BMC digital health最新文献

Background: More than a quarter of night shift workers (NSWs) have symptoms severe enough to meet diagnostic criteria for Shift Work Disorder (SWD). This study sought to understand the experiences of both NSWs and employee health stakeholders (EHSs) to inform the design of an effective digital precision circadian medicine intervention for NSWs experiencing SWD.

Methods: NSWs (N = 20) participated in virtual focus groups (N = 5) and were asked about their experiences with night shift work, desired components of a digital intervention for SWD, and feedback on a potential digital precision circadian medicine intervention (i.e., Arcashift™) for SWD. Eligibility criteria: fixed night schedule for 6 + months, diagnosed with SWD, and aged 18-50 years. EHSs (N = 5) participated in virtual 1-on1 interviews, where they were asked about what motivations, goals, and return-on-investments (ROIs) mattered with regards to investing in a digital intervention for NSWs. Focus groups and interviews were digitally recorded and transcribed. Combined transcript reflexive thematic analysis was conducted to identify themes.

Results: The reflexive thematic analysis produced three themes. The first theme, the trials and tribulations of night shift work, related to the physical, mental, and emotional tolls related to working the night shift and resulted from problem-focused discussions with NSWs about what it is like to work the night shift. Subthemes included: physically and mentally draining, the world runs on daytime hours, and lack of respect and consideration. The remaining two themes, thrown to the wolves and shifting towards an app, were the result of shifting focus group conversations with NSWs and interviews with EHSs towards solution-focused thinking by presenting a digital precision circadian medicine intervention (i.e., Arcashift™) through which NSWs' SWD could be improved.

Conclusion: This study represents a strong preliminary step toward the development of an app for the intervention of SWD. There is a critical need for a real-world intervention for SWD, and stakeholders were optimistic about the potential of an app to help address SWD. Future work is needed to assess the extent to which the proposed app, informed by these stakeholder insights, is able to improve outcomes for employees and ROIs for EHSs.

Supplementary information: The online version contains supplementary material available at 10.1186/s44247-025-00167-3.

Background: Use of wearable vital signs sensors (WVSSs) to monitor hospitalised patients is growing but uncertainty exists about how such sensors should be adopted into existing practice. The aim of this observational study was to determine the completeness of data capture and accuracy of measurements recorded by a suite of WVSSs. The implications of using such measurements to derive early warning scores was also assessed.

Methods: Adult inpatients with Covid-19 wore four WVSSs recording heart rate/respiratory rate (HR/RR), oxygen saturation (SpO₂), axillary temperature and blood pressure (BP). Wearable vitals were paired with traditional vitals (measured by nurses) recorded concurrently. The accuracy of the wearable vitals was assessed using traditional vitals as the reference. National early warning (NEWS2) scores were calculated using wearable and traditional vitals.

Results: Forty-eight patients were monitored for 204 days with the sensors. Median sensor wear was 3.9(IQR:1.7-5.9), 3.9(IQR:1.6-5.9) and 3.8(IQR:0.9-5.9) days for HR/RR, temperature and SpO₂ respectively. The BP cuff was worn for median 1.9(IQR:0.9-3.8) days in 33 patients. Length of hospital stay was 8(IQR:6-13) days. Completeness of data capture was 84% for HR/RR, 98% for temperature, 72% for SpO₂ and 36% for BP.There were 1633 HR, 1614 RR, 1412 temperature, 1294 SpO₂ and 59 BP wearable-traditional measurement pairs. 59.7% of HR pairs were within ± 5 bpm, 38.5% of RR pairs within ± 3breaths/min, 24.4% of temperature pairs within ± 0.3℃, 32.9% of SpO₂ pairs within ± 2% and 39.0% of BP pairs within ± 10 mmHg. Agreement between wearable and traditional RRs was poor at high RRs.In a ward setting, 613 NEWS2 scores were calculated using wearable-traditional HR, RR, temperature and SpO₂ pairs. The median NEWS2_traditional was 1(IQR:1-2) and the median NEWS2_wearable was 4(IQR:3-6). Using traditional NEWS2 alerts as a reference, 86% (225/262) of wearable NEWS2 5 + alerts and 89% (82/92) of wearable NEWS2 7 + alerts were false positives.

Conclusions: Agreement between vital signs recorded by wearable sensors and concurrent traditional vitals is poor. In this context, data from wearable sensors should not be used in existing track and trigger systems.

Trial registration: The COSMIC-19 study was registered with clinicaltrials.gov (registration: NCT04581031, date of registration: Oct 6th 2020).

Supplementary information: The online version contains supplementary material available at 10.1186/s44247-025-00151-x.

