eHealth in the Management of Depressive Episodes in Catalonia's Primary Care From 2017 to 2022: Retrospective Observational Study

BACKGROUND

The reasons for mental health consultations are becoming increasingly relevant in primary care. The Catalan health care system is undergoing a process of digital transformation, where eHealth is becoming increasingly relevant in routine clinical practice.

OBJECTIVE

This study aimed to analyze the approach to depressive episodes and the role of eHealth in the Catalan health care system from 2017 to 2022.

METHODS

A retrospective observational study was conducted on diagnostic codes related to depressive episodes and mood disorders between 2017 and 2022 using data from the Catalan Institute of Health. The sociodemographic evolution and prevalence of depression and mood disorders in Catalonia were analyzed between 2017 and 2022. Sociodemographic variables were analyzed using absolute frequency and percentage. The prevalence of depressive episodes was calculated, highlighting the year-to-year changes. The use of eHealth for related consultations was assessed by comparing the percentages of eHealth and face-to-face consultations. A comparison of sociodemographic variables based on attendance type was conducted. Additionally, a logistic regression model was used to explore factors influencing face-to-face attendance. The analysis used R software (version 4.2.1), with all differences examined using 95% CIs.

RESULTS

From 2017 to 2022, there was an 86.6% increase in the prevalence of depression and mood disorders, with women consistently more affected (20,950/31,197, 67.2% in 2017 and 22,078/33,169, 66.6% in 2022). In 2022, a significant rise in depression diagnoses was observed in rural areas (difference 0.71%, 95% CI 0.04%-1.43%), contrasting with a significant decrease in urban settings (difference -0.7%, 95% CI -1.35% to -0.05%). There was a significant increase in antidepressant use in 2022 compared to 2017 (difference 2.4%, 95% CI 1.87%-3.06%) and the proportion of eHealth visits rose from 4.34% (1240/28,561) in 2017 to 26.3% (8501/32,267) in 2022. Logistic regression analysis indicated that men (odds ratio [OR] 1.06, 95% CI 1.04-1.09) and younger individuals had a higher likelihood of eHealth consultations in 2022. Furthermore, individuals using eHealth consultations were more likely to use antidepressants (OR 1.54, 95% CI 1.50-1.57) and anxiolytics (OR 1.06, 95% CI 1.03-1.09).

CONCLUSIONS

The prevalence of depression in Catalonia has significantly increased in the last 6 years, likely influenced by the COVID-19 pandemic. Despite ongoing digital transformation since 2011, eHealth usage remained limited as of 2017. During the lockdown period, eHealth accounted for nearly half of all health care consultations, representing a quarter of consultations by 2022. In the immediate aftermath of the COVID-19 pandemic, emerging evidence suggests a significant role of eHealth in managing depression-related consultations, along with an apparent likelihood of patients being prescribed antidepressants and anxiolytics. Further research is needed to understand the long-term impact of eHealth on diagnostic practices and medication use.

Diagnosing homo digitalis: towards a standardized assessment for digital tool competencies

Introduction

In the 21st century, digital devices have become integral to our daily lives. Still, practical assessments designed to evaluate an individual's digital tool competencies are absent. The present study introduces the "Digital Tools Test" ("DIGI"), specifically designed for the evaluation of one's proficiency in handling common applications and functions of smartphones and tablets. The DIGI assessment has been primarily tailored for prospective use among older adults and neurological patients with the latter frequently suffering from so-called apraxia, which potentially also affects the handling of digital tools. Similar to traditional tool use tests that assess tool-selection and tool-action processes, the DIGI assessment evaluates an individual's ability to select an appropriate application for a given task (e.g., creating a new contact), their capacity to navigate within the chosen application and their competence in executing precise and accurate movements, such as swiping.

Methods

We tested the implementation of the DIGI in a group of 16 healthy adults aged 18 to 28 years and 16 healthy adults aged 60 to 74 years. All participants were able to withstand the assessment and reported good acceptance.

