DIGITAL HEALTH最新文献

Introduction: The COVID-19 pandemic necessitated a major expansion in telemedicine use. The continued use of telemedicine post-pandemic has the potential to enhance healthcare use for people at risk for sub-optimal healthcare access and utilization, such as patients with previous preventable hospitalization. This study analyzed the association between pre-pandemic preventable hospitalizations (PPHs) and telemedicine use during the pandemic.

Methods: This retrospective cohort study uses Medicaid administrative claims data (01/2018-06/2022) for patients of a large Federally Qualified Health Center in Arizona that implemented telemedicine in March 2020. Bivariate and multivariable generalized estimating equations were used to analyze the relationship between the outcome and predictor variables. We also analyze racial/ethnic and primary language disparities in telemedicine use among those with PPH and report the average predicted probability.

Results: There was a statistically significant relationship between telemedicine use and PPH even after adjusting for comorbidity severity (OR:1.85; CI: 1.74, 1.96). Analyses restricted to those who had PPHs showed an seven-percentage point difference in the predicted probability of telemedicine use between non-Hispanic White individuals and Asian/Pacific Islanders, the group with the lowest probability of telemedicine use among our study sample.

Conclusion: Telemedicine is a unique tool that can be leveraged by interventions that aim to optimize healthcare use among those with a history of preventable hospitalizations. However, the lack of targeted interventions to identify and address barriers to telemedicine use among minoritized groups could limit the impact of such interventions and widen disparities.

Background and aim: Self-care technologies may support patients with multiple sclerosis (MS) in their everyday disease management by enabling self-monitoring of various health indicators, such as symptom levels and physical activity levels. The aim of this study was to assess the usefulness of tracking self-selected MS- and health-related measures via a digital self-tracking tool for people with MS (PwMS) over a period of six weeks.

Methods: An initial development phase was followed by a six-week testing phase with 58 test participants. The evaluation phase followed a sequential, exploratory mixed-methods design, consisting of 14 interviews with test participants during the testing phase, followed by a survey of all participants after the testing phase to confirm and elaborate on the interview findings. The interview data were analyzed through a five-step thematic analysis, and the survey data were analyzed descriptively.

Results: The results of the mixed-methods study can be summarized in the following findings: (1) Use of the self-tracking tool assisted users in clarifying patterns regarding their symptoms, physical activity, sleep quality and emotional well-being. (2) Tracking physical activity and, to some extent, sleep had a motivational effect on participants in relation to increasing activity and/or changing habits. (3) Data quality/accuracy constitutes an important criterion for considering the self-tracking tool relevant. (4) The self-tracking tool may support dialogue between patients and healthcare professionals, and/or it may potentially play a role in peer-to-peer support.

Conclusion: The results of the present study indicate that the self-tracking of symptoms, sleep, physical activity and other measures may contribute positively to everyday self-management among PwMS. Professional support in interpreting and acting upon the data should be considered.

Background: Group psychotherapy is an effective treatment for postpartum depressive and anxiety symptoms, and interpersonal connection and support through the group process can aid recovery. Little is known about the implication of the delivery of interpersonally oriented group therapy in this population through videoconferencing.

Objective: To pragmatically evaluate the implementation of a conversationally-oriented postpartum videoconferencing psychotherapy group for depression and anxiety within the clinical setting.

Methods: Over 8 weeks, five to six patients and one therapist facilitator (closed group) meet weekly for 1 hour via a secure videoconferencing platform. We evaluated group adoption metrics for all postpartum videoconferencing psychotherapy groups offered during the evaluation period (October 2021-August 2022), and offered patients the opportunity to complete baseline and post-group quality improvement surveys to evaluate outcomes including acceptability (Satisfaction with Therapist and Therapy Scale-Revised, STTS-R), group process (Group Questionnaire, GQ), and effectiveness (Edinburgh Postnatal Depression Scale, EPDS).

Results: Of 153 patients (n = 26 groups), most (72.5%) attended >70% of group sessions. Of 137 patients (n = 24 groups) who were sent surveys, n = 50 (36.5%) completed both baseline and post-group surveys. Mean (SD) ratings were high for acceptability (STTS-R-therapy: 25.0/30 (3.1); STTS-R-therapist: 27.6/30 (2.3)) and group process with GQ ratings of 81.4/91 (7.8) (positive bond), 34.1/56 (3.8) (positive working relationship) and 23.5/63 (4.4) (negative relationship). Patients with probable depression (EPDS ≥ 13) significantly decreased from n = 23 (50%) to n = 19 (41.3%, p < .001), although the absolute score difference was minimal.

