ethiopia

    • Authors: Merkineh Mekebo, Tesfaye Gobena, Behailu Hawulte, Dawit Tamiru, Adera Debella, Elias Yadeta, Addis Eyeberu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe major aim of this study was to assess the level of District health information system 2 (DHIS 2) implementation in the public health facilities (HFs) in Dire Dawa City Administration.MethodsThis study was employed both quantitative (cross-sectional) and qualitative (phenomenological) study designs. All public HFs found in Dire Dawa City Administration and health workers were participated in the study. Quantitative data were collected using a pre-tested, structured, self-administered questionnaire. The collected data were entered into Epi-Data and analyzed using STATA version 14 software. A descriptive summary was computed using proportion and frequencies. Qualitative data were collected from in-depth interview with key informants (KIs), and the results were then analyzed thematically.ResultsThe overall implementation level of DHIS 2 was 80%, which shows good implementation. The main difficulties encountered in implementing DHIS 2 were a lack of power backup (64.3%), unreliable internet connectivity (43%), and a lack of training (34.6%). According to an in-depth interview with a 32-year-old professional, “…there is offline and online DHIS 2 software for data collection and reporting that is an opportunity for the health center, but there is a challenge of interruption of electricity lost unsaved data and hinder data to enter and view for making a decision….”ConclusionThe level of DHIS 2 implementation in this study was good compared to other studies in Ethiopia. However, more than half of the HFs require infrastructure maintenance and support.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-11T07:16:03Z
      DOI: 10.1177/20552076221131151
      Issue No: Vol. 8 (2022)
       
  • Issues with the Swedish e-prescribing system – An analysis of health
           information technology-related incident reports using an existing
           classification system

    • Authors: Md Shafiqur Rahman Jabin, Tora Hammar
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo identify issues with the Swedish e-prescribing system and devise a set of recommendations to overcome the identified challenges.MethodsA number of health information technology-related incidents were collected retrospectively from various sources using purposive and snowball sampling. A search term containing five keywords was used to identify the electronic prescription-related incidents. The identified incidents (n = 24) were subjected to an existing framework, i.e., the Health Information Technology Classification System. Special attention was paid to the software-related issues, which were analysed using thematic analysis.ResultsSeveral types of software-related issues (n = 22) were identified: system configuration, interface with other software systems or components, software functionality, data storage and backup, record migration, software not accessible, and network/server down or slow. Both human and technical factors contributed to these incidents, including prescriptions not cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These software problems led to various consequences, such as incidents affecting multiple patients’ care management, delays in patient care, and risks of serious deterioration of health. Several temporary initiatives or administrative adjustments, for instance, cover letters to patients and local strategies, were used to overcome some of these challenges.ConclusionsThis study provides insights into the challenges related to the e-prescribing system, contributing factors, consequences, and actions taken to mitigate those risks. Therefore, healthcare organisations using the e-prescribing system should adopt the provided recommendations to minimise the risks of design and developmental challenges, implementation and use-related issues, and the problems related to monitoring, evaluation, and optimisation.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-11T07:15:00Z
      DOI: 10.1177/20552076221131139
      Issue No: Vol. 8 (2022)
       
  • Feasibility of a tailored and virtually supported home exercise program
           for people with multiple myeloma using a novel eHealth application

    • Authors: Graeme M. Purdy, Chris P. Venner, Puneeta Tandon, Margaret L. McNeely
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductioneHealth exercise interventions have the unique ability to leverage the benefits of in-person programming (tailoring and supervision) with the benefits of home programming (flexibility). There may be a role for eHealth-delivered exercise for people with multiple myeloma (MM), as exercise tailoring and supervision are critical for successful outcomes due to the significant impacts/risks of myeloma-related side effects. The purpose of this study was to determine the safety, feasibility, and preliminary efficacy of a 12-week virtually supported eHealth exercise program.MethodsParticipants with MM completed a 12-week virtually supported home exercise program involving virtually supervised group workouts, independent workouts, and aerobic exercise. Tailoring was facilitated by the functionality of HEAL-Me, a novel eHealth app. Participants completed virtual fitness assessments and questionnaires at baseline and week 12.ResultsTwenty-nine participants consented, 26 completed all follow-up testing (90%). Exercise adherence was 90% (group), 83% (independent), and 90% (aerobic). No serious adverse events (grade ≥3) occurred. Significant improvements were found for quality of life and physical fitness. There was a high level of program/app satisfaction: 96% of participants agreed or strongly agreed that the exercise program was beneficial, 93% found it enjoyable, 89% were satisfied or very satisfied with delivery through the HEAL-Me app, and 48% felt that the eHealth program helped them manage cancer-related symptoms and side-effects.ConclusionAn eHealth intervention that is individually tailored and includes virtual supervision and active support from the healthcare team is feasible and acceptable to people with MM. The findings from this study warrant investigation using a large-scale randomized controlled trial.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-11T07:14:03Z
      DOI: 10.1177/20552076221129066
      Issue No: Vol. 8 (2022)
       
  • Design, implementation, and evaluation of an innovative intelligence
           information management system for premature infants

    • Authors: Shahrbanoo Pahlevanynejad, Navid Danaei, Reza Safdari
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionLow birth weight is the most important condition of neonatal community health and the main cause of neonates' mortality. Identifying the indexes associated with this condition, and factors to prevent, and managing related data can help reduce the birth of premature infants to reduce the mortality rate due to this condition. The goal of present study was to design, implement and evaluate an innovative intelligence information management system for premature infants.Material and methodThe present study was a multidisciplinary research that was done in 2019 to 2021 in four integrated phases in Iran. The first phase aimed to compare the current status of registration systems of premature infants through a systematic review and semi-structured interviews by using the Delphi model Then the minimum data set was determined and was designed a proposed model based on it. In the second phase, the structure and how the user interacts with the system were determined, and, using Microsoft Visio software, Unified Modeling Language diagrams were drawn to define the logical relationship of data. In the third phase, the system was developed, and finally in the last phase, in three methods, users' views on the usability of the system were evaluated.ResultsThe findings of this study included 233 essential data elements that were placed in two main groups of essential data, and the system was approved by end users for 87.73% consent and 67.19% satisfaction for SUMI (Software Usability Measurement Inventory) and 7.97 of 9 in QUIS questionnaire.ConclusionThis research's results can be beneficial and functional such as a complete sample for design and development of other systems concerned to health systems.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-11T07:12:45Z
      DOI: 10.1177/20552076221127776
      Issue No: Vol. 8 (2022)
       
  • Virtual care post-pandemic: Why user engagement is critical to create and
           optimise future models of care

    • Authors: Reema Harrison, Melissa Prokopy, Tyrone Perreira
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Health systems are shifting from the use of virtual models of care reactively in response to the conditions of the pandemic, to deliberate planning for the integration of virtual models to enhance and extend current service provision. Use of virtual care in recent years has highlighted the critical role of clinician and consumer behaviour and mindsets in realising the opportunities of virtual care for improved health care and outcomes. Yet, the rapid and changing circumstances of the pandemic period provided limited opportunities for effective involvement of both clinicians and consumers in health system decision-making about when, how and which virtual services and associated technologies should be deployed. We explore the opportunity for enhanced engagement with these primary stakeholder groups to create quality healthcare as we emerge from the pandemic and enter a new phase of integrated virtual services.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-10T05:03:13Z
      DOI: 10.1177/20552076221131455
      Issue No: Vol. 8 (2022)
       
  • Global trends and hotspots in research on extended reality in sports: A
           bibliometric analysis from 2000 to 2021

    • Authors: Jie Zhao, Jie Mao, Jing Tan
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveExtended reality technologies (e.g. virtual reality (VR), augmented reality (AR) and mixed reality (MR)) are gaining popularity in sports owing to their unique advantages. This study aims to analyse the progress of the application of extended reality technology in sports and reveal its cooperative features, research hotspots and development trends.MethodsWe searched the literature in the Web of Science Core Collection (WoSCC) database within the period 2000 to 2021 and conducted a bibliometric analysis. The analysis methods included statistical, co-occurrence, hierarchical clustering and social network analyses.ResultsA total of 340 articles were gathered. The literature related to its research showed an increasing trend over time. The paper collaboration rate was 90.88% (309/340 papers), and the degree of author collaboration was 3.96 (1345/340). VR was found to be the most productive journal, and Queen's University Belfast was the most productive institution. The United States, China and the United Kingdom were the three main contributors to the field. The foundational themes in sports extended reality research were (i) sports games and extended reality systems, (ii) virtual simulation devices and artificial intelligence, (iii) sports training and performance and (iv) age-appropriate physical activity, sports rehabilitation and physical education.ConclusionThe level of author collaboration was low, but the degree of author collaboration is largely on the rise. The closeness of the collaboration between institutions and countries was also low. In addition, the subject of sport extended reality is relatively fragmented. Therefore, more research is needed to strengthen it in the future.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-10T05:02:21Z
      DOI: 10.1177/20552076221131141
      Issue No: Vol. 8 (2022)
       
  • The role of phone-based triage nurses in supporting older adults with
           multimorbidity to digitally self-manage – Findings from the ProACT
           proof-of-concept study

    • Authors: Julie Doyle, Patricia McAleer, Cora van Leeuwen, Suzanne Smith, Emma Murphy, Myriam Sillevis Smitt, Mary Galvin, An Jacobs, Lorraine Tompkins, James Sheerin, John Dinsmore
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAchieving patient-centred care necessitates supporting individuals to have more involvement in the self-management of their care. Digital health technologies are widely recognised as a solution to empower more effective self-management. However, given the complexity of multiple chronic condition (multimorbidity) management, coupled with changes that occur as part of the normal ageing process, human support alongside digital self-management is often necessary for older people with multimorbidity (PwM) to sustain successful self-management.MethodsThe aim of the study was to explore the role played by a clinical, nurse-led telephone triage service in responding to alerts generated by older adults using a digital health platform, ProACT, to self-manage multiple chronic conditions over a period of 1 year. Semi-structured interviews with participants with multimorbidity were carried out across four time points during the trial, while interviews and focus groups were conducted with triage nurses at the end of the trial. Thematic analysis was conducted on the resulting transcripts.ResultsThemes found in the data include the work of triage nurses; the benefits of triage support; tensions such as anxiety due to patient monitoring; and the relationship between triage nurses and participants.DiscussionThis work contributes to an understanding of how older adults with multimorbidity and triage nurses collaborate in multiple chronic disease self-management. Findings are discussed within the context of Hudon et al.'s patient-centred care framework and indicate that patient-centred care was achieved, with both PwM and triage participants reporting positive experiences, relationships and several benefits of the triage support alongside digital self-management.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-10T05:00:47Z
      DOI: 10.1177/20552076221131140
      Issue No: Vol. 8 (2022)
       
  • Weight loss in a digital app-based diabetes prevention program powered by
           artificial intelligence

    • Authors: Sarah A. Graham, Viveka Pitter, Jonathan H. Hori, Natalie Stein, OraLee H. Branch
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe National Diabetes Prevention Program (DPP) reduces diabetes incidence and associated medical costs but is typically staffing-intensive, limiting scalability. We evaluated an alternative delivery method with 3933 members of a program powered by conversational Artificial Intelligence (AI) called Lark DPP that has full recognition from the Centers for Disease Control and Prevention (CDC).MethodsWe compared weight loss maintenance at 12 months between two groups: 1) CDC qualifiers who completed ≥4 educational lessons over 9 months (n  =  191) and 2) non-qualifiers who did not complete the required CDC lessons but provided weigh-ins at 12 months (n  =  223). For a secondary aim, we removed the requirement for a 12-month weight and used logistic regression to investigate predictors of weight nadir in 3148 members.ResultsCDC qualifiers maintained greater weight loss at 12 months than non-qualifiers (M  =  5.3%, SE  =  .8 vs. M  =  3.3%, SE  =  .8; p  =  .015), with 40% achieving ≥5%. The weight nadir of 3148 members was 4.2% (SE  =  .1), with 35% achieving ≥5%. Male sex (β = .11; P  =  .009), weeks with ≥2 weigh-ins (β = .68; P 
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-10T04:44:23Z
      DOI: 10.1177/20552076221130619
      Issue No: Vol. 8 (2022)
       
  • Exploring enablers and inhibitors of eHealth educational tools: The needs
           of women searching for HPV and cervical cancer information

    • Authors: Hind Bitar, Sarah Alismail
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study explored the information women want to know about HPV and cervical cancer, and the enablers or inhibitors that may contribute to, or prevent, seeking online health information.MethodsTwo focus groups were conducted with women from the general public, followed by interviews with 12 physicians practicing in Saudi Arabia. The data was analyzed by using a thematic analysis approach.ResultsResearchers of this study identified six topics of information that were need-related, ten that were enabling, and six inhibiting subthemes related to online information seeking about HPV and cervical cancer.Discussion and conclusionIn accordance with the identified themes and sub-themes, we offer recommendations to optimize the health information-seeking task related to HPV and cervical cancer through eHealth educational solutions. User- and expert-based feedback can both strengthen and inform the design, development, and implementation of eHealth interventions.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-10T04:41:24Z
      DOI: 10.1177/20552076221130189
      Issue No: Vol. 8 (2022)
       
  • Text messaging to increase patient engagement in a large health care for
           the homeless clinic: Results of a randomized pilot study

    • Authors: Karyn Kershaw, Lisa Martelly, Cassidy Stevens, D. Keith McInnes, Allie Silverman, Thomas Byrne, Diana Aycinena, Lora L. Sabin, Lynn A. Garvin, Varsha G. Vimalananda, Robert Hass
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesTo assess the feasibility and effectiveness of text messaging to increase outpatient care engagement and medication adherence in an urban homeless population in Boston.MethodsBetween July 2017 and April 2018, 62 patients from a clinic serving a homeless population were sent automated text messages for four months. Messages were either appointment reminders and medication adherence suggestions (intervention group) or general health promotion messages (control group). Medical records were reviewed to evaluate appointment keeping, emergency room (ER) use, and hospitalizations. Pre- and post-surveys were administered to measure self-reported medication adherence.ResultsNo significant differences were found in inpatient or outpatient care between the intervention and control groups, though differences in no-show rates and medication adherence approached significance. Appointment no-show rates were 21.0% vs. 30.6% (p = 0.08) for intervention and control, respectively, and rates of completed appointments were 65.8% vs. 56.7% (p = 0.12). Mean ER visits were 3.86 vs 2.33 (p = 0.16) for intervention and control groups, and mean inpatient admissions were 0.6 versus 1.24 (p = 0.42). Self-reported medication adherence increased from 8.27 to 9.84 in intervention participants, compared to an increase from 8.27 to 8.68 in control participants (p = 0.07), on a 1–11 scale.ConclusionsText messaging showed the potential to improve patient engagement in care and medication adherence in an urban homeless population (findings approaching but not achieving statistical significance). Work is needed to enhance the effectiveness of text-messaging interventions, which may involve increasing ease of use for mobile phones and texting apps, and addressing high rates of phone theft and loss.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-10T04:40:03Z
      DOI: 10.1177/20552076221129729
      Issue No: Vol. 8 (2022)
       
  • A qualitative study to explore the acceptability and usefulness of
           personalized biofeedback to motivate physical activity in cancer survivors
           

    • Authors: Grace E. Brannon, Madison Ray, Patrick Cho, Miranda Baum, Muhammad Shaalan Beg, Therese Bevers, Susan M. Schembre, Karen Basen-Engquist, Yue Liao
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveMany cancer survivors do not meet recommended levels of exercise, despite the benefits physical activity offers. This study aimed to understand experiences of insufficiently active overweight/obese breast or colorectal cancer survivors, in efforts to (1) examine regular physical activity barriers, and (2) determine perceptions and acceptability of a remotely delivered physical activity intervention utilizing wearable sensors and personalized feedback messages.MethodsIn-person and virtual small group interviews were conducted engaging overweight/obese cancer survivors (n = 16, 94% female, 94% breast cancer survivors) in discussions resulting in 314 pages of transcribed data analyzed by multiple coders.ResultsAll participants expressed needing to increase physical activity, identifying lack of motivation centering on survivorship experiences and symptom management as the most salient barrier. They indicated familiarity with activity trackers (i.e., Fitbit) and expressed interest in biosensors (i.e., continuous glucose monitors [CGMs]) as CGMs show biological metrics in real-time. Participants reported (1) personalized feedback messages can improve motivation and accountability; (2) CGM acceptability is high given survivors’ medical history; and (3) glucose data is a relevant health indicator and they appreciated integrated messages (between Fitbit and CGM) in demonstrating how behaviors immediately affect one's body.ConclusionsThis study supports the use of wearable biosensors and m-health interventions to promote physical activity in cancer survivors. Glucose-based biofeedback provides relevant and motivating information for cancer survivors regarding their daily activity levels by demonstrating the immediate effects of physical activity. Integrating biofeedback into physical activity interventions could be an effective behavioral change strategy to promote a healthy lifestyle in cancer survivors.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-10T04:38:25Z
      DOI: 10.1177/20552076221129096
      Issue No: Vol. 8 (2022)
       
  • Feasibility of using activity trackers and apps to increase physical
           activity in whole families: The Step it Up Family intervention

    • Authors: Stephanie Schoeppe, Jo Salmon, Susan Williams, Deborah Power, Kim Waters, Stephanie Alley, Amanda L. Rebar, Melanie Hayman, Mitch J Duncan, Corneel Vandelanotte
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study examined the feasibility of an activity tracker and app intervention to increase physical activity in whole families.MethodsThis was a single-arm feasibility study with pre–post-intervention measures. Between 2017 and 2018, 40 families (58 children aged 6–10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family programme in Queensland, Australia. It was delivered using Garmin activity trackers and apps, weekly motivational text messages and an introductory session. Online surveys and semi-structured interviews conducted with parents assessed intervention usage, acceptability, usability, perceived usefulness, use of physical activity self-management strategies and programme influence. Analyses included descriptive statistics, Wilcoxon signed-rank test and qualitative content analysis.ResultsOverall, 38 families completed the post-intervention survey (95% family retention; 90% children, 95% mothers, 88% fathers). Garmin activity tracker usage was high (i.e. nearly 24/7 during the 6 weeks intervention). Families also used the Garmin apps regularly (i.e. mostly 2–6 times per week). Further, 80% of mothers and 52% of fathers read the motivational mobile text messages. Usability and perceived usefulness of the Garmin activity trackers and apps were rated high. Both parents significantly increased their use of physical activity self-management strategies from pre to post-intervention. Parents expressed that the intervention had increased awareness of physical (in)activity in the family, encouraged to be active and promoted outdoor family activities.ConclusionsUsing activity trackers and apps to increase physical activity in the whole family was well received by children and parents which suggests that this intervention approach is feasible. However, further testing is needed amongst more diverse family populations. These early findings support the implementation of a randomised controlled trial to examine intervention efficacy.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-07T05:49:09Z
      DOI: 10.1177/20552076221129083
      Issue No: Vol. 8 (2022)
       
  • Analyzing opioid-use disorder websites in the United States: An optimized
           website usability study

    • Authors: Shuhan He, Saishravan Shyamsundar, Paul Chong, Jasmine Kannikal, Joshua Calvano, Neha Balapal, Nick Kallenberg, Adarsh Balaji, Amala Ankem, Alister Martin
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAs the United States continues to tackle the opioid epidemic, it is imperative for digital healthcare organizations to provide Internet users with accurate and accessible online resources so that they can make informed decisions with regards to their health.ObjectiveThe primary objectives were to adapt and modify a previously established usability methodology from literature, apply this modified methodology in order to perform usability analysis of opioid-use-disorder (OUD)-related websites, and make important recommendations that OUD-related digital health organizations may utilize to improve their online presence.MethodsA list of 208 websites (later refined) was generated for usability testing using a modified Google Search methodology. Four keywords were chosen and used in the search: “DEA-X Waiver Training”, “opioid-use-disorder (OUD) Initiatives”, “Buprenorphine Assisted Treatment”, and “Opioid-Use Disorder Websites”. Usability analysis was performed concurrently with optimization of the methodology. OUD websites were analyzed and scored on several usability categories established by previous literature.Results“DEA-X Waiver Training” yielded websites that scored the highest average in “Accessibility” (0.84), while “Opioid-Use Disorder Websites” yielded websites that scored the highest average in “Content Quality” (0.67). “Buprenorphine Assisted Treatment” yielded websites that scored the highest average across “Marketing” (0.52), “Technology” (0.89), “General Usability” (0.69), and “Overall Usability” (0.68). “Technology” and “Marketing” were the highest and lowest scoring usability categories, respectively. T-test analysis revealed that each usability, except “Marketing” had a pair of one or more keywords that were significantly different with a p-value that was equal to or less than 0.05.ConclusionsBased on the study findings, we recommend that digital organizations in the OUD space should improve their “General Usability” score by making their websites easier to find online. Doing so, may allow users, especially individuals in the OUD space, to discover accurate information that they are seeking. Based on the study findings, we also made important recommendations that OUD-related digital organizations may utilize in order to improve website usability as well as overall reach.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-06T08:44:52Z
      DOI: 10.1177/20552076221121529
      Issue No: Vol. 8 (2022)
       
  • Telehealth-based interventions on lifestyle, body mass index, and glucose
           concentration in university staff during the coronavirus disease 2019
           pandemic: A pre-experimental study

    • Authors: Neidis M. Marquez, Jacksaint Saintila, Antonio J. Castellanos-Vazquez, Roussel Dávila-Villavicencio, Joel Turpo-Chaparro, Jhan A. Sánchez-Tarrillo, Saulo A. Salinas Arias, Yaquelin E. Calizaya-Milla, Wilter C. Morales-García
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Background: The coronavirus disease 2019 pandemic has impacted the health of the population. Technological advances become alternative tools for the promotion of lifestyle and prevention of non-communicable diseases in university personnel. Objective: This study analyzed the effect of an intervention based on a telehealth program and investigated its efficacy in improving lifestyle, body mass index, and glucose concentration in university staff during the coronavirus disease 2019 pandemic. Methods: A pre-experimental study was conducted between August and December 2021 on 100 workers of a private university located in Tarapoto, Peru. Information was collected on lifestyle practices and beliefs, body mass index, and glucose contraction before and after the intervention. After the intervention, 78 participants were analyzed; 22 workers did not respond to the invitation. Results: Comparison between pretest and follow-up showed an increase in lifestyle practices and beliefs (from 93.33 ± 9.44 to 96.23 ± 9.32, p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-06T06:09:15Z
      DOI: 10.1177/20552076221129719
      Issue No: Vol. 8 (2022)
       
  • Artificial intelligence healthcare service resources adoption by medical
           institutions based on TOE framework

    • Authors: Jinxin Yang, Biao Luo, Chen Zhao, Hongliang Zhang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesThis study used the Technology-Organization-Environment (TOE) framework to identify the factors involved in the decisions made by integrated medical and healthcare organizations to adopt artificial intelligence (AI) elderly care service resources.MethodThis study identified the Decision-making Trial and Evaluation Laboratory-Interpretive Structural Modeling (DEMATEL-ISM) method was used to construct a multilayer recursive structural model and to analyze the interrelationships between the levels. A MICMAC quadrant diagram was used for a cluster analysis.ResultsThe ISM recursive structural model was divided into a total of seven layers. The bottom layer contained the four factors of High risk of data leakage (T1), Lack of awareness of the value and benefits of AI healthcare technology (T5), Lack of management leadership support (O1), and Government policies (E1). Having a low dependency but high driving force, these factors are the root causes of adoption by healthcare organizations. The topmost layer contained the most direct factors, which had a high dependency but the low driving force, influencing adoption: Competitive pressures (E2), Lack of patient trust (E5), and Lack of excellent partnerships (E7). Healthcare organizations are more concerned with technology and their environments when deciding to adopt intelligent healthcare resources.ConclusionThe combination of the three methods of DEMATEL-ISM-MICMAC construction models provides new ideas for smart healthcare services for hospitals. The DEMATEL method favors the construction dimension of the micro-model, while the ISM method favors the construction dimension of the macro-model. Combining these two methods may reduce the loss of information within the system, simplify the matrix calculation workload, and improve the efficiency of operations while decomposing the complex problems into several sub-problems in a more comprehensive and detailed way. Conducting cluster analysis of the adoption determinants utilizing MICMAC quadrant diagrams may provide strong methodological guidance and decision-making recommendations for government departments, senior decision-makers in healthcare organizations, and policy-makers in associations in the senior care industry.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-06T06:08:03Z
      DOI: 10.1177/20552076221126034
      Issue No: Vol. 8 (2022)
       
  • Internet-based interventions to support recovery in youth: A systematic
           review

    • Authors: Vicki C Dallinger, Govind Krishnamoorthy, Lorelle J Burton, Carol du Plessis, Arun Pillai-Sasidharan, Alice Ayres
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Personal recovery represents a paradigm shift in how individuals are seen to benefit from mental health interventions, from a narrow view of symptom reduction to a holistic, multi-dimensional view of well-being, functional gains and rehabilitation. Although there is a large body of evidence supporting the use of recovery-oriented care in adults, research on personal recovery amongst youth with mental health concerns is an emerging area of research. Efforts to promote youth mental health have also focussed on the use of digital applications and platforms as a means of overcoming barriers related to factors including stigma and lack of available services. This systematic review aims to review the literature on existing internet-based, youth mental health interventions with regard to (a) identifying elements of the programs that align with the personal recovery and (b) outcome measures utilised in assessing personal recovery. Eleven papers were identified that met the inclusion criteria. Five of the programs reviewed from these eleven papers showed efficacy for recovery processes. The results offer preliminary support and guidance for the use of internet-based mental health interventions in the promotion of personal recovery amongst youth. Future research and practice are suggested to further develop understanding in this area.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-05T06:10:25Z
      DOI: 10.1177/20552076221129094
      Issue No: Vol. 8 (2022)
       
  • Effectiveness of a stepped-care programme of internet-based psychological
           interventions for healthcare workers with psychological distress: Study
           protocol for the RESPOND healthcare workers randomised controlled trial

    • Authors: Roberto Mediavilla, Kerry R McGreevy, Mireia Felez-Nobrega, Anna Monistrol-Mula, María-Fe Bravo-Ortiz, Carmen Bayón, Beatriz Rodríguez-Vega, Pablo Nicaise, Audrey Delaire, Marit Sijbrandij, Anke B. Witteveen, Marianna Purgato, Corrado Barbui, Federico Tedeschi, Maria Melchior, Judith van der Waerden, David McDaid, A-La Park, Raffael Kalisch, Papoula Petri-Romão, James Underhill, Richard A. Bryant, Josep Maria Haro, José Luis Ayuso-Mateos
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Background and aimsThe coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers’ mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms.MethodsWe present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional support intervention, namely psychological first aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire – Anxiety and Depression Scale summary score at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness.ConclusionsThis study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies.Registration detailsClinicalTrials.gov Identifier: NCT04980326.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-05T06:10:05Z
      DOI: 10.1177/20552076221129084
      Issue No: Vol. 8 (2022)
       
  • Factors affecting resting heart rate in free-living healthy humans

    • Authors: Jason Alexander, Magdalena Sovakova, Graham Rena
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Resting heart rate (RHR) is a potential cardiac disease prevention target because it is strongly associated with cardiac morbidity and mortality, yet community-based monitoring of RHR remains in its infancy. Recently, smartwatches have become available enabling measurement with non-intrusive devices of relationships between RHR and other factors outside the laboratory. We carried out cross-sectional observational retrospective analysis of anonymised smartwatch data obtained by participants in their everyday lives between 2016 and 2021 in a single centre community-based study, using convenience sampling. Between participants, overall RHR means strongly or moderately inversely correlated with means of stand hour (SH), calculated VO2 max, walking and running distance (WRD), steps and flights climbed (FC). Within participants, in quarterly averages, RHR inversely correlated moderately with frequency of standing (stand hours, SH). RHR also inversely correlated moderately with heart rate variability (HRV), consistent with the known impact of increasing parasympathetic dominance on RHR. These within participant correlations suggest that RHR might be modifiable by changes in SH and HRV within individuals. Indeed, analysing paired daily data, relationships between these three categories were dose dependent. 15 SH versus 5 SH associated with a reduction of 10 beats per minute in mean RHR and increase in mean HRV of 14 ms, respectively. We conclude that within individuals, RHR inversely correlates with frequency of standing and HRV, with paired daily measurements indicating effects are mediated that day. RHR also inversely correlates with fitness and activity measures between participants. Our findings provide initial community-based observational evidence supporting further prospective interventional investigation of frequency of standing or HRV modifiers, alongside more familiar interventions, for cardiac disease prevention.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-05T06:09:48Z
      DOI: 10.1177/20552076221129075
      Issue No: Vol. 8 (2022)
       
  • Evaluation of a village-based digital health kiosks program: A protocol
           for a cluster randomized clinical trial

    • Authors: Weibin Cheng, Zhang Zhang, Samantha Hoelzer, Weiming Tang, Yizhi Liang, Yumeng Du, Hao Xue, Qiru Zhou, Winnie Yip, Xiaochen Ma, Junzhang Tian, Sean Sylvia
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundTo address disparities in healthcare quality and access between rural and urban areas in China, reforms emphasize strengthening primary care and digital health utilization. Yet, evidence on digital health approaches in rural areas is lacking.ObjectiveThis study will evaluate the effectiveness of Guangdong Second Provincial General Hospital's Digital Health Kiosk program, which uses the Dingbei telemedicine platform to connect rural clinicians to physicians in upper-level health facilities and provide access to artificial intelligence-enabled diagnostic support. We hypothesize that our interventions will increase healthcare utilization and patient satisfaction, decrease out-of-pocket costs, and improve health outcomes.MethodsThis cluster randomized control trial will enroll clinics according to a partial factorial design. Clinics will be randomized to either a control arm with clinician medical training, a second arm additionally receiving Dingbei telemedicine training, or a third arm with monetary incentives for patient visits conducted through Dingbei plus all prior interventions. Clinics in the second and third arm will then be orthogonally randomized to a social marketing arm that targets villager awareness of the kiosk program. We will use surveys and Dingbei administrative data to evaluate clinic utilization, revenue, and clinician competency, as well as patient satisfaction and expenses.ResultsWe have received ethical approval from Guangdong Second Provincial General Hospital (IRB approval number: GD2H-KY IRB-AF-SC.07-01.1), Peking University (IRB00001052-21007), and the University of North Carolina at Chapel Hill (323385). Study enrollment began April 2022.ConclusionsThis study has the potential to inform future telemedicine approaches and assess telemedicine as a method to address disparities in healthcare access.Trial registration number: ChiCTR2100053872
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-05T03:20:58Z
      DOI: 10.1177/20552076221129100
      Issue No: Vol. 8 (2022)
       
  • Italian nurses’ experiences of the COVID-19 pandemic through social
           media: A longitudinal mixed methods study of Internet posts

    • Authors: Giacomo Rossettini, Verena Peressutti, Erica Visintini, Roberta Fontanini, Davide Caruzzo, Jessica Longhini, Alvisa Palese
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo examine the experience of Italian nurses posted on social media and discover changes, if any, over the waves.MethodsA mixed methods study reported according to the Good Reporting of a Mixed Methods Study criteria. All narratives (texts, letters and interviews) posted by Italian nurses from February 2020 to May 2020 (first wave) and from October 2020 to May 2021 (second/third wave) on the five most famous Italian professional social media platforms. The data were analysed qualitatively (first wave) and then quantitatively (second/third wave).ResultsA total of 380 narratives (202,626 words, 2510 quotes) were posted in the first wave, and 161 (68,388 words, 835 quotes) in the second/third wave. In the first wave, the following five themes emerged: (a) ‘sharing what is happening within myself’ (891; 35.5%); (b) ‘experiencing unprecedented working conditions’ (749; 29.8%); (c) ‘failing to rehabilitate the image of nurses in society’ (376; 15%); (d) ‘experiencing a deep change’ (253; 10.1%) and (e) ‘do not abandon us’ (241; 9.6%). The same themes and subthemes also emerged in the second/third wave with some significant differences, indicating changes in the lived experience of nurses. Moreover, in the second/third wave, a new theme emerged: ‘experiencing the mixed emotions towards jabs’.ConclusionsBy analysing their posts, Italian nurses continue to face challenges during the COVID-19 pandemic, with changes in their lived experiences across the waves. Governments, nursing associations and health care organizations should consider these changes to design policies to prevent the further loss of nurses.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-03T08:24:18Z
      DOI: 10.1177/20552076221129082
      Issue No: Vol. 8 (2022)
       
  • Health workers’ experience of a digital health intervention implemented
           in peri-urban communities in Karachi, Pakistan

    • Authors: Kaniz Amna Haider, Omar Gulam, Rehan Adamjee, Benazir Balouch, Zahra Hoodbhoy
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveDigital health interventions (DHIs) have the potential to improve access and quality of care in low-middle-income countries. The aim of this study was to assess the acceptability, usability and aesthetics of a DHI by frontline workers in peri-urban community settings in Karachi, Pakistan.MethodsA mixed-methods study was carried out in peri-urban field sites in Karachi, Pakistan, where maternal and childcare services are provided through front-line care providers using a DHI. These workers include community health workers, midwives, and physicians who were using the DHI for at least six months. For quantitative data, a questionnaire regarding the module design and interface, technical difficulty, and appropriate utilisation was assessed using a 5-point Likert scale. For qualitative data, focus group discussions (FGDs) based on experiences regarding operability, design, its effect on work efficiency and the provision of beneficial health services were conducted.ResultsThere were 93 respondents for the quantitative questionnaire who reported high satisfaction (>85%) with the DHI in many themes including content quality, aesthetics and ease of use. Participants were least satisfied with service quality (45% satisfaction only) due to issues related to data sync and network connections in these areas. During the FGDs, the workers stated that the DHI helped them with accessing previous data and providing quality health care services to the community.ConclusionAlthough frontline workers reported a few technical difficulties while using the DHI, the majority reported that it was acceptable, had user-friendly features and was beneficial in their work processes.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-03T08:23:30Z
      DOI: 10.1177/20552076221129076
      Issue No: Vol. 8 (2022)
       
  • Growth in the development of health and fitness mobile apps amid COVID-19
           pandemic

    • Authors: Pankush Kalgotra, Uzma Raja, Ramesh Sharda
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesTechnology in the form of mobile apps has played an essential role in facilitating, tracking, and maintaining health and fitness activities during the pandemic. When countries opted for partial or complete lockdowns to contain the spread of the coronavirus disease 2019 virus, it led to people working on their health and fitness-related activities from their homes, just as they continued working from home. This paper aims to quantify the impact of coronavirus disease 2019 on the development of health and fitness mobile apps. Specifically, we compute the effect of coronavirus disease 2019 on the growth of different sub-categories of health and fitness apps.MethodsWe scraped data about a population of 78,890 health and fitness apps from the iOS App Store. First, categories of health and fitness apps are identified using text analysis on the descriptions of apps. Second, the rise in the development of new apps is analyzed. To quantify the impact of coronavirus disease 2019 on the growth of the health and fitness apps, multiple time-series forecasting models are created for different categories of health and fitness apps.ResultsThe text analysis identified twelve different types of health and fitness apps on the app market. Our models estimated that the number of health and fitness apps on the iOS app market exceeded the expected growth by 29.9% after the pandemic. The results of all categories of health and fitness are discussed in the paper.ConclusionsOur analysis found significant growth in the development of new health and fitness apps after the pandemic outbreak. The post hoc study of the population of health and fitness apps presented the current state of this particular area of the app market. In addition, it provided potential growth areas in app markets where there are fewer apps.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-03T08:22:46Z
      DOI: 10.1177/20552076221129070
      Issue No: Vol. 8 (2022)
       
  • Effects of personalization and source expertise on users’ health beliefs
           and usage intention toward health chatbots: Evidence from an online
           experiment

    • Authors: Yu-li Liu, Wenjia Yan, Bo Hu, Zhuoyang Li, Yik Ling Lai
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveBased on the heuristic–systematic model (HSM) and health belief model (HBM), this study aims to investigate how personalization and source expertise in responses from a health chatbot influence users’ health belief-related factors (i.e. perceived benefits, self-efficacy and privacy concerns) as well as usage intention.MethodsA 2 (personalization vs. non-personalization) × 2 (source expertise vs. non-source expertise) online between-subject experiment was designed. Participants were recruited in China between April and May 2021. Data from 260 valid observations were used for the data analysis.ResultsSource expertise moderated the effects of personalization on health belief factors. Perceived benefits and self-efficacy mediated the relationship between personalization and usage intention when the source expertise cue was presented. However, the privacy concerns were not influenced by personalization and source expertise and did not significantly affect usage intention toward the health chatbot.DiscussionThis study verified that in the health chatbot context, source expertise as a heuristic cue may be a necessary condition for effects of the systematic cue (i.e. personalization), which supports the HSM's arguments. By introducing the HBM in the chatbot experiment, this study is expected to provide new insights into the acceptance of healthcare AI consulting services.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-03T06:45:33Z
      DOI: 10.1177/20552076221129718
      Issue No: Vol. 8 (2022)
       
  • The digital rainbow: Digital determinants of health inequities

    • Authors: Tina Jahnel, Hans-Henrik Dassow, Ansgar Gerhardus, Benjamin Schüz
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The widely used socioecological rainbow model from Dahlgren and Whitehead specifies determinants of health inequity on multiple hierarchical levels and suggests that these determinants may interact both within and between levels. At the time of its inception, digital determinants only played a minor role in tackling inequities in public health and were therefore not specifically considered. This has dramatically changed: From today's perspective, health inequities increasingly depend on digital determinants. In this article, we suggest adapting the Dahlgren-Whitehead model to reflect these developments. We propose a model that allows formulating testable hypotheses, interpreting research findings, and developing policy implications against the background of the global spread of digital technologies. This may facilitate the development of a new line of research and logic models for public health interventions in the digital age. Using the COVID-19 pandemic as a case study, we illustrate how the digitization of all aspects of life affects the different levels of determinants of health inequities in the Dahlgren–Whitehead model. In doing so, we deliberately argue for not introducing a separate digital sphere in its own right, but for understanding digitization as a phenomenon that permeates all levels of determinants of health inequities. As a result, we present a digital rainbow model that integrates Dahlgren and Whitehead's 1991 model with digital environments to identify current health promotion and research issues without changing the rainbow model's initial structure.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-03T06:43:45Z
      DOI: 10.1177/20552076221129093
      Issue No: Vol. 8 (2022)
       
  • Effect of a model based on education and teleassistance for the management
           of obstetric emergencies in 10 rural populations from Colombia

    • Authors: María Fernanda Escobar, María Paula Echavarria, Juan Carlos Gallego, Natalia Riascos, Hilda Vasquez, Daniela Nasner, Stephanie Pabon, Zindy Alexandra Castro, Didier Augusto Cardona, Ana Milena Castro, Isabella Ramos, María Antonia Hincapie, Juan Pedro Kusanovic, Diana Marcela Martínez-Ruíz, Javier Andrés Carvajal
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionPregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia.MethodsA quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL).ResultsA total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease.ConclusionThe implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-03T06:42:45Z
      DOI: 10.1177/20552076221129077
      Issue No: Vol. 8 (2022)
       
  • Scent-delivery devices as a digital healthcare tool for olfactory
           training: A pilot focus group study in Parkinson's disease patients

    • Authors: Neel Desai, Emanuela Maggioni, Marianna Obrist, Mine Orlu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Parkinson's disease (PD) patients display a combination of motor and non-motor symptoms. The most common non-motor symptom is scent (olfactory) impairment, occurring at least four years prior to motor symptom onset. Recent and growing interest in digital healthcare technology used in PD has resulted in more technologies developed for motor rather than non-motor symptoms. Human–computer interaction (HCI), which uses computer technology to explore human activity and work, could be combined with digital healthcare technologies to better understand and support olfaction via scent training – leading to the development of a scent-delivery device (SDD). In this pilot study, three PD patients were invited to an online focus group to explore the association between PD and olfaction, understand HCI and sensory technologies and were demonstrated a new multichannel SDD with an associated mobile app. Participants had a preconceived link, a result of personal experience, between olfactory impairment and PD. Participants felt that healthcare professionals did not take olfactory dysfunction concerns seriously prior to PD diagnosis. Two were not comfortable with sharing scent loss experiences with others. Participants expected the multichannel SDD to be small, portable and easy-to-use, with customisable cartridges to deliver chosen scents and the mobile app to create a sense of community. None of the participants regularly performed scent training but would consider doing so if some scent function could be regained. Standardised digital SDDs for regular healthcare check-ups may facilitate improvement in olfactory senses in PD patients and potential earlier PD diagnosis, allowing earlier therapeutic and symptomatic PD management.
      Citation: DIGITAL HEALTH
      PubDate: 2022-10-03T06:40:54Z
      DOI: 10.1177/20552076221129061
      Issue No: Vol. 8 (2022)
       
  • Lack of alternative: Chinese first-time mothers’ construction of social
           support network of online secondary groups

    • Authors: Wenjuan Xin
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAs a result of rapid modernization and the long-term implementation of One Child Policy, Chinese first-time mothers’ primary child-raising social support network is gradually shrinking. At the same time, the social support system for child raising is still very incomplete. Therefore, Chinese first-time mothers generally face great pressure.ObjectiveThis paper aims to understand Chinese first-time mothers’ construction of social support network of online secondary groups.MethodsThis paper employs a qualitative research method, with semi-structured interviews with 23 participants, two focus groups and observations conducted in nine online child-raising communities.ResultsBased on the principle of instrumental rationality first-time mothers use various strategies to join different types of online communities and their online social support network is always the dynamic changing. The online social support network is a supplementary channel in which first-time mothers can obtain both instrumental and emotional support. But communication risks and ethical issues remain, such as information exchange interfered by commercial capital, widespread anxiety and superficial social relationships.ConclusionsOnline social support network is an alternative for Chinese first-time mothers and they urgently need a more well-rounded social support network system with government leading and multiple subjects participating in it.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-30T06:39:19Z
      DOI: 10.1177/20552076221129062
      Issue No: Vol. 8 (2022)
       