Results

The results revealed a significant performance disparity, with older adults displaying notably lower proficiency in the DIGI. The DIGI performance of older adults exhibited a correlation with their ability to employ a set of novel mechanical tools, but not with their ability to handle a set of familiar common tools. There was no such correlation for the younger group.

Conclusion

In conclusion, this study introduces an innovative assessment tool aimed at evaluating common digital tool competencies. Our preliminary results demonstrate good acceptance and reveal expected group differences. For current cohorts of older adults, the results seem to indicate that the ability to use novel tools may aid digital tool use. In the next step, the psychometric properties of the DIGI assessment should be evaluated in larger and more diverse samples. The advancement of digital tool competency assessments and rehabilitation strategies is essential when we aim at facilitating societal inclusion and participation for individuals in affected populations.

Making food systems more resilient to food safety risks by including artificial intelligence, big data, and internet of things into food safety early warning and emerging risk identification tools

To enhance the resilience of food systems to food safety risks, it is vitally important for national authorities and international organizations to be able to identify emerging food safety risks and to provide early warning signals in a timely manner. This review provides an overview of existing and experimental applications of artificial intelligence (AI), big data, and internet of things as part of early warning and emerging risk identification tools and methods in the food safety domain. There is an ongoing rapid development of systems fed by numerous, real-time, and diverse data with the aim of early warning and identification of emerging food safety risks. The suitability of big data and AI to support such systems is illustrated by two cases in which climate change drives the emergence of risks, namely, harmful algal blooms affecting seafood and fungal growth and mycotoxin formation in crops. Automation and machine learning are crucial for the development of future real-time food safety risk early warning systems. Although these developments increase the feasibility and effectiveness of prospective early warning and emerging risk identification tools, their implementation may prove challenging, particularly for low- and middle-income countries due to low connectivity and data availability. It is advocated to overcome these challenges by improving the capability and capacity of national authorities, as well as by enhancing their collaboration with the private sector and international organizations.

Digital leadership: Norwegian healthcare managers' attitudes towards using digital tools

Background

Health services are undergoing digitalization and applying new digital tools. These changes may provide healthcare managers with opportunities to exercise digital leadership. However, managers' attitudes may influence the extent to which they demonstrate digital leadership. This study explores the attitudes of Norwegian healthcare managers towards: (1) digital tools and change and (2) to what extent digital tools are applicable to various tasks of managers.

Methods

Cross-sectional study including 154 managers in hospitals and municipal health services in a Norwegian county. The questionnaire was about management and digital tools, and the data was analyzed by descriptive statistics, correlations, and content analysis.

Results

The healthcare managers perceived that digital tools facilitated a positive change in organizational work processes aligned with values and goals. Digital tools supported administrative tasks such as gaining control over responsibilities. However, 76 managers stated that certain tasks, including interactions with employees (e.g. performance appraisals and sick leave follow-up) and the building of an organizational culture, should not be performed using digital tools or using them only to a limited extent; for these tasks, they preferred in-person meetings.

Discussion

Norwegian healthcare managers' attitudes toward digital tools are generally positive, but there are areas where they find the tools less suitable.

Conclusions

The results provide new insights into healthcare by indicating that many managers may have positive attitudes toward digital tools. However, digital leadership may not be applicable equally in all areas of healthcare managers' work. This raises the question of whether digital leadership can or should be exercised uniformly in every area of health services.

CRUSE® -An innovative mobile application for patient monitoring and management in chronic spontaneous urticaria

BACKGROUND

Chronic spontaneous urticaria (CSU) is unpredictable and can severely impair patients' quality of life. Patients with CSU need a convenient, user-friendly platform to complete patient-reported outcome measures (PROMs) on their mobile devices. CRUSE® , the Chronic Urticaria Self Evaluation app, aims to address this unmet need.