Discussion: Videoconferencing-based group therapy can be implemented with a robust group process and acceptability in the postpartum period. Impact on clinical outcomes should be further investigated.

[This corrects the article DOI: 10.1177/20552076241247374.].

Background: Electronic health (eHealth) has been widely adopted in chronic disease management. Prior studies focused on time-based reminders as a cue to facilitate behavior change intentions, ignoring the development of automatic cue-behavior associations via other cue types.

Objective: Hence, this study utilized avatar appearance as a visual-based cue to help establish the automatic association between appearance transformation and health behavior to form habits without intention.

Methods: To better understand users' attitudes and experiences toward applying changes in avatar appearance to develop cue-behavior associations for hypertensive patients. Fifteen participants were recruited in a 14-day experiment. After excluding one participant who dropped out of the experiment, others were randomly assigned to two groups. One group consisted of a visual-based cue (a virtual plant) and basic behavior change techniques (BCTs). The other group only included basic BCTs. Attitudes and experience outcomes were collected by interview, and qualitative data were analyzed using thematic analysis.

Results: 57% of participants had been diagnosed with hypertension for more than five years, and more than 50% of participants have experience using mobile apps or wearables. 66% of participants did physical activity more than three times every week. The result shows that tailored time-based reminders, blood pressure monitoring, and daily dietary intake were the most attractive features. Additionally, hypertensive participants have positive attitudes toward avatar appearance as a visual-based cue to develop cue-behavior association, which enhances self-management motivation.

Conclusion: This study proposes a visual-based cue design for habit formation and conducts a qualitative method to explore hypertensive patients' perceptions. The findings offer insights from user's perspectives into hypertensive patients' attitudes toward visual-based cues and perception of the connection between avatar appearance and health behavior for self-management. Subsequent discussions present eHealth design guidelines of habit formation from intention, automatic cue-behavior association, and self-management perspectives.

Objective: Virtual Reality (VR) and Augmented Reality (AR) are innovative technologies that can serve as effective tools for creating health interventions by altering psychological distance. Based on construal level theory and the reality-virtuality continuum, we designed, tested, and compared VR and AR campaigns to encourage proactive measures against COVID-19.

Methods: 143 participants were randomly assigned to one of three messages: VR, AR, and a CDC video, and completed surveys before, immediately, and one week following message exposure.

Results: VR and AR increased preventive intentions and behaviors against COVID-19 both in the short and long run. VR was particularly effective as it also increased risk perceptions, more preventive intentions in the short term, and more preventive behaviors, including social distancing and mask wearing, in the long term. VR was more efficient than AR in enhancing risk perceptions and preventive intentions right after being exposed to the messages as well as promoting behaviors such as avoiding crowds, maintaining social distance from others, and wearing a mask in indoor public areas one week later. Moreover, among the three conditions, VR was the only intervention that generated actual behavior change after one week, which indicated potential long-term advantages of VR compared to other mediums. VR decreased social, spatial, and hypothetical distances to a greater degree than AR. VR was more effective than video. However, AR was not more persuasive than video.

Conclusions: Insights gained from the findings extend beyond the pandemic phase, offering practical applications for employing VR and AR technologies in health campaigns.

Objective: Optimal metabolically healthy status is important to prevent various chronic diseases. This study investigated the association between lifelog-derived physical activity and metabolically healthy status.

Methods: This cross-sectional study included 51 Korean adults aged 30-40 years with no history of chronic diseases. Physical activity data were obtained by the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Lifelog-derived physical activity was defined by step counts and walking speed for 1 week, as recorded by the Samsung Health application on both the Samsung Galaxy Fit2 and mobile phones. Participants without metabolic syndrome components were categorized as the metabolically healthy group (n = 31) and the remaining participants as the metabolically unhealthy group (n = 20). Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models. The predictive ability of each physical activity measure was evaluated according to the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) values.