  • A digital self-care intervention for Ugandan patients with heart failure
           and their clinicians: User-centred design and usability study

    • Authors: Jason Hearn, Sahr Wali, Patience Birungi, Joseph A Cafazzo, Isaac Ssinabulya, Ann R Akiteng, Heather J Ross, Emily Seto, Jeremy I Schwartz
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThe prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness and associated self-care behaviours. Interventions targeted at improving HF self-care have been shown to improve patient quality of life and reduce hospitalizations in high-income countries. However, such interventions remain underutilized in resource-limited settings like Uganda. This study aimed to develop a digital health intervention that enables improved self-care amongst HF patients in Uganda.MethodsWe implemented a user-centred design (UCD) process to develop a self-care intervention entitled Medly Uganda. The ideation phase comprised a scoping review and preliminary data collection amongst HF patients and clinicians in Uganda. An iterative design process was then used to advance an initial prototype into a functional digital health intervention. The evaluation phase involved usability testing of the intervention amongst Ugandan patients with HF and their clinicians.ResultsMedly Uganda is a digital health intervention that allows patients to report daily HF symptoms, receive tailored treatment advice and connect with a clinician when showing signs of decompensation. The system harnesses Unstructured Supplementary Service Data (USSD) technology that is already widely used in Uganda for mobile phone-based financial transactions. Usability testing showed Medly Uganda to be both acceptable and feasible amongst clinicians, patients and caregivers.ConclusionsMedly Uganda is a functional digital health intervention with demonstrated acceptability and feasibility in enabling Ugandan HF patients to better care for themselves. We are hopeful that the system will improve self-care efficacy amongst HF patients in Uganda.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-28T05:37:10Z
      DOI: 10.1177/20552076221129064
      Issue No: Vol. 8 (2022)
       
  • Effects of a serious game on knowledge, attitude and practice in vector
           control and dengue prevention among adults in primary care: A randomised
           controlled trial

    • Authors: Alon Tan, Eileen Koh, Usha Sankari, Jiasheng Tang, Chi Keong Goh, Ngiap Chuan Tan
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveDengue is endemic but vaccination against it is optional in tropical Singapore. Despite vector control measures to curb mosquito breeding, dengue infection continues to be prevalent. A serious game has been developed to raise the community awareness of dengue vector control programme among residents in Singapore. The study aimed to evaluate the effectiveness of this serious game on the knowledge, attitude and practice (KAP) in dengue prevention among adults. It also determined their willingness to be vaccinated against dengue.MethodsA randomised controlled trial was conducted among volunteer adults who were visiting a regional primary care clinic in Sengkang, Singapore. 400 participants were randomly allocated to receive information regarding dengue prevention from either playing a serious game (intervention) or visiting a dengue prevention website (control). Before and after receiving information on dengue prevention, participants completed a self-administered online questionnaire within a two-week interval to assess the KAP score and their interest to vaccinate against dengue. Participants, who played serious game, evaluated the game with the System Usability Scale (SUS).ResultsA total of 374 participants, comprising of 178 participants (89%) from intervention group and 196 participants (98%) from control group, completed both questionnaires. 157 (78.5%) participants in the intervention group completed playing the serious game. Participants in both groups had increased KAP score from baseline, but the mean difference in score (SD) was greater when assessing participants’ daily practice towards dengue prevention in the serious game group compared to the control group (1.0 (2.8) vs 0.3 (1.9), p = .009). There was a positive correlation (rho = 0.275) between mean change in KAP score and highest achievement attained within serious game (p = .001). The mean SUS (SD) was 61.8 (19.2) among participants who played the serious game. 84.2% of the study population was willing to undertake the dengue vaccination at baseline. Participants in both groups had increased proportion of participants who showed interest in dengue vaccination from baseline but the difference between serious game group and control group were not significant (5.6% vs 2.6%, p = .131).ConclusionsSerious game is at least equally effective compared to conventional web-based learning in promoting dengue prevention measures and vaccination intention among adults, and may be considered as a feasible alternative to digitally engage local residents.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-28T05:10:58Z
      DOI: 10.1177/20552076221129099
      Issue No: Vol. 8 (2022)
       
  • Movement-based patient-therapist attunement in psychological therapy and
           its association with early change

    • Authors: Brian Schwartz, Julian A. Rubel, Anne-Katharina Deisenhofer, Wolfgang Lutz
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveAttunement is a novel measure of nonverbal synchrony reflecting the duration of the present moment shared by two interaction partners. This study examined its association with early change in outpatient psychotherapy.MethodsAutomated video analysis based on motion energy analysis (MEA) and cross-correlation of the movement time-series of patient and therapist was conducted to calculate movement synchrony for N = 161 outpatients. Movement-based attunement was defined as the range of connected time lags with significant synchrony. Latent change classes in the HSCL-11 were identified with growth mixture modeling (GMM) and predicted by pre-treatment covariates and attunement using multilevel multinomial regression.ResultsGMM identified four latent classes: high impairment, no change (Class 1); high impairment, early response (Class 2); moderate impairment (Class 3); and low impairment (Class 4). Class 2 showed the strongest attunement, the largest early response, and the best outcome. Stronger attunement was associated with a higher likelihood of membership in Class 2 (b = 0.313, p = .007), Class 3 (b = 0.251, p = .033), and Class 4 (b = 0.275, p = .043) compared to Class 1. For highly impaired patients, the probability of no early change (Class 1) decreased and the probability of early response (Class 2) increased as a function of attunement.ConclusionsAmong patients with high impairment, stronger patient-therapist attunement was associated with early response, which predicted a better treatment outcome. Video-based assessment of attunement might provide new information for therapists not available from self-report questionnaires and support therapists in their clinical decision-making.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-28T05:10:40Z
      DOI: 10.1177/20552076221129098
      Issue No: Vol. 8 (2022)
       
  • A quality improvement initiative for patient knowledge comprehension
           during the discharge procedure using a novel computer-generated
           patient-tailored discharge document in cardiology

    • Authors: André de Wit, John de Heide, Paul Cummins, Ada van Bruchem-van de Scheur, Rohit Bhagwandien, Mattie Lenzen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe duration of hospital admissions has shortened significantly. This challenges healthcare professionals to provide the necessary information and instructions in a limited time. Patient-tailored discharge information may improve the patient's understanding of the discharge information but may also be time-consuming. The objective of this descriptive quality improvement study was to evaluate patient comprehension of discharge information using a novel computer-generated patient-tailored discharge document.MethodsA prospective pre-post study comparing patient-tailored discharge information with conventional discharge information, for patients undergoing an electrophysiological procedure during two periods of six weeks between January and March 2016.Group I received conventional discharge information (n  =  55). Group II received a computer-generated, patient-tailored discharge document (n  =  57). Their comprehension of the discharge information was evaluated using a peer-reviewed questionnaire distributed among patients, comparing groups I and II using Likert scales. Nurses and nurse practitioners evaluated the use of personalized discharge information by means of a short survey.ResultsIn terms of discharge information, comprehensibility was equivalent; however, an increase in comprehension was observed in patients seeking a telephone consultation with the cardiology department within one-week post-discharge. A reduction in discharge preparation time and an increased uniformity of discharge information were reported by nurses. Nurse practitioners found the web tool easy to use and time-saving.ConclusionsIn this study, computer-generated patient-tailored discharge information was equivalent to conventional discharge information. A more positive trend was seen for patients who initiated teleconsultation with the hospital within one-week post-discharge. This suggests that for this subgroup the patient-tailored discharge web tool might lead to an improvement in care. However, more research with a larger number of participants is needed to confirm this trend.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-26T05:24:32Z
      DOI: 10.1177/20552076221129079
      Issue No: Vol. 8 (2022)
       
  • A randomized controlled trial for evaluating the impact of integrating a
           computerized clinical decision support system and a socially assistive
           humanoid robot into grand rounds during pre/post-operative care

    • Authors: Izidor Mlakar, Urška Smrke, Vojko Flis, Andrej Bergauer, Nina Kobilica, Tadej Kampič, Samo Horvat, Damjan Vidovič, Bojan Musil, Nejc Plohl
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Although clinical decision support systems (CDSSs) are increasingly emphasized as one of the possible levers for improving care, they are still not widely used due to different barriers, such as doubts about systems’ performance, their complexity and poor design, practitioners’ lack of time to use them, poor computer skills, reluctance to use them in front of patients, and deficient integration into existing workflows. While several studies on CDSS exist, there is a need for additional high-quality studies using large samples and examining the differences between outcomes following a decision based on CDSS support and those following decisions without this kind of information. Even less is known about the effectiveness of a CDSS that is delivered during a grand round routine and with the help of socially assistive humanoid robots (SAHRs). In this study, 200 patients will be randomized into a Control Group (i.e. standard care) and an Intervention Group (i.e. standard care and novel CDSS delivered via a SAHR). Health care quality and Quality of Life measures will be compared between the two groups. Additionally, approximately 22 clinicians, who are also active researchers at the University Clinical Center Maribor, will evaluate the acceptability and clinical usability of the system. The results of the proposed study will provide high-quality evidence on the effectiveness of CDSS systems and SAHR in the grand round routine.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-26T05:24:01Z
      DOI: 10.1177/20552076221129068
      Issue No: Vol. 8 (2022)
       
  • From hybrid to fully remote clinical trial amidst the COVID-19 pandemic:
           Strategies to promote recruitment, retention, and engagement in a
           randomized mHealth trial

    • Authors: Leigh Ann Simmons, Jennifer E Phipps, Mackenzie Whipps, Paige Smith, Kathryn A Carbajal, Courtney Overstreet, Jennifer McLaughlin, Koen De Lombaert, Devon Noonan
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Clinical trials worldwide were disrupted when the COVID-19 pandemic began in early 2020. Most intervention trials moved to some form of remote implementation due to restrictions on in-person research activities. Although the proportion of remote trials is growing, they remain the vast minority of studies in part due to few successful examples. Our team transitioned Goals for Reaching Optimal Wellness (GROWell), an NIH-funded (R01NR017659) randomized control trial (RCT; ClinicalTrials.gov identifier NCT04449432) originally designed as a hybrid intervention, into a fully remote clinical trial. GROWell is a digital dietary intervention for people who enter pregnancy with overweight or obesity. Primary outcomes include gestational weight gain and six-month postpartum weight retention. Strategies that we have tested, refined, and deployed include: (a) use of a HIPAA-compliant, web-based participant recruitment and engagement platform; (b) use of a HIPAA-compliant digital health platform to disseminate GROWell and conduct study visits (c) interconnectivity of these two platforms for seamless recruitment, consent, enrollment, intervention delivery, follow-up, and study team blinding; (d) detailed SMS messages to address initial challenges with protocol adherence; (e) email notifications alerting the study team about missed participant surveys so they can follow-up; (f) remuneration using email gift cards with recipient choice of vendor; and (g) geotargeting social media campaigns to improve participation of Black Indigenous and People of Color Communities. These strategies have resulted in screen failure rates improving by 7%, study task adherence improving by an average of 20–30% across study visits, and study completion rates of 82%. Researchers may consider some or all of these approaches in future remote mHealth trials.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-26T05:23:33Z
      DOI: 10.1177/20552076221129065
      Issue No: Vol. 8 (2022)
       
  • From human-centric digital health to digital One Health: Crucial new
           directions for mutual flourishing

    • Authors: Deborah Lupton
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      This brief communication puts forward an argument for expanding the concept of ‘digital health’ to that of ‘digital One Health’ by going beyond a human-centric approach to incorporating nonhuman agents, including other living things, places and space. One Health approaches recognise the interconnected and ecological dimensions of human health and wellbeing, but rarely focus on the role of digital technologies. A set of key questions can take the idea of digital One Health forward: (i) How can we learn more about and establish deeper connections with other animals and the natural environment through digital media, devices and data'; (ii) How can we attune humans to these more-than-human worlds using digital technologies, cultivating attentiveness and responsiveness'; (iii) How can we better develop and implement digital technologies that support the health and wellbeing of the planet and all its living creatures (including humans) so that all can flourish'; and (iv) How can digital technologies affect ecological systems, for better or for worse' Developing digital One Health expands both the digital health field and the One Health perspective, leading them into crucial new directions for mutual flourishing.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-23T06:16:26Z
      DOI: 10.1177/20552076221129103
      Issue No: Vol. 8 (2022)
       
  • International migrants and coronavirus disease 2019 vaccinations: Social
           Media, motivated information management, and vaccination willingness

    • Authors: Hyunjin Seo, Yuchen Liu, Muhammad Ittefaq, Fatemeh Shayesteh, Ursula Kamanga, Annalise Baines
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study examines how those who were born outside the United States and migrated to the country in the past decade used social media and other online sites to deal with uncertainties around the coronavirus disease 2019 pandemic. In particular, we examine how they used digital communication technologies to tap into online resources and social connections both in the United States and their origin country and how various aspects of online information management were associated with their willingness to get vaccinated against the virus.MethodWe conducted an online survey and in-depth interviews with international migrants aged 18–64 years who moved to the United States in 2011 or later and were living in two neighboring states in the US Midwest as of spring 2021. Since this research involves understanding how these international migrants dealt with uncertainties related to coronavirus disease 2019 vaccinations, we collected the survey and interview data when each state had a vaccination rate of less than 10% and very limited vaccination eligibility for those aged 64 years and below.ResultsOur results show that international migrants” perceived uncertainty, positive and negative emotions, efficacy, and outcome expectancy affect their information seeking related to the coronavirus disease 2019 vaccination. In addition, issue salience moderates the effect between information seeking and vaccine willingness.ConclusionThis research provides relevant and timely scholarly and policy implications that help advance research in this area and better support international migrant communities during public health crises such as the coronavirus disease 2019 pandemic.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-23T06:15:56Z
      DOI: 10.1177/20552076221125972
      Issue No: Vol. 8 (2022)
       
  • Home-based digital health technologies for older adults to self-manage
           multiple chronic conditions: A data-informed analysis of user engagement
           from a longitudinal trial

    • Authors: Yiyang Sheng, Julie Doyle, Raymond Bond, Rajesh Jaiswal, Shane Gavin, John Dinsmore
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAgeing populations are resulting in higher prevalence of people with multiple chronic conditions (multimorbidity). Digital health platforms have great potential to support self-management of multimorbidity, increasing a person's awareness of their health and well-being, supporting a better understanding of diseases and encouraging behaviour change. However, little research has explored the long-term engagement of older adults with such digital interventions.MethodsThe aim of this study is to analyse how 60 older adults with multimorbidity engaged with digital symptom and well-being monitoring through a digital health platform over a period of approximately 12 months. Data analysis focused on user retention, frequency of monitoring, intervals in monitoring and patterns of daily engagement.ResultsOur findings show that the overall engagement with the digital health platform was high, with more than 80% of participants using the technology devices for over 200 days. The submission frequency for symptom parameters (e.g. blood glucose (BG), blood pressure (BP), etc.) was between three and four times per week which was higher than that of self-report (2.24) and weight (2.84). Submissions of exercise (6.12) and sleep (5.67) were more frequent. The majority of interactions happened in the morning time. The most common time of submission for symptom parameters was 10 am, whereas 8 am was the most common time for weight measurements.ConclusionsThe findings indicate the patterns of engagement of older adults with complex chronic diseases with digital home-based self-management systems.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-23T06:15:32Z
      DOI: 10.1177/20552076221125957
      Issue No: Vol. 8 (2022)
       
  • Perception of E-health Technology Scale in Chinese Brief (PETS-C Brief):
           Translation, item reduction, and psychometric testing

    • Authors: Rick Yiu Cho Kwan, Simon Ching Lam, Shao Ling Wang, Arkers Kwan Ching Wong, Lei Shi, Frances Kam Yuet Wong
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionPerception of e-health is a broad concept involving many aspects of values and thoughts related to e-health. It is an important precursor to using e-health technologies to promote health. The purpose of this study is to validate an instrument for measuring perceptions of e-health technology among healthcare professionals.MethodsThis methodological study was conducted in China. We based on an existing instrument to develop a new instrument (i.e. PETS-C Brief). In phase 1, we modified and translated the existing instrument into Chinese. Subsequently, we employed the modified and translated instrument to conduct a cross-sectional survey. In phase 2, we randomly selected data from 400 participants to run an exploratory factor analysis and item analysis to reduce the number of items and develop factors. In phase 3, we employed the data from the remaining participants to run a confirmatory factor analysis to confirm the instrument structure.ResultsIn phase 1, the modified and translated instrument showed good content and face validities (S-CVI = 0.96, mean comprehensibility = 93.5%). 1338 participants completed the survey. In phase 2, the number of items was reduced from 40 to 19, which demonstrated a 4-factor model. In phase 3, the goodness-of-fit of the 4-factor PETS-C Brief was shown to be acceptable (χ2/d.f. = 6.40, CFI = 0.93, RMR = 0.40, NFI = 0.92, RMSEA = 0.076, IFI = 0.93).DiscussionThis study suggests using this instrument to survey perceptions of e-health technology in Chinese people. Future studies should examine its other important psychometric properties, including convergent/discriminant and predictive validity on behaviors using e-health technology.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-22T04:44:55Z
      DOI: 10.1177/20552076221126055
      Issue No: Vol. 8 (2022)
       
  • User needs gathering for the design of information and communications
           technology-supported occupational stress management intervention: A
           quantitative study

    • Authors: Manoja Weerasekara, Åsa B Smedberg, Ganga Karunathilaka, Hélène Sandmark
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionThe software industry is considered a growing industry with a high propensity to cause stress reactions among employees due to its demanding and technology-driven nature. There are convincing shreds of evidence that information and communications technology (ICT) interventions can effectively solve stress-related disorders. However, several identified constraints have hindered its potential benefits, such as poor adherence, lack of engagement, high attrition and lack of personalisation.ObjectiveThe study presented in this article aims to gather the user needs of software employees in Sri Lanka to identify design ideas for an ICT-supported intervention for occupational stress management (ICTSMI) in the software industry.Materials and methodsThe study followed a quantitative approach using an online questionnaire in which three key areas were investigated: (1) stressors, (2) coping strategies and (3) design preferences. A total of 408 valid responses were collected and analysed using SPSS software.ResultsFindings revealed that the majority of software employees were with a moderate level of stress. They perceived work stressors and role stressors as common causes of stress. The most frequently used coping strategy was to seek social support, followed by digital activities and sports and physical exercises. The male and female design preferences varied to a greater extent but only slightly varied based on their job category. However, findings suggested the necessity of further elicitation of user needs to support the design process.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-21T08:56:08Z
      DOI: 10.1177/20552076221127778
      Issue No: Vol. 8 (2022)
       
  • Research and application of tongue and face diagnosis based on deep
           learning

    • Authors: Li Feng, Zong Hai Huang, Yan Mei Zhong, WenKe Xiao, Chuan Biao Wen, Hai Bei Song, Jin Hong Guo
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo explore the technical research and application characteristics of deep learning in tongue-facial diagnosis.MethodsThrough summarizing the merits and demerits of current image processing techniques used in the traditional medical tongue and face diagnosis, the research status of deep learning in tongue image preprocessing, segmentation, and classification was analyzed and reviewed, and the algorithm was compared and verified with the real tongue and face image. Images of the face and tongue used for diagnosis in conventional medicine were systematically reviewed, from acquisition and pre-processing to segmentation, classification, algorithm comparison, result from analysis, and application.ResultsDeep learning improved the speed and accuracy of tongue and face diagnostic image data processing. Among them, the average intersection ratio of U-net and Seg-net models exceeded 0.98, and the segmentation speed ranged from 54 to 58 ms.ConclusionThere is no unified standard for lingual-facial diagnosis objectification in terms of image acquisition conditions and image processing methods, thus further research is indispensable. It is feasible to use the images acquired by mobile in the field of medical image analysis by reducing the influence of environmental and other factors on the quality of lingual-facial diagnosis images and improving the efficiency of image processing.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-19T06:06:54Z
      DOI: 10.1177/20552076221124436
      Issue No: Vol. 8 (2022)
       
  • Objective measurement of adherence to topical steroid medication after
           penetrating keratoplasty using an electronic monitoring aid: A pilot study
           

    • Authors: Sylvain Poinard, Thibaud Garcin, Marie-Caroline Trone, Marielle Mentek, Charles Lambert, Paul Bonjean, Didier Renault, Gilles Thuret, Philippe Gain, Anne-Sophie Gauthier
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesCorneal transplantation is the most common transplant worldwide and its success critically depends on the management of corneal graft rejection through topical steroid therapy during the first 12 months after surgery. There is currently no published data on adherence after keratoplasty. This pilot study aims to explore the adherence to topical steroid after penetrating keratoplasty using a smart electronic device.MethodsThirty patients undergoing penetrating keratoplasty were included to evaluate the adherence to topical dexamethasone medication for 12 months after surgery. Patients received the usual post-transplantation treatment (topical dexamethasone) and follow-up after surgery (day 15, months 1, 2, 3, 4, 5, 6, 9, and 12). Adherence to treatment was monitored using the KaliJAR device (Kali Care, Santa Clara, CA, USA), which recorded the number of single-dose units (SDU) discarded. At control visits, data recorded by the device were compared to the manually count of SDU. Adherence ratio and individual adherence curve were explored for all patients.ResultsData from 27 patients showed a high agreement between adherence ratio calculated based on the device data and obtained from manual counting of the discarded SDU (intraclass coefficient correlation of 0.87 [95% CI: 0.738–0.938]). Mean adherence to the treatment over the 12-month study period was 95.2 ± 4%.ConclusionsAdherence to topical dexamethasone for 12 months after corneal transplantation was high. The connected device was able to record accurately the discarded SDU. This approach would be a particular interest in the early identification and personalized follow-up of poorly adherent patients.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-16T12:39:35Z
      DOI: 10.1177/20552076221121155
      Issue No: Vol. 8 (2022)
       
  • Recruitment strategies and reach of a digital fall-prevention intervention
           for community-dwelling older adults

    • Authors: Beatrice Pettersson, Saranda Bajraktari, Dawn A Skelton, Magnus Zingmark, Erik Rosendahl, Lillemor Lundin-Olsson, Marlene Sandlund
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundTo have an impact on the population's health, preventive interventions have to reach a large proportion of the intended population. Digital solutions show potential for providing wider access to fall preventive exercise. However, there is a lack of knowledge about how to reach the target group. The aim of this study was to describe the recruitment process used in the Safe Step randomised controlled trial and the characteristics of the participants reached.MethodsSeveral recruitment methods, both digital and non-digital, were adopted to reach the intended sample size. Sociodemographic parameters from the baseline questionnaire were used to describe participant characteristics. The characteristics were also compared to a representative sample of older adults in the Swedish population.ResultsIn total, 1628 older adults were recruited. Social media proved to be the most successful recruitment strategy, through which 76% of the participants were recruited. The participants reached had a mean age of 75.9 years, lived in both urban and rural locations, were already frequent users of the Internet and applications (smartphone/tablet) (79.9%), had higher education (71.9%), and a large proportion were women (79.4%). In comparison with the general population participants in the Safe Step study were more highly educated (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-15T07:09:50Z
      DOI: 10.1177/20552076221126050
      Issue No: Vol. 8 (2022)
       
  • Factors affecting doctor’s recommendation for mobile health services

    • Authors: Xiaojing Hu, Hongjun Fang, Ping Wang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveAs a new medical service mode, the value of mobile health (mHealth) services has received increasing attention and recognition. However, compared with the owners of mobile devices, the user scale of mHealth services is still small. It is well known that doctors’ recommendations have an important impact on what kind of medical service patients choose. To explore the key factors affecting doctors’ recommendation of mHealth services to patients, and to provide countermeasures for mHealth service providers and hospital managers, so as to promote doctors to recommend mHealth services to more patients.MethodsThrough literature review, expert consultation and pre-test, a questionnaire including 22 questions was designed, and 114 valid questionnaires were collected by online research. Net Promoter Score (NPS) was used to evaluate doctors’ recommendation willingness, and multivariate logistics analysis was used to evaluate the key factors affecting doctors’ recommendation willingness.ResultsThe NPS of doctors was 6.06%, among which the recommenders, neutrals and critics accounted for 29.56%, 46.96% and 23.48%, respectively. The attitude towards mHealth services and whether they pay attention to and/or are willing to try new technologies are the key factors affecting the doctors’ recommendation, and the usefulness for patients most often emphasized by mHealth service providers to doctors does not affect doctors’ recommendation willingness. In addition, whether mHealth services can help doctors establish personal brands may be a potential factor to enhance doctors’ recommendation willingness.ConclusionIn order to improve the recommendation willingness of doctors, mHealth service providers and hospital managers should focus on doctors who have a positive attitude towards mHealth services and are highly innovative (which often means younger and lower professional levels). At the same time, they should think about how to use mHealth services to help doctors establish personal brands in the future.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-15T07:09:12Z
      DOI: 10.1177/20552076221125976
      Issue No: Vol. 8 (2022)
       
  • “Staying at Home”: A pivotal trial of telemedicine-based internal
           medicine hospitalization at a nursing home

    • Authors: G Barkai, H Amir, O. Dulberg, E Itelman, G Gez, T Carmon, L Merhav, S Zigler, A Atamne, O Pinhasov, E Zimlichman, G Segal
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundIn-hospital stay of acutely ill elderlies could be reduced by increasing the availability of community-based hospitalizations. The feasibility of remotely managing these patients by specialized internists, without leaving their nursing homes should be sought. In the current pivotal study, we aimed to evaluate the aforementioned model.MethodsThis was a prospective, open-label study at a tertiary medical center and a nursing home. The study aimed at comparing clinical outcomes of patients hospitalized in each location.ResultsOver a period of 5.5 months, we recruited 18 patients designated for hospitalization, meeting our inclusion criteria to either in-hospital stay or staying in their nursing home and treated by means of telemedicine from our tertiary medical center. The mean age was 85.3 years. Out of 114 hospitalization days, 44 days (48%) were at the nursing home. No significant difference was noted in terms of age, gender, and length of stay between the patients who were hospitalized in either location. In almost all cases, diagnosis changed during hospitalization. Three patients died during the study, all included in the in-hospital group. No safety breaching events happened in the nursing home-hospitalization group.ConclusionsRemote, telemedicine-based hospitalization of nursing home-dwelling elderlies is safe and feasible, potentially reducing the length of in-hospital stay by almost 50%. Larger studies in this realm are warranted.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-15T06:04:13Z
      DOI: 10.1177/20552076221125958
      Issue No: Vol. 8 (2022)
       
  • Global use and outcomes of the hearWHO mHealth hearing test

    • Authors: Karina C De Sousa, Cas Smits, David R Moore, Shelly Chada, Herman Myburgh, De Wet Swanepoel
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesThe objective of this study was to examine the uptake, user characteristics, and performance of the free WHO smartphone hearing screening test (hearWHO) as a global hearing health promotion initiative.MethodWe retrospectively examined the data of 242 626 tests conducted by adults (> 18 years) on the hearWHO app between February 2019 and May 2021. Test uptake was evaluated by country, WHO world region, test date, and demographics of age and gender.ResultsThe hearWHO test was completed in nearly every country globally (n = 179/195), with the greatest uptake seen in China and India. Uptake was greatest in the Western Pacific (32.9%) and European (24.8%) WHO regions. There was a high uptake of tests (44%) by young adults under the age of 30 years. Referral rates were typically higher for older age groups in most WHO regions, except for the African and Eastern Mediterranean regions, where overall hearWHO test uptake was lowest. Most testing (49%) took place in March (2019–2021) coinciding with World Hearing Day (3rd of March) each year.ConclusionsDigital mhealth tools provide many benefits in healthcare, including health promotion, access to information, and services for hearing loss. The hearWHO test was mainly reaching younger adults, positioning it as an important measure for public health advocacy to prevent hearing loss. Since hearing loss is primarily age related, more targeted campaigns or community-based initiatives should be directed toward older adults.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-13T02:30:14Z
      DOI: 10.1177/20552076221113204
      Issue No: Vol. 8 (2022)
       
  • A deep learning-based diagnostic tool for identifying various diseases via
           facial images

    • Authors: Omneya Attallah
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      With the current health crisis caused by the COVID-19 pandemic, patients have become more anxious about infection, so they prefer not to have direct contact with doctors or clinicians. Lately, medical scientists have confirmed that several diseases exhibit corresponding specific features on the face the face. Recent studies have indicated that computer-aided facial diagnosis can be a promising tool for the automatic diagnosis and screening of diseases from facial images. However, few of these studies used deep learning (DL) techniques. Most of them focused on detecting a single disease, using handcrafted feature extraction methods and conventional machine learning techniques based on individual classifiers trained on small and private datasets using images taken from a controlled environment. This study proposes a novel computer-aided facial diagnosis system called FaceDisNet that uses a new public dataset based on images taken from an unconstrained environment and could be employed for forthcoming comparisons. It detects single and multiple diseases. FaceDisNet is constructed by integrating several spatial deep features from convolutional neural networks of various architectures. It does not depend only on spatial features but also extracts spatial-spectral features. FaceDisNet searches for the fused spatial-spectral feature set that has the greatest impact on the classification. It employs two feature selection techniques to reduce the large dimension of features resulting from feature fusion. Finally, it builds an ensemble classifier based on stacking to perform classification. The performance of FaceDisNet verifies its ability to diagnose single and multiple diseases. FaceDisNet achieved a maximum accuracy of 98.57% and 98% after the ensemble classification and feature selection steps for binary and multiclass classification categories. These results prove that FaceDisNet is a reliable tool and could be employed to avoid the difficulties and complications of manual diagnosis. Also, it can help physicians achieve accurate diagnoses without the need for physical contact with the patients.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-10T08:35:26Z
      DOI: 10.1177/20552076221124432
      Issue No: Vol. 8 (2022)
       
  • What to watch: Practical considerations and strategies for using YouTube
           for research

    • Authors: Wuyou Sui, Anna Sui, Ryan E Rhodes
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      YouTube is the second-most visited webpage in the world and boasts over 2 billion users and 500 h of videos uploaded every hour. Despite this popularity, relatively few articles have discussed the practical use of searching and YouTube as a research tool and source of data. The purpose of our paper is to propose a step-by-step schematic for utilizing the YouTube platform. Our discussions include (a) when/whether to use YouTube for research; (b) selecting an appropriate research design; (c) how to search for YouTube data; (d) what data can be pulled from YouTube; and (e) the contextual limitations for interpreting YouTube data. Further, we provide practical strategies and considerations when searching, collecting, or interpreting YouTube data. These discussions are informed by our own work using the YouTube platform. Effective methods used to search for YouTube data are likely to extend beyond simply searching the platform itself; the search strategy and search results themselves should also be documented. While not exhaustive, we feel these considerations and strategies present themselves as a conceptual foothold for future research using the YouTube platform.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-09T02:04:26Z
      DOI: 10.1177/20552076221123707
      Issue No: Vol. 8 (2022)
       
  • Distinguish bipolar and major depressive disorder in adolescents based on
           multimodal neuroimaging: Results from the Adolescent Brain Cognitive
           Development study®

    • Authors: Yujun Liu, Kai Chen, Yangyang Luo, Jiqiu Wu, Qu Xiang, Li Peng, Jian Zhang, Weiling Zhao, Mingliang Li, Xiaobo Zhou
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundMajor depressive disorder and bipolar disorder in adolescents are prevalent and are associated with cognitive impairment, executive dysfunction, and increased mortality. Early intervention in the initial stages of major depressive disorder and bipolar disorder can significantly improve personal health.MethodsWe collected 309 samples from the Adolescent Brain Cognitive Development study, including 116 adolescents with bipolar disorder, 64 adolescents with major depressive disorder, and 129 healthy adolescents, and employed a support vector machine to develop classification models for identification. We developed a multimodal model, which combined functional connectivity of resting-state functional magnetic resonance imaging and four anatomical measures of structural magnetic resonance imaging (cortical thickness, area, volume, and sulcal depth). We measured the performances of both multimodal and single modality classifiers.ResultsThe multimodal classifiers showed outstanding performance compared with all five single modalities, and they are 100% for major depressive disorder versus healthy controls, 100% for bipolar disorder versus healthy control, 98.5% (95% CI: 95.4–100%) for major depressive disorder versus bipolar disorder, 100% for major depressive disorder versus depressed bipolar disorder and the leave-one-site-out analysis results are 77.4%, 63.3%, 79.4%, and 81.7%, separately.ConclusionsThe study shows that multimodal classifiers show high classification performances. Moreover, cuneus may be a potential biomarker to differentiate major depressive disorder, bipolar disorder, and healthy adolescents. Overall, this study can form multimodal diagnostic prediction workflows for clinically feasible to make more precise diagnose at the early stage and potentially reduce loss of personal pain and public society.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-06T06:57:44Z
      DOI: 10.1177/20552076221123705
      Issue No: Vol. 8 (2022)
       
  • Accuracy of wrist-worn wearable devices for determining exercise intensity

    • Authors: Wei-Te Ho, Yi-Jen Yang, Tung-Chou Li
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveAs an indicator of exercise intensity, heart rate can be measured in a timely manner using wrist-worn devices. No study has attempted to estimate a target exercise intensity using wearable devices. The objective of the study was to evaluate the validity of prescribing exercise intensity using wrist-worn devices.MethodsThirty healthy subjects completed a maximal cardiopulmonary exercise test. Their heart rates were recorded using an electrocardiogram and two devices—Apple Watch Series 6 and Garmin Forerunner 945. Exercise intensity with the target heart rate was defined as resting heart rate + (maximal heart rate − resting heart rate) *n% (n%: 40–60% for moderate-intensity exercise and 60–89% for vigorous-intensity exercise). Heart rate was analyzed at the lower and upper limits of each exercise intensity (HR40, HR60, and HR89). The mean absolute percentage error and concordance correlation coefficient were calculated, and Bland–Altman plots and scatterplots were constructed.ResultsBoth devices showed a low mean absolute error (1.16–1.48 bpm for Apple and 1.35–2.25 for Garmin) and mean absolute percentage error ( 0.95 for both devices, except that Garmin showed moderate correlation at the upper limit of vigorous activity with concordance correlation coefficient = 0.936. Moreover, Bland–Altman plots and scatterplots demonstrated a strong correlation without systematic error when the values obtained via the two devices were compared with electrocardiogram measurements.ConclusionsOur findings indicate the high validity of exercise prescriptions based on the heart rate measured by the two devices. Additional research should explore other populations to confirm these findings.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-05T06:11:56Z
      DOI: 10.1177/20552076221124393
      Issue No: Vol. 8 (2022)
       
  • Comparative study of different SES neighborhood clinics for health
           literacy and internet access

    • Authors: William C Livingood, Maria A B Bautista, Carmen Smotherman, Daidre Azueta, Jeremy Coleman, Reetu Grewal, Eric Stewart, Lori A. Orlando, Christopher Scuderi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAs healthcare services are increasingly dependent on patient utilization of technology to effectively deliver services, the digital divide has the potential to exacerbate health disparities if health literacy and internet access present formidable barriers to patient use of technology.MethodsWe examined the differences in health literacy and internet access between lower and upper SES neighborhood primary-care clinics in Northeast Florida. The REALM-SF for health literacy was used to assess health literacy and census survey questions were used to assess internet and technology access, during the Fall, 2020. The clinics were affiliated with a safety-net hospital in a major city in Southeastern U.S.ResultsAnalysis of key demographic data confirmed that the responding patients from economically disadvantaged neighborhood clinics resided in economically disadvantaged zip codes (307 responding patients lived in lower SES neighborhoods) and did have lower education levels (3% of the patients from Upper SES clinics had 11 grade or lower education, compared to 21%–29% of patients from Lower SES clinics). Patient health literacy significantly differed between clinics located in economically disadvantaged neighborhoods and clinics located in more affluent neighborhoods, with Upper SES clinics being 2.4 times more likely to have 9th grade or higher reading level. Access to internet technology was also higher in the Upper SES clinics, with 59% of respondents from Upper SES clinics versus 32%–40% from Lower SES clinics owning a computer or an IPAD.ConclusionResults of this study have important implications for patient-engaged use of digital technology for health. Healthcare and public health clinics should be aware of the difference in health literacy and internet access when implementing technology-based services, so that advances in medicine, including precision medicine and telehealth, can be disseminated and implemented with broad populations, including disadvantaged groups.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-05T06:11:40Z
      DOI: 10.1177/20552076221123715
      Issue No: Vol. 8 (2022)
       
  • The feasibility of an online educational lifestyle program for people with
           multiple sclerosis: A qualitative analysis of participant semi-structured
           interviews

    • Authors: William Bevens, J Reece, PL Jelinek, TJ Weiland, N Nag, S Simpson-Yap, K Gray, GA Jelinek, SL Neate
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo explore the feasibility of a randomised controlled trial of a multiple sclerosis online course (MSOC) via qualitative analysis of participant semi-structured interviews.MethodsThe MSOC was developed in two arms: intervention arm which contained evidence-based lifestyle modification recommendations, and standard-care arm which delivered information from MS websites reflecting standard advice. Participants were recruited via online advertisements, completed a baseline questionnaire, and randomised. Seven modules were delivered over six weeks. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, interviews were analysed using reflexive thematic analysis.ResultsFourteen of the 17 course completers were interviewed: 86% (12/14) female; mean age 50 years; residing in Australia, New Zealand, and the USA, predominantly had relapsing-remitting MS, mean time from diagnosis 9.5 years, and patient-determined disease steps disability assessment distributed evenly across all three categories. Four themes were identified: 1) “Hearing our stories” (hope for the future, feeling represented, exploring the journey of others with MS, learning from diversity, and wanting to connect with others); 2) “Taking the plunge” (not wanting to be first, feelings of nervousness or reluctance and feeling confronted); 3) “The accessibility and safety of being online” (ease of access, going at your own pace, making it work and not letting others down); and 4) “unpacking the course” (ease of navigation, visuals, understandability, and length and timing).ConclusionParticipants felt represented, found the course accessible and content was easy to understand. These experiences provide important insights and considerations for this digital health intervention.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-05T06:11:37Z
      DOI: 10.1177/20552076221123713
      Issue No: Vol. 8 (2022)
       
  • The relationship between the orthopedic job market and sports medicine
           fellowship applications between 2010 and 2017

    • Authors: Marcus A Hoof, Symone M Brown, Cadence B Miskimin, Mary K Mulcahey
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Objectives: More than 90% of graduating orthopedic residents pursue at least one year of fellowship training. There are no studies to date that examine the trends for sports medicine positions in the orthopedic job market. The purpose of this study was to evaluate trends in orthopedic sports medicine positions using postings from four orthopedic journals. Methods: Print advertisements for job positions in three American orthopedic journals (Journal of Bone and Joint Surgery, Journal of the American Academy of Orthopaedic Surgeons, and American Journal of Sports Medicine) between 2010 and 2017 were reviewed. The results were compared to sports medicine fellowship match trends. Results: Between 2010 and 2017, there were a total of 403 postings for orthopedic sports medicine positions, 186 in Journal of Bone and Joint Surgery, 113 in Journal of the American Academy of Orthopaedic Surgeons, and 52 in American Journal of Sports Medicine. There was a 43% decline in print sports medicine advertisements from 2010 to 2015. The number of job advertisements for sports medicine positions remained consistent (approximately 10%) from 2010 to 2015, then dropped to 2.1% (57/2698) and 1.4% (66/4735) in 2016 and 2017, respectively. Conclusion: There is no direct correlation between job positions advertised in orthopedic journals and sports medicine fellowship positions offered. Additionally, there has been an increase in job advertisements requiring fellowship training, indicating an increased demand for sub-specialty trained orthopedic surgeons. Lastly, the drop in total orthopedic advertisements in the years proceedi ng 2015 may serve as a harbinger for the transition to largely online content, and job postings in journals may not be the most reliable source of job opportunities, but further investigation should be done in relation to this topic.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-02T06:20:58Z
      DOI: 10.1177/20552076221123118
      Issue No: Vol. 8 (2022)
       
  • Effects of immersive virtual nature on nature connectedness: A systematic
           review protocol

    • Authors: Elena Brambilla, Evi Petersen, Karen Stendal, Vibeke Sundling, Tadhg E MacIntyre, Giovanna Calogiuri
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveNature Connectedness, an individual’s cognitive, affective, and behavioral connection with the natural world, has been linked to various health and well-being outcomes. As Nature Connectedness can be elicited and strengthened through direct contact with nature, in the past decade studies have investigated whether similar effects can be achieved through technologies that simulate highly immersive and realistic experiences of nature, such as Immersive Virtual Nature. This protocol describes the methodology for a systematic review that will summarize the existing evidence on the effects of Immersive Virtual Nature on Nature Connectedness in non-clinical populations.MethodsThe review will be conducted following the guidelines of Preferred Reporting Items for Systematic Reviews and MetaAnalyses. Terms such as “immersive virtual environment,” “natural setting*,” and “contact with nature” were searched in Scopus, WebOfScience, GoogleScholar, Medline, and GreenFILE (22–28 November 2021). Papers in English, describing experimental studies, with or without control/comparison, and testing the effects of Immersive Virtual Nature interventions on Nature Connectedness outcomes in non-clinical populations were included. The risk of bias will be assessed using Cochrane’s Risk of Bias 2 for randomized studies, and the Risk Of Bias In Non-randomized Studies - of Interventions. The data synthesis will be performed through meta-analysis, assuming that the Cochrane Consumers and Communication Group guidelines are met.ConclusionThe findings will be relevant for understanding the potential and challenges of Immersive Virtual Nature as a tool to promote health and well-being in the general population, providing information on the consistency and limitations of the existing literature and recommendations for future research.
      Citation: DIGITAL HEALTH
      PubDate: 2022-09-02T01:20:09Z
      DOI: 10.1177/20552076221120324
      Issue No: Vol. 8 (2022)
       
  • Use of the Xiaomi Mi Band for sleep monitoring and its influence on the
           daily life of older people living in a nursing home