METHODS

CRUSE® was developed by an international steering committee of urticaria specialists. Priorities for the app based on recent findings in CSU were defined to allow patients to track and record their symptoms and medication use over time and send photographs. The CRUSE® app collects patient data such as age, sex, disease onset, triggers, medication, and CSU characteristics that can be sent securely to physicians, providing real-time insights. Additionally, CRUSE® contains PROMs to assess disease activity and control, which are individualised to patient profiles and clinical manifestations.

RESULTS

CRUSE® was launched in Germany in March 2022 and is now available for free in 17 countries. It is adapted to the local language and displays a country-specific list of available urticaria medications. English and Ukrainian versions are available worldwide. From July 2022 to June 2023, 25,710 observations were documented by 2540 users; 72.7% were females, with a mean age of 39.6 years. At baseline, 93.7% and 51.3% of users had wheals and angioedema, respectively. Second-generation antihistamines were used in 74.0% of days.

CONCLUSIONS

The initial data from CRUSE® show the wide use and utility of effectively tracking patients' disease activity and control, paving the way for personalised CSU management.

Effectiveness of digital health interventions to increase cardiorespiratory fitness: A systematic review and meta-analysis

Background

Interventions using commercial digital health tools do favorably affect health outcomes. However, the effect of digital tools on cardiorespiratory fitness, a more novel indicator cardiovascular risk, is unclear.

Purpose

Synthesize the digital health intervention literature and answer the following question: What is the effect of interventions using mobile health apps, wearable activity trackers, and/or text messaging on cardiorespiratory fitness?

Methods

A systematic review and a meta-analysis (PROSPERO CRD42023423925) were conducted to evaluate the immediate digital health intervention effect on adult cardiorespiratory fitness. In March 2023, a search of databases Embase, MEDLINE, CINHAL, and Cochrane Library was completed. Studies were included if the intervention used a mobile health app, text messaging, and/or activity tracker. Studies were excluded if an objective measure of fitness was not used; the sample included children; the setting was hospital-based; and the digital health technology was only used for data collection or described as virtual reality. Using a random-effects model, two separate meta-analyses were completed: one for single-group studies and one for multi-group studies. Standardized mean difference effect sizes (Cohen's d) were calculated. Study quality was evaluated with the Cochrane Risk of Bias tool and ROBINS-I tool.

Results

Fifty-three studies (3657 individuals) with pre-post designs (12 single-group, 41 multi-group) were included. Most studies targeted participants with a specific chronic health condition. Digital health interventions in the single-group studies had a moderate-to-large effect size (d = 0.62, 95% confidence interval (CI) [0.41-0.84], p < 0.001), and multi-group studies had small-to-moderate effect size (d = 0.38, 95% CI 0.21-0.55, p < 0.001). Significant heterogeneity of effects was observed in both the single-group and multi-group studies.

Conclusions

Interventions using text messaging, a mobile app, or activity tracker alone or in combination are effective in improving cardiorespiratory fitness in adults, particularly for those with a chronic health condition.

Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise

BACKGROUND

Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities.

OBJECTIVE

This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030.

METHODS

A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference.

RESULTS

The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis.

CONCLUSIONS

The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.

The NYCKidSeq randomized controlled trial: Impact of GUÍA digitally enhanced genetic results disclosure in diverse families