Results: Among the physical activity measures, lifelog-derived walking speed was significantly inversely associated with prevalent metabolically unhealthy status. The lifelog component model including walking speed, age, and sex had the highest AUC value for metabolically unhealthy status. Adding lifelog-derived step counts to the IPAQ-SF-derived metabolic equivalent (MET) model (including age, sex, and IPAQ-SF-METs) yielded 37% and 13% increases in the NRI and IDI values, respectively. Incorporating walking speed into the IPAQ-SF-derived MET model improved metabolically unhealthy status prediction by 42% and 21% in the NRI and IDI analyses, respectively.

Conclusions: Slow walking speed derived from the lifelog was associated with a higher prevalence of metabolically unhealthy status. Lifelog-derived physical activity information may aid in identifying individuals with metabolic abnormalities.

Background: Germany's healthcare system provides high-quality, universal health coverage to almost all residents. However, a major challenge lies in the strong separation of healthcare structures, which hinders efficient interprofessional and intersectoral communication and collaboration. The mandatory nationwide implementation of the telematics infrastructure may offer a solution to enhance healthcare professionals' communication and collaboration.

Objective: Our study aims to elicit participants' perceptions of and attitudes towards the implementation and usage of the telematics infrastructure in fostering interprofessional communication and collaboration between home-care nursing services and general practitioner practices.

Methods: We conducted interviews with seven members of general practitioner practices and 10 in home-care nursing services. Using thematic content analysis, we identified five themes, of which four along with 10 subthemes were integrated into Greenhalgh et al.'s 'nonadoption, abandonment, scale-up, spread and sustainability' framework.

Results: Participants recognised the potential of digital technology to enhance interprofessional communication and collaboration. However, this potential largely depended on individual healthcare actors' willingness to seek information, invest and adapt. Attitudes towards the telematics infrastructure varied widely from hopeful confidence to outright rejection. Home-care nursing services generally viewed the telematics infrastructure with optimism, while general practitioners expressed reservations, particularly due to technological disruptions, lack of user-friendliness, and organisational structures.

Conclusion: Our findings highlight the potential of digital technology to enhance interprofessional communication. Successful implementation of technological innovations, however, goes beyond technological aspects and involves social, political and organisational processes. Future implementation strategies for such innovations in healthcare should involve users early and ensure clear communication.

Background: The persistently high incidence of stroke in many nations is suggestive of an area for further improvement on existing strategies of primary stroke prevention. Although the era of digitalisation has led to the increasing use of mobile applications (apps) in healthcare, more studies are needed to determine the efficacy of apps in producing the desired health outcomes across different nations and cultures.

Objective: To describe the development and evaluate the usability of a mobile app in delivering a culturally adapted stroke prevention educational programme for middle-aged adults in the Republic of China.

Methods: The educational programme was developed in three phases. In Phase 1, the process involved analysing requirements and designing structured modules. Phase 2 concentrated on expert consultation and technical development to deliver the educational programme. Phase 3 included a usability trial and refinement of the educational program based on trial results.

Results: Educational content was derived from the Chinese Guidelines for the Prevention and Treatment of Stroke and the Dietary Guidelines for Residents. The WeChat platform was used to deliver the educational programme. Participants expressed satisfaction with the content, interface, and functions of the apps, indicating that the apps have good usability.

Conclusions: The development process of the Educational Programme was designed to maximise the culturally appropriate, and impact of lifestyle changes and stroke prevention. An app-based educational programme that has demonstrated good usability is a vital factor prior to deploying it in an intervention to evaluate its effects on health outcomes.

Objective: Establish a relationship between digital health intervention (DHI) and health system challenges (HSCs), as defined by the World Health Organization; within the context of hazard identification (HazID), leading to safety claims. To improve the justification of safety of DHIs and provide a standardised approach to hazard assessment through common terminology, ontology and simplification of safety claims. Articulation of results, to provide guidance for health strategy and regulatory/standards-based compliance.

Methods: We categorise and analyse hazards using a qualitative HazID study. This method utilises a synergy between simplicity of DHI intended use and the interaction from a multidisciplinary team (technologists and health informaticians) in the hazard analysis of the subject under assessment as an influencing factor. Although there are other methodologies available for hazard assessment. We examine the hazards identified and associated failures to articulate the improvements in the quality of safety claims.

Results: Applying the method provides the hazard assessment and helps generate the assurance case. Justification of safety is made and elicits confidence in safety claim. Controls to hazards contribute to meeting the HSC.

Conclusions: This method of hazard assessment, analysis and the use of ontologies (DHI & HSC) improves the justification of safety claim and evidence articulation.