    • Authors: Patricia Concheiro-Moscoso, Betania Groba, Francisco José Martínez-Martínez, María del Carmen Miranda-Duro, Laura Nieto-Riveiro, Thais Pousada, Javier Pereira
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Background: Lower quantity and poorer sleep quality are common in most older adults, especially for those who live in a nursing home. The use of wearable devices, which measure some parameters such as the sleep stages, could help to determine the influence of sleep quality in daily activity among nursing home residents. Therefore, this study aims to analyse the influence of sleep and its changes concerning the health status and daily activity of older people who lived in a nursing home, by monitoring the participants for a year with Xiaomi Mi Band 2. Methods: This is a longitudinal study set in a nursing home in [Details omitted for double-anonymized peer reviewed]. The Xiaomi Mi Band 2 will be used to measure biomedical parameters and different assessment tools will be administered to participants for evaluating their quality of life, sleep quality, cognitive state, and daily functioning. Results: A total of 21 nursing home residents participated in the study, with a mean age of 86.38 ± 9.26. The main outcomes were that sleep may influence daily activity, cognitive state, quality of life, and level of dependence in activities of daily life. Moreover, environmental factors and the passage of time could also impact sleep. Conclusions: Xiaomi Mi Band 2 could be an objective tool to assess the sleep of older adults and know its impact on some factors related to health status and quality of life of older nursing homes residents. Trial Registration: NCT04592796 (Registered 16 October 2020) Available on: https://clinicaltrials.gov/ct2/show/NCT04592796.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-30T06:46:23Z
      DOI: 10.1177/20552076221121162
      Issue No: Vol. 8 (2022)
       
  • The experiences of 33 national COVID-19 dashboard teams during the first
           year of the pandemic in the World Health Organization European Region: A
           qualitative study

    • Authors: Erica Barbazza, Damir Ivanković, Karapet Davtyan, Mircha Poldrugovac, Zhamin Yelgezekova, Claire Willmington, Bernardo Meza-Torres, Véronique L.L.C. Bos, Óscar Brito Fernandes, Alexandru Rotar, Sabina Nuti, Milena Vainieri, Fabrizio Carinci, Natasha Azzopardi-Muscat, Oliver Groene, David Novillo-Ortiz, Niek Klazinga, Dionne Kringos
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundGovernments across the World Health Organization (WHO) European Region have prioritised dashboards for reporting COVID-19 data. The ubiquitous use of dashboards for public reporting is a novel phenomenon.ObjectiveThis study explores the development of COVID-19 dashboards during the first year of the pandemic and identifies common barriers, enablers and lessons from the experiences of teams responsible for their development.MethodsWe applied multiple methods to identify and recruit COVID-19 dashboard teams, using a purposive, quota sampling approach. Semi-structured group interviews were conducted from April to June 2021. Using elaborative coding and thematic analysis, we derived descriptive and explanatory themes from the interview data. A validation workshop was held with study participants in June 2021.ResultsEighty informants participated, representing 33 national COVID-19 dashboard teams across the WHO European Region. Most dashboards were launched swiftly during the first months of the pandemic, February to May 2020. The urgency, intense workload, limited human resources, data and privacy constraints and public scrutiny were common challenges in the initial development stage. Themes related to barriers or enablers were identified, pertaining to the pre-pandemic context, pandemic itself, people and processes and software, data and users. Lessons emerged around the themes of simplicity, trust, partnership, software and data and change.ConclusionsCOVID-19 dashboards were developed in a learning-by-doing approach. The experiences of teams reveal that initial underpreparedness was offset by high-level political endorsement, the professionalism of teams, accelerated data improvements and immediate support with commercial software solutions. To leverage the full potential of dashboards for health data reporting, investments are needed at the team, national and pan-European levels.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-30T06:46:05Z
      DOI: 10.1177/20552076221121154
      Issue No: Vol. 8 (2022)
       
  • Temporal processing deficit in children with
           attention-deficit/hyperactivity disorder: An online assessment

    • Authors: Agnes S Chan, Zihan Ding, Tsz-lok Lee, Sophia L Sze, Natalie S Yang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTemporal processing deficits were found among children with attention-deficit/hyperactivity disorder (ADHD). The present study aims to develop an online temporal processing assessment that can be conducted remotely, and the sensitivity of the test was assessed on a group of children with ADHD.MethodsA total of 188 children were recruited, including 94 typically developing (TD) children, and 94 children with ADHD. The online assessment consists of two temporal-order judgment (TOJ) tasks. One task used tone pairs presented with two interstimulus intervals (ISIs) (305ms and 40ms). Another task used pairs of consonant-vowel (CV) syllables with 20 varying ISI levels. Participants were asked to determine the sequence of the sound pairs.ResultsThe results showed that ADHD children were less accurate (ISI 305ms: M = 83.90%; ISI 40ms: M = 66.28%) than TD children (ISI 305ms: M = 89.36%; ISI 40ms: M = 77.16%) in the tone task. Similarly, ADHD children showed a higher ISI passing threshold (M = 283.64ms) than TD children (M = 199.76ms) and higher accuracy in the CV task. Hierarchical binary logistic regression suggested a model to predict ADHD children using accuracy in ISI 40ms in the tone task and ISI passing threshold in the CV task. Receiver operating characteristic (ROC) analysis yielded a sensitivity of 75.58% and a specificity of 51.11%.ConclusionADHD children showed temporal processing deficits of both tones and CVs. The online assessment may be a valid tool for differentiating ADHD children from TD children.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-30T06:45:25Z
      DOI: 10.1177/20552076221120325
      Issue No: Vol. 8 (2022)
       
  • The engagement of tertiary students with an online mental health
           intervention during the coronavirus disease 2019 pandemic: A feasibility
           study

    • Authors: Michaela C Pascoe, Sarah Dash, Bojana Klepac Pogrmilovic, Rhiannon K Patten, Alexandra G Parker
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundWe discuss the feasibility of a brief, online mental health promotion programme for tertiary students and establish recommendations for future programmes.MethodsThe programme ‘Student Elevenses’ was delivered at a tertiary education institution. ‘Student Elevenses’ aimed to promote student wellbeing during the coronavirus disease 2019 crisis, comprised of 10–15-min daily online micro-interventions targeting six lifestyle areas for wellbeing, and was delivered via video conference. Upon programme completion, all students were invited to complete barriers to engagement survey, irrespective of whether they had attended or heard of the programme. Descriptive statistics were calculated for demographics, as well as feasibility and acceptability outcomes including recruitment rates, attendance rates and reported barriers to attendance. Open-ended questions were coded for themes.ResultsLess than 1% of those who consented to participate actually attended the programme, with attendance ranging from 2 to 17 participants. Participants were predominantly female (68%), domestic students (81%) and had a mean age of 29.5 years. The barriers students reported included fixed time, online format, a belief programme would not be helpful, preference for existing supports and perceived impacts of coronavirus disease 2019. Students recommended embedding support within policies/teaching, offering a range of supports and involving students in design.ConclusionBarriers to mental health promotion via telehealth should be considered to promote accessibility and acceptability for tertiary students. Future programmes should consider reaching students through mandatory activities (e.g. lectures, tutorials) and should include student consultation and co-design to support the development of programmes that meet student needs and preferences.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-30T06:45:22Z
      DOI: 10.1177/20552076221117746
      Issue No: Vol. 8 (2022)
       
  • Cognitive fatigability assessment test (cFAST): Development of a new
           instrument to assess cognitive fatigability and pilot study on its
           association to perceived fatigue in multiple sclerosis

    • Authors: Liliana Barrios, Rok Amon, Pietro Oldrati, Marc Hilty, Christian Holz, Andreas Lutterotti
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundFatigue is a common symptom of many diseases, including multiple sclerosis. It manifests as a cognitive or physical condition. Fatigue is poorly understood, and effective therapies are missing. Furthermore, there is a lack of methods to measure fatigue objectively. Fatigability, the measurable decline in performance during a task, has been suggested as a complementary method to quantify fatigue.ObjectiveTo develop a new and objective measurement of cognitive fatigability and investigate its association with perceived fatigue.MethodsWe introduced the cognitive fatigability assessment test (cFAST), a novel smartphone-based test to quantify cognitive fatigability. Forty-two people with multiple sclerosis (23 fatigued and 19 non-fatigued, defined by the Fatigue Scale for Motor and Cognitive Functions) took part in our validation study. Patients completed cFAST twice. We used t-tests, Monte Carlo sampling, and area under the receiver operating characteristic curves to evaluate our approach using two sets of proposed metrics.ResultsWhen classifying fatigue, our fatigability metric Δresponse time has a mean area under the receiver operating characteristic curve of 0.74 (95% CI 0.64–0.84), making it the best performing metric for this task. Furthermore, Δresponse time shows a statistically significant difference between the fatigued and non-fatigued groups (t = 2.27, P = .03). Particularly, cognitively-fatigued patients decline in performance, while non-fatigued patients do not.ConclusionsWe introduce cFAST, a new instrument to quantify cognitive fatigability. Our pilot study provides evidence that cognitive fatigability assessment test produces a quantifiable drop in cognitive performance in a short period. Furthermore, our results indicate that cFAST may have the potential to serve as a surrogate for subjective cognitive fatigue. cFAST is significantly shorter than the existing fatigability assessments and does not require specialized equipment. Thus, it could enable frequent and remote monitoring, which could substantially aid clinicians in better understanding and treating fatigue.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-26T06:44:24Z
      DOI: 10.1177/20552076221117740
      Issue No: Vol. 8 (2022)
       
  • What possibly affects nighttime heart rate' Conclusions from N-of-1
           observational data

    • Authors: Igor Matias, Eric J. Daza, Katarzyna Wac
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundHeart rate (HR), especially at nighttime, is an important biomarker for cardiovascular health. It is known to be influenced by overall physical fitness, as well as daily life physical or psychological stressors like exercise, insufficient sleep, excess alcohol, certain foods, socialization, or air travel causing physiological arousal of the body. However, the exact mechanisms by which these stressors affect nighttime HR are unclear and may be highly idiographic (i.e. individual-specific). A single-case or “n-of-1” observational study (N1OS) is useful in exploring such suggested effects by examining each subject's exposure to both stressors and baseline conditions, thereby characterizing suggested effects specific to that individual.ObjectiveOur objective was to test and generate individual-specific N1OS hypotheses of the suggested effects of daily life stressors on nighttime HR. As an N1OS, this study provides conclusions for each participant, thus not requiring a representative population.MethodsWe studied three healthy, nonathlete individuals, collecting the data for up to four years. Additionally, we evaluated model-twin randomization (MoTR), a novel Monte Carlo method facilitating the discovery of personalized interventions on stressors in daily life.ResultsWe found that physical activity can increase the nighttime heart rate amplitude, whereas there were no strong conclusions about its suggested effect on total sleep time. Self-reported states such as exercise, yoga, and stress were associated with increased (for the first two) and decreased (last one) average nighttime heart rate.ConclusionsThis study implemented the MoTR method evaluating the suggested effects of daily stressors on nighttime heart rate, sleep time, and physical activity in an individualized way: via the N-of-1 approach. A Python implementation of MoTR is freely available.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-25T04:35:35Z
      DOI: 10.1177/20552076221120725
      Issue No: Vol. 8 (2022)
       
  • Use of YouTube to watch health-related videos and participation in online
           support groups among US adults with heart disease, diabetes, and
           hypertension

    • Authors: Aisha T Langford, Kerli T Orellana, Nancy Buderer
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveSocial media use has grown over time. However, it is unclear how people with a self-reported history of cardiovascular disease or cardiovascular disease-related risk factors such as diabetes and hypertension use social media.MethodsData from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4) were analyzed (N = 3865). Only respondents with complete data for all variables of interest were included in the analyses, resulting in 306 respondents with a heart condition, 1291 with hypertension, and 608 with diabetes. We explored associations between two dependent variables: (1) participated in an online forum or support group and (2) watched a health-related video on YouTube, and sociodemographic factors and patient-provider communication. Analyses were conducted separately by medical condition. Odds ratios, 95% confidence intervals, and p-values were calculated.ResultsIn respondents with a heart condition, hypertension, or diabetes, 5.4%, 8.4%, and 10.3% had participated in an online support group and 29.6%, 40.4%, and 36.6% had watched health-related videos on YouTube, respectively. Univariately, the odds of using online support groups was associated with younger age (vs.> = 65) in people with a heart condition and hypertension, but not diabetes. Regarding YouTube, younger age was associated with watching health-related videos across all three medical conditions, with additional gender and education associations observed in those with hypertension. There were no associations between social media use and patient-provider communication.ConclusionsThese findings may inform the selection of social media platforms for behavioral interventions depending on the intended patient population and goals (e.g. social support vs. video-based health education).
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-25T04:35:24Z
      DOI: 10.1177/20552076221118822
      Issue No: Vol. 8 (2022)
       
  • Digitization in health-related self-help – Results of an online survey
           among self-help organizations in Germany

    • Authors: Stefan Nickel, Katharina Bremer, Marie-Luise Dierks, Marius Haack, Silke Wittmar, Bernhard Borgetto, Christopher Kofahl
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundNowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic.DesignThe online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30–40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed.ResultsSHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a “high” or “very high” benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups).ConclusionsAt many points in the survey it was shown that digital media can be a useful extension of “traditional” collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help.Patient or Public ContributionThe study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-23T05:00:28Z
      DOI: 10.1177/20552076221120726
      Issue No: Vol. 8 (2022)
       
  • Remote patient monitoring for chronic heart failure in France: When an
           innovative funding program (ETAPES) meets an innovative solution
           (Satelia® Cardio)

    • Authors: N Pages, F Picard, F Barritault, W Amara, S Lafitte, P Maribas, P Abassade, J Ph Labarre, R Boulestreau, H Chaouky, M Abdennadher, H Lemieux, R Lasserre, C Bedel, L Betito, S Nisse-Durgeat, B Diebold
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionRemote patient monitoring (RPM) is a telehealth activity to collect and analyze patient health or medical data. Its use has expanded in the past decade and has improved medical outcomes and care management of non-communicable chronic diseases. However, implementation of RPM into routine clinical activities has been limited. The objective of this study was to describe the French funding program for RPM (known as ETAPES) and one of the RPM solution providers (Satelia®) dedicated to chronic heart failure (CHF).MethodsA descriptive assessment of both the ETAPES funding program and Satelia® RPM solution was conducted. Data were collected from official legal documents and information that was publicly available online from the French Ministry of Health.Results and DiscussionETAPES was formally created in 2016 based on previous legislation pertaining to the national health insurance funding strategy. However, it only started to operate in 2018. Patients with CHF were only eligible if they were at medium or high risk of re-hospitalization with a New York Heart Association (NYHA) score superior or equal to two and a BNP>100 pg/ml or NT pro BNP>1000 pg/ml. Medical monitoring was supported through the therapeutic education of a patient on the RPM model of care with a minimum of three training sessions during the first six months. The use of Satelia® Cardio is noteworthy since it relies only on symptomatic monitoring through which the patient manually reports their information by answering a simple questionnaire on a regular basis and does not rely on any connected devices.ConclusionInnovative funding programs and solutions for RPM need real-world evaluation in the future.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-22T07:14:16Z
      DOI: 10.1177/20552076221116774
      Issue No: Vol. 8 (2022)
       
  • What drives the use of wearable healthcare devices' A cross-country
           comparison between the US and Korea

    • Authors: Jong-Youn Rha, Youngwon Nam, Sun Young Ahn, Jihye Kim, Youchung Chang, Jisu Jang, Keiko Kurita, Jin-Young Park, Kunsun Eom, Hyunseok Moon, Myoung Hoon Jung, Yoon Jae Kim, Jeong-Eun Hwang, HyucK Choo
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveGiven the rapid growth of the wearable healthcare device market, we examined the associations among health-related and technology-related characteristics of using wearable healthcare devices and demonstrated how the associations differ between the US and Korean users.MethodsOnline self-administered surveys were conducted with 4098 participants (3035 in the US and 1063 in Korea) who were recruited through two online survey service providers based on quota sampling. The primary outcome was the use of wearable healthcare devices. Seven health-related, two technology-related, and five socio-demographic factors were included as explanatory variables. Binary logistic regression analyses and a Chow test were conducted.ResultsThe health-related characteristics that were significantly associated with using wearable healthcare devices included disease-related worries (β = 0.11**), health information seeking (β = 0.26***), physical activity (β = 0.62***), and health-related expenditures ($50–$199, β = 0.38***; $200 or more, β = 0.56***). Hedonic (β = 0.33***), social (β = 0.31***), and cognitive innovativeness (β = 0.14*) also exhibited positive relationships. Younger, higher earner, and individuals with a child were more likely to use wearable healthcare devices. However, for Korean users, several associations disappeared including health information seeking, hedonic and social innovativeness, age, and household income.ConclusionsKey drivers of using wearable healthcare devices include greater concern about a specific illness, active engagement in health-promoting behaviors, and hedonic and social motivation to adopt new technologies. However, more country-specific considerations are needed in future studies to identify the main benefits for target markets.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-18T06:38:28Z
      DOI: 10.1177/20552076221120319
      Issue No: Vol. 8 (2022)
       
  • Characteristics of Facebook’s third-party medical fact checkers

    • Authors: Alyson Haslam, Vinay Prasad
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionSocial media websites, such as Facebook, have made an effort to monitor and label news stories and op-eds that could be false or misleading. As such, we sought to evaluate fact checkers for news stories and op-eds that circulate on Facebook.MethodsWe searched all articles on HealthFeedback.org for names of reviewers and other quoted individuals cited in the article and their professional titles. We searched Twitter on March 10, 2021, to see whether the reviewers and quoted individuals had an account and noted the number of Twitter followers.ResultsThe median number of followers on Twitter for reviewers was 10,000 (since January 2020) versus 1012 (prior to January 2020; p = 0.007). The median number of followers on Twitter for quoted individuals was 153,050 (since January 2020) versus 314 (prior to January 2020; p = 0.04).ConclusionCurrent fact-checking processes appear to be strongly associated with large Twitter followings. Greater transparency in the process of determining misinformation is needed.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-18T06:38:23Z
      DOI: 10.1177/20552076221120318
      Issue No: Vol. 8 (2022)
       
  • The effect of information technology intervention on using appropriate VTE
           prophylaxis in non-surgical patients: A systematic review and
           meta-analysis

    • Authors: Mehrdad Karajizadeh, Soheil Hassanipour, Roxana Sharifian, Fatemeh Tajbakhsh, Hamid Reza Saeidnia
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionClinical decision support systems (CDSSs) play an important role in summarizing the best clinical practices, thereby promoting high standards of care in specific medical fields. These systems can serve as tools for gaining knowledge and mediating between clinical guidelines and physicians thereby providing the right information to the right person at the right time.ObjectiveThis review aims to evaluate the effect of CDSSs on adherence to guidelines for venous thromboembolism (VTE) prophylaxis and VTE events compared to routine care without CDSSs in non-surgical patients.MethodsIn order to conduct a systematic literature review, the published studies were identified through screening EMBASE, the international clinical trials registry, OVID, Cochrane database, PubMed, ISI Web of Science, and Scopus databases, from 1982 to March 2021. The included studies were reviewed by two independent reviewers; the proportion of patients that correctly received VTE prophylaxis has been next extracted for further analysis. Additionally, patients were divided into two groups: CDSS-recommended VTE prophylaxis and routine care without using a CDSS.ResultsTwelve articles (three randomized controlled trials, seven prospective cohort trials, and two retrospective cohort trials) were in fine analyzed. The use of CDSSs is found to be associated with a significant increase in the rate of using the appropriate prophylaxis for VTE (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-18T03:21:52Z
      DOI: 10.1177/20552076221118828
      Issue No: Vol. 8 (2022)
       
  • eHealth policy in Spain: A comparative study between general population
           and groups at risk of social exclusion in Spain

    • Authors: Ángela Fernández Da Silva, Bran Barral Buceta, Xosé María Mahou-Lago
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundIn recent years, the healthcare sector has experienced accelerated progress in terms of the inclusion of Information and Communication Technologies (ICTs) in its procedures and formalities. However, public administrations have been unable to adapt to the peculiarities of the most vulnerable groups. This leads to marginalization of at-risk groups within the healthcare system and contributes to the widening of the so-called digital divide.MethodsBased on the analysis of the literature, three dimensions have been constructed to identify the level of inclusion of web portals: the perception of quality, the perception of usability, and the importance attributed to their content. In order to obtain data on each of these dimensions, a study was designed based on the user test methodology as a central element (identifying and evaluating 11 vulnerable groups) and, in parallel, a survey of the general population and heuristic tests.ResultsA high percentage of vulnerable people at risk of social exclusion are not receiving adequate healthcare due to the digitalization of the system and the implementation of scarcely inclusive health web portals, which pose significant barriers in service provision for the 11 selected collectives. Meanwhile, the general population is being introduced to eHealth benefits, although the latter did not have high levels of digitization or a broad portfolio of services.ConclusionsThe general population has a relatively positive perspective of eHealth services, but only a minority of them make intensive use of them, and they are not widespread in Spain as a whole. Meanwhile, the population at risk of exclusion lacks the skills and resources to make real use of eHealth, needing “digital intermediaries” from the social sphere to achieve results. eHealth policies are not taking into account people with higher levels of marginalization, aggravating their exclusion and the digital divide.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-16T04:03:15Z
      DOI: 10.1177/20552076221120724
      Issue No: Vol. 8 (2022)
       
  • Artificial intelligence–aided diagnosis model for acute respiratory
           distress syndrome combining clinical data and chest radiographs

    • Authors: Kai-Chih Pai, Wen-Cheng Chao, Yu-Len Huang, Ruey-Kai Sheu, Lun-Chi Chen, Min-Shian Wang, Shau-Hung Lin, Yu-Yi Yu, Chieh-Liang Wu, Ming-Cheng Chan
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe aim of this study was to develop an artificial intelligence–based model to detect the presence of acute respiratory distress syndrome (ARDS) using clinical data and chest X-ray (CXR) data.MethodThe transfer learning method was used to train a convolutional neural network (CNN) model with an external image dataset to extract the image features. Then, the last layer of the model was fine-tuned to determine the probability of ARDS. The clinical data were trained using three machine learning algorithms—eXtreme Gradient Boosting (XGB), random forest (RF), and logistic regression (LR)—to estimate the probability of ARDS. Finally, ensemble-weighted methods were proposed that combined the image model and the clinical data model to estimate the probability of ARDS. An analysis of the importance of clinical features was performed to explore the most important features in detecting ARDS. A gradient-weighted class activation mapping (Grad-CAM) model was used to explain what our CNN sees and understands when making a decision.ResultsThe proposed ensemble-weighted methods improved the performances of the ARDS classifiers (XGB + CNN, area under the curve [AUC] = 0.916; RF + CNN, AUC = 0.920; LR + CNN, AUC = 0.920; XGB + RF + LR + CNN, AUC = 0.925). In addition, the ML model using clinical data to present the top 15 important features to identify the risk factors of ARDS.ConclusionThis study developed combined machine learning models with clinical data and CXR images to detect ARDS. According to the results of the Shapley Additive exPlanations values and the Grad-CAM techniques, an explicable ARDS diagnosis model is suitable for a real-life scenario.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-16T04:02:55Z
      DOI: 10.1177/20552076221120317
      Issue No: Vol. 8 (2022)
       
  • Tele-yoga for the management of Parkinson disease: A safety and
           feasibility trial

    • Authors: Aurora M James-Palmer, Jean-Francois Daneault
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesDespite current standard treatments, persons with Parkinson disease (PD) still experience motor and non-motor symptoms that impact daily function and quality of life, warranting the investigation of additional interventions. Holistic complementary interventions such as yoga have been shown to be beneficial for persons with PD. However, there are multiple barriers to in-person interventions such as transportation difficulties and disease-related mobility impairments which may be mitigated by digital health applications. Therefore, this study’s purpose was to assess the safety and feasibility of a synchronous tele-yoga intervention for persons with PD.MethodsSixteen participants were enrolled in a single group safety and feasibility trial. The entire study was conducted remotely and consisted of a baseline assessment followed by a six-week waiting period, then a second assessment, a six-week tele-yoga intervention period, a post-intervention assessment, a six-week follow-up period, and lastly a follow-up assessment. During the tele-yoga period, participants completed two one-on-one 30-minute tele-yoga sessions weekly for a total of 12 sessions. Primary outcomes included adverse events, adherence, technological challenges, and usability. Secondary outcomes included enjoyment and clinically relevant outcome measures assessing both motor and non-motor symptoms.ResultsNo severe adverse events were attributed to the intervention. Retention was 87.5%, assessment session adherence was 100%, and intervention session adherence was 97%. Technological challenges did not impact feasibility. The intervention was usable and enjoyable. While this study was not powered or designed to assess the efficacy of the intervention, preliminary improvements were shown for some of the clinically relevant outcome measures.ConclusionsOverall, this study showed that the implementation of a synchronous one-on-one tele-yoga intervention was safe, feasible, usable, and enjoyable for persons with PD. Randomized control trials investigating its efficacy should be initiated. The study was registered with ClinicalTrials.gov (NCT04240899, https://clinicaltrials.gov/ct2/show/NCT04240899).
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-16T04:02:35Z
      DOI: 10.1177/20552076221119327
      Issue No: Vol. 8 (2022)
       
  • Fat stigma and body objectification: A text analysis approach using social
           media content

    • Authors: Vajisha U Wanniarachchi, Chris Scogings, Teo Susnjak, Anuradha Mathrani
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      This study investigates how female and male genders are positioned in fat stigmatising discourses that are being conducted over social media. Weight-based linguistic data corpus, extracted from three popular social media (SM) outlets, Twitter, YouTube and Reddit, was examined for fat stigmatising content. A mixed-method analysis comprising sentiment analysis, word co-occurrences and qualitative analysis, assisted our investigation of the corpus for body objectification themes and gender-based differences. Objectification theory provided the underlying framework to examine the experiential consequences of being fat across both genders. Five objectifying themes, namely, attractiveness, physical appearance, lifestyle choices, health and psychological well-being, emerged from the analysis. A deeper investigation into more facets of the social interaction data revealed overall positive and negative attitudes towards obesity, which informed on existing notions of gendered body objectification and weight/fat stigmatisation. Our findings have provided a holistic outlook on weight/fat stigmatising content that is posted online which can further inform policymakers in planning suitable props to facilitate more inclusive SM spaces. This study showcases how lexical analytics can be conducted by combining a variety of data mining methods to draw out insightful subject-related themes that add to the existing knowledge base; therefore, has both practical and theoretical implications.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-16T04:02:28Z
      DOI: 10.1177/20552076221117404
      Issue No: Vol. 8 (2022)
       
  • Prospects for financial technology for health in Africa

    • Authors: Don Eliseo Lucero-Prisno, Alaka Hassan Olayemi, Idongesit Ekpenyong, Precious Okereke, Osman Aldirdiri, Julian MA Buban, Sudi Ndikumana, Kwasi Yelarge, Noah Sesay, Foday Umaro Turay, Junjie Huang, MBN Kouwenhoven
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Over the years, technology has revolutionized the operations of many industries, ranging from manufacturing and agriculture to financial institutions which are usually the first users of innovations. Owing to the recent technological trends in the financial sector, such as mobile money, artificial intelligence, and medical robotics, as well as the rapidly increasing human population and the emergence of new patterns of disease, it is necessary for the healthcare sector to adopt new strategies to deliver efficient and effective healthcare services. Financial technology (FinTech), a combination of financial services and technology, entails the incorporation of modern, innovative technologies by industries into their financial services. FinTech is an endless array of applications, products, and services which includes mobile banking, cryptocurrency, insurance, and investment apps among many others. Any enterprise that employs technology to enhance or automate financial services and processes is referred to as FinTech. This fast-growing industry serves the interests of both the business sector and the consuming public. There have been many applications and uses of FinTech, however, its employment in the field of health remains to be explored further and maximized, particularly in the developing world like Africa. This paper aims to explore the prospects of FinTech for healthcare in Africa.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-10T05:23:32Z
      DOI: 10.1177/20552076221119548
      Issue No: Vol. 8 (2022)
       
  • Assessing eHealth literacy among internet users in Lebanon: A
           cross-sectional study

    • Authors: Marco Bardus, Arda Keriabian, Martine Elbejjani, Samar Al-Hajj
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveAssessing the level of eHealth literacy in a population is essential to designing appropriate public health interventions. This study aimed to assess eHealth literacy among adult internet users in Lebanon, recruited through social media and printed materials. The study examined the relationship between internet use, perceived eHealth literacy, and sociodemographic characteristics.MethodsA cross-sectional study based on a web-based questionnaire was conducted between January and May 2020. The survey assessed internet use and eHealth literacy using the homonymous scale (eHEALS) in English and Arabic. Cronbach's alpha and factor analyses were used to evaluate eHEALS’ psychometric properties. A generalized linear model was used to identify factors predicting the eHEALS.ResultsA total of 2715 respondents were recruited mostly through Facebook (78%) and printed materials (17%). Most respondents completed the survey in English (82%), were aged 30 ± 11 years, female (60%), Lebanese (84%), unmarried (62%), employed (54%), and with a graduate-level education (53%). Those who completed the eHEALS questionnaire (n = 2336) had a moderate eHealth literacy (M = 28.7, SD = 5.5). eHEALS was significantly higher among older females with a high education level, recruited from Facebook, Instagram, or ResearchGate, and perceived the Internet as a useful and important source of information.ConclusionsFuture internet-delivered public health campaigns in Lebanon should account for moderate-to-low levels of eHealth literacy and find ways to engage older males with low education levels representing neglected segments (e.g. Syrians). To be more inclusive, campaigns should reach neglected population segments through non-digital, community-based outreach activities.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-10T05:23:23Z
      DOI: 10.1177/20552076221119336
      Issue No: Vol. 8 (2022)
       
  • Attitudes and perception of artificial intelligence in healthcare: A
           cross-sectional survey among patients

    • Authors: Sebastian J Fritsch, Andrea Blankenheim, Alina Wahl, Petra Hetfeld, Oliver Maassen, Saskia Deffge, Julian Kunze, Rolf Rossaint, Morris Riedel, Gernot Marx, Johannes Bickenbach
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe attitudes about the usage of artificial intelligence in healthcare are controversial. Unlike the perception of healthcare professionals, the attitudes of patients and their companions have been of less interest so far. In this study, we aimed to investigate the perception of artificial intelligence in healthcare among this highly relevant group along with the influence of digital affinity and sociodemographic factors.MethodsWe conducted a cross-sectional study using a paper-based questionnaire with patients and their companions at a German tertiary referral hospital from December 2019 to February 2020. The questionnaire consisted of three sections examining (a) the respondents’ technical affinity, (b) their perception of different aspects of artificial intelligence in healthcare and (c) sociodemographic characteristics.ResultsFrom a total of 452 participants, more than 90% already read or heard about artificial intelligence, but only 24% reported good or expert knowledge. Asked on their general perception, 53.18% of the respondents rated the use of artificial intelligence in medicine as positive or very positive, but only 4.77% negative or very negative. The respondents denied concerns about artificial intelligence, but strongly agreed that artificial intelligence must be controlled by a physician. Older patients, women, persons with lower education and technical affinity were more cautious on the healthcare-related artificial intelligence usage.ConclusionsGerman patients and their companions are open towards the usage of artificial intelligence in healthcare. Although showing only a mediocre knowledge about artificial intelligence, a majority rated artificial intelligence in healthcare as positive. Particularly, patients insist that a physician supervises the artificial intelligence and keeps ultimate responsibility for diagnosis and therapy.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-08T07:35:43Z
      DOI: 10.1177/20552076221116772
      Issue No: Vol. 8 (2022)
       
  • Clinical decision support for intervention reduction in neonatal patients:
           A usability assessment

    • Authors: Patrice D. Tremoulet
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study investigated how effectively simplified cognitive walkthroughs, performed independently by four nonclinical researchers, can be used to assess the usability of clinical decision support software. It also helped illuminate the types of usability issues in clinical decision support software tools that cognitive walkthroughs can identify.MethodA human factors professor and three research assistants each conducted an independent cognitive walkthrough of a web-based demonstration version of T3, a physiologic monitoring system featuring a new clinical decision support software tool called MAnagement Application (MAP). They accessed the demo on personal computers in their homes and used it to walk through several pre-specified tasks, answering three standard questions at each step. Then they met to review and prioritize the findings.ResultsEvaluators acknowledged several positive features including concise, helpful tooltips and an informative column in the patient overview which allows users direct (one-click) access to protocol eligibility and compliance criteria. Recommendations to improve usability include: modify the language to clarify what user actions are possible; visually indicate when eligibility flags are snoozed; and specify which protocol's data is currently being shown.ConclusionIndependent, simplified cognitive walkthroughs can help ensure that clinical decision support software tools will appropriately support clinicians. Four researchers used this technique to quickly, inexpensively, and effectively assess T3's new MAP tool, which suggests positive actions, such as removing a patient from a ventilator. Results indicate that, while there is room for usability improvements, the MAP tool may help reduce clinician's cognitive load, facilitating improved care. The study also confirmed that cognitive walkthroughs identify issues that make clinical decision support software hard to learn or remember to use.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-08T06:54:25Z
      DOI: 10.1177/20552076221113696
      Issue No: Vol. 8 (2022)
       
  • Free interactive counselling program in a mobile communication application
           for improving health education on indwelling ureteric stents after
           ureterorenoscopic lithotripsy: An observational study

    • Authors: Tzu-Yu Chuang, Weiming Cheng, Yi-Chun Chiu, Yu-Hua Fan, Chia-Chi Chi, Chang-Chi Chang, Chia-Heng Liao
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study examines the potential benefit of an interactive counselling program via a mobile application (app), which can instantly provide patients with the necessary information and correct response regarding their condition.MethodsWe designed a free ‘Ureteric Stent Interactive Program’ for patients receiving ureterorenoscopic lithotripsy and provided the program to interested patients. Patient data were collected from medical records and depending on whether patients used our program, they were divided into two groups: ‘program-user’ and ‘non-user’. The differences between the groups were analysed using Fisher’s exact tests.ResultsOf the 70 patients, 50 elected to use the program. The program-user group was significantly younger (
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-05T06:38:29Z
      DOI: 10.1177/20552076221117754
      Issue No: Vol. 8 (2022)
       
  • Digital health transformation in Saudi Arabia: A cross-sectional analysis
           using Healthcare Information and Management Systems Society’ digital
           health indicators

    • Authors: Nouf Al-Kahtani, Sumaya Alruwaie, Bnan Mohammed Al-Zahrani, Rahaf Ali Abumadini, Afnan Aljaafary, Bayan Hariri, Khalid Alissa, Zahra Alakrawi, Arwa Alumran
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThe digital revolution has had a huge impact on healthcare around the world. Digital technology could dramatically improve the accuracy of diagnosis, treatment, health outcomes, efficiency of care, and workflow of healthcare operations. Using health information technology will bring major improvements in patient outcomes.PurposeThis study aims to measure the readiness for digital health transformation at different hospitals in the Eastern Province, Saudi Arabia in relation to Saudi Vision 2030 based on the four dimensions adopted by the Healthcare Information and Management Systems Society: person-enabled health, predictive analytics, governance and workforce, and interoperability.MethodsThe study was conducted with a cross-sectional design using data collected through an online questionnaire from 10 healthcare settings, the questionnaire consists of the four digital health indicators. The survey was developed by Healthcare Information and Management Systems Society for the purpose of assessing the level of digital maturity in healthcare settings.ResultsTen healthcare facilities in the Eastern Province, both private and governmental, were included in the study. The highest total scores for digital health transformation were reported in private healthcare facilities (median score for private facilities = 77, public facilities = 71). The ‘governance and workforce’ was the most implemented dimension among the healthcare facilities in the study (median = 80), while the dimension that was least frequently implemented was predictive analytics (median score = 70). In addition, tertiary hospitals scored the least in digital transformation readiness (median = 74) compared to primary and secondary healthcare facilities in the study.ConclusionThe results of the study show that private healthcare facilities scored higher in digital health transformation indicators. These results will be useful for promoting policymakers’ understanding of the level of digital health transformation in the Eastern Province and for the creation of a strategic action plan.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-04T07:19:26Z
      DOI: 10.1177/20552076221117742
      Issue No: Vol. 8 (2022)
       
  • Patient and clinician experiences of remote consultation during the
           SARS-CoV-2 pandemic: A service evaluation

    • Authors: Sue Schutz, Helen Walthall, Joanna Snowball, Raluca Vagner, Nicola Fernandez, Emilia Bartram, Clair Merriman
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesDuring the SARS-CoV-2 pandemic, clinicians were instructed to move all but emergency consultations to remote means to reduce the spread of the virus. The aim of this study was to evaluate patients’ and clinicians’ experiences of moving to remote means of consultation with their health care professionals during the SARS-CoV-2 pandemic.MethodsThe study design was a qualitative service evaluation. Twenty-six clinicians and forty-eight patients who met the inclusion criteria consented to be interviewed. Clinician participants were from either medical, nursing, or allied health professional backgrounds. Patients were recruited from diabetes, acute care, and haematology and cancer areas. Data analysis was conducted using a thematic analysis framework.ResultsFollowing coding and thematic analysis of the data collected from clinicians, five themes were identified: personal and professional well-being; providing a safe and high-quality experience; adapting to a new way of working; making remote consultations fit for purpose and an awareness of altered dynamics during consultation. Patient data was coded into 3 themes: remote consultation adds value; remote consultation brings challenges and concerns about remote consultation.ConclusionsClinician and patient experiences reported here are reflected in the literature. The study indicates that remote consultation is not suitable for all patients and in all contexts. Whilst maintaining the benefits to patients, remote means of consultation needs organisational support and preparation. A way forward that maintains the benefits whilst addressing concerns seems urgent.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-04T07:19:21Z
      DOI: 10.1177/20552076221115022
      Issue No: Vol. 8 (2022)
       
  • Provider-to-provider synchronous telemedical consultations in
           ophthalmology: Advice for implementation

    • Authors: Carly Stewart, Josephine Coffey-Sandoval, Erik A. Souverein, Thomas C. Lee, Sudha Nallasamy
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      We previously demonstrated the non-inferiority of a synchronous (real-time) telemedicine model (compared to gold standard in-person examination) for pediatric ophthalmology consultations using a Polycom conferencing system, smart glasses, digital slit lamp, and digital indirect ophthalmoscope. Although we acknowledge there is a learning curve associated with becoming proficient with this system, we believe implementation of a synchronous telemedicine model is advantageous to both patient and provider in the right care setting. In conducting 348 such examinations over the course of our study and dozens of subsequent examinations after the implementation of our model in the community, we have gleaned many insights into optimizing the experience and efficiency. We wish to share these insights to help guide those interested in adopting such a model to expand access to specialists for underserved patients or improve efficiencies in their practice.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-02T07:09:01Z
      DOI: 10.1177/20552076221117744
      Issue No: Vol. 8 (2022)
       
  • Effects of brief exposure to misinformation about e-cigarette harms on
           Twitter on knowledge and perceptions of e-cigarettes

    • Authors: Jessica Liu, Caroline Wright, Olga Elizarova, Jennifer Dahne, Jiang Bian, Philippa Williams, Brittany Zulkiewicz, Andy SL Tan
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThis study examined whether exposure to misinformation found on Twitter about e-cigarette harms leads to inaccurate knowledge and misperceptions of harms of e-cigarette use among cigarette smokers.MethodsWe conducted an online randomized controlled experiment in November 2019 among an online sample of 2400 adult US and UK cigarette smokers who did not currently use e-cigarettes. Participants viewed four tweets in one of four conditions: 1) e-cigarettes are as or more harmful than smoking, 2) e-cigarettes are completely harmless, 3) e-cigarette harms are uncertain and 4) control (physical activity). Outcomes were knowledge about e-cigarettes and harm perceptions of e-cigarette use for five diseases. We conducted multiple logistic and linear regressions to analyze the effect of experimental conditions on outcomes, controlling for baseline knowledge and perceived harms.FindingsParticipants in the ‘as or more harmful’ condition (vs. control group) had higher odds of accurate knowledge about e-cigarettes containing toxic chemicals (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-02T07:08:48Z
      DOI: 10.1177/20552076221116780
      Issue No: Vol. 8 (2022)
       
  • Materiality and the mediating roles of eHealth: A qualitative study and
           comparison of three cases

    • Authors: Susanne Frennert, Lena Petersson, Mirella Muhic, Christofer Rydelfält, Veronica Milos Nymberg, Björn Ekman, Gudbjörg Erlingsdottir
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Against the backdrop of eHealth solutions increasingly becoming a part of healthcare professionals’ ways of doing care work, this paper questions how the solutions mediate the experience of healthcare professionals when deployed. We undertook a qualitative study of three eHealth solutions, conducting qualitative interviews with a diverse sample of 102 healthcare professionals from different care settings across the south of Sweden. Materiality and postphenomenology serve as analytic tools for achieving an understanding of the mediating roles of eHealth solutions. The analysis emphasises the mediating roles consisting of interrelated paradoxes: (1) changing and perpetuating boundaries between patients and professional groups, (2) (dis)enabling augmented information and knowledge processes and (3) reconfiguring professional control over work. This contribution provides critical insights into materiality as a category of analysis in studies on the deployment of eHealth solutions, as these technologies have both intended and unintended consequences for care work. Our study identified general positive consequences of all three solutions, such as the increased feeling of closeness to patients and colleagues over time and space; increased ‘understanding’ of patients through patient-generated data; and increased autonomy, due to the fact that asynchronous communication makes it possible to decide when and which patient to attend to. We also identified general unintended consequences of the solutions, such as maintenance of power relations maintained due to organisational structures and professional relations, disabled information and knowledge processes due to the lack of non-verbal clues, reduced professional autonomy due to technical scripts determining what data is collected and how it is categorised, and uneven workload due to the dependency on patient input and compliance.
      Citation: DIGITAL HEALTH
      PubDate: 2022-08-01T07:39:14Z
      DOI: 10.1177/20552076221116782
      Issue No: Vol. 8 (2022)
       
  • Investigating psychological variables for technologies promoting physical
           activity