Digital solutions are needed to support rapid increases in the application of genetic/genomic tests (GTs) in diverse clinical settings and patient populations. We developed GUÍA, a bilingual digital application that facilitates disclosure of GT results. The NYCKidSeq randomized controlled trial enrolled diverse children with neurologic, cardiac, and immunologic conditions who underwent GTs. The trial evaluated GUÍA's impact on understanding the GT results by randomizing families to results disclosure genetic counseling with GUÍA (intervention) or standard of care (SOC). Parents/legal guardians (participants) completed surveys at baseline, post-results disclosure, and 6 months later. Survey measures assessed the primary study outcomes of participants' perceived understanding of and confidence in explaining their child's GT results and the secondary outcome of objective understanding. The analysis included 551 diverse participants, 270 in the GUÍA arm and 281 in SOC. Participants in the GUÍA arm had significantly higher perceived understanding post-results (OR = 2.8, CI[1.004, 7.617], p = 0.049) and maintained higher objective understanding over time (OR = 1.1, CI[1.004, 1.127], p = 0.038) compared to SOC. There was no impact on perceived confidence. Hispanic/Latino(a) individuals in the GUÍA arm maintained higher perceived understanding (OR = 3.9, CI[1.603, 9.254], p = 0.003), confidence (OR = 2.7, CI[1.021, 7.277], p = 0.046), and objective understanding (OR = 1.1, CI[1.009, 1.212], p = 0.032) compared to SOC. This trial demonstrates that GUÍA positively impacts understanding of GT results in diverse parents of children with suspected genetic conditions and builds a case for utilizing GUÍA to deliver complex results. Continued development and evaluation of digital applications in diverse populations are critical for equitably scaling GT offerings in specialty clinics.

Co-development and evaluation of the Musculoskeletal Telehealth Toolkit for physiotherapists

INTRODUCTION

In-person physiotherapy services are not readily available to all individuals with musculoskeletal conditions, especially those in rural regions or with time-intensive responsibilities. The COVID-19 pandemic highlighted that telehealth may facilitate access to, and continuity of care, yet many physiotherapists lack telehealth confidence and training. This project co-developed and evaluated a web-based professional development toolkit supporting physiotherapists to provide telehealth services for musculoskeletal conditions.

METHODS

A mixed-methods exploratory sequential design applied modified experience-based co-design methods (physiotherapists [n = 13], clinic administrators [n = 2], and people with musculoskeletal conditions [n = 7]) to develop an evidence-informed toolkit. Semi-structured workshops were conducted, recorded, transcribed, and thematically analysed, refining the toolkit prototype. Subsequently, the toolkit was promoted via webinars and social media. The usability of the toolkit was examined with pre-post surveys examining changes in confidence, knowledge, and perceived telehealth competence (19 statements modelled from the theoretical domains framework) between toolkit users (>30 min) and non-users (0 min) using chi-squared tests for independence. Website analytics were summarised.

RESULTS

Twenty-two participants engaged in co-design workshops. Feedback led to the inclusion of more patient-facing resources, increased assessment-related visual content, streamlined toolkit organisation, and simplified, downloadable infographics. Three hundred and twenty-nine physiotherapists from 21 countries completed the baseline survey, with 172 (52%) completing the 3-month survey. Toolkit users had greater improvement in knowledge, confidence, and competence than non-users in 42% of statements. Seventy-two percentage of toolkit users said it changed their practice, and 95% would recommend the toolkit to colleagues. During the evaluation period, the toolkit received 5486 total views.

DISCUSSION

The co-designed web-based Musculoskeletal Telehealth Toolkit is a professional development resource that may increase physiotherapist's confidence, knowledge, and competence in telehealth.

Evaluating the Added Value of Digital Contact Tracing Support Tools for Citizens: Framework Development

BACKGROUND

The COVID-19 pandemic revealed that with high infection rates, health services conducting contact tracing (CT) could become overburdened, leading to limited or incomplete CT. Digital CT support (DCTS) tools are designed to mimic traditional CT, by transferring a part of or all the tasks of CT into the hands of citizens. Besides saving time for health services, these tools may help to increase the number of contacts retrieved during the contact identification process, quantity and quality of contact details, and speed of the contact notification process. The added value of DCTS tools for CT is currently unknown.

OBJECTIVE

To help determine whether DCTS tools could improve the effectiveness of CT, this study aims to develop a framework for the comprehensive assessment of these tools.

METHODS

A framework containing evaluation topics, research questions, accompanying study designs, and methods was developed based on consultations with CT experts from municipal public health services and national public health authorities, complemented with scientific literature.