Background: The global prevalence of dementia is increasing exponentially. Early detection of dementia-causing diseases could support therapeutic intervention to decelerate disease progression. Wearable digital technologies can be used to identify early signs of such diseases and remotely monitor disease progression. However, technologies must be acceptable to users. This study explored the perspectives of participants on the acceptability of various wearable technologies for early detection.

Method: Participants from the Cognitive Decline using Digital Devices (CODEC-II) cohort used four different wearables (smartwatch, electroencephalographic [EEG] headband, active and passive smartphone apps) for two weeks every three months over a year. A subgroup participated in semi structured interviews after two weeks to discuss their experiences and acceptance of the devices. Data was analysed using the framework analysis approach, aided by N-Vivo (v14.23.2).

Results: Twenty-one participants were interviewed, including individuals with subjective cognitive decline (n = 10), mild cognitive impairment (MCI) (n = 7), dementia with Lewy bodies (n = 1), and three caregivers. Five key themes were identified, including ease of use, wearability, usefulness, transparency, and behavioral intention. Many participants relied on the research team to help set up the technology for them due to high levels of digital anxiety. Individuals with MCI particularly struggled with cognitive testing games in the active smartphone app, which they experienced increased awareness of their own cognitive impairments. Participants preferred wrist-worn over head-worn devices due to familiarity and impact on their appearance. While some participants enjoyed using the wearables, others questioned their accuracy for medical purposes. There was also a lack of understanding around what data were being collected from the wearables and how it was being collected, with some expressing concerns about data disclosure. Participants with professional or caregiving responsibilities described how their busy lifestyles hindered daily use of the wearables.

Conclusion: These findings highlight the importance of using an inclusive design approach to meet users' needs and support digital inclusivity, and an effective communication strategy to increase transparency and reduce data disclosure concerns. Future research is needed to explore the effectiveness of implementing current recommendations to support digital health equity and codesign a communication strategy with users to ensure the information is understandable.

Trial registration: CODEC-II was retrospectively registered as a clinical trial under the registry ClinicalTrials.gov (trial registration number: NCT07051408, date of registration: 3rd June 2025).

Supplementary information: The online v

Background: Despite the increasing use of digital health interventions (DHIs) in low- and middle-income countries (LMICs), gender disparities persist in access, utilization, and outcomes. Barriers to women's phone ownership and use include affordability, digital literacy, and social norms; these are not only technological, but institutional as reflected in the limited integration of gender equity in national digital health strategies. While the body of evidence on DHI effectiveness is growing how to implement gender equitable digital programs is less clear.

Methods: We conducted an umbrella review of systematic reviews to synthesize gender-related outcomes on DHIs in LMICs. Eligible DHIs included those used by community health workers and client-facing interventions for health communication, self-management, and symptom monitoring. We included only reviews that reported quantitative outcomes with confidence intervals and reported the study design for included studies. We classified interventions along the Gender Equality Continuum. Findings were reported using PRISMA guidelines.

Results: Of the reviews analyzed, only eight (5.5%) explicitly applied a gender lens. Barriers to women's participation in DHIs included limited phone ownership, financial dependence, and socio-cultural norms restricting access to health information. Gender-responsive interventions that accounted for these challenges were rare. Gender-transformative approaches (which seek to shift harmful gender norms), such as engaging men in health-seeking behaviors, showed promise but remain underutilized and under evaluated. Measurement of gender-related barriers and their influence on outcomes was limited. No studies used validated gender scales.

Conclusions: Based on these findings, we propose the Gender Framework for Responsive and Adaptive Design in Digital Health (FORWARD) to guide implementers in designing DHIs that address gender disparities. Gender FORWARD emphasizes gender-responsive design at individual (i.e. literacy and access), workforce (i.e. usability, interoperability, and supportive supervision), and ecosystem (i.e. capture and use of gender data in decision-making) levels. This framework offers a critical resource for researchers, implementors, and policy makers to improve digital health equity by ensuring interventions are inclusive, accessible, and sustainable across genders.

Purpose: The Senaptec Sensory Station (SSS) is a device that can measure visual acuity (VA) and contrast sensitivity (CS), but validity has not been established in clinical populations. Therefore, we examined analytical and initial clinical validation of VA and CS measured via the SSS in Parkinson's disease (PD).

Methods: SSS was used in 34 PD (aged 69.6 (SD = 9.4) years old) to measure VA (via visual clarity outcome) and CS (via SSS-CS6 and SSS-CS18 outcomes). Analytical validation was performed through comparison to reference VA and CS eye-charts (ETDRS VA, MARS CS), and clinical validation was performed through correlation with clinical measures.