    • Authors: Patricia Rick, Milagrosa Sánchez-Martín, Aneesha Singh, Sergio Navas-León, Mercedes Borda-Mas, Nadia Bianchi-Berthouze, Ana Tajadura-Jiménez
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundMany technological interventions designed to promote physical activity (PA) have limited efficacy and appear to lack important factors that could increase engagement. This may be due to a discrepancy between research conducted in this space, and software designers’ and developers’ use of this research to inform new digital applications.ObjectivesThis study aimed to identify (1) what are the variables that act as barriers and facilitators to PA and (2) which PA variables are currently considered in the design of technologies promoting PA including psychological, physical, and personal/contextual ones which are critical in promoting PA. We emphasize psychological variables in this work because of their sparse and often simplistic integration in digital applications for PA.MethodsWe conducted two systematized reviews on PA variables, using PsycInfo and Association for Computing Machinery Digital Libraries for objectives 1 and 2.ResultsWe identified 38 PA variables (mostly psychological ones) including barriers/facilitators in the literature. 17 of those variables were considered when developing digital applications for PA. Only few studies evaluate PA levels in relation to these variables. The same barriers are reported for all weight groups, though some barriers are stronger in people with obesity.ConclusionsWe identify PA variables and illustrate the lack of consideration of these in the design of PA technologies. Digital applications to promote PA may have limited efficacy if they do not address variables acting as facilitators or barriers to participation in PA, and that are important to people representing a range of body weight characteristics.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-29T07:29:38Z
      DOI: 10.1177/20552076221116559
      Issue No: Vol. 8 (2022)
       
  • Frozen section telepathology service: Efficiency and benefits of an
           e-health policy in South Tyrol

    • Authors: Ilaria Girolami, Stefania Neri, Albino Eccher, Matteo Brunelli, Mattew Hanna, Liron Pantanowitz, Esther Hanspeter, Guido Mazzoleni
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Objective/BackgroundTelepathology has been widely adopted to allow intraoperative pathology examinations to be performed remotely and for obtaining second opinion teleconsultation. In the Italian northern region of South Tyrol, the widespread geographical distances and consequent cost for the health system of having a travelling pathologist cover intraoperative consultations in peripheral hospitals was a key driver for the implementation of a telepathology system.MethodsIn 2010, four Menarini D-Sight whole slide scanners to digitize entire pathology slides were placed in the peripheral hospitals of Merano, Bressanone, Brunico, and in the hub hospital of Bolzano. Digital workstations were also installed to allow pathologists to remotely perform intraoperative consultations with digital slides. This study reviews the outcome after 12 years of telepathology for this intended clinical use.ResultsAfter an initial validation phase with 100 cases which yielded a sensitivity of 65% (CI 43–84%) and specificity of 100% (CI 95–100%), there were 2058 intraoperative consultations handled by telepathology. The cases evaluated were mainly breast sentinel lymph nodes, followed by urological, gynecological and general surgical pathology frozen section specimens. There were no false-positive cases and 165 (8%) false-negative cases, yielding an overall sensitivity and specificity of 65% (CI 61–69%) and 100% (CI 99–100%), respectively.ConclusionTelepathology is reliable for remote intraoperative diagnosis and, despite technical issues and initial acquaintance issues, proved beneficial for patient care in satellite hospitals, improved standardization, promoted innovation, and resulted in cost savings for the health system.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-29T07:01:05Z
      DOI: 10.1177/20552076221116776
      Issue No: Vol. 8 (2022)
       
  • #DomesticViolence During the COVID-19 Global Pandemic: An Analysis of
           Public Commentary via Twitter

    • Authors: Gabriela López, Katherine W Bogen, Richard J Meza-Lopez, Nicole R Nugent, Lindsay M Orchowski
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The current study sought to characterize commentary regarding intimate partner violence during the COVID-19 (SARS-CoV-2) pandemic via the Twitter hashtags #DomesticAbuse and #DomesticViolence. A sample of 481 original, English-language tweets containing the hashtag #DomesticAbuse or #DomesticViolence posted across five consecutive weekdays from March 22 to March 27, 2020—during which many places were enacting lockdown mandates—was examined using thematic content analyses. Overall, Twitter users commented on potential increased rates of IPV, while adding details about abuse tactics that could be employed by perpetrators during the pandemic. Additionally, Twitter users disclosed personal experiences of IPV victimization. Four themes were identified, including (1) type of domestic violence (i.e. whether the violence was COVID-specific or general domestic violence), (2) commentary about IPV (i.e. general reflections, decentralizing and centralizing survivorhood), (3) perpetrator tactic (i.e. abuse tactic used by the perpetrator), and (4) institutions responsible (i.e. institutions responsible for providing services to survivors). Overall, the commentary on Twitter reflected an effort to raise awareness and share informational aid for potential victims/survivors of IPV. Data highlight the potential of social media networks in conveniently facilitating the sharing and spreading of useful resources to other users. Future research should examine whether resources shared via Twitter reach individuals who need them and empower individuals to garner support.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-26T06:33:21Z
      DOI: 10.1177/20552076221115024
      Issue No: Vol. 8 (2022)
       
  • Prediction of intensive care unit admission (>24h) after surgery in
           elective noncardiac surgical patients using machine learning algorithms

    • Authors: Lan Lan, Fangwei Chen, Jiawei Luo, Mengjiao Li, Xuechao Hao, Yao Hu, Jin Yin, Tao Zhu, Xiaobo Zhou
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundTo develop a highly discriminative machine learning model for the prediction of intensive care unit admission (>24h) using the easily available preoperative information from electronic health records. An accurate prediction model for ICU admission after surgery is of great importance for surgical risk assessment and appropriate utilization of ICU resources.MethodData were collected retrospectively from a large hospital, comprising 135,442 adult patients who underwent surgery except for cardiac surgery between 1 January 2014, and 31 July 2018 in China. Multiple existing predictive machine learning algorithms were explored to construct the prediction model, including logistic regression, random forest, adaptive boosting, and gradient boosting machine. Four secondary analyses were conducted to improve the interpretability of the results.ResultsA total of 2702 (2.0%) patients were admitted to the intensive care unit postoperatively. The gradient boosting machine model attained the highest area under the receiver operating characteristic curve of 0.90. The machine learning models predicted intensive care unit admission better than the American Society of Anesthesiologists Physical Status (area under the receiver operating characteristic curve: 0.68). The gradient boosting machine recognized several features as highly significant predictors for postoperatively intensive care unit admission. By applying subgroup analysis and secondary analysis, we found that patients with operations on the digestive, respiratory, and vascular systems had higher probabilities for intensive care unit admission.ConclusionCompared with conventional American Society of Anesthesiologists Physical Status and logistic regression model, the gradient boosting machine could improve the performance in the prediction of intensive care unit admission. Machine learning models could be used to improve the discrimination and identify the need for intensive care unit admission after surgery in elective noncardiac surgical patients, which could help manage the surgical risk.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-25T11:34:38Z
      DOI: 10.1177/20552076221110543
      Issue No: Vol. 8 (2022)
       
  • Strengthening urban primary healthcare service delivery using electronic
           health technologies: A qualitative study in urban Nepal

    • Authors: Prayog Bhattarai, Abha Shrestha, Shangzhi Xiong, Nicholas Peoples, Chandrika Ramakrishnan, Shrinkhala Shrestha, Ruoyu Yin, Biraj Karmacharya, Lijing L. Yan, Tazeen H. Jafar
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundNepal is a South Asian country with a high burden of non-communicable diseases. Electronic health technologies are a promising strategy to mitigate the rising burden of non-communicable diseases by strengthening primary healthcare center service delivery. However, electronic health implementation in Nepal is limited. Furthermore, electronic health use at the primary healthcare center level is chronically understudied. This qualitative study seeks to understand the perceived awareness, benefits, and determinants of electronic health uptake in Nepal, focusing on primary healthcare center-level non-communicable disease management.MethodsWe conducted in-depth interviews with 27 participants including policymakers, health experts, facility administrators, providers, and non-communicable diseases patients in 2019. We selected six urban primary healthcare center facilities via cluster convenience sampling for recruiting facility administrators, providers, and patients, and used convenience sampling to recruit policymakers and experts. We conducted thematic data analysis inductively and deductively using the electronic health readiness assessment framework to understand perceived barriers and facilitators of electronic health implementation.ResultsWhile there was general awareness and acceptance of electronic health, multiple barriers impede readiness for implementation. These include policy making gaps, language barriers, low user technical literacy, concerns of overreliance on technology, and inadequate training for administrators and providers. Stakeholder suggestions include creating electronic health interfaces that meet the needs of end users (providers and patients), providing training to enable end users to effectively use electronic health technologies, and strong policy support at the national level.ConclusionWe identify several determinants for effectively promoting the use of electronic health for non-communicable diseases service delivery at the primary healthcare center level in Nepal.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-22T06:40:14Z
      DOI: 10.1177/20552076221114182
      Issue No: Vol. 8 (2022)
       
  • Instant messaging client gives the opportunity to recognize gut microbiota
           and dysbiosis-related disease: An investigation study on WeChat APP

    • Authors: Yujie Liu, Sheng Zhang, Xia Wu, Qianqian Li, Yun Wang, Yihao Huang, Faming Zhang, Bota Cui, Xiang Lu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesGut microbiota and dysbiosis are closely related to the occurrence and development of various diseases. It is necessary to popularize gut microbiota-related knowledge to the public. And the instant messaging client on smartphones supplies a perfect tool to achieve this goal. Hence, we will describe the current status of gut microbiota education spread by WeChat official accounts.MethodsThe keywords of “gut microbiota,” “fecal microbiota transplantation (FMT),” and “probiotics” were searched in the articles published from January 2015 to August 2020 on the WeChat official accounts. And the data were analyzed based on the 10 common gut dysbiosis-related diseases.ResultsA total of 3061 WeChat official accounts have published 11,239 articles on gut microbiota dysbiosis-related diseases, with a rising trend in the total article numbers and the total pageviews. The keywords of “gut microbiota” dominate 50.61%, and the articles on inflammatory bowel disease had the largest proportion. Additionally, articles on the keyword “gut microbiota” also included cancer and obesity, articles on the keyword “FMT” mainly consist of Clostridium difficile infection and psychological disease, and the keyword “probiotics” was mainly related to obesity and irritable bowel syndrome disease. The top three total pageviews were on inflammatory bowel disease, obesity, and cancer.ConclusionThis study indicates the current research hotspots and public concerns on the gut microbiota, and WeChat as an instant messaging client plays an important role in promoting the scientific popularization of gut microbiota.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-22T06:25:52Z
      DOI: 10.1177/20552076221115018
      Issue No: Vol. 8 (2022)
       
  • A personalized mobile app for physical activity: An experimental
           mixed-methods study

    • Authors: Huong Ly Tong, Juan C Quiroz, Ahmet Baki Kocaballi, Kiran Ijaz, Enrico Coiera, Clara K Chow, Liliana Laranjo
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesTo investigate the feasibility of the be.well app and its personalization approach which regularly considers users’ preferences, amongst university students.MethodsWe conducted a mixed-methods, pre-post experiment, where participants used the app for 2 months. Eligibility criteria included: age 18–34 years; owning an iPhone with Internet access; and fluency in English. Usability was assessed by a validated questionnaire; engagement metrics were reported. Changes in physical activity were assessed by comparing the difference in daily step count between baseline and 2 months. Interviews were conducted to assess acceptability; thematic analysis was conducted.ResultsTwenty-three participants were enrolled in the study (mean age = 21.9 years, 71.4% women). The mean usability score was 5.6 ± 0.8 out of 7. The median daily engagement time was 2 minutes. Eighteen out of 23 participants used the app in the last month of the study. Qualitative data revealed that people liked the personalized activity suggestion feature as it was actionable and promoted user autonomy. Some users also expressed privacy concerns if they had to provide a lot of personal data to receive highly personalized features. Daily step count increased after 2 months of the intervention (median difference = 1953 steps/day, p-value
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-22T06:25:47Z
      DOI: 10.1177/20552076221115017
      Issue No: Vol. 8 (2022)
       
  • Adolescents’ opinions on the use of a smartphone application as an oral
           health education tool: A qualitative study

    • Authors: Nazirah Ab Mumin, Zamros Yuzadi Mohd Yusof, Jamaludin Marhazlinda, Unaizah Obaidellah
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Developing health-related smartphone applications for oral health education should consider the end-user's perspectives to ensure they will be usable. This study aimed to explore the opinions of secondary school students in Selangor, Malaysia regarding the use of a smartphone application for oral health education and to identify the features for an oral health education smartphone application from the perspectives of adolescents. Focus group discussions were conducted among Form Two (14-year-old) and Form Four (16-year-old) students from selected government secondary schools in Selangor utilising a semi-structured topic guide until data saturation was achieved. Data were analysed using framework analysis. Ten focus group discussions were conducted involving 77 participants. Mixed opinions were recorded on the use of health-related smartphone applications for oral health education. The preferred features in a health-related smartphone application are disease detection, have games and rewards, educational and fun, access to a dentist, reminders, and user-friendliness. Adolescents are aware of the positive aspect of using health-related smartphone applications for oral health education; however, they are wary of the need to install one. Nevertheless, identifying adolescents’ preferred features of an oral health education app is the first step in developing an application tailored to their needs. Smartphone application could be a timely strategy to improve oral health education delivery and behaviour improvement for this age group.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-21T04:51:28Z
      DOI: 10.1177/20552076221114190
      Issue No: Vol. 8 (2022)
       
  • Predicting death risk analysis in fully vaccinated people using novel
           extreme regression-voting classifier

    • Authors: Eysha Saad, Saima Sadiq, Ramish Jamil, Furqan Rustam, Arif Mehmood, Gyu Sang Choi, Imran Ashraf
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Vaccination for the COVID-19 pandemic has raised serious concerns among the public and various rumours are spread regarding the resulting illness, adverse reactions, and death. Such rumours can damage the campaign against the COVID-19 and should be dealt with accordingly. One prospective solution is to use machine learning-based models to predict the death risk for vaccinated people by utilizing the available data. This study focuses on the prognosis of three significant events including ‘not survived’, ‘recovered’, and ‘not recovered’ based on the adverse events followed by the second dose of the COVID-19 vaccine. Extensive experiments are performed to analyse the efficacy of the proposed Extreme Regression- Voting Classifier model in comparison with machine learning models with Term Frequency-Inverse Document Frequency, Bag of Words, and Global Vectors, and deep learning models like Convolutional Neural Network, Long Short Term Memory, and Bidirectional Long Short Term Memory. Experiments are carried out on the original, as well as, a balanced dataset using Synthetic Minority Oversampling Approach. Results reveal that the proposed voting classifier in combination with TF-IDF outperforms with a 0.85 accuracy score on the SMOTE-balanced dataset. In line with this, the validation of the proposed voting classifier on binary classification shows state-of-the-art results with a 0.98 accuracy.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-21T04:51:16Z
      DOI: 10.1177/20552076221109530
      Issue No: Vol. 8 (2022)
       
  • Medical students’ intention to integrate digital health into their
           medical practice: A pre-peri COVID-19 survey study in Canada

    • Authors: Guy Paré, Louis Raymond, Marie-Pascale Pomey, Geneviève Grégoire, Alexandre Castonguay, Antoine Grenier Ouimet
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveWe aimed to explore the factors that influence medical students’ intention to integrate dHealth technologies in their practice and analyze the influence of the COVID-19 pandemic on their perceptions and intention.MethodsWe conducted a two-phased survey study at the University of Montreal's medical school in Canada. The study population consisted of 1367 medical students. The survey questionnaire was administered in two phases, that is, an initial survey (t0) in February 2020, before the Covid-19 pandemic, and a replication survey (t1) in January 2021, during the pandemic. Component-based structural equation modeling (SEM) was used to test seven research hypotheses.ResultsA total of 184 students responded to the survey at t0 (13%), whereas 138 responded to the survey at t1 (10%). Findings reveal that students, especially those who are in their preclinical years, had little occasion to experiment with dHealth technologies during their degree. This lack of exposure may explain why a vast majority felt that dHealth should be integrated into medical education. Most respondents declared an intention to integrate dHealth, including AI-based tools, into their future medical practice. One of the most salient differences observed between t0 and t1 brings telemedicine to the forefront of medical education. SEM results confirm the explanatory power of the proposed research model.ConclusionsThe present study unveils the specific dHealth technologies that could be integrated into existing medical curricula. Formal training would increase students’ competencies with these technologies which, in turn, could ease their adoption and effective use in their practice.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-21T02:56:44Z
      DOI: 10.1177/20552076221114195
      Issue No: Vol. 8 (2022)
       
  • E-solutions in Estonian community pharmacies: A literature review

    • Authors: Anita Tuula, Kristiina Sepp, Daisy Volmer
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveEstonian innovative electronic solutions have long been leading the way in the healthcare sector. This article aims to give an overview of all e-solutions and their usability in community pharmacies in Estonia and how they compare and operate with the wider e-health system.MethodsA comprehensive literature review was conducted on publicly accessible information regarding Estonian e-health and electronic community pharmacy solutions.FindingsWhile Estonian e-health system, including the e-prescription system is developed and maintained by the nationally funded Health and Wellbeing Infosystem Center, community pharmacy owners have established many noteworthy systems such as the e-pharmacist decision-support system, commodities info systems, online pharmacies, a telehealth prescription reminder service, and an automated dosage dispense system. Some pharmacies are collaborating with private healthcare service providers to allow quick and easy prescription renewal through an electronic channel.ConclusionDifferent electronic systems have overall greatly improved Estonian pharmacy services, accuracy and flow of consultations, and accessibility of medicines. In some cases, more support and active involvement is still needed from government agencies for full implementation.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-19T04:50:36Z
      DOI: 10.1177/20552076221113731
      Issue No: Vol. 8 (2022)
       
  • Evidence-based guiding principles to build public trust in personal data
           use in health systems

    • Authors: Felix Gille, Sarah Smith, Nicholas Mays
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivePublic trust in health systems is pivotal for their effective and efficient functioning. In particular, public trust is essential for personal data use, as demonstrated in debates in many countries, for example, about whether data from COVID-19 contact tracing apps should be pooled or remain on individuals’ smartphones. Low levels of public trust pose a risk not only to health system legitimacy but can also harm population health.MethodsSynthesising our previous qualitative and theoretical research in the English National Health Service which enabled us to conceptualise the nature of public trust in health systems, we present guiding principles designed to rebuild public trust, if lost, and to maintain high levels of public trust in personal data use within the health system, if not.ResultsTo build public trust, health system actors need to not rush trust building; engage with the public; keep the public safe; offer autonomy to the public; plan for diverse trust relationships; recognise that trust is shaped by both emotion and rational thought; represent the public interest; and work towards realising a net benefit for the health system and the public.ConclusionsBeyond policymakers and government officials, the guiding principles address a wide range of actors within health systems so that they can work collectively to build public trust. The guiding principles can be used to inform policymaking in health and health care and to analyse the performance of different governments to see if those governments that operate in greater conformity with the guiding principles perform better.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-18T06:58:47Z
      DOI: 10.1177/20552076221111947
      Issue No: Vol. 8 (2022)
       
  • Analysis of depression in social media texts through the Patient Health
           Questionnaire-9 and natural language processing

    • Authors: Nam Hyeok Kim, Ji Min Kim, Da Mi Park, Su Ryeon Ji, Jong Woo Kim
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveAlthough depression in modern people is emerging as a major social problem, it shows a low rate of use of mental health services. The purpose of this study was to classify sentences written by social media users based on the nine symptoms of depression in the Patient Health Questionnaire-9, using natural language processing to assess naturally users’ depression based on their results.MethodsFirst, train two sentence classifiers: the Y/N sentence classifier, which categorizes whether a user’s sentence is related to depression, and the 0–9 sentence classifier, which further categorizes the user sentence based on the depression symptomology of the Patient Health Questionnaire-9. Then the depression classifier, which is a logistic regression model, was generated to classify the sentence writer’s depression. These trained sentence classifiers and the depression classifier were used to analyze the social media textual data of users and establish their depression.ResultsOur experimental results showed that the proposed depression classifier showed 68.3% average accuracy, which was better than the baseline depression classifier that used only the Y/N sentence classifier and had 53.3% average accuracy.ConclusionsThis study is significant in that it demonstrates the possibility of determining depression from only social media users’ textual data.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-18T06:58:37Z
      DOI: 10.1177/20552076221114204
      Issue No: Vol. 8 (2022)
       
  • Telemedicine acceptance and efficacy in the context of preventive
           cardiology interventions: A systematic review

    • Authors: Felix Gass, Martin Halle, Stephan Mueller
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionTelemedicine is being used in an increasing number of healthy lifestyle intervention studies in preventive cardiology. However, the optimal telemedicine-based approach for patients with cardiovascular disease remains unclear. Therefore, the aim of this systematic review is to identify which design features are associated with the acceptance and efficacy of telemedicine in this specific patient population.MethodsThe databases PubMed/MEDLINE, Embase and the Web of Science Core Collection were searched from 5 October 2010 to 5 October 2020. This systematic review only included randomized controlled or quasi-randomized controlled trials with a comparator to a telemedicine-based intervention group and a designated measure of adherence. We adopted a narrative synthesis approach to define telemedical design features, which were clustered into three main categories (social, exercise related and barrier removal) and compared to adherence (graded as good, medium and bad) and primary outcomes (significant improvement, no significant change).ResultsWe screened a total of 865 records, of which 14 were included in this review, containing 13 identified design features. In 8 studies (57.1%), adherence was graded as good (4 studies medium, 2 studies bad). A positive primary outcome occurred in 10 (71.4%) studies. Personal contact showed the most pronounced (while not statistically significant) positive association with adherence and study outcomes.ConclusionGiven the remote nature of telemedical lifestyle intervention studies, including recurring personal contact in the intervention seems to be a key factor in ensuring that adherence levels remain comparable to those seen in centre-based interventions.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-18T06:58:17Z
      DOI: 10.1177/20552076221114186
      Issue No: Vol. 8 (2022)
       
  • The use of virtual complementary and integrative therapies by neurology
           outpatients: An exploratory analysis of two cross-sectional studies
           assessing the use of technology as treatment in an academic neurology
           department in New York City

    • Authors: Mia T Minen, Neil A Busis, Steven Friedman, Maya Campbell, Ananya Sahu, Kazi Maisha, Quazi Hossain, Mia Soviero, Deepti Verma, Leslie Yao, Farng-Yang A Foo, Jaydeep M Bhatt, Laura J Balcer, Steven L Galetta, Sujata Thawani
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPrior to the COVID-19 pandemic, about half of patients from populations that sought care in neurology tried complementary and integrative therapies (CITs). With the increased utilization of telehealth services, we sought to determine whether patients also increased their use of virtual CITs.MethodsWe examined datasets from two separate cross-sectional surveys that included cohorts of patients with neurological disorders. One was a dataset from a study that examined patient and provider experiences with teleneurology visits; the other was a study that assessed patients with a history of COVID-19 infection who presented for neurologic evaluation. We assessed and reported the use of virtual (and non-virtual) CITs using descriptive statistics, and determined whether there were clinical characteristics that predicted the use of CITs using logistic regression analyses.FindingsPatients who postponed medical treatment for non-COVID-19-related problems during the pandemic were more likely to seek CITs. Virtual exercise, virtual psychotherapy, and relaxation/meditation smartphone applications were the most frequent types of virtual CITs chosen by patients. In both studies, age was a key demographic factor associated with mobile/virtual CIT usage.InterpretationsOur investigation demonstrates that virtual CIT-related technologies were utilized in the treatment of neurologic conditions during the pandemic, particularly by those patients who deferred non-COVID-related care.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-18T06:58:12Z
      DOI: 10.1177/20552076221109545
      Issue No: Vol. 8 (2022)
       
  • circadian rhythms are not captured equal: Exploring Circadian metrics
           extracted by differentcomputational methods from smartphone accelerometer
           and GPS sensors in daily life tracking

    • Authors: Congyu Wu, Megan McMahon, Hagen Fritz, David M. Schnyer
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo identify the differences between circadian rhythm (CR) metrics characterized by different mobile sensors and computational methods.MethodsWe used smartphone tracking and daily survey data from 225 college student participants, applied four methods (survey construct automation, cosinor regression, non-parametric method, Fourier analysis) on two types of smartphone sensor data (GPS, accelerometer) to characterize CR. We explored the inter-relations among the extracted circadian metrics as well as between the circadian metrics and participants’ self-reported mood and sleep outcomes.ResultsCompared to GPS signals, smartphone accelerometer activity follows an intradaily distribution that starts earlier in the day, winds down later, reaches half cumulative activity about the same time, conforms less to a sinusoidal wave, and exhibits more intradaily fragmentation but higher CR strength and lower interdaily disruption. We found a notable negative correlation between intradaily variability and CR strength especially pronounced in GPS activity. Self-reported sleep and mood outcomes showed significant correlations with particular CR metrics.ConclusionsWe revealed significant inter-relations and discrepancies in the circadian metrics discovered from two smartphone sensors and four CR algorithms and their bearings on wellbeing indicators such as sleep quality and loneliness.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-18T03:37:17Z
      DOI: 10.1177/20552076221114201
      Issue No: Vol. 8 (2022)
       
  • Sign of the times: Community engagement to refine a cardiovascular mHealth
           intervention through a virtual focus group series during the COVID-19
           Pandemic

    • Authors: LaPrincess C. Brewer, Jissy Cyriac, Ashok Kumbamu, Lora E. Burke, Sarah Jenkins, Sharonne N. Hayes, Clarence Jones, Lisa A. Cooper, Christi A. Patten
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAfrican-Americans are underrepresented in mobile health intervention research studies which can perpetuate health inequities and the digital divide. A community-based, user-centered approach to designing mobile health interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the coronavirus disease 2019 pandemic. We aimed to refine an existing mobile health intervention via a virtual focus group series.MethodsAfrican-American community members (n = 15) from churches in Minneapolis-St. Paul and Rochester, Minnesota were enrolled in a virtual (via videoconferencing), three-session focus group series over five months to refine a cardiovascular health-focused mobile health application (FAITH! [Fostering African-American Improvement in Total Health!] App). Participants accessed the app via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia cardiovascular health-focused education modules, a sharing board for social networking, and diet/physical activity self-monitoring. Participant feedback on app features prompted iterative revisions to the FAITH! App. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale range: 0–5) and user satisfaction.ResultsParticipants (mean age [SD]: 56.9 [12.3] years, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). The revised FAITH! App exceeded the goal Health Information Technology Usability Evaluation Scale score threshold of ≥4 (mean: 4.39, range: 3.20–4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and refinement of the moderated sharing board were identified as areas for future improvement.ConclusionsCommunity-partnered, virtual focus groups can optimize usability and increase participant satisfaction of mobile health lifestyle interventions that aim to promote cardiovascular health in African-Americans.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-18T02:50:16Z
      DOI: 10.1177/20552076221110537
      Issue No: Vol. 8 (2022)
       
  • Participant perspectives of automated short messaging service
           interventions to promote physical activity: A systematic review and
           thematic synthesis

    • Authors: J Stefanus Grobler, Verna Stavric, Nicola L Saywell
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionShort messaging service has the potential to improve participation in physical activity in individuals with long-term health conditions. However, successful implementation relies on participant engagement with such programmes. The aim of this study was to undertake a systematic review of qualitative literature exploring participant perspectives of short messaging service-based interventions designed to promote physical activity for people with long-term health conditions.MethodsCINHAL, MEDLINE, SPORTSDiscus, Scopus and Web of Science were searched up to 15 February 2021 looking for participants’ perspectives on short messaging service programmes designed to promote physical activity in people with long-term health conditions. Included studies were analysed using thematic synthesis.ResultsEight studies involving 533 participants were included and analysed using the principles of thematic analysis and 10 descriptive themes were identified. These descriptive themes were further refined to develop five final analytical themes: taking control of my own health, from information to action, relationship with the programme, perfection required for success and increased expectations.DiscussionThe findings agree with published work on the factors which influence behaviour. The findings from this synthesis demonstrate that automated short messaging service programmes to increase physical activity are generally acceptable. People report that these interventions support and encourage physical activity. The novel finding of this study was that having more regular and long-lasting contact has the potential to increase the expectations people have of healthcare services. This is a finding which needs to be considered and managed but should not discourage the use of automated short messaging service.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-15T07:11:11Z
      DOI: 10.1177/20552076221113705
      Issue No: Vol. 8 (2022)
       
  • Use of handheld electrocardiograph (SnapECG) for the remote monitoring of
           arrhythmias

    • Authors: Qian Gu, Zengguang Chen, Jiazheng Ma, Yaqing Zhou, Jinshuang Li, Lianghong Ying, Rui Hua, Wenhao Zhang, Ran Li, Fengwei Zou, Xiaoxuan Gong, Yiyang Zhan, Chunjian Li
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo investigate the value of a SnapECG monitoring in diagnosing arrhythmias compared with the conventional management.MethodsIn the first phase, the SnapECG and 12-lead electrocardiogram (ECG) were simultaneously adopted to detect arrhythmias in 439 hospitalized patients. The accuracies of the SnapECG in detecting different arrhythmias were assessed. In the second phase, 62 patients with palpitations were randomized to receive the SnapECG monitoring or conventional management for 3 months. The diagnosis rate, time of diagnosis, episodes before diagnosis, associated expenses, and scores of the modified European Heart Rhythm Association (EHRA), Self-rating Anxiety Scale (SAS), and the 36-item short-form health survey questionnaire (SF-36) were compared between groups.ResultsIn the first phase, the SnapECG monitoring showed a sensitivity of 83.55% and specificity of 96.79% in identifying tachyarrhythmias, and a sensitivity of 95.29% and specificity of 97.54% in identifying bradyarrhythmias. In the second phase, 1642 ECGs were recorded by the SnapECG, among which 290 abnormal ECGs were identified. Compared with the conventional management, the SnapECG monitoring increased the diagnosis rate of symptomatic arrhythmias (70.97% vs. 19.35%, P < 0.05), shortened the time of diagnosis (48.26 ± 36.78 days vs. 71.45 ± 30.01 days, P < 0.05) and consequently reduced the episodes of symptomatic arrhythmias prior to establishing diagnosis. The scores of modified EHRA, SAS, SF-36 significantly improved at 3-month compared with their baseline levels in the SnapECG group.ConclusionsRemote monitoring with the SnapECG can achieve early diagnosis of symptomatic arrhythmias. However, its sensitivity in identifying P-wave-related arrhythmias warrants further improvement.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-14T08:04:52Z
      DOI: 10.1177/20552076221113393
      Issue No: Vol. 8 (2022)
       
  • How online health groups help you lose weight: The role of group
           composition and social contact

    • Authors: Yixin Zhou, Jonathan J. H. Zhu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Online health-specific goal challenge groups gather people with the same health concerns and provide an environment to keep on track, exchange experiences, and compete for achievements. We examine how group health status composition influences social contact, and how both group health status composition and social contact affect individual health achievement. Using longitudinal data from 2479 online health challenge group users and their corresponding group information, we found that (a) compared with individual health status, group conditions (average weight status and member affiliation) are more strongly connected with social contact; (b) different mechanisms affect whether people participate in social contact and increase their participation, and weight loss; and (c) average group condition influences individuals’ weight loss through social contact. We emphasize the effect of group composition and the social contact process in health enhancement.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-14T08:03:02Z
      DOI: 10.1177/20552076221112838
      Issue No: Vol. 8 (2022)
       
  • Is blockchain the breakthrough we are looking for to facilitate genomic
           data sharing' The European Union perspective

    • Authors: Fidelia Cascini, Flavia Beccia, Francesco A Causio, Andrea Gentili, Andriy Melnyk, Stefania Boccia, Walter Ricciardi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The recent progress of genomics research is providing unprecedented insight into human genetic variance, susceptibility to disease and risk stratification. Current trends predict that a massive amount of genomic data will be produced in the upcoming years which, when coupled with the fast-paced development of the field, will create new social, ethical, and legal challenges. In the complex legislative environment of the European Union, genomic data sharing policies will have to weigh the benefits of scientific discovery against the ethical risks posed by the act of sharing sensitive data. In this complex, interconnected environment, blockchain provides a unique and novel solution to accountability, traceability, and transparency issues regarding genomic data sharing. Implementing a distributed ledger technology-based database could empower both patients and citizens to responsibly use genomic data pertaining to them because it allows for a higher degree of control over the recipients of their data and their uses. The blockchain technology will engage both data owners and policymakers to address the multiple issues of genomic data sharing and allow us to redefine the way we look at genomics.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-14T06:04:54Z
      DOI: 10.1177/20552076221114225
      Issue No: Vol. 8 (2022)
       
  • Towards an effective framework for integrating patient-reported outcomes
           in electronic health records

    • Authors: Panzhang Wang, Tao Li, Lei Yu, Liang Zhou, Tao Yan
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundIn the past decade, electronic modalities are increasingly deployed to integrate patient-reported outcomes into electronic health records. Most popularly, patient portals are used for remote questionnaires, and tablets are provided to patients in-office in case they need help. They are both useful. But some barriers are still in the way, which place burdens on patients and clinicians in the process of routine data collection.ObjectiveThis study aims to describe a portable and scalable framework which can simplify the patient-reported outcome integration by mitigating the related burdens.MethodsA framework was proposed to use a modular approach to replace the tethered approach. The framework was open-sourced on GitHub. After development and testing, it was evaluated on an instrument with 24 questions in a real clinical setting. Patients were randomly selected in every modality-based group. For objective analysis, completion time and response rate were collected. No-show data was collected and analyzed. For subjective analysis, the NASA Task Load Index was used to measure workload, and the Net Promoter Score was used to assess user satisfaction.ResultsThe model could contain 46,656 questions. A quick response code could store 1120 encoded items. For remote visits, the response rate was improved compared to the portal group (76.6% vs. 61.1%). The completion time was reduced by 37.5% when compared to the tablet group and was reduced by 43.4% when compared to the portal group. The workload for clinicians and patients was both reduced significantly (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-14T06:04:31Z
      DOI: 10.1177/20552076221112152
      Issue No: Vol. 8 (2022)
       
  • Time to act mature—Gearing eHealth evaluations towards technology
           readiness levels

    • Authors: Stephanie Jansen-Kosterink, Marijke Broekhuis, Lex van Velsen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      It is challenging to design a proper eHealth evaluation. In our opinion, the evaluation of eHealth should be a continuous process, wherein increasingly mature versions of the technology are put to the test. In this article, we present a model for continuous eHealth evaluation, geared towards technology maturity. Technology maturity can be determined best via Technology Readiness Levels, of which there are nine, divided into three phases: the research, development, and deployment phases. For each phase, we list and discuss applicable activities and outcomes on the end-user, clinical, and societal front. Instead of focusing on a single perspective, we recommend to blend the end-user, health and societal perspective. With this article we aim to contribute to the methodological debate on how to create the optimal eHealth evaluation design.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-12T06:52:25Z
      DOI: 10.1177/20552076221113396
      Issue No: Vol. 8 (2022)
       
  • REDCap mobile data collection: Using implementation science to explore the
           potential and pitfalls of a digital health tool in routine voluntary
           medical male circumcision outreach settings in Zimbabwe

    • Authors: Vi Tran, Farai Gwenzi, Phiona Marongwe, Olbarn Rutsito, Pesanai Chatikobo, Vernon Murenje, Joseph Hove, Tinashe Munyaradzi, Zoe Rogers, Mufuta Tshimanga, Vuyelwa Sidile-Chitimbire, Sinokuthemba Xaba, Gertrude Ncube, Lewis Masimba, Batsirai Makunike-Chikwinya, Marrianne Holec, Scott Barnhart, Bryan Weiner, Caryl Feldacker
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundDigital data collection tools improve data quality but are limited by connectivity. ZAZIC, a Zimbabwean consortium focused on scaling up male circumcision (MC) services, provides MC in outreach settings where both data quality and connectivity is poor. ZAZIC implemented REDCap Mobile app for data collection among roving ZAZIC MC nurses. To inform continued scale-up or discontinuation, this paper details if, how, and for whom REDCap improved data quality using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.MethodsData were collected for this retrospective, cross-sectional study for nine months, from July 2019 to March 2020, before COVID-19 paused MC services. Data completeness was compared between paper- and REDCap-based tools and between two ZAZIC partners using two sample, one-tailed t-tests.ResultsREDCap reached all roving nurses who reported 26,904 MCs from 1773 submissions. REDCap effectiveness, as measured by data completeness, decreased from 89.2% in paper to 76.6% in REDCap app for Partner 1 (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-12T06:52:06Z
      DOI: 10.1177/20552076221112163
      Issue No: Vol. 8 (2022)
       
  • Use of social media for COVID-19-related information and associated
           factors among health professionals in Northwest Ethiopia: A
           cross-sectional study

    • Authors: Masresha Derese Tegegne, Berhanu Fikadie Endehabtu, Jorn Klein, Monika Knudsen Gullslett, Tesfahun Melese Yilma
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundSocial media has become an alternative platform for communication during medical crises like the COVID-19 pandemic. This study aimed to assess social media usage for COVID-19-related information among health professionals.MethodA quantitative cross-sectional study design was conducted among 370 health professionals. The data were analyzed using SPSS version 25 software. Data were collected using a semi-structured, self-administered, and pre-tested questionnaire. Descriptive and binary logistic regression analysis techniques were used to describe respondents’ social media usage for COVID-19 information and identify its associated factors.ResultsAbout 54% (95% CI: 48–58%) of the participants had good social media usage for COVID-19-related information. Age≤30 (AOR = 2.02, 95% CI: 1.14–3.58), Wi-Fi/broadband Internet access (AOR = 2.45, 95% CI: 1.38–4.33), taking computer training (AOR = 2.58, 95% CI: 1.37–4.85), basic computer skill (AOR = 3.28, 95% CI: 1.71–6.29), and usefulness of social media (AOR = 3.56, 95% CI: 1.57–8.04) were found to be the significant factors associated with usage of social media for COVID-19-related information.ConclusionThe present study confirms that more than half of health professionals had good social media usage for COVID-19-related information. This shows that social media platforms can be used as a source of COVID-19-related information for health professionals if basic computer training is offered, internet connection is available in the workplace, and the usefulness of social media is emphasized.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-11T10:45:12Z
      DOI: 10.1177/20552076221113394
      Issue No: Vol. 8 (2022)
       
  • An update on computational anthropomorphic anatomical models

    • Authors: Azadeh Akhavanallaf, Hadi Fayad, Yazdan Salimi, Antar Aly, Hassan Kharita, Huda Al Naemi, Habib Zaidi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The prevalent availability of high-performance computing coupled with validated computerized simulation platforms as open-source packages have motivated progress in the development of realistic anthropomorphic computational models of the human anatomy. The main application of these advanced tools focused on imaging physics and computational internal/external radiation dosimetry research. This paper provides an updated review of state-of-the-art developments and recent advances in the design of sophisticated computational models of the human anatomy with a particular focus on their use in radiation dosimetry calculations. The consolidation of flexible and realistic computational models with biological data and accurate radiation transport modeling tools enables the capability to produce dosimetric data reflecting actual setup in clinical setting. These simulation methodologies and results are helpful resources for the medical physics and medical imaging communities and are expected to impact the fields of medical imaging and dosimetry calculations profoundly.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-11T10:45:02Z
      DOI: 10.1177/20552076221111941
      Issue No: Vol. 8 (2022)
       
  • Remote visits for people with multiple sclerosis during the COVID-19
           pandemic in Austria: The TELE MS randomized controlled trial

    • Authors: Patrick Altmann, Fritz Leutmezer, Markus Ponleitner, Dominik Ivkic, Nik Krajnc, Paulus Stefan Rommer, Thomas Berger, Gabriel Bsteh
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionContinuous monitoring is the hallmark of managing chronic disease. Multiple sclerosis (MS), in particular, requires patients to visit their treating neurologists typically twice a year, at least. In that respect, the COVID-19 pandemic made us rethink our communication strategies. This study determined satisfaction with remote visits for people with MS (pwMS) by comparing non-inferiority to conventional visits.MethodsTELE MS was a randomized controlled trial that was open to any person with MS. We randomized a volunteer sample of 45 patients. We compared satisfaction with remote visits (via phone or via videochat) with conventional outpatient visits. The primary endpoint was patient satisfaction determined by the Telemedicine Perception Questionnaire (TMPQ, min: 17 and max: 85 points) with the hypothesis of non-inferiority of televisits to conventional visits. Physician satisfaction measured on the PPSM score (Patient and Physician Satisfaction with Monitoring, min: 5 and max: 25 points) was the secondary endpoint.ResultsThe trial met both endpoints. Mean (SD) TMPQ scores in the individual groups were 58 (6.7) points for conventional visits, 65 (7.5) points for phone visits, and 62 (5.5) points for video visits. Physician satisfaction over the whole cohort was similarly high. Median (range) PPSM scores were 23 (16–25) for the whole cohort, 19 (16–25) for conventional visits, 25 (17–25) for phone visits, and 25 (16–25) for video visits.ConclusionsTelevisits in multiple sclerosis yield a high level of satisfaction for both patients and treating physicians. This concept for remote patient monitoring adopted during the current pandemic may be communicable to other chronic diseases as well. ClinicalTrials.gov identifier: NCT04838990
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-11T03:18:47Z
      DOI: 10.1177/20552076221112154
      Issue No: Vol. 8 (2022)
       
  • Frequent and diverse use of electronic health records in the United
           States: A trend analysis of national surveys

    • Authors: Han Zheng, Shaohai Jiang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveConsidering the increasing integration of electronic health records (EHRs) into medical practice by healthcare organizations, it is especially pertinent to understand its actual usage by the general public in recent years. This study aims to explore factors associated with the frequency and diversity of EHR usage in the United States over time.MethodsWe analyzed three iterations (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS). HINTS is a national cross-sectional survey conducted by the National Cancer Institute to document attitudes and perceptions about health information access and use among American adults.ResultsBoth frequency and diversity of EHR usage have slightly increased across the years. However, its overall usage still remained low. Three technology-related enablers (access to digital devices, access to the Internet, and perceived usefulness of EHRs) were positively related to EHR usage in all three iterations. In addition, perceived health status was a constant and negative predictor of EHR usage over years. Doctor–patient communication was positively associated with the frequency of EHR usage in two survey waves.ConclusionsMore initiatives to increase EHR usage in the United States are needed. We advocate for providing affordable Internet access and smartphone to underserved populations; in medical encounters, doctors should have more patient-centered communication, introduce the benefits of EHRs to patients, and promote EHR adoption in terms of frequency and diversity.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-07T06:47:11Z
      DOI: 10.1177/20552076221112840
      Issue No: Vol. 8 (2022)
       