RESULTS

These efforts resulted in a framework aiming to assist with the assessment of the following aspects of CT: speed; comprehensiveness; effectiveness with regard to contact notification; positive case detection; potential workload reduction of public health professionals; demographics related to adoption and reach; and user experiences of public health professionals, index cases, and contacts.

CONCLUSIONS

This framework provides guidance for researchers and policy makers in designing their own evaluation studies, the findings of which can help determine how and the extent to which DCTS tools should be implemented as a CT strategy for future infectious disease outbreaks.

Testing a Digital Health App for Patients With Alcohol-Associated Liver Disease: Mixed Methods Usability Study

BACKGROUND

Alcohol-associated liver disease (ALD) is increasingly common and associated with serious and costly health consequences. Cessation of drinking can improve ALD morbidity and mortality; however, support for cessation is not routinely offered to those diagnosed with ALD, and continued drinking or resumption of drinking after diagnosis is common. Mobile health (mHealth) has the potential to offer convenient and scalable support for alcohol cessation to those diagnosed with ALD, but mHealth interventions for alcohol cessation have not been designed for or evaluated in a population with ALD.

OBJECTIVE

This study aims to understand how individuals with ALD would perceive and use an mHealth tool for alcohol cessation and to gather their perspectives on potential refinements to the tool that would allow it to better meet their needs.

METHODS

We interviewed 11 individuals who attended clinic visits related to their ALD to elicit their needs related to support for alcohol cessation and views on how mHealth could be applied. After completing initial interviews (pre), participants were provided with access to an mHealth app designed for alcohol cessation, which they used for 1 month. Afterward, they were interviewed again (post) to give feedback on their experiences, including aspects of the app that met their needs and potential refinements. We applied a mixed methods approach, including a qualitative analysis to identify major themes from the interview transcripts and descriptive analyses of use of the app over 1 month.

RESULTS

First, we found that a diagnosis of ALD is perceived as a motivator to quit drinking but that patients had difficulty processing the overwhelming amount of information about ALD they received and finding resources for cessation of alcohol use. Second, we found that the app was perceived as usable and useful for supporting drinking recovery, with patients responding favorably to the self-tracking and motivational components of the app. Finally, patients identified areas in which the app could be adapted to meet the needs of patients with ALD, such as providing information on the medical implications of an ALD diagnosis and how to care for their liver as well as connecting individuals with ALD to one another via a peer-to-peer support forum. Rates of app use were high and sustained across the entire study, with participants using the app a little more than half the days during the study on average and with 100% (11/11) of participants logging in each week.

CONCLUSIONS

Our results highlight the need for convenient access to resources for alcohol cessation after ALD diagnosis and support the potential of an mHealth approach to integrate recovery support into care for ALD. Our findings also highlight the ways the alcohol cessation app should be modified to address ALD-specific concerns.

Digital Tool-Assisted Hospitalization Detection in the Tailored Antiplatelet Initiation to Lessen Outcomes due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention Study Compared to Traditional Site-Coordinator Ascertainment: Intervention Study

BACKGROUND

Accurate, timely ascertainment of clinical end points, particularly hospitalizations, is crucial for clinical trials. The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study extended the main TAILOR-PCI trial's follow-up to 2 years, using a smartphone-based research app featuring geofencing-triggered surveys and routine monthly mobile phone surveys to detect cardiovascular (CV) hospitalizations. This pilot study compared these digital tools to conventional site-coordinator ascertainment of CV hospitalizations.

OBJECTIVE

The objectives were to evaluate geofencing-triggered notifications and routine monthly mobile phone surveys' performance in detecting CV hospitalizations compared to telephone visits and health record reviews by study coordinators at each site.

METHODS

US and Canadian participants from the TAILOR-PCI Digital Follow-Up Study were invited to download the Eureka Research Platform mobile app, opting in for location tracking using geofencing, triggering a smartphone-based survey if near a hospital for ≥4 hours. Participants were sent monthly notifications for CV hospitalization surveys.