Results: Difference in VA LogMar score between the reference eye chart and the SSS was - 0.03 (0.23); e.g., approximately a single letter on the eye chart. There was moderate agreement between the SSS and eye chart VA measurement in PD (ICC = 0.42). Additionally, there was moderate correlation between SSS and eye chart (0.8 cpd) CS measurement in PD, specifically for SSS-CS6 (6 cpd) (r = 0.46). However, there was poor correlation between eye chart and SSS-CS18 (18 cpd). SSS VA and CS measures correlated moderately with cognitive function, disease duration and severity, providing clinical validation evidence.

Conclusion: VA and CS can be measured with SSS in PD with moderate comparability to reference eye charts (dependent on cpd for CS), and digital outcomes may provide clinically meaningful outcomes to use in PD trials. A range of human, technological and protocol factors may impact validity of VA and CS measurement via SSS, which should be further examined in future studies.

Background: Sustained HIV care engagement is essential for pregnant women living with HIV (PWLHIV) on lifelong antiretroviral therapy (ART). However, transferring clinics, missed HIV visits, and disengagement from HIV care can make monitoring engagement challenging. This study evaluated the acceptability, feasibility, and fidelity of a biometric fingerprint scanning (BFS) system to monitor women's engagement in HIV care across a network of large, urban clinics in Malawi using a cloud-based BFS system. Differences in BFS coverage compared to the standard of care monitoring (SOC) system were also examined.

Methods: PWLHIV aged ≥18 years, attending their first antenatal visit, and residing in Lilongwe District, Malawi, were enrolled and followed through 9-months postpartum at 5 clinics. An implementation evaluation survey was administered at 9-month postpartum to evaluate BFS acceptability and feasibility. BFS recorded attendance at each study and routine HIV visit, with daily data uploads to facilitate participant identification across sites. SOC attendance data were abstracted for fidelity assessment and comparison of BFS coverage. Descriptive statistics assessed acceptability, feasibility, and fidelity. Using the Conceptual framework of Implementation Fidelity, the composite score for the four fidelity aspects (Coverage, Consistency, Duration, Content) was calculated and categorized as "high" (≥ 80%), "moderate" (50%-79%), and "low adherence" (<50%). Chi-square tests and Poisson regression with generalized estimating equations and robust variance were used to assess differences in BFS coverage, with statistical significance set at p < 0.05.

Results: Of 399 participants, 91% completed a 9-month postpartum visit. Acceptability was high, with 83% comfortable using BFS and 98% finding it easy to use. Feasibility was high, with 99% recommending it. Fidelity was moderate, with a composite score of 68%. BFS was operational for 88% of 612 working days, used consistently at a median of 50% (IQR 30, 70) of HIV visits, and 75% of participants reported using it as trained. BFS captured 52% of 3,554 visits compared to 48% with SOC (PR = 1.06, 95% CI: 1.04-1.09).

Conclusion: BFS was acceptable and feasible for monitoring HIV visits across clinics, showing better coverage compared to the SOC system despite moderate fidelity. Further research is needed to identify barriers and facilitators to BFS implementation.

Supplementary information: The online version contains supplementary material available at 10.1186/s44247-025-00162-8.

Background: Mobile-health-applications demonstrate potential for reducing physical inactivity, yet evidence of their effectiveness in delivering performance feedback, particularly in workplace settings, remains limited. This 12-week randomised controlled trial evaluated the effects of mobile-application-based performance feedback (MABPF) on physical activity (PA) levels and sedentary time (ST) among 150 staff (aged 47.11 ± 6.46 years) of Nnamdi Azikiwe University, Nigeria. Participants were randomly allocated to three groups: MABPF with hourly reminders (n = 52), MABPF only (n = 50), and control group (n = 48). All groups received education on cardiovascular risk factors and physical activity benefits. PA and sedentary time was assessed at baseline, 6, and 12 weeks using the International Physical Activity Questionnaire-short form. Also, PA was objectively measured using pedometer, and Google Fit. Primary outcomes included step counts, PA levels, and ST.

Results: At baseline, 14% of participants demonstrated low PA levels, with no significant between-group differences. Both MABPF intervention groups showed significant improvements in pedometer step counts, Google Fit metrics, walking scores, moderate and vigorous PA, total PA, and ST reduction (p < 0.05 for all comparisons). Between-group analyses revealed that MABPF with hourly reminders was significantly more effective than both MABPF-only and control groups for pedometer step counts (F = 7.336, significantly greater ST reduction compared to control (F = 3.405, p = 0.038).

Conclusion: MABPF interventions, particularly when combined with hourly reminders, significantly improved PA behaviours and reduced ST among university staff. These findings support the potential of theory-informed mobile health interventions for promoting PA in workplace settings.

Clinical trial registration: Pan African Clinical Trial Registry number, PACTR202405808298188 on 24 May, 2024.