  • Outpatient portal use among pregnant individuals: Cross-sectional,
           temporal, and cluster analysis of use

    • Authors: Evan Morgan, Patrick Schnell, Priti Singh, Naleef Fareed
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundOutpatient portal technology can improve patient engagement. For pregnant individuals, the level of engagement could have important implications for maternal and infant outcomes.ObjectiveThis study: (1) cross-sectionally and temporally characterized the outpatient portal use among pregnant individuals seen at our academic medical center; and (2) identified clusters of the outpatient portal user groups based on the cross-sectional and temporal patterns of use.MethodsWe used outpatient portal server-side log files to execute a hierarchical clustering algorithm to group 7663 pregnant individuals based on proportions of outpatient portal function use. Post-hoc analyses were performed to further assess outpatient portal use on key encounter characteristics.ResultsThe most frequently used functions were MyRecord (access personal health information), Visits (manage appointments), Messaging (send/receive messages), and Billing (view bills, insurance information). Median outpatient portal function use plateaued by the third trimester. Four distinct clusters were identified among all pregnant individuals: “Schedulers,” “Resulters,” “Intense Digital Engagers,” and “Average Users.” Post-hoc analyses revealed that the use of the Visits function increased and the use of the MyRecord function decreased over time among clusters.ConclusionsOur identification of distinct cluster groups of outpatient portal users among pregnant individuals underscores the importance of avoiding the use of generalizations when describing how such patients might engage with patient-facing technologies such as an outpatient portal. These results can be used to improve user experience and training with outpatient portal functions and may educate maternal health providers on patient engagement with the outpatient portal.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-07T06:47:02Z
      DOI: 10.1177/20552076221109553
      Issue No: Vol. 8 (2022)
       
  • The environmental sustainability of data-driven health research: A scoping
           review

    • Authors: Gabrielle Samuel, A.M. Lucassen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Data-Driven and Artificial Intelligence technologies are rapidly changing the way that health research is conducted, including offering new opportunities. This will inevitably have adverse environmental impacts. These include carbon dioxide emissions linked to the energy required to generate and process large amounts of data; the impact on the material environment (in the form of data centres); the unsustainable extraction of minerals for technological components; and e-waste (discarded electronic appliances) disposal. The growth of Data-Driven and Artificial Intelligence technologies means there is now a compelling need to consider these environmental impacts and develop means to mitigate them. Here, we offer a scoping review of how the environmental impacts of data storage and processing during Data-Driven and Artificial Intelligence health-related research are being discussed in the academic literature. Using the UK as a case study, we also offer a review of policies and initiatives that consider the environmental impacts of data storage and processing during Data-Driven and Artificial Intelligence health-related research in the UK. Our findings suggest little engagement with these issues to date. We discuss the implications of this and suggest ways that the Data-Driven and Artificial Intelligence health research sector needs to move to become more environmentally sustainable.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-06T06:39:31Z
      DOI: 10.1177/20552076221111297
      Issue No: Vol. 8 (2022)
       
  • Detection of the most influential variables for preventing postpartum
           urinary incontinence using machine learning techniques

    • Authors: José Alberto Benítez-Andrades, María Teresa García-Ordás, María Álvarez-González, Raquel Leirós-Rodríguez, Ana F López Rodríguez
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPostpartum urinary incontinence is a fairly widespread health problem in today’s society among women who have given birth. Recent studies analysing the different variables that may be related to Postpartum urinary incontinence have brought to light some variables that may be related to Postpartum urinary incontinence in order to try to prevent it. However, no studies have been found that analyse some of the intrinsic and extrinsic variables of patients during pregnancy that could give rise to this pathology.ObjectiveThe objective of this study is to assess the most influential variables in Postpartum urinary incontinence by means of machine learning techniques, starting from a group of intrinsic variables, another group of extrinsic variables and a mixed group that combines both types.MethodsInformation was collected on 93 patients, pregnant women who gave birth. Experiments were conducted using different machine learning classification techniques combined with oversampling techniques to predict four variables: urinary incontinence, urinary incontinence frequency, urinary incontinence intensity and stress urinary incontinence.ResultsThe results showed that the most accurate predictive models were those trained with extrinsic variables, obtaining accuracy values of 70% for urinary incontinence, 77% for urinary incontinence frequency, 71% for urinary incontinence intensity and 93% for stress urinary incontinence.ConclusionsThis research has shown that extrinsic variables are more important than intrinsic variables in predicting problems related to postpartum urinary incontinence. Therefore, although not conclusive, it opens a line of research that could confirm that the prevention of Postpartum urinary incontinence could be achieved by following healthy habits in pregnant women.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-06T06:39:22Z
      DOI: 10.1177/20552076221111289
      Issue No: Vol. 8 (2022)
       
  • There's an app for that, but nobody's using it: Insights on improving
           patient access and adherence to digital therapeutics in Germany

    • Authors: Florian Dahlhausen, Maximillian Zinner, Linn Bieske, Jan P Ehlers, Philip Boehme, Leonard Fehring
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundMobile health applications and their subset digital therapeutics—defined as evidence-based software interventions to prevent, manage, or treat a medical condition—offer great potential to improve patient care. However, such solutions often struggle to reach widespread adoption.ObjectiveThis study seeks to explore healthcare stakeholders’ roles and potential for fostering patient access and adherence to evidence-based digital therapeutics and thereby improve health outcomes from the perspective of digital therapeutics developers and distributors.MethodsSemi-structured qualitative and semiquantitative interviews were conducted with 19 experts from developers and distributors of digital therapeutics in Germany to discuss their perceived relevance of different healthcare stakeholders and strategies in promoting patient access and adherence to digital therapeutics.ResultsHealthcare professionals were found to have the greatest potential to promote both access and patient adherence to digital therapeutics, followed by health insurers, pharmaceutical companies, and patients themselves. In terms of patient access, healthcare professionals have potential due to their ability to prescribe digital therapeutics. Other stakeholders’ potential stems from their capacity to influence healthcare professionals prescription decision. In terms of patient adherence, only healthcare professionals are of high relevance by onboarding patients and monitoring digital therapeutics use. Most healthcare stakeholders currently do not fully leverage their potential. Further educating healthcare professionals and simplifying processes for them, empowering patients to seek treatment with digital therapeutics, and designing digital therapeutics’ product features for better adherence can help improve patient access and adherence.ConclusionsEstablished healthcare stakeholders and digital therapeutics developers both need to take action to improve patient access and adherence to digital therapeutics. Several macro-level changes can support these efforts, including broader information dissemination, improved financial incentives, simplified prescription and activation processes, and a wider adoption of blended care and pay-for-performance payment models.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-04T05:34:41Z
      DOI: 10.1177/20552076221104672
      Issue No: Vol. 8 (2022)
       
  • Advancing understanding of dietary and movement behaviours in an Asian
           population through real-time monitoring: Protocol of the Continuous
           Observations of Behavioural Risk Factors in Asia study (COBRA)

    • Authors: Sarah Martine Edney, Su Hyun Park, Linda Tan, Xin Hui Chua, Borame Sue Lee Dickens, Salome A Rebello, Nick Petrunoff, Andre Matthias Müller, Cheun Seng Tan, Falk Müller-Riemenschneider, Rob M van Dam
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundModifiable risk factors for non-communicable diseases, including eating an unhealthy diet and being physically inactive, are influenced by complex and dynamic interactions between people and their social and physical environment. Therefore, understanding patterns and determinants of these risk factors as they occur in real life is essential to enable the design of precision public health interventions.ObjectiveThis paper describes the protocol for the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). The study uses real-time data capture methods to gain a comprehensive understanding of eating and movement behaviours, including how these differ by socio-demographic characteristics and are shaped by people's interaction with their social and physical environment.MethodsCOBRA is an observational study in free-living conditions. We will recruit 1500 adults aged 21–69 years from a large prospective cohort study. Real-time data capture methods will be used for nine consecutive days: an ecological momentary assessment app with a global positioning system enabled to collect location data, accelerometers to measure movement, and wearable sensors to monitor blood glucose levels. Participants receive six EMA surveys per day between 8 a.m. and 9.30 p.m. to capture information on behavioural risk factors including eating behaviours and diet composition movement behaviours (physical activity, sedentary behaviour, sleep), and related contextual factors. The second wave of ecological momentary assessment surveys with a global positioning system enabled will be sent 6 months later. Data will be analysed using generalised linear models to examine associations between behavioural risk factors and contextual determinants.DiscussionFindings from this study will advance our understanding of dietary and movement behaviours as they occur in real-life and inform the development of personalised interventions to prevent chronic diseases.
      Citation: DIGITAL HEALTH
      PubDate: 2022-07-01T06:34:25Z
      DOI: 10.1177/20552076221110534
      Issue No: Vol. 8 (2022)
       
  • Preparing infection detection technology for hospital at home after lower
           limb external fixation

    • Authors: Sowmya Annadatha, Qirui Hua, Marie Fridberg, Tobias Lindstrøm Jensen, Jianan Liu, Søren Kold, Ole Rahbek, Ming Shen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPatients with severe bone fractures and complex bone deformities are treated by orthopedic surgeons with external fixation for several months. During this long treatment period, there is a high risk of inflammation and infection at the superficial skin area (pin site). This can develop into a devastating, sometimes fatal, and always costly condition of deep bone infection.ObjectiveFor pin site infection surveillance, thermography technology could be the solution to build an objective and continuous home-based remote monitoring tool to avoid frequent nursing care and hospital visits. However, future studies of infection monitoring require a preliminary step to automate the process of locating and detecting the pin sites in thermal images reliably for temperature measurement, and this step is the aim of this study.MethodsThis study presents an automatic approach for identifying and annotating pin sites on visible images using bounding boxes and transferring them to the corresponding thermal images for temperature measurement. The pin site is detected by applying deep learning-based object detection architecture YOLOv5 with a novel loss evaluation and regression method, control distance intersection over union. Furthermore, we address detecting pin sites in a practical environment (home setting) accurately through transfer learning.Results and conclusionThe proposed model offers the pin site detection in 1.8 ms with a high precision of 0.98 and enables temperature information extraction. Our work for automatic pin site annotation on thermography paves the way for future research on infection assessment on thermography.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-27T06:47:20Z
      DOI: 10.1177/20552076221109502
      Issue No: Vol. 8 (2022)
       
  • Co-creation with research participants to inform the design of electronic
           informed consent

    • Authors: Evelien De Sutter, David Geerts, Pascal Borry, Kristien Coteur, Dorien Bamps, Heleen Marynissen, Els Ampe, Els Geenens, Marleen Depré, Isabelle Huys
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study aimed to provide recommendations for a personalized electronic informed consent interface that is adapted to research participants’ needs and could enable a longitudinal interaction between the participants and the research team.MethodsThe co-creation process consisted of three co-creation workshops, one focus group discussion, and four semi-structured interviews. In total, 24 participants, who had taken part in four disparate clinical studies in Belgium, were involved. Descriptive statistics and qualitative content analysis were applied to analyze the survey data and audio recordings.ResultsVarying perceptions on the type and amount of information described in an informed consent form were reported. Other findings were related to the structure and presentation of information, setting preferences for data sharing, and electronically signing new informed consent versions. Regarding the long-term interaction, most of the participants wanted to receive progress updates, including the results, of the study in which they had taken part. They proposed to receive a notification, preferably via email, in case new information is made available on the electronic informed consent interface.ConclusionsTo optimally support the design of an electronic informed consent interface, it is key to understand the research participants’ needs. Study findings suggest that an electronic informed consent interface may be a promising technological application to interactively provide study-related information and to keep participants informed during and after the clinical study.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-27T06:46:49Z
      DOI: 10.1177/20552076221109068
      Issue No: Vol. 8 (2022)
       
  • Evaluating mobile Health technology use among cancer caregivers in the
           digital era

    • Authors: Minakshi Raj, Vibhuti Gupta, Flora Hoodin, Caroline Clingan, Chloe Roslin, Lilian Yahng, Thomas Braun, Sung Won Choi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionDigital health technology-based interventions have the potential to support cancer caregivers in caregiving responsibilities and in managing their own health and well-being. The objective of this study was to examine the association between caregiving characteristics and different types of digital health technologies used in a national sample of caregivers of patients undergoing hematopoietic cell transplantation (HCT).MethodsWe conducted an online, cross-sectional survey of 948 HCT caregivers.ResultsSpousal caregivers comprised nearly one-third of respondents (27.1%) with a median age of 59 years (range: 18–80 years), compared with parents (32.9%: 38 years), adult children (28.9%: 38 years), and other (11.1%; e.g. friend, other family member: 36 years). Almost two-thirds (65.4%) of all respondents reported using an app for fitness or step counting and 41.3% reported using a smartwatch. However, spousal caregivers were the least likely group to use mobile apps (0.72; P 
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-23T05:50:22Z
      DOI: 10.1177/20552076221109071
      Issue No: Vol. 8 (2022)
       
  • A critical review of the role of technology and context in digital health
           research

    • Authors: Petter Nielsen, Sundeep Sahay
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Digital health represents a research field dedicated to realising digital technologies’ potential and developing knowledge about their feasibility and impacts. Yet, drawing on a critical review of the articles in the most prominent multidisciplinary digital health journals, this paper argues that the digital health field has not profoundly engaged with its core subject, namely technology. The features of digital technologies remain in the background, and research is disconnected from the complexities of healthcare settings, including multiple technologies, established practices and people. Instead, the overarching focus in the digital health literature is the processing capabilities of digital technologies and their posited impacts. This paper proposes a research direction in digital health where technology and the context of use take a more prominent role. It argues that realising the potential of digital health requires intensive investigation drawing on different disciplines, grounded on understanding healthcare processes, related informational needs and the concrete features of digital technologies.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-23T05:50:12Z
      DOI: 10.1177/20552076221109554
      Issue No: Vol. 8 (2022)
       
  • The accuracy of teledentistry in caries detection in children – A
           diagnostic study

    • Authors: Mohammad AlShaya, Deema Farsi, Nada Farsi, Najat Farsi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Introduction: The increasing burden of dental caries and the lack of effective dental caries screening protocols in non-dental settings, such as schools, demand an innovative and cost-effective approach. Teledentistry is the field of dentistry that combines telecommunication with health records and digital imaging to improve access to dental care and help in epidemiological surveys. This study aimed to assess the accuracy of non-dentist teledentistry in caries detection compared with the clinical dental examination of a sample of 5–10-year-old schoolchildren.MethodsA calibrated dentist examined schoolchildren aged 5–10 years old. The dentist and two teachers took intraoral photographs for each child, using a smartphone. The photographs were concealed; therefore, the dentist assessed the three sets of photographs blindly two weeks after the clinical examination. Accuracy was measured to compare the teledentistry examination with the clinical dental examination.ResultsThe mean DMFT of primary teeth was 3.38, 3.42, and 3.17 upon clinical examination, dental-teledentistry examination (findings of photographs taken by a dentist), and non-dental teledentistry (findings of photographs taken by teachers), respectively. The mean DMFT of permanent teeth was 0.75, 0.69, and 0.65 upon clinical examination, dental-teledentistry examination, and non-dental teledentistry examination, respectively. In primary teeth, dental teledentistry and non-dental teledentistry examinations showed 95 and 98.3 sensitivity and 94.3 and 91.4 specificity, respectively. In permanent teeth, dental teledentistry and non-dental teledentistry examinations showed 80.8 and 88.5 sensitivity and 94.1 and 96.1 specificity, respectively.ConclusionsTeledentistry has acceptable accuracy for caries detection in schoolchildren compared to a clinical dental examination.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-23T05:50:05Z
      DOI: 10.1177/20552076221109075
      Issue No: Vol. 8 (2022)
       
  • A gamified app for supporting undergraduate students’ mental health: A
           feasibility and usability study

    • Authors: Iolie Nicolaidou, Loizos Aristeidis, Lambros Lambrinos
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Resilience, a person's mental ability to deal with challenging situations adaptively, is an important life skill. Supporting students in building psychological resilience and coping during crises (with the COVID-19 pandemic being a prime example) is crucial. Very few mobile applications (apps) for mental health explicitly report behavioral change techniques. Moreover, only a handful of the apps that support resilience are gamified, or use smartphone sensors readily available in modern smartphones for health self-management, or were designed for use by a nonclinical population. This study describes the design of a prototype for a gamified, theory-based mobile app that utilizes the Internet of Things to provide personalized data and enhance undergraduate students’ resilience. A total of 74 participants evaluated the prototype and completed an online questionnaire during the COVID-19 lockdowns. The questionnaire included questions examining the design's feasibility for supporting resilience and questions on the System Usability Scale evaluating its usability. Regarding the evaluation of the prototype on improving psychological resilience, positive responses (M = 3.76 out of 5, SD = 0.82) were received for all functions (goal setting for studying, socializing and physical exercise, progress monitoring using sensors or self-reporting, reflection, motivational badges). The System Usability Scale returned an evaluation score of 72.9, indicating a satisfactory degree of usability. The resilience app is a promising proof of concept. Combining Internet of Things capabilities with active user interaction while incorporating behavior change techniques in a gamified environment was well accepted by students. Implications for the design of gamified environments for well-being are drawn. Future research will empirically validate its design using quasi-experimental methods.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-22T06:52:02Z
      DOI: 10.1177/20552076221109059
      Issue No: Vol. 8 (2022)
       
  • Development of a Healthcare Information System for Community Care of Older
           Adults and Evaluation of Its Acceptance and Usability

    • Authors: Kup-Sze Choi, Sze-Ho Chan, Cho-Lik Ho, Marek Matejak
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe need for health and social care for community-dwelling elderly is on the rise as the population ages. Through the provision of comprehensive services by multiple professionals in local communities, elderly people can receive continual care in a non-medical setting, which is favorable for early detection and intervention of potential problems. However, the lack of digitalization in primary care affects the effectiveness of the services and precludes full exploitation of the data. This study proposed an information system dedicated to caring for community-dwelling elderly people and investigated its acceptance and usability.MethodsAn information system was designed for elderly care centers in the community, where data generated during care delivery, involving socio-demographic data, bio-measurements and health assessments and questionnaires, were digitized and stored for information management and exchange. A study was conducted to evaluate the acceptance and usability of the system after routine use of 6 months. The users of the system at an elderly care center were recruited to respond to a technology acceptance questionnaire and a system usability questionnaire.ResultsThe mean scores of the acceptance and usability questionnaires reached 5.1 out of the highest possible score of 7. The constructs of the acceptance questionnaire had good reliability. The social influence and facilitating conditions constructs had a significant correlation with the behavioral intention construct.ConclusionsThe proposed information system demonstrated good acceptance and usability, which supported the feasibility of implementing it in community care centers for older adults. Further research will be conducted to address the limitation of sample size by extending the system to other elderly care centers, forming a large user base for a more in-depth and comprehensive performance evaluation.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-21T05:12:49Z
      DOI: 10.1177/20552076221109083
      Issue No: Vol. 8 (2022)
       
  • An intelligent system for assisting personalized COVID-19 vaccination
           location selection: Taiwan as an example

    • Authors: Yu-Cheng Lin, Tin-Chih Toly Chen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      In many regions of the world, with the gradual increase in the supply of COVID-19 vaccines, COVID-19 vaccination has changed from centralized government control to personalized selection. When choosing a location for COVID-19 vaccination, in addition to subjective preferences, objective information (such as the expected waiting time at a COVID-19 vaccination location and the crowdedness and reliability of the vaccination location) also need to be considered. However, it is not convenient for an individual to collect and compare such information. To address this issue, this research applies web content mining to extract the conditions of COVID-19 vaccination locations. Then, a novel asymmetric calibrated fuzzy inverse of column sum and fuzzy Vise Kriterijumska Optimizacija I Kompromisno Resenje recommendation mechanism is proposed. Finally, an intelligent system is developed to assist a user in selecting a personalized COVID-19 vaccination location. In a regional experiment conducted in Taichung City, Taiwan, the developed intelligent system was applied to assist 20 users in choosing personalized COVID-19 vaccination locations. The successful recommendation rate was 95%.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-20T03:46:55Z
      DOI: 10.1177/20552076221109062
      Issue No: Vol. 8 (2022)
       
  • A novel low-cost bubble continuous positive airway pressure device with
           pressure monitoring and controlling system for low resource settings

    • Authors: Etagegnehu Dagnachew Feleke, Eyerusalem Gebremeskel Gebremaryam, Feven Tadele Regassa, Hawi Rorissa Kuma, Hayat Solomon Sabir, Ahmed Mohammed Abagaro, Kokeb Dese
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundCurrently bubble continuous positive airway pressure (bCPAP) is commonly used in low resource settings to treat respiratory distress. However, the accumulation of condensate in the patient's exhalation limb during operation could significantly increase pressure delivered to the body, which can lead to severe respiratory failure in the infant. The objective of this research was to develop a novel low-cost bCPAP device that can monitor and control the pressure delivered to infants.MethodsWhen the neonate expires, the pressure sensor inside the expiratory limb measures the instant positive end-expiratory pressure. The microcontroller decides whether to turn the relay to switch the path of expiration between the two expiratory tubes connected to the valve outlets. This depends on the pressure reading and the cutoff pressure value inserted by the physician.ResultsThe system was tested for accuracy, safety, cost, ease of use, and durability. The prototype was accurate in eight iterations at eight different depths of water that were made to monitor and control the pressure. It was safe and provided suitable pressure for the neonate, and the prototype was built in less than 193 USD.ConclusionsThe performance testing of the device demonstrated accurate and safe control and monitoring of continuous positive air pressure (CPAP) and oxygen levels with humidity levels safe for infants. The device provides humidified, blended, and pressurized gas for the patient. It allows physicians to easily monitor and control the accumulation of condensate in the exhalation limb of the CPAP machine accurately and safely.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-20T03:46:14Z
      DOI: 10.1177/20552076221109060
      Issue No: Vol. 8 (2022)
       
  • Using markers for digital engagement and social change: Tracking
           meaningful narrative exchange in transmedia edutainment with text
           analytics techniques

    • Authors: Roel O Lutkenhaus, Hua Wang, Arvind Singhal, Jeroen Jansz, Martine PA Bouman
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      While social media offer an unprecedented opportunity for orchestrating large-scale communication campaigns, it is often difficult to track audience responses on various digital platforms over time and to ascertain if their engagement is aligned with the original intention. In this article, we share a promising solution—the purposive embedding and tracking of unique content elements as “markers” using text analytics techniques. Four markers were introduced in an Indian melodramatic television serial, Main Kuch Bhi Kar Sakti Hoon (I, A Woman, Can Achieve Anything), which was part of a larger transmedia edutainment initiative in India to promote sanitation, family planning, and gender equality. These markers served as anchors for audience engagement with the originally intended messaging embedded in the narratives as well as for program monitoring and evaluation. We applied various web-based tools to systematically track marker-related engagement on Facebook, Twitter, and YouTube across eight months. We also conducted semantic network analysis to better understand how marker-related social media comments evolved over time. Our investigation of using markers for digital engagement and narrative exchange in MKBKSH makes an important and timely methodological contribution to the scholarship and praxis of social and behavior change communication.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-20T03:46:03Z
      DOI: 10.1177/20552076221107892
      Issue No: Vol. 8 (2022)
       
  • The quality of digital health software: Should we be concerned'

    • Authors: Peter Kokol, Helena Blažun Vošner, Marko Kokol, Jernej Završnik
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The digitalization of healthcare fuelled by advances in technology and the increased prevalence of mobile smart devices and health-related internet of things can offer equitable access to expert-level healthcare globally. Growing demand for telemedicine, mobile health apps, and advanced data analytics have further established their role in a modern information society during the Covid-19 crisis. Digital health is, in essence, powered by software (DHSW), which has to operate in the specific digital health environment characteristics and is therefore highly and intrinsically complex and prone to software defects and faults. Given the lack of standardization regarding DHSW quality, we explored the available reviewed research on this crucial topic in this brief paper, using a synthetic thematic analysis approach. We assert that neither the volume, distribution nor scope of the DHSW quality research content is satisfactory, and significant research gaps exist. Based on the presented evidence, we can only conclude that we should be concerned and that the time to act is now to ensure that the unavoidable increase of usage and prevalence of DHSW will not – in the end – reduce the quality of care due to subpar software and software-based digital health systems.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-17T05:59:44Z
      DOI: 10.1177/20552076221109055
      Issue No: Vol. 8 (2022)
       
  • Time-specific associations of wearable sensor-based cardiovascular and
           behavioral readouts with disease phenotypes in the outpatient setting of
           the Chronic Renal Insufficiency Cohort

    • Authors: Nicholas F. Lahens, Mahboob Rahman, Jordana B. Cohen, Debbie L. Cohen, Jing Chen, Matthew R. Weir, Harold I. Feldman, Gregory R. Grant, Raymond R. Townsend, Carsten Skarke, and the CRIC Study Investigators*
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Patients with chronic kidney disease are at risk of developing cardiovascular disease. To facilitate out-of-clinic evaluation, we piloted wearable device-based analysis of heart rate variability and behavioral readouts in patients with chronic kidney disease from the Chronic Renal Insufficiency Cohort and controls (n  =  49). Time-specific partitioning of heart rate variability readouts confirm higher parasympathetic nervous activity during the night (mean RR at night 14.4  ±  1.9 ms vs. 12.8  ±  2.1 ms during active hours; n  =  47, analysis of variance (ANOVA) q  =  0.001). The α2 long-term fluctuations in the detrended fluctuation analysis, a parameter predictive of cardiovascular mortality, significantly differentiated between diabetic and nondiabetic patients (prominent at night with 0.58  ±  0.2 vs. 0.45  ±  0.12, respectively, adj. p  =  0.004). Both diabetic and nondiabetic chronic kidney disease patients showed loss of rhythmic organization compared to controls, with diabetic chronic kidney disease patients exhibiting deconsolidation of peak phases between their activity and standard deviation of interbeat intervals rhythms (mean phase difference chronic kidney disease 8.3 h, chronic kidney disease/type 2 diabetes mellitus 4 h, controls 6.8 h). This work provides a roadmap toward deriving actionable clinical insights from the data collected by wearable devices outside of highly controlled clinical environments.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-17T05:59:24Z
      DOI: 10.1177/20552076221107903
      Issue No: Vol. 8 (2022)
       
  • Cyber-attacks are a permanent and substantial threat to health systems:
           Education must reflect that

    • Authors: O’Brien Niki, Ghafur Saira, Sivaramakrishnan Arvind, Durkin Mike
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Cyber-attacks on healthcare institutions have increased in recent years and have made headlines through the COVID-19 pandemic. With the fallout of attacks increasingly reported in academic research and in the media, there is a real urgency to address cyber-threats that must be augmented across and within health systems. Until now, clinical healthcare professionals have considered cyber-attacks on healthcare organisations a predominantly information and communication technology issue, but this perception is no longer fit-for-purpose. This commentary provides insights into the scale of cyber-attacks and their impact on staff wellbeing, arguing that cybersecurity education for all staff in healthcare organisations must be improved through online resources, simulation, and gaming. The role of national educators, policymakers, and multilateral organisations in achieving this is outlined alongside implications for future policy and practice.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-17T05:59:12Z
      DOI: 10.1177/20552076221104665
      Issue No: Vol. 8 (2022)
       
  • Critical user-configurations in mHealth design: How mHealth-app design
           practices come to bias design against chronically ill children and young
           people as mHealth users

    • Authors: Claudia M Bagge-Petersen, Henriette Langstrup, Jakob E Larsen, Anne Frølich
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Mobile health smartphone applications (mHealth-apps) are increasingly emerging to assist children's and young people's management of chronic conditions. However, difficulties persist in applying design approaches in mHealth projects that return apps that are useful to this group. In this article, we explore ethnographically two self-proclaimed ‘user-driven’ projects designing mHealth apps for Danish patients below the age of 18 living with, respectively, haemophilia and rheumatoid arthritis. These projects initially included the perspectives of children and young people to inform the designs, however, eventually launched the final apps for adult patients only. Through a concept of ‘critical user-configuration’, we examine the projects’ challenges with attuning the designs to children and young people and how these drove their exclusion as users of the emerging mHealth apps. Critical user-configuration draws attention to critical moments in design practices where significant shifts in user-configurations take place, shaping who can become a user. More specifically, we uncover three critical moments: where mHealth projects expand the group of prospective users; where test subjects are selected; and where data governance systems and digital health infrastructures are mobilised in the design process. Throughout these critical moments, there is a drift from user-driven to data-driven design approaches which increasingly exclude groups of users who are less datafiable – in our case children and young people. We argue that besides giving voice to minors in mHealth design processes, we need to be mindful of the design practices that become decisive for – often implicitly – who can be configured as a user.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-16T05:50:44Z
      DOI: 10.1177/20552076221109531
      Issue No: Vol. 8 (2022)
       
  • A virtual reality-based mind–body approach to downregulate
           psychophysiological arousal in adolescent insomnia

    • Authors: Massimiliano de Zambotti, Dilara Yuksel, Orsolya Kiss, Giacinto Barresi, Nicole Arra, Laila Volpe, Christopher King, Fiona C Baker
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveIn this study, we describe the rationale, supported by preliminary data, for a novel, digital, immersive virtual reality (VR)-based mind–body approach, designed to reduce bedtime arousal in adolescents with insomnia.MethodsFifty-two high-school students (16–20 years; 32 female) with (N = 18) and without (N = 34) DSM-5 insomnia symptoms engaged with 20 min of immersive VR-guided meditation and paced breathing (0.1 Hz) (intervention condition) and 20 min of quiet activity (control condition), right before bedtime, on two separate evenings.ResultsThe intervention resulted in acute autonomic and cortical modulation (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-16T05:50:34Z
      DOI: 10.1177/20552076221107887
      Issue No: Vol. 8 (2022)
       
  • Building the hospital intelligent twins for all-scenario intelligence
           health care

    • Authors: Weibin Cheng, Wanmin Lian, Junzhang Tian
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The COVID-19 pandemic has accelerated a long-term trend of smart hospital development. However, there is no consistent conceptualization of what a smart hospital entails. Few hospitals have genuinely reached being “smart,” primarily failing to bring systems together and consider implications from all perspectives. Hospital Intelligent Twins, a new technology integration powered by IoT, AI, cloud computing, and 5G application to create all-scenario intelligence for health care and hospital management. This communication presented a smart hospital for all-scenario intelligence by creating the hospital Intelligent Twins. Intelligent Twins is widely involved in medical activities. However, solving the medical ethics, protecting patient privacy, and reducing security risks involved are significant challenges for all-scenario intelligence applications. This exploration of creating hospital Intelligent Twins that can be a worthwhile endeavor to assess how to inform evidence-based decision-making better and enhance patient satisfaction and outcomes.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-13T06:20:36Z
      DOI: 10.1177/20552076221107894
      Issue No: Vol. 8 (2022)
       
  • Effectiveness of the “Essential Coaching for Every Mother” postpartum
           text message program on maternal psychosocial outcomes: A randomized
           controlled trial

    • Authors: Justine Dol, Megan Aston, Amy Grant, Douglas McMillan, Gail Tomblin Murphy, Marsha Campbell-Yeo
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo determine the effectiveness of the Essential Coaching for Every Mother program on maternal self-efficacy, perceived social support, postpartum anxiety, and postpartum depression at six-weeks postpartum.MethodsParticipants from Nova Scotia were randomized, stratified by parity, to receive either the Essential Coaching for Every Mother postpartum text-message program or usual care, from birth to six-weeks postpartum. Participants completed surveys at enrollment (after birth) and at 6 weeks. Differences between groups were analyzed using analysis of covariance, considering parity and group allocation.ResultsOf the 171 participants recruited (53% primiparous), 150 completed the baseline survey (intervention n = 78, control n = 72). At baseline, newborns were on average 4.4 days old (SD: 3.9) and mothers 31.4 years old (SD: 4.5). Controlling for maternal age, primiparous women in the intervention group had a greater increase in maternal self-efficacy than primiparous women in the control group (mean difference [MD] = 4.84 (standard error [SE] = 0.75) vs. MD = 2.13 (SE = 0.81), p = 0.034). Women allocated to the intervention group had a greater reduction in postpartum anxiety symptoms than women in the control group for both multiparous and primiparous women (MD = −3.91 (SE = 1.82) vs. 2.81 (SE = 1.86), p = 0.011). There was no significant change in postpartum depression scores or perceived social support for either group.DiscussionThis study presents the results of the first Canadian postpartum text message program, which found improved psychosocial outcomes for postpartum women. Given the potential to reach numerous women at a low cost across geographical locations, the scalability of this intervention can improve maternal self-efficacy and reduce postpartum anxiety.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-13T06:20:31Z
      DOI: 10.1177/20552076221107886
      Issue No: Vol. 8 (2022)
       
  • Posture and musculoskeletal implications for students using mobile phones
           because of learning at home policy

    • Authors: Bonardo Prayogo Hasiholan, Indri Hapsari Susilowati
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      There is an increasing trend of awkward postures due to smartphone use among students learning from home. Previous research in several countries has shown that the use of smartphones during a pandemic impacts musculoskeletal complaints. This study aimed to determine the postures performed by the students when using mobile phones and their implications for musculoskeletal complaints. A total of 709 students who learned from home voluntarily completed an online questionnaire regarding identity, work posture, and duration, while muscle and bone complaints experienced when using mobile phones were obtained through the Nordic Musculoskeletal Questionnaire. Furthermore, a bivariate analysis of body postures was carried out to identify perceived complaints using the chi-square method. The results showed a significant relationship between standing and leaning on a table posture (p-value: 0.026) with elbow, knee, and ankle complaints.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-10T06:38:23Z
      DOI: 10.1177/20552076221106345
      Issue No: Vol. 8 (2022)
       
  • Designing illustrative social media stories to promote adolescent peer
           support and healthy sexual behaviors

    • Authors: Lauren S Chernick, Alexis Konja, Ariana Gonzalez, Melissa S Stockwell, Anke Ehrhardt, Susanne Bakken, Carolyn L Westhoff, Peter S Dayan, John Santelli
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveAdolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support.MethodsWe conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14–19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients.ResultsFemales (n  =  22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5–12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n  =  39) found the images “relatable,” “super-realistic,” and “educational.”ConclusionCollecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-10T06:38:14Z
      DOI: 10.1177/20552076221104660
      Issue No: Vol. 8 (2022)
       
  • Type-II fuzzy approach with explainable artificial intelligence for
           nature-based leisure travel destination selection amid the COVID-19
           pandemic

    • Authors: Yu-Cheng Lin, Tin-Chih Toly Chen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      During the coronavirus disease 2019 (COVID-19) pandemic, it is difficult for travelers to choose suitable nature-based leisure travel destinations because many factors are related to health risks and are highly uncertain. This research proposes a type-II fuzzy approach with explainable artificial intelligence to overcome this difficulty. First, an innovative type-II alpha-cut operations fuzzy collaborative intelligence method was used to derive the fuzzy priorities of factors critical for nature-based leisure travel destination selection. Subsequently, a type-II fuzzy Vise Kriterijumska Optimizacija I Kompromisno Resenje method, which is also novel, was employed to evaluate and compare the overall performance of nature-based leisure travel destinations. Furthermore, several measures were taken to enhance the explainability of the selection process and result. The effectiveness of the proposed type-II fuzzy approach was evaluated in a regional experiment conducted in Taichung City, Taiwan, during the COVID-19 pandemic.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-09T01:19:14Z
      DOI: 10.1177/20552076221106322
      Issue No: Vol. 8 (2022)
       
  • Chronic pain self-management in middle-aged and older adults: A collective
           intelligence approach to identifying barriers and user needs in eHealth
           interventions

    • Authors: Paul M O’Reilly, Owen M Harney, Michael J Hogan, Caroline Mitchell, Brian E McGuire, Brian Slattery
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveseHealth refers to health services and health information delivered or enhanced through the internet and related technologies. The number of eHealth interventions for chronic pain self-management is increasing. However, little evidence has been found for the overall efficacy of these interventions for older adults. The aim of the current study was to use a Collective Intelligence approach to identify the barriers and specific user needs of middle-aged and older adults using eHealth for chronic pain self-management.MethodsA Collective Intelligence workshop was conducted with middle-aged and older adults to generate, clarify, select, and structure ideas in relation to barriers to eHealth use and specific design requirements for the purposes of chronic pain self-management. Prior to attending the workshop, participants received a trigger question requesting the identification of five barriers to eHealth use for chronic pain self-management. These barriers were categorised and presented to the group along with barrier-related scenarios and user need prompts, resulting in the generation of a set of ranked barriers and a set of user needs.ResultsA total of 78 barriers were identified, from which six categories emerged: Content, Support, Technological, Personal, Computer Literacy and Accessibility. Additional idea-writing and group reflection in response to these barriers revealed 97 user needs.ConclusionThis is the first study to use Collective Intelligence methods to investigate barriers to eHealth technology use and the specific user needs of middle-aged and older adults in the context of chronic pain self-management. The results of the current study provide a platform for the design and development of enhanced eHealth interventions for this population.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-08T05:52:32Z
      DOI: 10.1177/20552076221105484
      Issue No: Vol. 8 (2022)
       
  • The role of telemedicine services in changing users’ intentions for
           presenting to the emergency departments in Saudi Arabia

    • Authors: Amjad Alfaleh, Abdullah Alkattan, Alaa Alageel, Mohammed Salah, Mona Almutairi, Khlood Sagor, Khaled Alabdulkareem
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundEmergency department (ED) overcrowding is described as one of the main issues in any hospital. In Saudi Arabia, the ministry of health applied new telemedicine technology to serve patients by using the mobile application, including the Sehha application and 937 medical call center. The main aim of this study is to determine the role of different telemedicine services in changing the intention users’ intentions for visiting the emergency departments in Saudi Arabia.MethodsA cross-sectional study was conducted during August 2020 to May 2021 among 319 patients using two telemedicine services in Saudi Arabia, including the medical call center and Sehha smartphone application. The primary endpoint of this study was to determine the number of patients intended to visit ER before and after contacting one of the two telemedicine services and the frequency of people who changed their opinion to visit an ED.ResultsThis study analyzed the data from 319 patients who completed the survey provided by the Saudi Ministry of Health concerning information related to their health status and ED visits. Among patients that had the intention to visit the ED (N = 159), 53 of them did not go to EDs after using telemedicine services (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-08T05:52:00Z
      DOI: 10.1177/20552076221091358
      Issue No: Vol. 8 (2022)
       
  • Healthcare in the hand: Patients’ use of handheld technology in video
           consultations with their general practitioner

    • Authors: Carole Jepsen, Elle Christine Lüchau, Elisabeth Assing Hvidt, Anette Grønning
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo analyse how the patient's use of handheld technology in video consultations with their general practitioner affects communication and the possibilities for the delivery of quality healthcare. Focusing on the visually communicated aspects of the video consultation, we present three episodes from our recordings of eight video consultations between Danish general practitioners and patients.MethodsUsing a multimodal social semiotic framework to conduct a micro-level analysis, we present episodes from our data in which the hardware's affordance of mobility gave rise to salient events in the interactions of patients who used handheld devices to carry out their video consultations.ResultsPatients’ use of technology plays a significant role in the interactions between general practitioner and patient and is thus an important factor to consider in how practice is shaped when using handheld video consultation technology.ConclusionsOur findings demonstrate that the mobility of handheld devices (smartphone, tablet) can be used to augment sensing and embodiment and enhance the delivery of healthcare in video consultations. However, mobility may also disrupt the interaction. As a result, possibilities for the delivery of quality healthcare lie quite literally in the patients’ hands.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-07T05:13:37Z
      DOI: 10.1177/20552076221104669
      Issue No: Vol. 8 (2022)
       
  • Impacts of physician promotion on the online healthcare community: Using a
           difference-in-difference approach

    • Authors: Yuan-Teng Hsu, Ya-Ling Chiu, Jying-Nan Wang, Hung-Chun Liu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      In this study, we use a difference-in-difference approach to explore how physician promotion, the advancement of a physician's offline reputation, affects patient behavior toward physicians in online healthcare communities; this allows us to explore how patients interpret the signals created by physician promotion. The study sample was collected from over 140,000 physician online profiles after 25 months of continuous observation, with 280 physicians who were promoted at month 13 as the treatment group and a control group obtained by propensity score matching. Our results show that a physician's promotion causes more patients to choose that physician, makes patients willing to give more psychological rewards, and makes them tend to give that physician a higher online rating. This implies that patient behavior is susceptible to the signal of physician promotion because the quality of the physician is unlikely to have changed significantly in the short term. These findings extend prior research on reputation in online communities and have crucial implications for theory and practice.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-06T04:54:48Z
      DOI: 10.1177/20552076221106319
      Issue No: Vol. 8 (2022)
       
  • Assessments of a novel digital follow-up tool Rehabkompassen® to identify
           rehabilitation needs among stroke patients in an outpatient setting

    • Authors: Xiaolei Hu, Karolina Jonzén, Marcus Karlsson, Olof A Lindahl
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionIt remains a huge challenge to identify individual rehabilitation needs in a time-efficient manner for providing patient-tailored rehabilitation during the continuum of stroke care. We have recently demonstrated the usefulness of a paper-version Rehab-Compass as a follow-up tool. The aim of the current study was to develop a digital version of the Rehab-Compass and evaluate its usability and feasibility.MethodsThe novel digital tool Rehabkompassen® was developed by an iterative and participatory design process. Patients’ rehabilitation needs were visualized by the tool and used before, during, and after the consultation. The usability and feasibility of the tool was assessed by task completion rate, the System Usability Scale, and satisfaction questionnaires among 2 physicians and 24 adult stroke patients in an outpatient clinical setting.ResultsRehabkompassen® identified and graphically visualized a panoramic view of the stroke patients’ multidimensional needs in individual- and group levels. The instrument appeared to be feasible and time efficient in clinical use with a 100% overall task completion rate for both patients and physicians. A majority of the patients reported that it was very easy or fairly easy to answer the digital questionnaires and to understand their own digital Rehab-Compass graph. Two physicians reported a high mean score on the System Usability Scale (95/100) and were positive about using the tool in the future.ConclusionsThe current results indicated that Rehabkompassen® was a feasible, useful, and time-saving follow-up tool for the identification of rehabilitation needs among stroke survivors in the post-acute continuum of care after stroke. Further research is needed to evaluate the efficacy of the digital instrument among stroke patients.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-03T07:52:04Z
      DOI: 10.1177/20552076221104662
      Issue No: Vol. 8 (2022)
       
  • Technology-supported models of nutrition care: Perspectives of health
           service providers

    • Authors: Amandine Barnett, Jaimon T Kelly, Charlene Wright, Katrina L Campbell
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo determine the perspectives to the adoption, scale-up, sustainability, and spread of technology-supported models of nutrition care, in hospital and ambulatory care settings.MethodsThirty-one health service providers participated in individual semi-structured interviews from a tertiary health service in Queensland, Australia. The Non-adoption, Abandonment, and challenges to the Scale up, Spread and Sustainability (NASSS) framework, designed to evaluate technology-supported models’ success, informed the qualitative design.ResultsKey findings were that technology-supported models of care could benefit many chronic condition patient groups; dietitians are well suited to adopting this technology: and the value proposition in creating efficiency gains in the health service. However, challenges of transitioning and sustainability were identified. Perceived enablers for technology supported models of care included: previous intentions for technology supported models of care prior to the 2019 novel coronavirus pandemic; opportunity for clinicians to complete higher valued tasks; and integration of technology systems and assisted staff roles. Perceived barriers included: suitability for patients is dependent on experience and ability to use technology, varied confidence by clinicians when conducting clinical assessments; high investment required for set up and ongoing maintenance; and patients desire for adopting face-to-face care over technology. Health service providers perceived that embedding and adapting such models requires maintenance of high-quality service and continued research.ConclusionsHealth service providers recognize adopting, scaling, and sustaining technology-supported models of nutrition care benefits patients, clinicians, and health services in general. Robust clinical trials and health service evaluations of technology-supported models of care, across practice settings are now needed.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-03T07:51:54Z
      DOI: 10.1177/20552076221104670
      Issue No: Vol. 8 (2022)
       
  • Assessing digital advertising exposure using a virtual experimental
           protocol

    • Authors: Jennifer Cantrell, Jeffrey Bingenheimer, Shreya Tulsiani, Elizabeth Hair, Donna Vallone, Sarah Mills, Raquel Gerard, William D. Evans
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionThe rapid increase in online public education campaigns underscores the need for a better understanding of the effects of exposure to digital advertising and targeted individual-level outcomes. The goal of this study is to develop a virtual experimental protocol to evaluate the dose-response effects of individual-level exposure to digital video ads on campaign outcomes in a naturalistic online browsing context.MethodsYoung adults aged 18–24 years (n = 221) completed three 5 min viewing sessions on a realistic mock-up of the YouTube mobile app over a period of 2 weeks, followed by a 10-min survey after the third session. Participants were randomized to view between 0 and 6 exposures of ads from an e-cigarette prevention campaign; respondents viewed a total of 2 ads per session, with 0 to 2 of those ads being non-skippable digital video ads from the campaign and/or a dummy ad. The video ads played prior to short YouTube videos. Outcomes measured were self-reported ad recognition, frequency of ad exposure, and main message knowledge.ResultsThis study demonstrates a rapidly accessible virtual experimental protocol for evaluating the dose-response effects of digital advertising and individual-level outcomes. Five digital exposures of non-skippable video ads delivered via this platform over a 2-week period generated the highest ad recognition when there were up to six exposures. Higher exposure levels may be needed for message knowledge and ad-content-related effects.ConclusionThis protocol can be extended to investigate dose-response effects and mechanisms of action of individual-level exposure to digital advertising for multiple campaign outcomes, including changes in knowledge, attitudes, and beliefs. Findings can inform evidence for adequate levels of digital exposure in public education campaigns.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-03T07:51:37Z
      DOI: 10.1177/20552076221102260
      Issue No: Vol. 8 (2022)
       
  • Technology-supported strategies for promoting user engagement with digital
           mental health interventions: A systematic review

    • Authors: Daniel Z Q Gan, Lauren McGillivray, Mark E Larsen, Helen Christensen, Michelle Torok
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAlthough digital mental health interventions (DMHIs) offer a potential solution for increasing access to mental health treatment, their integration into real-world settings has been slow. A key reason for this is poor user engagement. A growing number of studies evaluating strategies for promoting engagement with DMHIs means that a review of the literature is now warranted. This systematic review is the first to synthesise evidence on technology-supported strategies for promoting engagement with DMHIs.MethodsMEDLINE, EmbASE, PsycINFO and PubMed databases were searched from 1 January 1995 to 1 October 2021. Experimental or quasi-experimental studies examining the effect of technology-supported engagement strategies deployed alongside DMHIs were included, as were secondary analyses of such studies. Title and abstract screening, full-text coding and quality assessment were performed independently by two authors. Narrative synthesis was used to summarise findings from the included studies.Results24 studies (10,266 participants) were included. Engagement strategies ranged from reminders, coaching, personalised information and peer support. Most strategies were disseminated once a week, usually via email or telephone. There was some empirical support for the efficacy of technology-based strategies towards promoting engagement. However, findings were mixed regardless of strategy type or study aim.ConclusionsTechnology-supported strategies appear to increase engagement with DMHIs; however, their efficacy varies widely by strategy type. Future research should involve end-users in the development and evaluation of these strategies to develop a more cohesive set of strategies that are acceptable and effective for target audiences, and explore the mechanism(s) through which such strategies promote engagement.
      Citation: DIGITAL HEALTH
      PubDate: 2022-06-02T05:09:36Z
      DOI: 10.1177/20552076221098268
      Issue No: Vol. 8 (2022)
       
  • What criteria are young people using to select mobile mental health
           applications' A nominal group study

    • Authors: Katarzyna Kabacińska, Kaleigh McLeod, Annika MacKenzie, Kim Vu, Michelle Cianfrone, Andrew Tugwell, Julie M Robillard
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe popularity of smartphone technology provides a unique opportunity to make mental health support widely accessible, especially among young people. Despite the promising results of some mobile mental health support applications, the overwhelming number of available applications (apps) on the market makes it difficult to make a choice that will be safe and effective. Currently, widely available tools are either developed by experts, without end user input or are solely based on usability rankings. Thus, it remains unclear what aspects of mental health apps are important for young people. The purpose of this study was to determine what criteria young adults use when they select mental health applications and what is the relative importance of these criteria to inform the development of a user-driven app-rating platform.MethodsWe conducted 4 group sessions with 47 youth and young adults aged 15–25 in British Columbia, Canada using a modified nominal group technique. This method allows for establishing the relative importance of criteria in a structured group discussion. We recorded, transcribed and analysed the resulting data using qualitative content analysis and quantitative methods.ResultsCriteria that are the most important to young adults when selecting mental health apps include accessibility, security and grounding in scientific evidence. We identified specific aspects of the discussed criteria which were ranked in the order of importance.ConclusionConsulting end users about their priorities when evaluating mental health apps ensures that their values and priorities are incorporated into future app-rating platforms, alongside expert opinions. The present study also outlines the common contexts in which apps are used as well as their desirable features to inform mental health app development.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-30T06:57:30Z
      DOI: 10.1177/20552076221102775
      Issue No: Vol. 8 (2022)
       
  • Telemedicine options to address identified health needs in Botswana

    • Authors: Benson Ncube, Maurice Mars, Richard E Scott
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveGlobal efforts to implement national ehealth strategies have occurred, yet specific telemedicine implementations have fallen behind. A weakness inherent within many, perhaps most, national ehealth strategies, including Botswana's – is a lack of telemedicine focus. This is despite its potential to address many current healthcare system needs. The development of a telemedicine-specific strategy, to complement the existing ehealth strategy, has been proposed. This paper reports on an emulated process to determine prioritised health needs, identify broad solutions, consider ehealth and then telemedicine solutions, and prioritise these as insight for telemedicine-specific strategy development.MethodsThe eHealth Strategy Development Framework (eHSDF) was adopted and steps 5–7 were emulated. Key informants participated in telephone-based semi-structured interviews in November 2020, using a key informant interview guide. Participants were asked specific questions related to national health needs, proposed solutions, and prioritisation. The interviews were recorded and transcribed for analysis.ResultsEleven key informants identified the top five perceived health issues as human resource shortages, congestion and overcrowding, prevalence of diseases, poor referral system, and lack of diagnostic and case management skills. Solutions were proposed, some of which included: Telehealth (including telemedicine), health informatics, and elearning. Telemedicine solutions included: a health professional help desk, teleconsultations, and apps for specialist referral. eLearning solutions were training, mentoring, and continuing professional development.ConclusionA telemedicine-specific strategy, addressing the identified health issues and aligned to the existing national ehealth strategy, would provide the required focus to enable the development and deployment of telemedicine activities in the country.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-30T06:56:55Z
      DOI: 10.1177/20552076221102768
      Issue No: Vol. 8 (2022)
       
  • Understanding the user: Patients’ perception, needs, and concerns of
           health apps for chronic constipation

    • Authors: V Vien Lee, Smrithi Vijayakumar, Ni Yin Lau, Agata Blasiak, Kewin Tien Ho Siah, Dean Ho
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveChronic constipation is a prevalent gastrointestinal disorder that requires long-term management and treatment adherence. With increasing smartphone usage, health app adoption represents an opportunity to incorporate personalized, patient-led care into chronic constipation management. Despite the number of apps available targeting patients with constipation, studies have not yet examined user needs and barriers towards successful app adoption and sustained usage. Accordingly, the current study explored user perception, needs, and concerns of health apps in patients with chronic constipation.MethodsFifteen participants with chronic constipation (age range = 28–79 years, 10 females) in Singapore completed a 60 min semi-structured qualitative interview exploring participant's experiences with and attitudes towards chronic constipation and health apps. Participants also completed two questionnaires regarding their constipation symptoms and general technology usage. Interviews were audio-recorded, transcribed verbatim, and coded using NVivo.ResultsFour themes and 10 sub-themes were identified using inductive thematic analysis. Themes and sub-themes cover importance of patient identity, disease-based expectations of health apps, barriers towards adoption and sustained usage of health apps, necessary conditions when adopting health apps (including perception of supportive benefits, clear understanding of app intention, personalized technology, and trusted sources), and push factor expectations which includes creative engagement and incentivization embedded within the app.ConclusionThe findings captured barriers and key elements necessary for successful health app adoption and continued usage by patients with chronic constipation. Identified elements that matter to patients can provide app developers with user-focused insights and recommendations to develop effective health apps that sustain user engagement.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-30T06:16:19Z
      DOI: 10.1177/20552076221104673
      Issue No: Vol. 8 (2022)
       
  • Using self-monitoring technology for nutritional counseling and weight
           management

    • Authors: Chelsea A Carpenter, Umelo A Ugwoaba, Michelle I Cardel, Kathryn M Ross
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Self-monitoring of weight, dietary intake, and physical activity is a key strategy for weight management in adults with obesity. Despite research suggesting consistent associations between more frequent self-monitoring and greater success with weight regulation, adherence is often suboptimal and tends to decrease over time. New technologies such as smartphone applications, e-scales, and wearable devices can help eliminate some of the barriers individuals experience with traditional self-monitoring tools, and research has demonstrated that these tools may improve self-monitoring adherence. To improve the integration of these tools in clinical practice, the current narrative review introduces the various types of self-monitoring technologies, presents current evidence regarding their use for nutrition support and weight management, and provides guidance for optimal implementation. The review ends with a discussion of barriers to the implementation of these technologies and the role that they should optimally play in nutritional counseling and weight management. Although newer self-monitoring technologies may help improve adherence to self-monitoring, these tools should not be viewed as an intervention in and of themselves and are most efficacious when implemented with ongoing clinical support.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-30T06:15:50Z
      DOI: 10.1177/20552076221102774
      Issue No: Vol. 8 (2022)
       
  • Challenges in the development of digital public health interventions and
           mapped solutions: Findings from a scoping review

    • Authors: Ihoghosa Iyamu, Oralia Gómez-Ramírez, Alice XT Xu, Hsiu-Ju Chang, Sarah Watt, Geoff Mckee, Mark Gilbert
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Background“Digital public health” has emerged from an interest in integrating digital technologies into public health. However, significant challenges which limit the scale and extent of this digital integration in various public health domains have been described. We summarized the literature about these challenges and identified strategies to overcome them.MethodsWe adopted Arksey and O’Malley's framework (2005) integrating adaptations by Levac et al. (2010). OVID Medline, Embase, Google Scholar, and 14 government and intergovernmental agency websites were searched using terms related to “digital” and “public health.” We included conceptual and explicit descriptions of digital technologies in public health published in English between 2000 and June 2020. We excluded primary research articles about digital health interventions. Data were extracted using a codebook created using the European Public Health Association's conceptual framework for digital public health.Results and analysisOverall, 163 publications were included from 6953 retrieved articles with the majority (64%, n = 105) published between 2015 and June 2020. Nontechnical challenges to digital integration in public health concerned ethics, policy and governance, health equity, resource gaps, and quality of evidence. Technical challenges included fragmented and unsustainable systems, lack of clear standards, unreliability of available data, infrastructure gaps, and workforce capacity gaps. Identified strategies included securing political commitment, intersectoral collaboration, economic investments, standardized ethical, legal, and regulatory frameworks, adaptive research and evaluation, health workforce capacity building, and transparent communication and public engagement.ConclusionDeveloping and implementing digital public health interventions requires efforts that leverage identified strategies to overcome diverse challenges encountered in integrating digital technologies in public health.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-27T05:32:31Z
      DOI: 10.1177/20552076221102255
      Issue No: Vol. 8 (2022)
       
  • Effect of the whole seamless connection of nursing from WeChat interactive
           platform on stigma and quality of life in patients with urinary system
           cancer

    • Authors: Haiyan Hao, Xinyu Yang, Huixia Zhu, Ziheng Wang, Haiyan Zhang, Chunxia Huang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo evaluate the effects of intervention by “whole seamless connection of nursing from WeChat interactive platform” on stigma and quality of life of the patients with urinary system cancer.MethodsOverall, 80 patients with urinary cancer were randomly divided (40 cases per group) into control and observation groups. Routine nursing was provided to the control group, whereas positive psychological intervention was provided to the intervention group through a “whole seamless connection of nursing from the WeChat interactive platform” in addition to routine nursing. The Chinese version of social impact and cancer patients’ quality of life scales were used to evaluate the effects before and after the intervention.ResultsAfter the intervention, the total score for stigma was significantly lower (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-27T05:28:20Z
      DOI: 10.1177/20552076221102772
      Issue No: Vol. 8 (2022)
       
  • Accuracy and reliability of a wireless vital signs monitor for
           hospitalized patients in a low-resource setting

    • Authors: Assumpta Nantume, Noah Kiwanuka, Asad Muyinda, Teresa Cauvel, Sona Shah
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe purpose of this study was to evaluate the accuracy and reliability of neoGuard in comparison to a conventional bedside monitor on patients in a low-resource clinical setting.DesignThis was a single-arm methods comparison study involving the use of a wearable vital signs monitor (neoGuardTM) versus a conventional bedside monitor (Edan iM8).SettingThe study was conducted at Jinja Regional Referral Hospital, a tertiary care hospital situated in Eastern Uganda.ParticipantsThirty patients (10 male, 20 female) were enrolled from the adult recovery ward at JRRH. Participants were eligible for the study if they were at least 18 years of age, had 2 sets of normal vital sign measurements obtained 1 h apart, and were able and willing to provide informed consent.Main Outcome and MeasuresThe primary outcome measures were (i) bias (mean deviation) and (ii) limits of agreement [95% CI]. Bland-Altman plots were generated to illustrate the level of agreement between the neoGuardTM technology and the Edan iM8 monitor.ResultsBland-Altman analysis was performed for 24 participants; datasets from six participants were excluded due to missing or invalid measurements. Findings showed a moderate level of agreement for measurement of SpO2, PR, and RR, with>80% of subject means falling within the predefined acceptability limits. However, there was also notable variation in accuracy between subjects, with large standard deviations observed for measurement of all four parameters. While the level of agreement for measurement of temperature was low, this is partly explained by limitations in the comparison method.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-26T04:03:06Z
      DOI: 10.1177/20552076221102262
      Issue No: Vol. 8 (2022)
       
  • Classification of cardiac arrhythmia using a convolutional neural network
           and bi-directional long short-term memory

    • Authors: Shahab Ul Hassan, Mohd S Mohd Zahid, Talal AA Abdullah, Khaleel Husain
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Cardiac arrhythmia is a leading cause of cardiovascular disease, with a high fatality rate worldwide. The timely diagnosis of cardiac arrhythmias, determined by irregular and fast heart rate, may help lower the risk of strokes. Electrocardiogram signals have been widely used to identify arrhythmias due to their non-invasive approach. However, the manual process is error-prone and time-consuming. A better alternative is to utilize deep learning models for early automatic identification of cardiac arrhythmia, thereby enhancing diagnosis and treatment. In this article, a novel deep learning model, combining convolutional neural network and bi-directional long short-term memory, is proposed for arrhythmia classification. Specifically, the classification comprises five different classes: non-ectopic (N), supraventricular ectopic (S), ventricular ectopic (V), fusion (F), and unknown (Q) beats. The proposed model is trained, validated, and tested using MIT-BIH and St-Petersburg data sets separately. Also, the performance was measured in terms of precision, accuracy, recall, specificity, and f1-score. The results show that the proposed model achieves training, validation, and testing accuracies of 100%, 98%, and 98%, respectively with the MIT-BIH data set. Lower accuracies were shown for the St-Petersburg data set. The performance of the proposed model based on the MIT-BIH data set is also compared with the performance of existing models based on the MIT-BIH data set.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-26T04:02:36Z
      DOI: 10.1177/20552076221102766
      Issue No: Vol. 8 (2022)
       
  • Usability testing of a wireless individual indicator system application:
           Monitoring exposure to outdoor air pollution among Malaysian Traffic
           Police

    • Authors: Putri Anis Syahira Mohamad Jamil, Karmegam Karuppiah, Nur Athirah Diyana Mohammad Yusof, Dayana Hazwani Mohd Suadi Nata, Nurhanim Abdul Aziz, Vivien How, Shamsul Bahri Mohd Tamrin, Hassan Sadeghi Naeni
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesDesigns for low-cost air monitors and associated performance data appear in many peer-reviewed articles; however, few manuscripts provide feedback from end user's experiences or comprehensive evaluation. The present study addresses the usability of the wireless outdoor individual exposure indicator system from the viewpoint of the Malaysian Traffic Police (end users). This study is one of the first to chronicle end user experiences for low-cost pollution sensing.MethodThe evaluation involved 12 target end users to assess the usability of a prototype for Malaysian Traffic Police to manage their exposure to outdoor air pollution. The test evaluation includes a pre-test, post-task and post-test questionnaire (Post-Study System Usability Questionnaire). The main components in this Post-Study System Usability Questionnaire are Overall satisfaction, System Usefulness, Information Quality and Interface Quality.FindingsThe results of the Post-Study System Usability Questionnaire indicated the mean score of the Overall satisfaction item (2.33), System Usefulness (2.25), Information Quality (2.36) and Interface Quality (2.17) on a scale of 1–10. Prototype users were satisfied with the system because the score is close to 1 on the Post-Study System Usability Questionnaire.ConclusionsA user-friendly wireless outdoor individual exposure indicator system is now available for Malaysian Traffic Police. Users have stated that they are happy to use the system at work. However, in addition to more technological advances, practical implementation requires evidence supporting its efficacy, viability and effectiveness.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-26T04:02:27Z
      DOI: 10.1177/20552076221103336
      Issue No: Vol. 8 (2022)
       
  • Exploring the experiences of people and family carers from
           under-represented groups in self-managing Parkinson's disease and their
           use of digital health to do this

    • Authors: Danielle Nimmons, Megan Armstrong, Jennifer Pigott, Kate Walters, Anette Schrag, Della Ogunleye, Wesley Dowridge, Joy Read, Nathan Davies
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionDigital health is thought to enable people to better manage chronic conditions, such as Parkinson's. However, little is known about how people from under-represented groups with chronic conditions use digital health to self-manage.ObjectiveThe objective of our study was to explore the experiences of people and family carers from under-represented groups in self-managing Parkinson's, including their use of digital health to do this.MethodsSemi-structured interviews (n = 18, including four dyadic) were conducted remotely, with 16 people with Parkinson's and six family carers in 2020–2021. Participants were purposively sampled from under-represented groups: belong to an ethnic minority, or having significant physical or sensory impairment. Interviews were audio-recorded, transcribed and analysed using thematic analysis.ResultsThree main themes of importance were developed: ‘self-management support’, ‘digital health use to support self-management’ and ‘identity, attitudes and characteristics’. Participants received medical, psychological, social and practical self-management support. Some participants used digital health resources, e.g., Parkinson's UK website. Digital literacy was the biggest barrier to using digital health, regardless of background, often dependant on previous occupation and confidence. Few ethnic minority participants thought race or culture alters self-management ability and most believed there was no need for digital health interventions to be tailored to an individual's race or culture. Some felt inclusivity was important in terms of diverse images of people. A range of considerations were identified to optimise digital health, such as assistive equipment for people with sensory impairment.ConclusionsBarriers to using digital health for self-management were primarily dependent on personal factors including digital literacy and attitudes but rarely race or culture. We recommend the optimisation of digital health interventions by providing assistive technology at low cost, and visual inclusiveness should be promoted by including images of people from diverse backgrounds.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-26T04:02:15Z
      DOI: 10.1177/20552076221102261
      Issue No: Vol. 8 (2022)
       
  • Patient and physician perspectives on the use and outcome measures of
           mHealth apps: Exploratory survey and focus group study

    • Authors: Rita Jezrawi, Sarmini Balakumar, Rafia Masud, Itzhak Gabizon, Vinai Bhagirath, Jobin Varughese, Michael Brown, Dan Trottier, JD Schwalm, Michael McGillion, Elizabeth Alvarez, Cynthia Lokker
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveFactors that physicians and patients consider when making decisions about using or recommending health apps are not well understood. We explored these factors to better assess how to support such decision making.MethodsWe conducted an exploratory cross-sectional study in Ontario using qualitative focus groups and quantitative surveys. 133 physicians and 94 community dwelling adults completed online surveys and we held two focus groups of nine community dwelling participants who had cardiovascular risk factors and an interest in using mHealth apps. Quantitative survey data was analyzed descriptively. Focus groups were audio-recorded and transcribed verbatim prior to inductive thematic content analysis. We integrated the results from the surveys and focus groups to understand factors that influence physicians' and patients' selection and use of such apps.ResultsPhysicians recommend apps to patients but the level of evidence they prefer to use to guide selection did not align with what they were currently using. Patients trusted recommendations and reviews from medical organizations and healthcare professionals when selecting apps and were motivated to continue using apps when they supported goal setting and tracking, data sharing, decision making, and empowerment.ConclusionsThe findings highlight the significance of evaluating mHealth apps based on metrics that patients and physicians value beyond usage and clinical outcome data. Patients engage with apps that support them in confidently managing their health. Increased training and awareness of apps and creating a more rigorous evidence base showing the value of apps to supporting health goals will support greater adoption and acceptance of mHealth apps.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-25T06:54:19Z
      DOI: 10.1177/20552076221102773
      Issue No: Vol. 8 (2022)
       
  • Role of decentralized clinical trials in cancer drug development: Results
           from a survey of oncologists and patients

    • Authors: Begoña de las Heras, Adam Daehnke, Kamal S Saini, Melissa Harris, Kenneth Morrison, Ariel Aguilo, Isagani Chico, Laura Vidal, Robin Marcus
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      As a result of the unprecedented challenges imposed by the COVID-19 pandemic on enrollment to cancer clinical trials, there has been an urgency to identify and incorporate new solutions to mitigate these difficulties. The concept of decentralized or hybrid clinical trials has rapidly gained currency, given that it aims to reduce patient burden, increase patient enrollment and retention, and preserve quality of life, while also increasing the efficiency of trial logistics. Therefore, the clinical trial environment is moving toward remote collection and assessment of data, transitioning from the classic site-centric model to one that is more patient-centric.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-25T04:02:26Z
      DOI: 10.1177/20552076221099997
      Issue No: Vol. 8 (2022)
       
  • Perceptions of traditional Chinese medicine doctors about using wearable
           devices and traditional Chinese medicine diagnostic instruments: A
           mixed-methodology study

    • Authors: Siyu Zhou, Kai Li, Astushi Ogihara, Xiaohe Wang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study aimed to investigate the perceptions of traditional Chinese medicine doctors about wearable devices and diagnostic instruments and explore the factors that influence them.MethodsData on the perceptions of the traditional Chinese medicine doctors in Hangzhou, China, about wearable devices and diagnostic instruments were collected through face-to-face semi-structured interviews. The author coded the interview responses using grounded theory. A cross-sectional survey was conducted in four traditional Chinese medicine hospitals in Hangzhou, China. The responses of 385 traditional Chinese medicine doctors were considered valid. Descriptive statistics and binary logistic regression models were used for analysis.ResultsThis study categorized the perceptions of traditional Chinese medicine about wearable devices and traditional Chinese medicine diagnostic instruments under convenience, reliability, suitable population, machine usage scenario, and the integration of traditional Chinese medicine and information communication technology. Convenience encompassed portability and the convenience of carrying instruments or wearing the devices and operating them and the human–device interface. Reliability encompassed the underlying principles, accuracy, durability, and reference to diagnosis. Suitability for people encompassed age distinction and disease differentiation. Machine usage scenarios included use in daily life, educational institutions, and primary medical institutions. The combination of traditional Chinese medicine and information communication technology encompassed the integration of traditional Chinese medicine and wearable functions and diagnostic interpretation. The perceptions of traditional Chinese medicine doctors were affected by age, title, type of hospital, and specialty.ConclusionsThe use of wearable devices and traditional Chinese medicine diagnostic instruments has gradually been accepted by traditional Chinese medicine doctors. Traditional Chinese medicine doctors need to improve their knowledge and skills for information communication technology integration, and their standardized training should incorporate information communication technology and digital health.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-24T05:19:30Z
      DOI: 10.1177/20552076221102246
      Issue No: Vol. 8 (2022)
       
  • Usability and effectiveness of adherence monitoring of a mobile app
           designed to monitor and improve adherence to event-driven and daily HIV
           pre-exposure prophylaxis among men who have sex with men in Taiwan

    • Authors: Huei-Jiuan Wu, Yi-Fang Yu, Stephane Wen-Wei Ku, Yuan-Chi Tseng, Chien-Wen Yuan, Chia-Wen Li, Po-Hsien Huang, Nai-Ying Ko, Peter L. Anderson, Carol Strong
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe UPrEPU mobile app is a self-monitoring system to enable men who have sex with men to optimize their pre-exposure prophylaxis adherence for HIV prevention. The app was designed to accommodate a rather complicated event-driven dosing schedule. We aim to evaluate the usability of the UPrEPU app and its effectiveness in improving adherence monitoring.MethodsFrom May to October 2020, 35 participants were enrolled for the usability study and followed up for 4 months. Blood samples for the drug concentration in the dried blood spots were obtained once during the second to fourth follow-up visits. The effectiveness of adherence monitoring was analyzed using Cohen's kappa statistic to calculate the concordance between the average number of pills taken and drug concentration in the dried blood spots.ResultsOverall retention was 91.4% (32 participants) at the end of the study. Participants used the app for a mean of 29 days and made 2565 data entries in total, with an average of 76 data entries. The average systematic usability scale score for the app was 71.5, indicating acceptable usability. Slight agreement was reached between the dried blood spots measurement and the number of pills taken and recorded in the app (weighted kappa: 0.21).ConclusionsOur user-centered UPrEPU app demonstrated that it could accommodate both daily and event-driven dosing schedules for men who have sex with men clients with acceptable usability scores. We confirmed that complex behaviors such as different drug-dosing regimens that are contingent on sexual behaviors could be incorporated into the design of a mobile app.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-23T05:15:33Z
      DOI: 10.1177/20552076221102770
      Issue No: Vol. 8 (2022)
       
  • Canadian perspectives of digital mental health supports: Findings from a
           national survey conducted during the COVID-19 pandemic

    • Authors: Nelson Shen, Iman Kassam, Sheng Chen, Clement Ma, Wei Wang, Navi Boparai, Damian Jankowicz, Gillian Strudwick
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesThe impact of the COVID-19 pandemic on population mental health has highlighted the potential for digital mental health to support the needs of those requiring care. This study sought to understand the digital mental health experiences and priorities of Canadians affected by mental health conditions (i.e. seekers, patients, and care partners).MethodsA national cross-sectional electronic survey of Canadians was administered through a market research firm's survey panel. Seekers, patients, and care partners were asked about their digital mental health experiences (e.g. uptake, barriers to access) and priorities. Survey responses were summarized using descriptive statistics.ResultsOverall, 1003 participants completed the survey. 70.2% of participants routinely use digital mental health supports to support themselves or those they care for; however, only 28.6% of participants are satisfied with the available digital mental health supports. Most participants (73.3%) have encountered some barriers when accessing digital mental health supports. Awareness of digital mental health supports was a top barrier identified by participants. The top digital mental health priorities consisted of digital mental health curation, navigation, and a digital mental health passport.ConclusionsMost participants use digital mental health supports for themselves or others, however, many are unaware of digital mental health supports available. Efforts to improve navigating access to digital and in-person mental health services are seen as a top priority, highlighting the need to enable seekers, patients, and care partners to find the appropriate support and make decisions on how to best improve their mental health.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-23T05:14:53Z
      DOI: 10.1177/20552076221102253
      Issue No: Vol. 8 (2022)
       
  • “Who needs an app' Fertility patients’ use of a novel
           mobile health app”

    • Authors: Skye A Miner, Eden N Gelgoot, Alix Lahuec, Samantha Wunderlich, Darryl Safo, Felicia Brochu, Shrinkhala Dawadi, Stephanie Robins, Siobhan Bernadette, Laura O’Connell, Peter Chan, Carolyn Ells, Hananel Holzer, Kirk Lo, Neal Mahutte, Sophia Ouhilal, Zeev Rosberger, Togas Tulandi, Phyllis Zelkowitz
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe number of couples experiencing infertility treatment has increased, as has the number of women and men experiencing infertility treatment-related stress and anxiety. Therefore, there is a need to provide information and support to both men and women facing fertility concerns. To achieve this goal, we designed a mhealth app, Infotility, that provided men and women with tailored medical, psychosocial, lifestyle, and legal information.MethodsThis study specifically examined how fertility factors (e.g. time in infertility treatment, parity), socio-demographic characteristics (e.g. gender, education, immigrant status), and mental health characteristics (e.g. stress, depression, anxiety, fertility-related quality of life) were related to male and female fertility patients’ patterns of use of the Infotility app.ResultsOverall, the lifestyle section of the app was the most highly used section by both men and women. In addition, women without children and highly educated women were more likely to use Infotility. No demographic, mental health or fertility characteristics were significantly associated with app use for men.ConclusionThis study shows the feasibility of a mhealth app to address the psychosocial and informational needs of fertility patients.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-23T05:14:33Z
      DOI: 10.1177/20552076221102248
      Issue No: Vol. 8 (2022)
       
  • Investigating the needs and concerns of older adults with multimorbidity
           and their healthcare professionals for conceivable digital
           psychotherapeutic interventions

    • Authors: Orla Moran, Julie Doyle, Suzanne Smith, Oonagh Giggins, John Dinsmore
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Multimorbidity, defined as the concurrent experience of more than one chronic health condition in an individual, affects ∼65% of people over 65 and 85% of those over 85 years old with 30% of those also experiencing mental health concerns. This can lead to reduced quality of life and functioning as well as poorer outcomes in terms of condition management, adherence to treatment, and ultimately disease prognosis and progression. Digital health interventions offer a viable means of condition self-management, as well as psychological support, particularly for those who may have difficulty accessing in-person services. To best meet the needs of older adults with multimorbidity, deeper insights are needed into their specific concerns and issues around condition management, particularly with regard to distress in relation to managing one's condition. The present study aimed to explore this using one-to-one qualitative interviews and focus groups with people with chronic health conditions and healthcare professionals. Participants were 11 older adults with multimorbidity (4 males; mean age: M = 72.7 years) and 14 healthcare professionals including five clinical nurse specialists, four pharmacists, two general practitioners, one occupational therapist, one speech and language therapist and one dietician. Thematic analysis was used to identify key themes, which included: patient feelings of anxiety or worry leading to an unwillingness to access essential information; the various mental health challenges faced by those with multimorbidity; the importance of personal values in providing motivation; and the importance of social support. Findings are discussed in relation to the potential development of transdiagnostically applicable digital interventions for the management of distress in those with multimorbidity.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-23T05:14:21Z
      DOI: 10.1177/20552076221089097
      Issue No: Vol. 8 (2022)
       
  • The role of digital mobile technology in elderly health management among
           health care workers in Indonesia: Analysis of knowledge, attitudes, and
           practice

    • Authors: Anastasia A. Dinakrisma, Purwita Wijaya Laksmi, Teofilus Abdiel, Johannes P. Fernandez, Nuri Indahwati, Anindya Pradipta Susanto, Arya Ananda Indrajaya Lukmana, Prasandhya Astagiri Yusuf
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundTechnology, including information and communication technology (ICT), plays a significant role in the quality of health services. However, its application in elderly health services is still lacking. The aim of this study was to determine the knowledge of, attitudes toward, and practices of cell phone and mobile application use for elderly health care among Indonesian health care workers.MethodsThis was a cross-sectional study conducted with health care workers in Jakarta, Indonesia. The potential subjects were contacted through instant messenger application and/or through conventional short message service or telephone calls from August through November 2020.ResultsThere were 134 subjects. All the subjects had used various health applications to assist with their daily work, including telemedicine (64.2%), guidelines (60.4%), and medical calculators (46.3%). However, 96.3% of the subjects were not aware of the existence of a health application for geriatric assessment. Furthermore, 98.5% of subjects thought that it is important to use ICT to manage geriatric patients, and 94.8% felt that comprehensive geriatric assessment (CGA) in digital form would help them manage geriatric patients better. Nevertheless, 35.10% of subjects had never applied CGA to their geriatric patients.ConclusionsThe current health care system has begun to enter a period of using ICT in performing health services for geriatric patients. Nevertheless, only a few Indonesian health care workers were aware of or were using the geriatric mobile application. It is essential to improve the dissemination of geriatric health care and e-health literacy among them to improve the quality of elderly health care.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-23T04:04:37Z
      DOI: 10.1177/20552076221102771
      Issue No: Vol. 8 (2022)
       
  • Factors associated with eHealth literacy focusing on digital literacy
           components: A cross-sectional study of middle-aged adults in South Korea

    • Authors: Jaegyeong Lee, Sunghee H Tak
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundDigital technology has dramatically changed the world in which we live, and the ability to access and understand information through these new technologies is becoming increasingly important. eHealth literacy is closely related to digital literacy, and some concepts may overlap to a certain extent. Identifying personal and digital-related factors related to eHealth literacy levels in middle-aged adults would be useful for planning tailored interventions and health promotion strategies.ObjectiveWe aimed to identify the differences in digital literacy and eHealth literacy levels according to demographic features, and to elucidate the factors associated with eHealth literacy in the middle-aged population.MethodsWe conducted a cross-sectional, observational study from 4th to 8th February 2021. A total of 320 South Korean participants aged 40–64 years were recruited and completed an online questionnaire, where demographic features, chronic disease status, frequency of Internet use, digital skills, digital competence, and eHealth literacy were measured. eHealth literacy was measured with the eHEALS. We used multiple regression analysis to elucidate the factors associated with eHealth literacy.ResultsMultiple regression analysis revealed that digital competence was the highest contributor to an individual's eHealth literacy (β = 0.330, P 
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-20T08:36:07Z
      DOI: 10.1177/20552076221102765
      Issue No: Vol. 8 (2022)
       
  • Motivate me to exercise with you: The effects of social media fitness
           influencers on users’ intentions to engage in physical activity and the
           role of user gender

    • Authors: Julia Durau, Sandra Diehl, Ralf Terlutter
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveSocial media fitness influencers are evolving into a new digital form of health communicators whom consumers might turn to for assistance with more physical activity and exercise at home, especially in the current COVID-19 crisis. Drawing from source credibility theory, social cognitive theory, protection motivation theory and literature on physical activity, physical fitness and gender, we analyse how male and female users’ evaluations of social media fitness influencers and user health-related variables impact intentions to exercise with the social media fitness influencer.MethodsTwo consecutive studies using male and female YouTube fitness influencers were carried out. Structural equation modelling was conducted to test the proposed models and estimate the path coefficients.ResultsStudy 1 (N = 507) shows that the respective influencer's perceived trustworthiness, expertise and attractiveness are important for the influencer's evaluation, and that it is the perceived motivating power rather than the attitude toward the influencer that increases intentions to exercise for male and female users. Study 2 (N = 445) extends Study 1 and shows that physical fitness, training involvement with YouTube fitness videos and lower health increase behavioural intentions. A more negative body image also raises intentions to exercise, but only among female users.ConclusionSocial media fitness influencers who are perceived as trustworthy, as experts and as attractive, can be effective for increasing men's and women's physical activity. Perceived motivating power of the influencer emerged as a key variable that predicts intentions to exercise. User health-related variables have different effects on intentions to exercise for men and women.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-20T08:14:08Z
      DOI: 10.1177/20552076221102769
      Issue No: Vol. 8 (2022)
       
  • The effect of auditory stimulation using delta binaural beat for a better
           sleep and post-sleep mood: A pilot study

    • Authors: Roya Dabiri, Mohammad Reza Monazzam Esmaielpour, Mojahede Salmani Nodoushan, Farin khaneshenas, Seyed Abolfazl Zakerian
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAlthough previous evidence confirms the effects of sleep deprivation on mental health and wellbeing, due to the interaction effects of sleep and mood on each other, the influence of sleep improvement has received less attention.ObjectiveThis study aimed to find whether binaural beat technology can enhance sleep quality and thus post-sleep mood.MethodsTwenty healthy students participated in this pilot study. All subjects were investigated for two weeks (a baseline week and an experimental week). In the first week, there was no intervention, but in the second week, all subjects were exposed to a 90 min binaural beat in the delta frequency range. The individuals’ sleep was monitored for two weeks using a sleep diary form, and a Profile of Mood State questionnaire was employed to assess their mood at the end of the first and second weeks.ResultsAuditory stimulation with delta binaural beat enhanced sleep parameters such as sleep failure, the number of awakenings, real duration of sleep, sleep quality, and feeling following the waking of the individuals. Finally, students’ moods improved by reducing anxiety and anger, but other mood parameters did not indicate a significant difference.ConclusionThe findings of this study confirmed that auditory stimulation with a delta binaural beat seems to be a low-cost and alternative method for medicine and other treatment methods with side effects.ApplicationThis study demonstrates the use of technology with a neuroergonomics approach to improve sleep and mood disorders.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-20T08:14:01Z
      DOI: 10.1177/20552076221102243
      Issue No: Vol. 8 (2022)
       
  • Evaluating the impact of a novel telerehabilitation service to address
           neurological, musculoskeletal, or coronavirus disease 2019 rehabilitation
           concerns during the coronavirus disease 2019 pandemic

    • Authors: Katelyn Brehon, Jay Carriere, Katie Churchill, Adalberto Loyola-Sanchez, Petra O’Connell, Elisavet Papathanasoglou, Rob MacIsaac, Mahdi Tavakoli, Chester Ho, Kiran Pohar Manhas
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionA novel telerehabilitation service provides wayfinding and self-management advice to persons with neurological, musculoskeletal, or coronavirus disease 2019 related rehabilitation needs.MethodWe utilized multiple methods to evaluate the impact of the service. Surveys clarified health outcomes (quality of life, self-efficacy, social support) and patient experience (telehealth usability; general experience) 3-months post-call. We analysed associations between, and within, demographics and survey responses. Secondary analyses described health care utilization during the first 6 months.ResultsSixty-eight callers completed the survey (42% response rate). Self-efficacy was significantly related to quality of life, interpersonal support and becoming productive quickly using the service. Becoming productive quickly was significantly related to quality of life. Education level was related to ethnicity. Survey respondents’ satisfaction and whether they followed the therapist's recommendations were not significantly associated with demographics. Administrative data indicated there were 124 callers who visited the emergency department before, on, or after their call. The average (SD) frequency of emergency department visits before was 1.298 times (1.799) compared to 0.863 times (1.428) after.DiscussionThis study offers insights into the potential impact of the telerehabilitation service amidst pandemic restrictions. Usability measurements showed that callers were satisfied, corroborating literature from pre-pandemic contexts. The satisfaction and acceptability of the service does not supplant preferences for in-person visits. The survey sample reported lower quality of life compared with the provincial population, conflicting with pre-pandemic research. Findings may be due to added stressors associated with the pandemic. Future research should include population-level comparators to better clarify impact.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-18T04:27:19Z
      DOI: 10.1177/20552076221101684
      Issue No: Vol. 8 (2022)
       
  • Expecting parents’ perceptions of the digital parental support
           “childbirth journey” constructed as a serious game—an intervention
           study

    • Authors: Caroline Bäckström, Tanja Rolfson, Henrik Engström, Rajna Knez, Margaretha Larsson
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe aim of this study was to explore expecting parents’ perceptions of the Childbirth Journey as an intervention that includes medical information for parental support, constructed as a serious game.MethodsIn this qualitative study, semi-structured interviews were held with expecting parents in Sweden who were able to talk about specific parts of the Childbirth Journey they appreciated or found difficult to understand. A phenomenographic methodology was employed for data analysis.ResultsParticipants perceived the Childbirth Journey to be easily accessible and customized with reliable information. The design and features of the intervention were perceived by the expecting parents to enhance the intervention’s usability, appeal, and trustworthiness. When parental couples used the Childbirth Journey together, it gave them an opportunity to discuss and better understand each other’s situation. The participants proposed several changes to the existing version of the game, mostly related to extending practical information and illustrated scenarios but also to the further development of the game’s design and animations. The participants found the Knowledge portal to be the most appealing part of the Childbirth Journey.ConclusionsThe Childbirth Journey intervention was concluded to be a valuable digital complement to in-person professional support, especially given the current COVID-19 pandemic restrictions in place in Sweden, which do not allow antenatal visits by partners. However, in its current form, the Childbirth Journey has some deficiencies and would therefore benefit from further development and exploration.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-16T07:35:46Z
      DOI: 10.1177/20552076221097776
      Issue No: Vol. 8 (2022)
       
  • Telemedicine and artificial intelligence to support self-isolation of
           COVID-19 patients: Recent updates and challenges

    • Authors: Jessica A Huang, Intan R Hartanti, Michelle N Colin, Dian AE Pitaloka
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundAsymptomatic and high-risk COVID-19 patients are advised to self-isolate at home. However, patients may not realize that the condition is deteriorating until too late.ObjectiveThis study aims to review various artificial intelligence-based telemedicine research during the COVID-19 outbreak and proposes a framework for developing telemedicine powered by artificial intelligence to monitor progression in COVID-19 patients during isolation at home. It also aims to map challenges using artificial intelligence-based telemedicine in the community.MethodsA systematic review was performed for the related articles published in 2019–2021 and conducted in the PubMed and ScienceDirect database using the keywords “telemedicine,” “artificial intelligence,” and “COVID-19”. The inclusion criteria were full-text articles and original research written in the English language.ResultsThirteen articles were included in this review to describe the current application of artificial intelligence-based telemedicine during the COVID-19 pandemic. Various current applications have been implemented, such as for early diagnosis and tracing of contact for the users, to monitor symptoms and decision-making treatment, clinical management, and virtual and remote treatment. We also proposed the framework of telemedicine powered by artificial intelligence for support the self-isolation of COVID-19 patients based on the recent update in technology. However, we identified some challenges for using digital health technologies because of the ethical and practical use, the policy and regulation, and device use both for healthcare workers and patients.ConclusionArtificial intelligence promises to improve the practice of medicine in various ways. However, practical applications still need to be explored, and medical professionals also need to adapt to these advances for better healthcare delivery to the public.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-16T06:57:06Z
      DOI: 10.1177/20552076221100634
      Issue No: Vol. 8 (2022)
       
  • Association between online health information-seeking and medication
           adherence: A systematic review and meta-analysis

    • Authors: Hooi Min Lim, Adam G Dunn, Jing Ran Lim, Adina Abdullah, Chirk Jenn Ng
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThe evidence of the impact of online health information-seeking (OHIS) on health outcomes has been conflicting. OHIS is increasingly recognised as a factor influencing health behaviour but the impact of OHIS on medication adherence remains unclear.ObjectivesWe conducted a systematic review and meta-analysis to examine the associations between OHIS and medication adherence.MethodsWe searched Medline, Embase, Web of Science, Scopus, CINAHL and Psychology and Behavioural Science Collection for studies published up to December 2020. The inclusion criteria were studies that reported the associations of OHIS and medication adherence, quantitative design, reported primary data only, related to any health condition where medications are used and conducted on patients either in clinical or community settings. A meta-analysis was used to examine the association between OHIS and medication adherence.ResultsA total of 17 studies involving 24,890 patients were included in this review. The study designs and results were mixed. In the meta-analysis, there was no significant association (n = 7, OR 1.356, 95% CI 0.793-2.322, p = 0.265), or correlation (n = 4, r = -0.085, 95% CI −0.572-0.446, p = 0.768) between OHIS and medication adherence. In the sub-group analysis of people living with HIV/AIDS, OHIS was associated with better medication adherence (OR 1.612, 95% CI 1.266-2.054, p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-13T02:58:57Z
      DOI: 10.1177/20552076221097784
      Issue No: Vol. 8 (2022)
       
  • Exploring the feasibility and acceptability of a sleep wearable headband
           among a community sample of chronic pain individuals: An at-home
           observational study

    • Authors: Zoe Zambelli, Cecilia E. Jakobsson, Laura Threadgold, Antonio R. Fidalgo, Elizabeth J. Halstead, Dagmara Dimitriou
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundChronic pain conditions affect up to one third of the adult population in the United Kingdom. Sleep problems are prevalent and negatively impact quality of life. Lack of standardised tools for routine screening and assessment of sleep changes have been a barrier for sleep management. Novel sleep wearables offer an exciting and accessible way to measure sleep but have not been tested outside of the consumer-led landscape and are not commonly used in research and clinical settings.AimsThe study aimed to explore the feasibility and acceptability of a sleep monitoring headband (Dreem 2) utilising EEG technology and accompanying smartphone application among a cohort of adults with chronic pain.ResultsTwenty-one adults (81% women) completed a one-week home sleep study using a sleep headband and accompanying app. Ninety per cent of participants met the pre-defined requirement of two-night's sleep recording. All participants recorded one night of sleep data via the sleep headband. The majority (76%) of participants were satisfied with the sleep study, and 86% of participants were willing to wear the headband longer than the 2-night minimum requirement. Finally, 76% reported the headband as ‘somewhat’ or ‘extremely’ comfortable whist awake; 57% rated the headband as comfortable during sleep.ConclusionThe Dreem 2 headband appears to be a feasible and acceptable means of collecting sleep measurements among individuals with chronic pain, despite common sleep disturbances. These devices may have utility for screening, assessment and monitoring in research and practice. Further research is needed to provide guidelines and training for integration.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-11T07:24:59Z
      DOI: 10.1177/20552076221097504
      Issue No: Vol. 8 (2022)
       
  • Exploring the effect of an eHealth intervention on women's physical
           activity: Design and rationale for a randomized controlled trial

    • Authors: Melissa Black, Jennifer Brunet
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis manuscript reports on the protocol for a three-arm randomized controlled trial aiming to assess the effect a self-determination theory-based eHealth intervention on physical activity among insufficiently active women who are overweight or obese.MethodsThe intervention-of-interest provided (A) six weekly behavioural support emails, (B) a wearable activity tracker, and (C) a copy and verbal explanation of the Canadian physical activity guidelines, and was compared to an intervention that provided (B + C) and another that provided (C). Women from a local community were invited to participate in this study. Participants were recruited between September 2018 and March 2019. Data were collected using self-report and direct measures three times: at baseline (week 0), post-intervention (week 7), and at follow-up (week 21). The primary outcome was self-reported total metabolic equivalent minutes of physical activity per week (MET-m/week); exploratory outcomes included number of days of strength training per week, self-determination theory constructs (i.e. motivational regulations, basic psychological needs satisfaction and thwarting), and well-being indicators (i.e. affect, vitality, depression).ConclusionFindings will provide insight into which combination of intervention components may be more effective at promoting physical activity among insufficiently active women who are overweight or obese, and thus inform the design of future interventions aiming to promote physical activity.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-09T11:08:11Z
      DOI: 10.1177/20552076221093134
      Issue No: Vol. 8 (2022)
       
  • Portable hardware & software technologies for addressing ophthalmic health
           disparities: A systematic review

    • Authors: Margarita Labkovich, Megan Paul, Eliott Kim, Randal A. Serafini, Shreyas Lakhtakia, Aly A Valliani, Andrew J Warburton, Aashay Patel, Davis Zhou, Bonnie Sklar, James Chelnis, Ebrahim Elahi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Vision impairment continues to be a major global problem, as the WHO estimates 2.2 billion people struggling with vision loss or blindness. One billion of these cases, however, can be prevented by expanding diagnostic capabilities. Direct global healthcare costs associated with these conditions totaled $255 billion in 2010, with a rapid upward projection to $294 billion in 2020. Accordingly, WHO proposed 2030 targets to enhance integration and patient-centered vision care by expanding refractive error and cataract worldwide coverage. Due to the limitations in cost and portability of adapted vision screening models, there is a clear need for new, more accessible vision testing tools in vision care. This comparative, systematic review highlights the need for new ophthalmic equipment and approaches while looking at existing and emerging technologies that could expand the capacity for disease identification and access to diagnostic tools. Specifically, the review focuses on portable hardware- and software-centered strategies that can be deployed in remote locations for detection of ophthalmic conditions and refractive error. Advancements in portable hardware, automated software screening tools, and big data-centric analytics, including machine learning, may provide an avenue for improving ophthalmic healthcare.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-06T11:09:48Z
      DOI: 10.1177/20552076221090042
      Issue No: Vol. 8 (2022)
       
  • A chronological and geographical analysis of personal reports of COVID-19
           on Twitter from the UK

    • Authors: Su Golder, Ari Z Klein, Arjun Magge, Karen O’Connor, Haitao Cai, Davy Weissenbacher, Graciela Gonzalez-Hernandez
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveGiven the uncertainty about the trends and extent of the rapidly evolving COVID-19 outbreak, and the lack of extensive testing in the United Kingdom, our understanding of COVID-19 transmission is limited. We proposed to use Twitter to identify personal reports of COVID-19 to assess whether this data can help inform as a source of data to help us understand and model the transmission and trajectory of COVID-19.MethodsWe used natural language processing and machine learning framework. We collected tweets (excluding retweets) from the Twitter Streaming API that indicate that the user or a member of the user's household had been exposed to COVID-19. The tweets were required to be geo-tagged or have profile location metadata in the UK.ResultsWe identified a high level of agreement between personal reports from Twitter and lab-confirmed cases by geographical region in the UK. Temporal analysis indicated that personal reports from Twitter appear up to 2 weeks before UK government lab-confirmed cases are recorded.ConclusionsAnalysis of tweets may indicate trends in COVID-19 in the UK and provide signals of geographical locations where resources may need to be targeted or where regional policies may need to be put in place to further limit the spread of COVID-19. It may also help inform policy makers of the restrictions in lockdown that are most effective or ineffective.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-05T11:57:28Z
      DOI: 10.1177/20552076221097508
      Issue No: Vol. 8 (2022)
       
  • Lights, camera…research! Short film and social media to recruit to
           HIV research in Indonesia

    • Authors: K Gedela, H Luis, RF Loverian, S Maharani, N Rajus, FS Wignall, A Garner, E Sukmaningrum, A McOwan, N Nwokolo, G Whitlock, I Irwanto
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionHIV prevalence among men who have sex with men has increased in Indonesia, amid reports of growing stigma against lesbian, gay, bisexual and transgender individuals and policies that have pushed back public health outreach to these groups.MethodsWe assessed the utility of tailored short film and targeted social media engagement to recruit men who have sex with men in Indonesia to HIV social science research. A short HIV testing promotion film, anonymised short survey and invite to a wider research study was embedded on a website platform and disseminated using geo and social/community group targeting for 1 month via a social networking app and social media platforms.ResultsFrom 3 January 2021 to 3 February 2021, there were over 2200 hits of the website within Indonesia. A total of 177 male web users who identified as men who have sex with men or preferred not to declare their sexuality, engaged by watching the short film and completing the survey, they were aged between 17 and 60 years old, of Indonesian nationality and living in Indonesia. Of these, 88% indicated having at least one HIV test in their lifetime, 66% had felt shame with respect to their sexuality and 53% indicated feeling afraid to have a HIV test. Ninety (51%) of the 177 validated using their email or mobile phone number demonstrating willingness to be contacted to join a further study. Twenty-three eligible men who have sex with men, aged 21–55 years old, joined a further social science research study. Participants were from diverse backgrounds and included men born in provinces outside Bali, of different socio-economic and employment backgrounds and diverse relationship contexts.DiscussionEngaging, empowering digital media involving key health messaging can provide health education in more effective ways, build trust and bring communities together. Targeted digital and social media approaches could reach increasingly marginalised and vulnerable communities to promote individual and public health and enable recruitment to valuable medical research.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-05T01:46:11Z
      DOI: 10.1177/20552076221090049
      Issue No: Vol. 8 (2022)
       
  • Assessing the performances of a chatbot to collect real-life data of
           patients suffering from primary headache disorders

    • Authors: Benjamin Chaix, Jean-Emmanuel Bibault, Rolland Romain, Arthur Guillemassé, Mikaël Neeral, Guillaume Delamon, Julien Moussalli, Benoît Brouard
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThere are many scales for screening the impact of a disease. These scales are generally used to diagnose or assess the type and severity of a disease and are carried out by doctors. The chatbot helps patients suffering from primary headache disorders through personalized text messages. It could be used to collect patient-reported outcomes.ObjectiveThe aims of this study were (1) to study whether the collection and analysis of remote scores, without prior medical intervention, are possible by a chatbot, (2) to perform suggested diagnosis and define the type of headaches, and (3) to assess the patient satisfaction and engagement with the chatbot.MethodVoluntary users of the chatbot were recruited online. They had to be over 18 and have a personal history of headaches. A questionnaire was presented (1) by text messages to the participants to evaluate migraines (2) based on the criteria of the International Headache Society. Then, the Likert scale (3) was used to assess overall satisfaction with the use of the chatbot.ResultsWe included 610 participants with primary headache disorders. A total of 89.94% (572/610) participants had fully completed the questionnaire (eight items), 4.72% (30/610) had partially completed it, and 5.41% (33) had refused to complete it. Statistical analysis was performed on 86.01% (547/610) of participants. Auto diagnostic showed that 14.26% (78/547) participants had a tension headache, and 85.74% (469/547) had a probable migraine. In this population, 15.78% (74/469) suffered from migraine without probable aura, and 84.22% (395/469) had migraine without aura. The patient’s age had a significant incidence regarding the auto diagnosis (P = .008
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-03T11:24:35Z
      DOI: 10.1177/20552076221097783
      Issue No: Vol. 8 (2022)
       
  • Technology-based interventions to improve adherence to antihypertensive
           medications – An evidence-based review

    • Authors: Gary Chun-Yun Kang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPoor adherence to anti-hypertensive medications leads to poorly controlled blood pressure which is associated with worse cardiovascular outcomes. Emerging technologies may be utilised advantageously in interventions to improve adherence and reduce morbidity and mortality from poorly controlled hypertension.ObjectiveTo determine the efficacy of technology-based interventions in improving adherence to antihypertensive medications.MethodsPubMed and EMBASE databases were searched using keywords and MeSH terms. Included studies met the following criteria: randomized controlled trial (RCT); adults ≥ 18 years old taking anti-hypertensives; intervention delivered by or accessed using a technological device or process; intervention designed to improve adherence.Results12 papers met inclusion criteria for the current review: 5 studies significantly improved adherence when compared to usual care; of these 5 studies, 2 had corresponding significant improvement in blood pressure. Successful interventions were: electronic medication bottle cap with audio-visual reminder; short message service (SMS) containing educational information (2 studies); reporting of self-measured blood pressure to a telephone-linked computer system; sending a video of every drug ingestion to obtain monetary rewards.ConclusionRCTs on technological interventions to improve adherence and those showing significant effect are rare. Some of the interventions show potential to be applied to other populations, especially if targeted at patients with poor adherence at baseline.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-03T07:02:41Z
      DOI: 10.1177/20552076221089725
      Issue No: Vol. 8 (2022)
       
  • Strategies for improving recruitment of pregnant women to clinical
           research: An evaluation of social media versus traditional offline methods
           

    • Authors: Kelsey M Cochrane, Jennifer A Hutcheon, Crystal D Karakochuk
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesTo evaluate the recruitment of pregnant women for a clinical trial in Vancouver, Canada, via social media versus offline methods and to explore optimization of social media campaigns.MethodsFacebook was used to run nine social media campaigns (15 weeks total, CA$675). Offline methods were used concurrently over 64 weeks (printing costs: CA$300). The cost, rate of recruitment and conversion rate in each group was calculated. Performance metrics of social media campaigns (reach, impressions, clicks, inquiries, enrolments) were recorded. Linear regression was used to explore the association between metrics and dollars spent per campaign.ResultsIn total, n = 481 inquiries were received: n = 51 (11%) via offline methods and n = 430 (89%) via social media. Enrolees (n = 60 total) included n = 24 (40%) and n = 36 (60%) via offline and social media methods, respectively. Gestational weeks upon inquiry (n = 251; mean ± SD) were not different among groups (offline: 13.3 ± 4.7; social media: 13.2 ± 5.6). Direct cost per enrolee was CA$13 and CA$19 via offline and social media methods, respectively (however, this does not include cost of labour). The rate of recruitment was approximately six times faster via social media. However, the conversion rate was higher via offline methods than social media (47% vs. 8%). The amount spent per campaign was significantly associated with improved clicks and inquiries, but not enrolments.ConclusionsSocial media was more efficient and effective than offline methods. We gained numerous insights for optimization of social media campaigns (dollars spent, attribution setting, photo testing, automatic optimization) to increase clicks and inquiries, however, this does not necessarily increase enrolments, which was more dependent on study-specific factors (e.g. time of year, study design).
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-03T03:53:39Z
      DOI: 10.1177/20552076221095707
      Issue No: Vol. 8 (2022)
       
  • Artificial intelligence and medical education: A global mixed-methods
           study of medical students’ perspectives

    • Authors: Hamza Ejaz, Hari McGrath, Brian LH Wong, Andrew Guise, Tom Vercauteren, Jonathan Shapey
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveMedical students, as clinicians and healthcare leaders of the future, are key stakeholders in the clinical roll-out of artificial intelligence-driven technologies. The authors aim to provide the first report on the state of artificial intelligence in medical education globally by exploring the perspectives of medical students.MethodsThe authors carried out a mixed-methods study of focus groups and surveys with 128 medical students from 48 countries. The study explored knowledge around artificial intelligence as well as what students wished to learn about artificial intelligence and how they wished to learn this. A combined qualitative and quantitative analysis was used.ResultsSupport for incorporating teaching on artificial intelligence into core curricula was ubiquitous across the globe, but few students had received teaching on artificial intelligence. Students showed knowledge on the applications of artificial intelligence in clinical medicine as well as on artificial intelligence ethics. They were interested in learning about clinical applications, algorithm development, coding and algorithm appraisal. Hackathon-style projects and multidisciplinary education involving computer science students were suggested for incorporation into the curriculum.ConclusionsMedical students from all countries should be provided teaching on artificial intelligence as part of their curriculum to develop skills and knowledge around artificial intelligence to ensure a patient-centred digital future in medicine. This teaching should focus on the applications of artificial intelligence in clinical medicine. Students should also be given the opportunity to be involved in algorithm development. Students in low- and middle-income countries require the foundational technology as well as robust teaching on artificial intelligence to ensure that they can drive innovation in their healthcare settings.
      Citation: DIGITAL HEALTH
      PubDate: 2022-05-02T07:08:32Z
      DOI: 10.1177/20552076221089099
      Issue No: Vol. 8 (2022)
       
  • High-throughput digital cough recording on a university campus: A
           SARS-CoV-2-negative curated open database and operational template for
           acoustic screening of respiratory diseases

    • Authors: Eric M. Keen, Emily J. True, Alyssa R. Summers, Everett Clinton Smith, Joe Brew, Simon Grandjean Lapierre
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveRespiratory illnesses have information-rich acoustic biomarkers, such as cough, that can potentially play an important role in screening populations for disease risk. To realize that potential, datasets of paired acoustic-clinical samples are needed for the development and validation of acoustic screening models, and protocols for collecting acoustic samples must be efficient and safe. We collected cough acoustic signatures at a high-throughput SARS-CoV-2 testing site on a college campus. Here, we share logistical details and the dataset of acoustic cough signatures paired with the gold standard in SARS-CoV-2 testing of SARS-CoV-2 genomic sequences using qRT-PCR.MethodsCough recordings were collected in winter-spring 2021 at a rural residential college (Sewanee, TN, USA), where approximately 2000 students were tested for SARS-CoV-2 on a weekly basis. Cough collection was managed by student volunteers using custom software.Results4302 coughs were recorded from 960 participants over 11 weeks. All coughs were COVID-19 negative. Approximately 30 s were required to check-in a participant and collect their cough.ConclusionThe value of acoustic screening tools depends upon our ability to develop and implement them reliably and quickly. For that to happen, high-quality datasets and logistical insights must be collected and shared on an ongoing basis.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-29T04:59:15Z
      DOI: 10.1177/20552076221097513
      Issue No: Vol. 8 (2022)
       
  • Prospective trial registration and publication rates of randomized
           clinical trials in digital health: A cross-sectional analysis of global
           trial registries

    • Authors: Mustafa Al-Durra, Robert P Nolan, Emily Seto, Joseph A Cafazzo
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesWe sought to examine the prevalence of prospective registration and publication rates in digital health trials.Materials and MethodsWe included 417 trials that enrolled participants in 2012 and were registered in any of the 17 WHO data provider registries. The evaluation of the prospective trial registration was based on the actual difference between the registration and enrollment dates. We identified existing publications through an automated PubMed search by every trial registration number as well as a pragmatic search in PubMed and Google based on extracted metadata from the trial registries.ResultsThe prospective registration and publication rates were at (38.4%) and (65.5%), respectively. We identified a statistically significant (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-27T03:59:29Z
      DOI: 10.1177/20552076221090034
      Issue No: Vol. 8 (2022)
       
  • Smartphone movement sensors for the remote monitoring of respiratory
           rates: Technical validation

    • Authors: Sophie Valentine, Adam C. Cunningham, Benjamin Klasmer, Mohammad Dabbah, Marko Balabanovic, Mert Aral, Dan Vahdat, David Plans
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundMobile health (mHealth) offers potential benefits to both patients and healthcare systems. Existing remote technologies to measure respiratory rates have limitations such as cost, accessibility and reliability. Using smartphone sensors to measure respiratory rates may offer a potential solution to these issues.ObjectiveThe aim of this study was to conduct a comprehensive assessment of a novel mHealth smartphone application designed to measure respiratory rates using movement sensors.MethodsIn Study 1, 15 participants simultaneously measured their respiratory rates with the app and a Food and Drug Administration-cleared reference device. A novel reference analysis method to allow the app to be evaluated ‘in the wild’ was also developed. In Study 2, 165 participants measured their respiratory rates using the app, and these measures were compared to the novel reference. The usability of the app was also assessed in both studies.ResultsThe app, when compared to the Food and Drug Administration-cleared and novel references, respectively, showed a mean absolute error of 1.65 (SD  =  1.49) and 1.14 (1.44), relative mean absolute error of 12.2 (9.23) and 9.5 (18.70) and bias of 0.81 (limits of agreement = –3.27 to 4.89) and 0.08 (–3.68 to 3.51). Pearson correlation coefficients were 0.700 and 0.885. Ninety-three percent of participants successfully operated the app on their first use.ConclusionsThe accuracy and usability of the app demonstrated here in individuals with a normal respiratory rate range show promise for the use of mHealth solutions employing smartphone sensors to remotely monitor respiratory rates. Further research should validate the benefits that this technology may offer patients and healthcare systems.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-25T11:01:02Z
      DOI: 10.1177/20552076221089090
      Issue No: Vol. 8 (2022)
       
  • Can digital engagement improve outcomes for total joint replacements'

    • Authors: Carly E Milliren, Bill Lindsay, Lisa Biernat, Todd A Smith, Betsy Weaver
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundPatient activation and engagement can improve outcomes of medical and surgical care by increasing involvement of patients in their care plan. We designed a digital engagement tool to improve surgical cancellation and post-surgical outcomes for adult patients undergoing total joint replacements by providing patient education materials via email or text, in small increments throughout the perioperative period.MethodsWe assessed the tool's impact using a quasi-experimental design comparing patients scheduled for surgery January–June 2017 (pre-intervention) versus January–June 2018 (post-intervention). Post-intervention patients with digital contact information in the medical record were automatically enrolled. We extracted de-identified administrative data for all patients during both time periods and utilized an intent-to-treat approach including all post-intervention patients regardless of enrollment. Surgical cancellation and post-surgical outcomes (length of stay, discharge to home and revisits and readmissions) were compared between periods using adjusted regression models. We also examined associations between measures of engagement with the intervention and outcomes.ResultsA total of 2027 joint replacement patients were included (720 hip replacements; 1307 knee replacements). Adjusting for gender, age and insurance type, both hip and knee patients in the post-intervention group were more likely to have a cancelled surgery, but cancellations were less likely to be on the day of surgery compared to pre-intervention patients. Post-intervention patients were also less likely to have length of stay>2 days. Forty- three per cent of hip and 47% of knee patients in the post-period received the intervention and most were highly engaged. Higher engagement was associated with lower odds of surgical cancellation, shorter stays and higher odds of discharge home.ConclusionFindings suggest that utilization of a digital patient engagement tool translates into improved hospital efficiency and patient outcomes, particularly for those highly engaged.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-25T05:37:57Z
      DOI: 10.1177/20552076221095322
      Issue No: Vol. 8 (2022)
       
  • Development of a framework to promote rural health workforce capability
           through digital solutions: A qualitative study of user perspectives

    • Authors: Robyn Ramsden, Sabrina Pit, Richard Colbran, Kristy Payne, Aaron JH Tan, Michael Edwards
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      A high-quality, sustained, health workforce contributes to a healthy population. However, a global reality is that rural health services, and the workforces that provide those services, are under unprecedented pressure. It is posited that improving a rural health practitioners’ capability could help to retain them working rurally for longer. Capability refers to skills and experience and the extent to which individuals can adapt to change, generate new knowledge and continue to improve their performance. With rapidly increasing access to, and use of, digital technology worldwide, there are new opportunities to build capability and leverage personal and professional support for those who are working rurally. In 2021, semi-structured interviews were conducted in rural Australia with thirteen General Practitioners and allied health professionals. Thematic analysis was adopted to analyse the data and map it to the Health Information Technology Acceptance Model. Whilst it could be assumed that low technology literacy would act as a barrier to the use of digital tools, the study demonstrated that this was not a significant impediment to participants’ willingness to adopt digital tools when social and professional networks weren't available face to face to address their capability challenges. The findings provide insight into the concept of health workforce capability and important considerations when designing capability support. This includes key features of health apps or digital tools to support the capability of the rural health workforce. Understanding the factors that make up a health professionals’ capability and the motivations or cues to act to build or maintain their capability may have a positive effect on their retention in a rural location.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-25T05:37:33Z
      DOI: 10.1177/20552076221089082
      Issue No: Vol. 8 (2022)
       
  • Understanding the attitudes and experiences of people living with
           potentially stigmatised long-term health conditions with respect to
           collecting and sharing health and lifestyle data

    • Authors: Richard Brown, Elizabeth Sillence, Lynne Coventry, Emma Simpson, Jo Gibbs, Shema Tariq, Abigail C. Durrant, Karen Lloyd
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThe emerging landscape of patient-generated data (PGData) provides an opportunity to collect large quantities of information that can be used to develop our understanding of different health conditions and potentially improve the quality of life for those living with long-term health condition (LTHCs). If the potential benefits of PGData are to be realised, we need a better understanding of the psychological barriers and facilitators to the collection and beneficial sharing of health and lifestyle data. Due to the understudied role that stigma plays in sharing PGData, we explore the attitudes and experiences of those living with potentially stigmatised LTHCs with respect to collecting and sharing health and lifestyle data.MethodsThis study used semi-structured interviews and a card sorting task to explore the attitudes and experiences of people living with potentially stigmatised LTHCs. Fourteen adult participants who reported having a range of conditions were recruited in England. Template analysis was used to analyse interview transcripts and descriptive statistics were used for the card sorting task.ResultsThe findings present four overarching themes: Preferences for collecting health and lifestyle data, Importance of anonymity, Expected use of data, and Sources of emotional support. Participants illustrated a general willingness to share health and lifestyle data; however, there were some notable differences in sharing experiences, varying both by information type and recipient group. Overall, participants did not identify health-related stigma as a barrier to collecting or sharing their personal health and lifestyle data.ConclusionsWe outline a number of preferences that participants feel would encourage them to collect and share data more readily, which may be considered when developing data sharing tools for the future.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-18T02:40:49Z
      DOI: 10.1177/20552076221089798
      Issue No: Vol. 8 (2022)
       
  • Expecting parents’ use of digital sources in preparation for parenthood
           in a digitalised society – a systematic review

    • Authors: Caroline Bäckström, Kristina Carlén, Viveca Larsson, Lena Birgitta Mårtensson, Stina Thorstensson, Marina Berglund, Therese Larsson, Björn Bouwmeester, Marie Wilhsson, Margaretha Larsson
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundIn today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.QuestionThe focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.MethodsA systematic review covered the thematic analysis of 39 articles.FindingsThe analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.ConclusionDifferent digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-15T05:45:18Z
      DOI: 10.1177/20552076221090335
      Issue No: Vol. 8 (2022)
       
  • Human-centered design exploration with Kenyan health workers on proposed
           digital mental health screening and intervention training development:
           Thematic analysis of user preferences and needs

    • Authors: Manasi Kumar, Paul Macharia, Vincent Nyongesa, Joseph Kathono, Obadia Yator, Shillah Mwaniga, Mary McKay, Keng Yen Huang, Rahul Shidhaye, Simon Njuguna, Shekhar Saxena
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundHealth providers' perceived sense of knowledge, competency, and self-efficacy to support the needs of their patients contributes to optimal patient health outcomes. With regards to mental health service delivery in Kenya, this area needs further exploration. Guided by the e-health technology acceptance mode, the needs and preferences of health care providers around mental health training for clinical management and their ability to intervene in peripartum adolescent mental health care are explored. We probed how well-equipped service providers are, their engagement with technology to learn and offer services. The health care provider's technology use preferences were also explored.MethodGuided by a human-centered design-focused qualitative inquiry we interviewed 20 specialists around their needs, perspectives, and preferences for digitized mental health screening and intervention. Mean age was 44.2 years, (range of 32–58 years), 25% (5) males and 75% (15) females. After a written consenting process, the online interviews (30−45 min) were conducted in April 2021, once personal information was de-identified interviews were transcribed and coded. Thematic analysis was used and we combined rapid appraisal of Google Jamboard online storyboards to do individual human-centered design personas alongside.ResultsOur participants were well-exposed to digital technologies. Prohibitive costs of data bundles, lack of funds for consistent online engagement, high workload, and instability of access to appropriate gadgets were found to be barriers to e-health training. Emerging opportunities were well-identified adolescent mental health service and intervention needs, willingness to take online courses offered on learning platforms, and wish for these to be disseminated through diverse social media. Other recommendations were the need to have a user-friendly interface such as data-light engaging and practical materials including animations, short, group-based learning.ConclusionUnderstanding contextual factors that influence perceived usefulness and ease of use of the remote/digital components would be critical for e-training development and its uptake.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-15T05:45:04Z
      DOI: 10.1177/20552076221090035
      Issue No: Vol. 8 (2022)
       
  • The bright side of social network sites: On the potential of online social
           capital for mental health

    • Authors: Felix S Hussenoeder
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Social network sites are an essential part of the daily lives of people around the globe, but our theoretical understanding of the phenomenon is still limited. However, to fully grasp the potential of social network sites and to be able to generate meaningful applications, a theoretical understanding of the phenomenon is needed. I want to introduce the concept of online social capital as the first step in this direction, and show how it could be applied to the area of mental health. Therefore, I will (1) bring together social network sites and social capital theory, (2) introduce online social capital with a special focus on its capacity and mobilization as well as on associated processes of relationship maintenance and information search, (3) explore potential implications for mental health promotion, (4) depict the mental health risks that are associated with the use of social network sites, and (5) highlight some areas for future research.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-12T07:37:51Z
      DOI: 10.1177/20552076221093133
      Issue No: Vol. 8 (2022)
       
  • Ethical issues of collecting, storing, and analyzing geo-referenced tweets
           for mental health research

    • Authors: Marta Fadda, Martin Sykora, Suzanne Elayan, Milo A Puhan, John A Naslund, Stephen J Mooney, Emiliano Albanese, Rosalba Morese, Oliver Gruebner
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Spatial approaches to epidemiological research with big social media data provide tremendous opportunities to study the relationship between the socio-ecological context where these data are generated and health indicators of interest. Such research poses a number of ethical challenges, particularly in relation to issues such as privacy, informed consent, data security, and storage. While these issues have received considerable attention by researchers in relation to research for physical health purposes in the past 10 years, there have been few efforts to consider the ethical challenges of conducting mental health research, particularly with geo-referenced social media data. The aim of this article is to identify strengths and limitations of current recommendations to address the specific ethical issues of geo-referenced tweets for mental health research. We contribute to the ongoing debate on the ethical implications of big data research and also provide recommendations to researchers and stakeholders alike on how to tackle them, with a specific focus on the use of geo-referenced data for mental health research purposes. With increasing awareness of data privacy and confidentiality issues (even for non-spatial social media data) it becomes crucial to establish professional standards of conduct so that compliance with ethical standards of conducting research with health-related social media data can be prioritized and easily assessed.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-12T07:37:43Z
      DOI: 10.1177/20552076221092539
      Issue No: Vol. 8 (2022)
       
  • Analyzing program data and promotional approaches to inform best practices
           from a mobile phone-based reproductive health message program in
           Afghanistan

    • Authors: Lara Lorenzetti, Kate F. Plourde, Sayed Haroon Rastagar, Arzoo S. Afzali, Ahmad S. Sultani, Abdul Khaleq Khalil, Abdul Waheed Adeeb, Shafiqullah Hemat, Catherine S. Todd
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveDigital health technologies have contributed to the adoption of beneficial reproductive, maternal, newborn, and child health (RMNCH) behaviors through social and behavior change programming, including in hard-to-reach settings. On-demand digital health interventions rely on promotions to build awareness and increase use among target audiences. There is little research on preferred content and use of promotional approaches for RMNCH digital health activities.MethodsWe conducted a retrospective descriptive analysis of Mobile for Reproductive Health (m4RH) data in Afghanistan to assess the use and changes in call volume via the 2-3-4 platform by promotional approaches over 23 months between October 2017 and August 2019.ResultsThere were 103,859 completed messages (CM) heard. Most callers reporting demographics were under 18 years, with roughly even distribution by gender. The number of CMs listened to across all menus increased with time. The basic m4RH family planning menu was most popular, with callers most frequently selecting information on intrauterine contraceptive devices. Nine types of promotional approaches were implemented. Compared against call volume, SMS blast promotion was the most productive promotional approach, radio broadcasts had modest increases, and social media and interpersonal communication demonstrated no clear change.Conclusionsm4RH use increased over time, particularly among younger people. The number of promotional approaches used does not appear as important as the type of approach used to generate program awareness. Mass media communications, including SMS blast promotions and radio broadcasts, may be the most effective strategies. Deeper program data analysis can guide tailoring of message content and promotional approaches to reach target audiences with the RMNCH content they most value.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-12T07:37:34Z
      DOI: 10.1177/20552076221089801
      Issue No: Vol. 8 (2022)
       
  • Web messaging among young people in online services: A descriptive
           mixed-methods study

    • Authors: Kiki Metsäranta, Minna Anttila, Tatjana Pajamäki, Heidi Holappa, Maritta Välimäki
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo describe web messaging patterns and the content of web messages among young people in a Finnish national online service.MethodsA descriptive mixed-method was used. The data consisted of text-based web messaging communication between young people and a counsellor in a nationwide online service between 1 January and 31 December 2018. Web messaging patterns were analysed using descriptive statistics. The content of the messages was analysed with thematic analysis and qualitative results were presented. In addition, the factors associated with messaging patterns and content were analysed.ResultsA total of 1941 messages were sent by 1354 young people. Most of them were between 12 and 17 years old and females. Less than one-fifth of young people had multiple two-way discussions with counsellor. The total period of two-way discussions and the number of words in each message varied widely. The number of words was lower in messages sent by males. The content of the messages was divided into three main themes: interpersonal relationships and environment (Social relationships), oneself (Construction of self), and health-related problems and support received from professionals (Health and wellbeing). The young people’s messages mostly contained topics related to the main theme of ‘Social environment’.ConclusionMost young people sent one message only. Messages ranged from simple, single messages to complex texts describing the daily life of young people. Girls were more active in messaging, and they wrote longer texts.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T04:27:56Z
      DOI: 10.1177/20552076221092534
      Issue No: Vol. 8 (2022)
       
  • A computer-aided diagnostic framework for coronavirus diagnosis using
           texture-based radiomics images

    • Authors: Omneya Attallah
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The accurate and rapid detection of the novel coronavirus infection, coronavirus is very important to prevent the fast spread of such disease. Thus, reducing negative effects that influenced many industrial sectors, especially healthcare. Artificial intelligence techniques in particular deep learning could help in the fast and precise diagnosis of coronavirus from computed tomography images. Most artificial intelligence-based studies used the original computed tomography images to build their models; however, the integration of texture-based radiomics images and deep learning techniques could improve the diagnostic accuracy of the novel coronavirus diseases. This study proposes a computer-assisted diagnostic framework based on multiple deep learning and texture-based radiomics approaches. It first trains three Residual Networks (ResNets) deep learning techniques with two texture-based radiomics images including discrete wavelet transform and gray-level covariance matrix instead of the original computed tomography images. Then, it fuses the texture-based radiomics deep features sets extracted from each using discrete cosine transform. Thereafter, it further combines the fused texture-based radiomics deep features obtained from the three convolutional neural networks. Finally, three support vector machine classifiers are utilized for the classification procedure. The proposed method is validated experimentally on the benchmark severe respiratory syndrome coronavirus 2 computed tomography image dataset. The accuracies attained indicate that using texture-based radiomics (gray-level covariance matrix, discrete wavelet transform) images for training the ResNet-18 (83.22%, 74.9%), ResNet-50 (80.94%, 78.39%), and ResNet-101 (80.54%, 77.99%) is better than using the original computed tomography images (70.34%, 76.51%, and 73.42%) for ResNet-18, ResNet-50, and ResNet-101, respectively. Furthermore, the sensitivity, specificity, accuracy, precision, and F1-score achieved using the proposed computer-assisted diagnostic after the two fusion steps are 99.47%, 99.72%, 99.60%, 99.72%, and 99.60% which proves that combining texture-based radiomics deep features obtained from the three ResNets has boosted its performance. Thus, fusing multiple texture-based radiomics deep features mined from several convolutional neural networks is better than using only one type of radiomics approach and a single convolutional neural network. The performance of the proposed computer-assisted diagnostic framework allows it to be used by radiologists in attaining fast and accurate diagnosis.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T04:26:56Z
      DOI: 10.1177/20552076221092543
      Issue No: Vol. 8 (2022)
       
  • Perspective on digital communication with health professions from close
           supporters of young people with long-term health conditions (The LYNC
           Study)

    • Authors: Ayako Temple, Kathryn Hamilton, Carol Bryce, Frances Griffiths, Jackie Sturt
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveTo understand the impact of digital communication using email and text between young people and their health care team on those in close supporting roles.MethodsTwelve people (nine parents and three partners) of young people with long-term health conditions were interviewed between November 2014 and March 2016. Thematic analysis was performed followed Braun and Clarke's (2006) 6-phase method.ResultsFour main themes were identified. Close supporters felt that digital clinical communication was useful for young persons’ self-management. As well as young patients, close supporters would also like to have direct access to the clinicians, but it was necessary to build up a trusting relationship between close supporters and clinicians initially. Video appointments were suggested for future digital communication technology.ConclusionsClose supporters were encouraging digital communication for their young person with diabetes. Clinicians should put an emphasis on establishing trusting relationships with both young people and close supporters which would be beneficial for their digital clinical communications.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T04:26:46Z
      DOI: 10.1177/20552076221092536
      Issue No: Vol. 8 (2022)
       
  • Digital tools to support the maintenance of physical activity in people
           with long-term conditions: A scoping review

    • Authors: Paul Clarkson, Aoife Stephenson, Chloe Grimmett, Katherine Cook, Carol Clark, Paul E Muckelt, Philip O’Gorman, Zoe Saynor, Jo Adams, Maria Stokes, Suzanne McDonough
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings.MethodsSearches were conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholar and clinical trial databases, for studies published between 2009 and 2019, across a range of long-term conditions. Screening and data extraction was undertaken by two independent reviewers and the Preferred Reporting Items for Scoping Reviews guidelines informed the review's conduct and reporting.ResultsA total of 38 results were identified from 34 studies, with the majority randomised controlled trials or protocols, with cardiovascular disease, type 2 diabetes mellitus and obesity the most common long-term conditions. Comorbidities were reported in>50% of studies but did not clearly inform intervention development. Most digital tools were web-browser-based ± wearables/trackers, telerehabilitation tools or gaming devices/components. Mobile device applications and combination short message service/activity trackers/wearables were also identified. Most interventions were supported by a facilitator, often for goal setting/feedback and/or monitoring. Physical activity maintenance outcomes were mostly reported at 9 months or 3 months post-intervention, while theoretical underpinnings were commonly social cognitive theory, the transtheoretical model and the theory of planned behaviour.ConclusionsThis review mapped the literature on a wide range of digital tools and long-term conditions. It identified the increasing use of digital tools, in combination with human support, to help people with long-term conditions, to maintain physical activity, commonly for under a year post-intervention. Clear gaps were the lack of digital tools for multimorbid long-term conditions, longer-term follow-ups, understanding participant's experiences and informs future questions around effectiveness.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T04:26:42Z
      DOI: 10.1177/20552076221089778
      Issue No: Vol. 8 (2022)
       
  • Tracking the trackers: Self-tracking in households as social practice

    • Authors: Mariannn (Maz) Hardey
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The purpose of this article is to examine the effect of different types of self-tracking users (trackers) on the health behaviours of others living in the same household. The study takes an international perspective, examining tracking practises from 13 households based in Europe, the United Kingdom and the United States to determine how trackers contribute to emerging cultural and social factors across life stages. The findings contribute to digital health understandings by shedding light on collective practises formed within frequently intergenerational households. The study emphasises the importance of cross-cultural and intergenerational tracking research to foster collective and symbolic health engagement. The article delves into the intersection of online and offline dynamics to describe the social practice of digital health culture. It sheds new light on structural and agency issues in households sharing self-tracking experiences.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T02:03:03Z
      DOI: 10.1177/20552076221093131
      Issue No: Vol. 8 (2022)
       
  • Nurses’ experiences of using AsthmaTuner – an eHealth self-management
           system for healthcare of patients with asthma

    • Authors: Katarina Schoultz, Ann Svensson, Maria Emilsson
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study describes nurses’ experiences of using eHealth for assessment in the healthcare of patients with asthma.MethodsFive nurses with experience of using AsthmaTuner in the healthcare of patients with asthma participated in the study. Individual semi-structured interviews were conducted with the nurses to understand their experiences of using the eHealth system. The transcribed interviews were analyzed using qualitative content analysis.ResultsThe results show that nurses as well as patients find the tool useful and easy-to-handle. AsthmaTuner gives the nurses access to more and better information about the patients, which facilitates assessments and makes their work more efficient. The patients become more involved in their care, gain increased control and take more responsibility for their illness and treatment.ConclusionsThe nurses appreciate eHealth in asthma care. Using AsthmaTuner makes the nurses’ work more efficient and the patients become more involved in their care.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T02:02:42Z
      DOI: 10.1177/20552076221092542
      Issue No: Vol. 8 (2022)
       
  • A digital mobile health platform increasing efficiency and transparency
           towards universal health coverage in low- and middle-income countries

    • Authors: Liesbeth Huisman, Shannen MC van Duijn, Nuno Silva, Rianne van Doeveren, Jacinta Michuki, Moses Kuria, David Otieno Okeyo, Isaiah Okoth, Nathalie Houben, Tobias F Rinke de Wit, Khama Rogo
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      In low-and middle-income countries, achieving universal health coverage remains challenging due to insufficient, temporary and fragmented funding as well as limited accessibility to quality healthcare. Leveraging a mobile health platform can be a powerful tool to address these problems. This paper demonstrates how analysing data collected from a mobile health platform helps optimize healthcare provider networks, monitor patient flows and assess the quality and equitability of access to care. The COVID-19 pandemic reinforces the importance of real-time data on health-seeking behaviour. Between 2018 and 2019, as a Kenyan universal health coverage pilot was being planned, Kisumu County, with support from PharmAccess Foundation, implemented household-level digital registration for healthcare and collected socio-economic and healthcare claims data using the M-TIBA platform. In total, 273,350 Kisumu households enrolled. The claims data showed many patients visit higher-level facilities for ailments, that can be treated at primary care levels, unnecessarily. High-level estimate of the disease burden at participating facilities revealed rampant overprescription of pertinent medicines for highly prevalent malaria and respiratory tract infections, exemplifying clinical management deficiencies. M-TIBA data allowed tracking of individual patient trajectories. Analyses of data are shown at the aggregate level. The paper shows how mobile health platforms can be used to generate valuable insights into access to and quality of care. Funding for healthcare can be united through mobile health platforms, limiting the fragmentation in funding. They can be useful for funders, health managers and policymakers to improve the implementation of universal health coverage programs in low-and middle-income countries.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T02:02:22Z
      DOI: 10.1177/20552076221092213
      Issue No: Vol. 8 (2022)
       
  • A bibliometric analysis on global eHealth

    • Authors: Hua Tian, Jie Chen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThe current coronavirus disease 2019 pandemic highlights the potential of eHealth. Drawing the knowledge map of eHealth research through data mining and visual analysis technology was helpful to systematically present the research status and future trends of global academic circles.MethodsBased on the web of Science Core Collection (SCIE/SSCI) database, using bibliometric theory and visual analysis technology, this work analyzed the global eHealth research publications from 2000 to 2021, and introduced the interdisciplinary characteristics, hot topics and future trends in this field.ResultsA total of 10188 authors, 891 journals, 3586 institutions, 98 countries using 12 languages had conducted eHealth research in the world. The United States, the Netherlands, Australia and the United Kingdom were the main forces and international cooperation. However, the international co-operation between Eastern and Western countries was still relatively few. The frontier of global eHealth research mainly focused on #0eHealth innovation, #1physical activity, #2generalised anxiety disorder, #3lightweight authentication protocol, #4 eHealth information, #5technology readiness, #6 ehealth literacy scale, #7family carer, #8citance analysis, #9 guiding patient. Clusters #3 lightweight authentication protocol and #9 guiding patient were the latest clusters, indicating the research trend and direction of eHealth in the future.ConclusionsCooperation network framework at the regional, national and global levels and the cooperation of multidisciplinary teams with complementary backgrounds and expertise were needed to realize the in-depth popularization and application of eHealth knowledge. Interdisciplinary international cooperation should be the trend of eHealth research in the future.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-11T02:02:05Z
      DOI: 10.1177/20552076221091352
      Issue No: Vol. 8 (2022)
       
  • Perceptions on mobile health use for health education in an Indigenous
           population

    • Authors: Valerie Umaefulam, Kalyani Premkumar, Marguerite Koole
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionIndigenous peoples in Canada face numerous health needs and challenges and often have poor health status due to inequitable access to care. Providing culturally appropriate support for health conditions, particularly chronic conditions that require self-management, can assist in averting complications and morbidity. Mobile health is a useful medium for delivering health education across different populations. However, meaningful user involvement is necessary because mobile health interventions suitable for one population may not be appropriate for another. Indigenous people’s views will inform the use of mobile health interventions in Indigenous communities.ObjectiveThe study explored the perception of Indigenous women on using mobile health as a tool for receiving health information.MethodsThis was a qualitative study, and participants comprised of 22 Indigenous women (First Nations and Métis) with or at risk of diabetes, aged 18–69 years in Saskatoon, Canada. After 12 weeks of disseminating diabetic eye care information via text messaging, data were collected via sharing circle discussions and analyzed using thematic analysis.ResultsParticipants indicated that the nature of messages such as the use of Indigenous languages, the message content, frequency of messages, group activities, and delivery formats such as voice messages, mobile applications, Internet, two-way messaging, and text messages were essential considerations in using mobile health as a tool for receiving health information.ConclusionDifferent factors need to be considered in using mobile health as a tool for health education among Indigenous peoples. These factors could be applicable in implementing mobile health solutions in other populations for the management of health conditions.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-08T05:45:44Z
      DOI: 10.1177/20552076221092537
      Issue No: Vol. 8 (2022)
       
  • A ubiquitous healthcare system of 3D printing facilities for making
           dentures: Application of type-II fuzzy logic

    • Authors: Min-Chi Chiu, Tin-Chih Toly Chen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      A ubiquitous healthcare (UH) system of multiple 3D printing facilities is established in this study for making dentures. The UH system receives orders from dental clinics, and then distributes the dentures to be printed among 3D printing facilities to save time. Compared with existing systems for similar purposes, the UH system has two novel features. The first is the consideration of the possibility of reprinting in formulating the plan to avoid replanning. The other is the cooperation with home delivery services that have gradually become popular during the COVID-19 pandemic to save transportation time. The new features are subject to considerable uncertainties. To account for the uncertainties, both printing time and transportation time are modelled using interval type-II trapezoidal fuzzy numbers. Subsequently, an interval type-II fuzzy mixed integer-linear programming (FMILP) model is formulated and optimized to plan the operations of the UH system. A case study has been conducted to illustrate the applicability of the proposed methodology. According to experimental results, the proposed methodology was able to shorten the order fulfillment time by up to 9%.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-07T03:05:49Z
      DOI: 10.1177/20552076221092540
      Issue No: Vol. 8 (2022)
       
  • User experience and acceptance of patients and healthy adults testing a
           personalized self-management app for depression: A non-randomized
           mixed-methods feasibility study

    • Authors: Gwendolyn Mayer, Svenja Hummel, Neele Oetjen, Nadine Gronewold, Stefan Bubolz, Kim Blankenhagel, Mathias Slawik, Rüdiger Zarnekow, Thomas Hilbel, Jobst-Hendrik Schultz
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivePrevious studies have shown positive treatment outcomes of e-mental health applications targeting depression. However, few applications provide personalized features. The aim of the present study is to ask for the user experience and acceptance of patients with depression and healthy adults, who tested the self-management app Self-administered Psycho Therapy SystemS over a period of 5 days. The results serve as a source for evidence-based recommendations for developers and clinicians.MethodsA total of 110 participants (41 patients and 69 healthy controls) tested the app Self-administered Psycho Therapy SystemS over a period of 5 days and completed evaluation sheets developed for the purpose of this study. Quantitative measures were asked with 5-point Likert-scaled items (range: −2 to + 2) for the perceived quality of the programme and its components, its practicality (both referred to as user experience) and its acceptance. Student’s t-tests and Pearson correlations were calculated for group comparisons and associations, respectively. Open text fields were analysed by applying a qualitative structuring content analysis.ResultsThe perceived quality of the total programme was rated with M = 0.96 (SD = 0.82), the practicality was M = 0.84 (SD = 0.08) and the acceptance was M = 0.25 (SD = 1.04). Patients rated perceived quality of the total programme and acceptance higher than healthy adults, while there was no difference in practicality. Acceptance was associated with increased depression scores (r = 0.33, p = .01), higher scores of perceived quality of the total programme (r = 0.48, p
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-07T03:04:48Z
      DOI: 10.1177/20552076221091353
      Issue No: Vol. 8 (2022)
       
  • The effectiveness of automated digital health solutions at successfully
           managing obesity and obesity-associated disorders: A PICO-structured
           investigation

    • Authors: James Christopher Price, Heitor Oliveira Santos, Allain Amador Bueno
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Most adults in the UK and USA are classified as overweight or obese. Recent studies suggest that the prevalence of obesity has further increased during the SARS-CoV-2 pandemic and associated lockdowns. Digital technologies may be effective at managing obesity and related comorbidities, a potential further justified by social isolation and distancing circumstances.This review of published literature employed a Patient-Intervention-Comparison-Outcome structured approach on the use of digital solutions to determine the effectiveness of their use in the management and treatment of obesity, hypertension, and type 2 diabetes and included commercially available, automated devices and applications that did not require intervention from a clinician. Our search covered studies published between January 2004 and February 2019, and 18 papers were included in the final analysis. The digital solutions reviewed were smartphone applications, wearable activity trackers, and ‘digital medicine offerings’ (DMO), including ingestible sensors and wearable patches.This study found that not all interventions were effective at encouraging the lifestyle changes required for the management of obesity. Smartphone applications requiring interaction from the patient appeared to be more effective at encouraging engagement with treatment interventions than more passive wearable activity trackers. Automated feedback from smartphone applications was effective at managing type 2 diabetes, while DMO were effective at reducing blood pressure.With the advancement of new technologies alongside a rapid increase in the prevalence of obesity and associated disorders, further studies comparing the various technologies available in larger sample populations for longer periods would help determine the most cost-effective preventive and therapeutic strategies.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-06T06:00:37Z
      DOI: 10.1177/20552076221091351
      Issue No: Vol. 8 (2022)
       
  • The good, the bad, and the poorly designed: The mobile app stores are not
           a user-friendly experience for health and medical purposes

    • Authors: Timothy Aungst, Sheila Seed, Nurisha Gobin, Rosa Jung
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The utilization of mobile health applications to help manage health conditions have grown in utilization within the past decade. However, the application stores (i.e. Google and Apple) are not designed in a user-friendly manner that allows consumers to identify high-quality health and medical-related mobile applications. Researchers have been interested in identifying applications that may be recommended for patient care but have found the ability to quantify and assess these applications to be difficult due to the current layout and organization of applications. We explain here in this brief communication our own research experience in the identification of mobile health applications on the application stores, along with trends noted in other mobile health research, and make suggestions on how the application store experience could be improved for both patients and health professionals. These include collaboration between developers, medical professionals and organizations, and technology companies to facilitate a better means of categorizing health applications for patient use, alongside other current endeavors being pursued such as application review organizations and the creation of digital health formulary databases.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-06T06:00:25Z
      DOI: 10.1177/20552076221090038
      Issue No: Vol. 8 (2022)
       
  • Social media use for health, cultural characteristics, and demographics: A
           survey of Pakistani millennials

    • Authors: Muhammad Ittefaq, Hyunjin Seo, Mauryne Abwao, Annalise Baines
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveOver the last 10 years, an extensive body of literature has been produced to investigate the role of social media in health. However, little is known about the impact of cultural characteristics (e.g. masculinity, collectivism, and uncertainty avoidance) on social media use regarding health-related information, especially in developing countries like Pakistan. The present study employed Hofstede’s cultural characteristics framework and uses and gratification theory to examine how Pakistani millennials’ demographic attributes and cultural characteristics are associated with their social media use for health-related information.MethodAn online survey of 722 people aged 18–35 living in Pakistan was conducted in spring 2020 to examine the intensity and frequency of social media use, health-related use of social media, cultural characteristics, and demographic attributes.ResultsResults showed that cultural characteristics—masculinity, collectivism, and uncertainty avoidance—are strongly related with their perceptions of social media importance, usefulness, and perceived ease of access for health-related information even when controlling for demographic characteristics. Age and gender are also significantly associated with their perspectives on social media for health.ConclusionsWe found that communicating and sharing information is the most important motivation for Pakistani millennials to use social media in the area of health with WhatsApp and YouTube being most preferred social media sites for health-related issues.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-06T05:59:50Z
      DOI: 10.1177/20552076221089454
      Issue No: Vol. 8 (2022)
       
  • Theoretical model and measurement of shared decision making in web-based
           pharmaceutical care consultation

    • Authors: Haihong Chen, Yuqi Xiong, Zinan Zhang, Qian Zhou, Dan Wang, Xuemei Wang, Xinping Zhang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesWe aimed to construct a theoretical model and an observer-based measurement of shared decision making (SDM) in web-based pharmaceutical care consultation.MethodsWe first constructed a theoretical model through analysis of SDM models and interviews with 24 key informants. Then, the initial measurement was formulated, and the content was evaluated by 16 key informants alone. A cross-sectional study was executed, where 300 provider-patient encounters were collected at the online platform ‘Good Doctor Website’, for reliability and validity assessment. Content validity was evaluated by appropriateness score, that is the median of 7–9 and without disagreement. Interrater reliability was evaluated by Spearman correlation coefficient using 30 out of 300 samples. Single indicator validity was tested by Pearson correlation analysis, and convergent validity was evaluated by the Multiple Indicators Multiple Causes (MIMIC) model using 300 samples.ResultsTheoretical model constructed included four elements: ‘comprehensive understanding of the patient's condition’, ‘exchanging ideas on medication options’, ‘achieving a medication plan’, and ‘providing decision support’. Measurement constructed included four dimensions and 19 items, and four dimensions were in accordance with four elements of the theoretical model. We found median scores of these dimensions and items were 7–9 and without disagreement, indicating good content validity. Spearman correlation coefficients of 19 items were greater than 0.750, suggesting good interrater reliability. Pearson coefficients between 19 items and their external variables were significant (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-04T08:19:10Z
      DOI: 10.1177/20552076221089794
      Issue No: Vol. 8 (2022)
       
  • Challenges in accessing maternal and child health services during COVID-19
           and the potential role of social networking technologies

    • Authors: Angella Musiimenta, Wilson Tumuhimbise, Esther C Atukunda, Sandrah Ayebaza, Phionah Kobutungi, Aaron T Mugaba, Justus Asasira, Godfrey R Mugyenyi, Jane Katusiime, Raphael Zender, Niels Pinkwart, Jessica E Haberer
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThe COVID-19 pandemic causes new challenges to women and their babies who still need to access postnatal care amidst the crisis. The novel application of social network technologies (SNTs) could potentially enhance access to healthcare during this difficult time.ObjectivesThis study describes the challenges experienced in accessing maternal and child health services by women with limited or no education during this COVID-19 pandemic and discusses the potential of SNTs to support maternal and child health amidst this crisis.MethodsWe administered surveys to women who had recently given birth in a rural setting and interviewed a purposively selected subset to ascertain their experiences of accessing maternal and child health services during the COVID-19 pandemic. Our analysis involved descriptive analysis of quantitative data using STATA 13 to describe study participants’ characteristics, and content analysis of qualitative data to derive categories describing maternal health challenges.ResultsAmong 50 women, the median age was 28 years (interquartile range 24–34), 42 (84%) completed upper primary education. Access to the health facility was constrained by transport challenges, fear of contracting COVID-19, and delays at the facility. Due to the COVID-19 crisis, 42 (84%) women missed facility visits, 46 (92%) experienced financial distress, 43 (86%) had food insecurity, and 44 (88%) felt stressed. SNTs can facilitate remote and timely access to health services and information, and enable virtual social connections and support.ConclusionSNTs have the potential to mitigate the challenges faced in accessing maternal and child health services amidst the ongoing COVID-19 pandemic.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-04T08:06:12Z
      DOI: 10.1177/20552076221086769
      Issue No: Vol. 8 (2022)
       
  • Telehealth adoption during the COVID-19 pandemic: A social media textual
           and network analysis

    • Authors: Joshua TL Anderson, Lindsay M Bouchacourt, Kristen L Sussman, Laura F Bright, Gary B Wilcox
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe telemedicine industry has rapidly grown during the COVID-19 pandemic, and telemedicine has become a common form of care. The present study looks at the online conversation regarding telemedicine at the beginning of the pandemic and one year later. The Technology Acceptance Model is utilized to explain the findings.MethodsBrandwatch and NUVI software captured social mentions on Twitter regarding telemedicine during the beginning of the pandemic (March 15, 2020–April 20, 2020) and one year later (March 12, 2021–April 19, 2021). SAS text-mining software analyzed the social mentions and organized them into ten unique topics for each time period. The research team analyzed the topics and organized them into themes. A network analysis was also performed to examine structure and influence within the network.ResultsIn March–April 2020, the themes focused on the use of telehealth in general, telehealth for mental health applications, and Medicare covering telehealth services. In March–April 2021, the themes focused on news events regarding telehealth and the rise in prominence of telehealth services. The network analysis shows a shift in the distribution of telehealth information among influential accounts and reveals that the network became more connected, with a change in the control of information spread.ConclusionsTechnology Acceptance Model explains the social acceptance and spread of telemedicine. The transition in the conversation about telemedicine suggests a pattern of greater system use consistent with the Technology Acceptance Model. Telemedicine may have greatly increased in use because of the pandemic, but data suggests that its use may persist after the pandemic subsides.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-01T06:14:40Z
      DOI: 10.1177/20552076221090041
      Issue No: Vol. 8 (2022)
       
  • Automated clinical pathway standardization using SNOMED CT- based semantic
           relatedness

    • Authors: Ayman Alahmar, Mohannad AlMousa, Rachid Benlamri
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      The increasing number of patients and heavy workload drive health care institutions to search for efficient and cost-effective methods to deliver optimal care. Clinical pathways are promising care plans that proved to be efficient in reducing costs and optimizing resource usage. However, most clinical pathways are circulated in paper-based formats. Clinical pathway computerization is an emerging research field that aims to integrate clinical pathways with health information systems. A key process in clinical pathway computerization is the standardization of clinical pathway terminology to comply with digital terminology systems. Since clinical pathways include sensitive medical terms, clinical pathway standardization is performed manually and is difficult to automate using machines. The objective of this research is to introduce automation to clinical pathway standardization. The proposed approach utilizes a semantic score-based algorithm that automates the search for SNOMED CT terms. The algorithm was implemented in a software system with a graphical user interface component that physicians can use to standardize clinical pathways by searching for and comparing relevant SNOMED CT retrieved automatically by the algorithm. The system has been tested and validated on SNOMED CT ontology. The experimental results show that the system reached a maximum search space reduction of 98.9% within any single iteration of the algorithm and an overall average of 71.3%. The system enables physicians to locate the proper terms precisely, quickly, and more efficiently. This is demonstrated using case studies, and the results show that human-guided automation is a promising methodology in the field of clinical pathway standardization and computerization.
      Citation: DIGITAL HEALTH
      PubDate: 2022-04-01T06:14:15Z
      DOI: 10.1177/20552076221089796
      Issue No: Vol. 8 (2022)
       
  • “I am chatbot, your virtual mental health adviser.” What drives
           citizens’ satisfaction and continuance intention toward mental health
           chatbots during the COVID-19 pandemic' An empirical study in China

    • Authors: Yonghan Zhu, Rui Wang, Chengyan Pu
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      IntroductionIn order to address the psychological problems during the COVID-19 pandemic, mental health chatbots have been extensively used by public sectors. According to Theory of Consumption Values, this paper proposed an analytical framework to investigate the determinants behind users’ satisfaction and continuance intention toward mental health chatbots.MethodsThe empirical study was conducted through an online survey, facilitated by the use of questionnaire posted on the WeChat platform. Seven-point Likert scale and closed-ended questions were employed. Totally 371 valid samples were collected. The research data was tested via the partial least squares structural equation modeling. Gender, age, and income were included as control variables.ResultsAnalysis of samples collected from 371 Chinese users suggested that personalization (functional value), enjoyment (emotional value), learning (epistemic value), and the condition of the COVID-19 pandemic (conditional value) have positive influences on user satisfaction and continuance intention, but such effects were weak. The findings also revealed that user satisfaction has weakly positive impact on continuance intention. However, voice interaction (functional value) was an insignificant predictor of user satisfaction and continuance intention.DiscussionThis study developed a critical perspective on the role of Theory of Consumption Values in the context of mental health chatbot usage, while Theory of Consumption Value has been increasingly employed to explain the use of AI-based public services. Thus, this research devotes to the enhancement of theoretical frameworks regarding the usage of mental health chatbots.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-31T05:42:11Z
      DOI: 10.1177/20552076221090031
      Issue No: Vol. 8 (2022)
       
  • The experiences of community-dwelling individuals with newly diagnosed
           

    • Authors: Jeppe Eriksen, Ann Bygholm, Signe Hudtloff Nielsen, Pernille Bertelsen
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe aim of this study was to examine the experiences of citizens with newly diagnosed type-2 diabetes when using a newly developed and implemented patient-reported outcome (PRO) questionnaire as part of clinical practice in a municipal setting. Specifically, the citizens’ experiences in completing the PRO questionnaire and using the PRO data in consultations were examined.MethodsThe study was based on participant observations and semi-structured interviews and conducted at the Centre for Diabetes in Copenhagen and online. Participants were recruited deliberately to represent different cases of citizens with type-2 diabetes. Ten citizens were observed during consultation with an healthcare professional (HCP) and subsequently interviewed. The interviews were recorded as audio or video and transcribed verbatim. A thematic analysis was performed on the basis of previously described guidelines.ResultsThe PRO instigated reflections and enlightened citizens on disease-specific matters and motivated citizens to engage in self-management activities. During the citizen-HCP consultations, the PRO data prepared the actors before the meeting and enabled structured, effective and relevant conversations. However, the PRO questionnaire lacked response options, triggered citizen concerns about future health conditions and made them unsure if their answers were correct and aware that they lacked disease-specific knowledge. The experiences were linked to the citizens' situation as newly diagnosed with type-2 diabetes.ConclusionThe informants found the PRO questionnaire and data meaningful and useful. However, adjustments are needed if the PRO instrument is to resemble the disease situation of citizens with newly diagnosed type-2 diabetes.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-31T05:31:48Z
      DOI: 10.1177/20552076221089792
      Issue No: Vol. 8 (2022)
       
  • Integrating the experience: Principles for digital transformation across
           the patient journey

    • Authors: Marnie de Mooij, Olivia Foss, Brian Brost
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      As medical science advances and the population ages, the prevalence of chronic conditions has also grown. The traditional model of care, with its focus on acute and episodic issues within the office visit, is not designed to meaningfully address long-term patient needs. With COVID-19 has come unprecedented digital adoption, bringing health care delivery to a critical juncture. While digital tools and technologies present vast opportunities for democratizing and decentralizing care experiences, their piecemeal application to the existing “sick care” model and its information technology infrastructure will not only limit their value, but will inevitably add cost, inefficiency, and burden to care teams. In order to build upon this momentum and reap the full benefits of practice digitization, care model transformation must occur. This entails holistically reexamining how every component of the health care experience, from the digital tools to visit interactions, synchronizes to address the full continuum of patient needs throughout the journey. By doing this, care shifts away from one-size-fits-all, fragmented strings of visits, toward seamless experiences that adapt to patients’ needs in real-time while integrating within their daily lives. Rather than acting as a substitute for care, technology instead is vital to promoting and amplifying the impact of all those involved. To achieve this, this paper outlines 10 principles for restructuring care to incorporate digital health capabilities. Each describes how all care model components work as a system that aligns with patient needs. By doing this, technology is now an integral in supporting relationships across the full continuum of care.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-31T05:31:28Z
      DOI: 10.1177/20552076221089100
      Issue No: Vol. 8 (2022)
       
  • Will the EU Medical Device Regulation help to improve the safety and
           performance of medical AI devices'

    • Authors: Emilia Niemiec
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      Concerns have been raised over the quality of evidence on the performance of medical artificial intelligence devices, including devices that are already on the market in the USA and Europe. Recently, the Medical Device Regulation, which aims to set high standards of safety and quality, has become applicable in the European Union. The aim of this article is to discuss whether, and how, the Medical Device Regulation will help improve the safety and performance of medical artificial intelligence devices entering the market. The Medical Device Regulation introduces new rules for risk classification of the devices, which will result in more devices subjected to a higher degree of scrutiny before entering the market; more stringent requirements on clinical evaluation, including the requirement for appraisal of clinical data; new requirements for post-market surveillance, which may help spot early on any new, unexpected side effects and risks of the devices; and requirements for notified bodies, including for expertise of the personnel and consideration of relevant best practice documents. The guidance of the Medical Device Coordination Group on clinical evaluation of medical device software and the MEDDEV2.7 guideline on clinical evaluation also attend to some of the problems identified in studies on medical artificial intelligence devices. The Medical Device Regulation will likely help improve the safety and performance of the medical artificial intelligence devices on the European market. The impact of the Regulation, however, is also dependent on its adequate enforcement by the European Union member states.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-31T05:30:53Z
      DOI: 10.1177/20552076221089079
      Issue No: Vol. 8 (2022)
       
  • Development and evaluation of smartphone usage management system for
           preventing problematic smartphone use

    • Authors: Sun Jung Lee, Mun Joo Choi, Sung Hye Yu, HyungMin Kim, So Jin Park, In Young Choi
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe increased use of smartphones has led to several problems, including excessive smartphone use and the decreased self-ability to control smartphone use. To prevent these problems, the MindsCare app was developed as a method of self-management and intervention based on an evaluation of smartphone usage. We designed the MindsCare app to manage smartphone usage and prevent problematic smartphone use by providing personalized interventions.MethodsWe recruited 342 Korean participants over the age of 20 and asked them to use MindsCare for 13 weeks. Subsequently, we evaluated the changes in average smartphone usage time and the usability of the app. We designed a usability evaluation questionnaire based on the Technology Acceptance Model and conducted factor and reliability analyses on the participants’ responses. In the eighth week of the study, participants responded to a survey on the usability of the app. We ultimately collected data from 190 participants.ResultsThe average score for the usability of the system was 3.61 on a five-point Likert scale, and approximately 58% of the participants responded positively to the evaluation items. In addition, our analysis of MindsCare data revealed a significant reduction in average smartphone use time in the eighth week compared to the baseline (t = 3.47, p = 0.001). Structural equation model analysis revealed that effort expectancy and performance expectancy had a positive relation with behavior intention for the app.ConclusionsThrough this study, we confirmed the MindsCare app's smartphone usage time reduction effect and proved its good usability. As a result, MindsCare may contribute to achieving users’ goals of reducing problematic smartphone use.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-29T07:29:04Z
      DOI: 10.1177/20552076221089095
      Issue No: Vol. 8 (2022)
       
  • mHealth intervention for carers of individuals with a history of stroke:
           Heuristic evaluation and user perspectives

    • Authors: Elton H Lobo, Finn Kensing, Anne Frølich, Lene J Rasmussen, Patricia M Livingston, Sheikh Mohammed Shariful Islam, John Grundy, Mohamed Abdelrazek
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundCaregiving in stroke is complex, with most carers having little to no preparation to care for individuals with a history of stroke, leading to emotional impact. Technologies such as Mobile Health can provide the carer with real-time support and prepare the carer to assume their new roles and responsibilities.ObjectivesTo perform a heuristic evaluation of mHealth interventions designed to support carers of individuals with a history of stroke and determine the user preferences in stroke caregiving technology to inform future researchers and developers regarding the best practices to support these individuals.MethodsTwenty adults (i.e. 10 usability experts and 10 carers) participated in an iterative user-centred design study that focused on developing and modifying the mHealth intervention (StrokeCaregiver (SeCr)) created to support stroke caregiving. The intervention was repeated in four cycles, including two cycles with five usability experts each and five carers each.ResultsSeCr was iteratively improved to develop a highly usable product in multiple cycles. Participants demonstrated critical needs in personalized information support, communication with their healthcare needs, and the trust of the user, content, and developer. These critical needs are required to be met to promote long-term acceptance and adherence.ConclusionsWhile SeCr was developed to address the needs of carers of individuals with a history of stroke, several considerations must be made to ensure it can be used in a real-world setting. Researchers and developers can use co-design or living lab approaches to further meet the needs and expectations of the carer and enable these individuals to be better prepared for stroke caregiving.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-29T07:28:59Z
      DOI: 10.1177/20552076221089070
      Issue No: Vol. 8 (2022)
       
  • Leveraging online shopping behaviors as a proxy for personal lifestyle
           choices: New insights into chronic disease prevention literacy

    • Authors: Yongzhen Wang, Xiaozhong Liu, Katy Börner, Jun Lin, Yingnan Ju, Changlong Sun, Luo Si
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveUbiquitous internet access is reshaping the way we live, but it is accompanied by unprecedented challenges in preventing chronic diseases that are usually planted by long exposure to unhealthy lifestyles. This paper proposes leveraging online shopping behaviors as a proxy for personal lifestyle choices to improve chronic disease prevention literacy, targeted for times when e-commerce user experience has been assimilated into most people's everyday lives.MethodsLongitudinal query logs and purchase records from 15 million online shoppers were accessed, constructing a broad spectrum of lifestyle features covering various product categories and buyer personas. Using the lifestyle-related information preceding online shoppers’ first purchases of specific prescription drugs, we could determine associations between their past lifestyle choices and whether they suffered from a particular chronic disease.ResultsNovel lifestyle risk factors were discovered in two exemplars—depression and type 2 diabetes, most of which showed reasonable consistency with existing healthcare knowledge. Further, such empirical findings could be adopted to locate online shoppers at higher risk of these chronic diseases with decent accuracy [i.e. (area under the receiver operating characteristic curve) AUC=0.68 for depression and AUC=0.70 for type 2 diabetes], closely matching the performance of screening surveys benchmarked against medical diagnosis.ConclusionsMining online shopping behaviors can point medical experts to a series of lifestyle issues associated with chronic diseases that are less explored to date. Hopefully, unobtrusive chronic disease surveillance via e-commerce sites can grant consenting individuals a privilege to be connected more readily with the medical profession and sophistication.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-28T07:44:35Z
      DOI: 10.1177/20552076221089092
      Issue No: Vol. 8 (2022)
       
  • A COVID-19 forecasting system for hospital needs using ANFIS and LSTM
           models: A graphical user interface unit

    • Authors: Sajad Shafiekhani, Peyman Namdar, Sima Rafiei
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundCenters for Disease Control and Prevention data showed that about 40% of coronavirus disease 2019 (COVID-19) patients had been suffering from at least one underlying medical condition were hospitalized; in which nearly 33% of them needed to be admitted to the intensive care unit (ICU) to receive specialized medical services. Our study aimed to find a proper machine learning algorithm that can predict confirmed COVID-19 hospital admissions with high accuracy.MethodsWe obtained data on daily COVID-19 cases in regular medical inpatient units, emergency department, and ICU in the time window between 21 July 2020 and 21 November 2021. Data for the first 183 days (training data set) were used for long short-term memory (LSTM) network, adaptive neuro-fuzzy inference system (ANFIS), support vector regression (SVR) and decision tree model training, whilst the remaining data for the last 60 days (test data set) were used for model validation. To predict the number of ICU and non-ICU patients, we used these models. Finally, a user-friendly graphical user interface unit was designed to load any time series data (here the trend of population of COVID-19 patients) and train LSTM, ANFIS, SVR or tree models for the prediction of COVID-19 cases for one week ahead.ResultsAll models predicted the dynamics of COVID-19 cases in ICU and non- wards. The values of root-mean-square error and R2 as model assessment metrics showed that ANFIS model had better predictive power among all models.ConclusionArtificial intelligence-based forecasting models such as ANFIS system or deep learning approach based on LSTM or regression models including SVR or tree regression play a key role in forecasting the required number of beds or other types of medical facilities during the coronavirus pandemic. Thus, the designed graphical user interface of the present study can be used for optimum management of resources by health care systems amid COVID-19 pandemic.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-28T07:44:03Z
      DOI: 10.1177/20552076221085057
      Issue No: Vol. 8 (2022)
       
  • Seniors’ eHealth literacy, health and education status and personal
           health knowledge

    • Authors: Gizell Green
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundThe COVID-19 pandemic made eHealth literacy skills and online health activities essential for seniors.Research aims(a) To examine the differences in eHealth literacy dimensions (awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information) as related to participants’ health status and education level. (b) To explore the effect of eHealth literacy dimensions on participants’ personal health knowledge.MethodsWe used a cross-sectional design with a convenience sample of 298 Israeli seniors aged 65 or over during the second lockdown. The questionnaire was composed of three sections: (a) background characteristics, (b) an eHealth Literacy scale, and (c) perceived personal health knowledge.ResultsParticipants with an excellent health status reported higher levels of awareness of sources and perceived efficiency than participants with poor or good health statuses. Furthermore, participants with a graduate degree understand online information better than participants with a high school education. Moreover, it was found that participants with a high school education sense that they are being smart on the net more than participants with an undergraduate degree. Finally, we found that eHealth literacy dimensions influenced the participants’ personal health knowledge.ConclusionAs the population ages, it becomes more at risk for disease, and as a result, its health status weakens. Therefore, it is important to provide seniors with appropriate intervention programs for improving their eHealth literacy, which may eliminate health inequality. In addition, caregivers need to develop patients’ eHealth literacy skills—finding, evaluation, and interpretation of online health knowledge relevant to them.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-28T06:14:02Z
      DOI: 10.1177/20552076221089803
      Issue No: Vol. 8 (2022)
       
  • Pregnant women’s use of a consumer-based meditation mobile app: A
           descriptive study

    • Authors: Jeni Green, Taylor Neher, Megan Puzia, Breanne Laird, Jennifer Huberty
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThe objectives of this study were to explore the satisfaction of pregnant or recently pregnant women with the existing Calm app content (i.e. non-pregnancy) and preferences and recommendations for the types of pregnancy-specific content that would be helpful to pregnant women.MethodsThis study was a national cross-sectional survey of subscribers to a meditation mobile app (i.e. Calm). Eligible participants were currently pregnant or recently pregnant (within the past 12 months) and used Calm during their pregnancy. Participants were asked about their Calm usage and perceived benefits of Calm during pregnancy, and interest in pregnancy-specific content. Descriptive statistics were used to characterize the sample.ResultsParticipants (N  =  111) were on average 34 years old (SD  =  5.4) and half of the sample was currently pregnant (N  =  55). The most common reasons for using the Calm app during pregnancy was for sleep problems (29%; n  =  31) or anxiety (27%; n  =  29). Women reported Calm was most helpful for improving sleep (32%; n  =  32), anxiety (25%; n  =  25), and stress (21%; n  =  21). Nearly all women wanted pregnancy-specific meditation content within the app (98%; n  =  98) and expressed interest in topics including pregnancy-related anxiety (68%; n  =  67), postpartum (50%; n  =  49), pregnancy-related sleep problems (41%; n  =  40), and labor and delivery (38%; n  =  37).ConclusionWomen who used the Calm app during pregnancy found it helpful for improving sleep, anxiety, and stress but desire pregnancy-specific content. Future meditation mobile app studies should utilize pregnancy-specific content and test the feasibility and efficacy of sleep and mental health in pregnant women.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-28T06:13:44Z
      DOI: 10.1177/20552076221089098
      Issue No: Vol. 8 (2022)
       
  • Associations among eHealth literacy, social support, individual
           resilience, and emotional status in primary care providers during the
           outbreak of the SARS-CoV-2 Delta variant

    • Authors: Richard Huan Xu, Lu-shao-bo Shi, Yi Xia, Dong Wang
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectiveThis study aimed to investigate eHealth literacy among primary care providers (PCPs) and explore its association with social support, individual resilience, anxiety, and depression during an outbreak of the SARS-CoV-2 Delta variant in Guangzhou, China.MethodsA cross-sectional web-based survey was conducted in 18 community healthcare centers in Guangzhou, China. The responses of 600 PCPs were tagged as valid responses. Information pertaining to their background, eHealth literacy, anxiety, depression levels, social support, and individual resilience was also collected. Multilevel analysis was used to determine the association among the measures to account for the nested random effect of community health centers in different districts.ResultsParticipants showed a moderate self-perceived level of eHealth literacy (M = 30, SD = 5.8). Participants who reported higher levels of eHealth literacy were more likely to exhibit lower levels of anxiety and depression, higher social support, and greater resilience. After adjusting for background characteristics, the results of the multilevel logistic analysis showed that eHealth literacy was significantly associated with anxiety and depression, social support, and individual resilience. Younger participants and those who were highly educated reported enhanced eHealth literacy.ConclusionsThis study presents a baseline reference for eHealth literacy among Chinese PCPs. Improving their ability to search for and use reliable web-based information was beneficial for facilitating perceived social support and raising resilience during the pandemic. Strategies to provide high-quality web-based information to PCPs to self-assess and identify psychological distress at an early stage should be encouraged.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-25T08:07:52Z
      DOI: 10.1177/20552076221089789
      Issue No: Vol. 8 (2022)
       
  • Teledentistry awareness, its usefulness, and challenges among dental
           professionals in Pakistan and Saudi Arabia

    • Authors: Farooq Ahmad Chaudhary, Basaruddin Ahmad, Muhammad Qasim Javed, Saeed Mustafa, Ayesha Fazal, Muhammad Mohsin Javaid, Ammar Ahmed Siddiqui, Mohammad Khursheed Alam, Shahab Ud Din
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      ObjectivesThis study aims to describe the perception of dental professionals in Pakistan and Saudi Arabia (SA) towards the practice of teledentistry, its usefulness and challenges.MethodsA cross-sectional study was carried out among 190 dentists from January 2021 to April 2021. The participants were included in the study using snowball sampling method. A 26-item adopted questionnaire was distributed using different social media channels. Chi-square test was used for analysis.ResultsOut of 190 participants, 46.3% were from Pakistan and 53.7% were from SA. The majority of participants in both countries agreed that teledentistry would enhance guidelines and advice (74.2%), improve peer-to-peer interaction (79.5%) and make patient's referrals more efficient (75.8%). For the usefulness, most participants agree that it is economical for the patients (61.1%), improves communication (74.7%), helps in educating the patients (86.3%), avoid unnecessary travel (76.8%), helps monitoring (71.6%), and benefits patients in remote areas (74.7%); however, more Pakistani participants perceived that time spent with the patient would increase compared to SA participants (p 
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-25T05:15:28Z
      DOI: 10.1177/20552076221089776
      Issue No: Vol. 8 (2022)
       
  • A framework for examining patient attitudes regarding applications of
           artificial intelligence in healthcare

    • Authors: Jordan P. Richardson, Susan Curtis, Cambray Smith, Joel Pacyna, Xuan Zhu, Barbara Barry, Richard R. Sharp
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundWhile use of artificial intelligence (AI) in healthcare is increasing, little is known about how patients view healthcare AI. Characterizing patient attitudes and beliefs about healthcare AI and the factors that lead to these attitudes can help ensure patient values are in close alignment with the implementation of these new technologies.MethodsWe conducted 15 focus groups with adult patients who had a recent primary care visit at a large academic health center. Using modified grounded theory, focus-group data was analyzed for themes related to the formation of attitudes and beliefs about healthcare AI.ResultsWhen evaluating AI in healthcare, we found that patients draw on a variety of factors to contextualize these new technologies including previous experiences of illness, interactions with health systems and established health technologies, comfort with other information technology, and other personal experiences. We found that these experiences informed normative and cultural beliefs about the values and goals of healthcare technologies that patients applied when engaging with AI. The results of this study form the basis for a theoretical framework for understanding patient orientation to applications of AI in healthcare, highlighting a number of specific social, health, and technological experiences that will likely shape patient opinions about future healthcare AI applications.ConclusionsUnderstanding the basis of patient attitudes and beliefs about healthcare AI is a crucial first step in effective patient engagement and education. The theoretical framework we present provides a foundation for future studies examining patient opinions about applications of AI in healthcare.
      Citation: DIGITAL HEALTH
      PubDate: 2022-03-25T05:15:15Z
      DOI: 10.1177/20552076221089084
      Issue No: Vol. 8 (2022)
       
  • Technology scripts in care practice: A case study of assistant nurses’
           use of a social alarm system in Swedish nursing homes

    • Authors: Fangyuan Chang, Sanna Kuoppamäki, Britt Östlund
      Abstract: DIGITAL HEALTH, Volume 8, Issue , January-December 2022.
      BackgroundTechnologies such as social alarm systems contain expectations about how they should be integrated and used in practice. These expectations, also called technology scripts, usually fail to consider all the complexity in care practice. Shifting the focus from technology scripts to care practice, this paper examines how a social alarm system is used in assistant nurses’ care practices in nursing homes.MethodsThe paper draws on observations of assistant nurses’ daily tasks (32 h) and semi-structured interviews with assistant nurses (n = 12) in two Swedish nursing homes. The observation data were used to understand the care contexts and assistant nurses’ technology-mediated care practices, while interviews were used to deeply understand assistant nurses’ perceptions of the system, their care practices, and which aspects they co