RESULTS

From 85 participants who consented to the Digital Study, downloaded the mobile app, and had not previously completed their final follow-up visit, 73 (85.8%) initially opted in and consented to geofencing. There were 9 CV hospitalizations ascertained by study coordinators among 5 patients, whereas 8 out of 9 (88.9%) were detected by routine monthly hospitalization surveys. One CV hospitalization went undetected by the survey as it occurred within two weeks of the previous event, and the survey only allowed reporting of a single hospitalization. Among these, 3 were also detected by the geofencing algorithm, but 6 out of 9 (66.7%) were missed by geofencing: 1 occurred in a participant who never consented to geofencing, while 5 hospitalizations occurred among participants who had subsequently turned off geofencing prior to their hospitalization. Geofencing-detected hospitalizations were ascertained within a median of 2 (IQR 1-3) days, monthly surveys within 11 (IQR 6.5-25) days, and site coordinator methods within 38 (IQR 9-105) days. The geofencing algorithm triggered 245 notifications among 39 participants, with 128 (52.2%) from true hospital presence and 117 (47.8%) from nonhospital health care facility visits. Additional geofencing iterative improvements to reduce hospital misidentification were made to the algorithm at months 7 and 12, elevating the rate of true alerts from 35.4% (55 true alerts/155 total alerts before month 7) to 78.7% (59 true alerts/75 total alerts in months 7-12) and ultimately to 93.3% (14 true alerts/5 total alerts in months 13-21), respectively.

CONCLUSIONS

The monthly digital survey detected most CV hospitalizations, while the geofencing survey enabled earlier detection but did not offer incremental value beyond traditional tools. Digital tools could potentially reduce the burden on study coordinators in ascertaining CV hospitalizations. The advantages of timely reporting via geofencing should be weighed against the issue of false notifications, which can be mitigated through algorithmic refinements.

Digital Health Technology for Real-World Clinical Outcome Measurement Using Patient-Generated Data: Systematic Scoping Review

BACKGROUND

Digital health technologies (DHTs) play an ever-expanding role in health care management and delivery. Beyond their use as interventions, DHTs also serve as a vehicle for real-world data collection to characterize patients, their care journeys, and their responses to other clinical interventions. There is a need to comprehensively map the evidence-across all conditions and technology types-on DHT measurement of patient outcomes in the real world.

OBJECTIVE

We aimed to investigate the use of DHTs to measure real-world clinical outcomes using patient-generated data.

METHODS

We conducted this systematic scoping review in accordance with the Joanna Briggs Institute methodology. Detailed eligibility criteria documented in a preregistered protocol informed a search strategy for the following databases: MEDLINE (Ovid), CINAHL, Cochrane (CENTRAL), Embase, PsycINFO, ClinicalTrials.gov, and the EU Clinical Trials Register. We considered studies published between 2000 and 2022 wherein digital health data were collected, passively or actively, from patients with any specified health condition outside of clinical visits. Categories for key concepts, such as DHT type and analytical applications, were established where needed. Following screening and full-text review, data were extracted and analyzed using predefined fields, and findings were reported in accordance with established guidelines.

RESULTS

The search strategy identified 11,015 publications, with 7308 records after duplicates and reviews were removed. After screening and full-text review, 510 studies were included for extraction. These studies encompassed 169 different conditions in over 20 therapeutic areas and 44 countries. The DHTs used for mental health and addictions research (111/510, 21.8%) were the most prevalent. The most common type of DHT, mobile apps, was observed in approximately half of the studies (250/510, 49%). Most studies used only 1 DHT (346/510, 67.8%); however, the majority of technologies used were able to collect more than 1 type of data, with the most common being physiological data (189/510, 37.1%), clinical symptoms data (188/510, 36.9%), and behavioral data (171/510, 33.5%). Overall, there has been real growth in the depth and breadth of evidence, number of DHT types, and use of artificial intelligence and advanced analytics over time.

CONCLUSIONS

This scoping review offers a comprehensive view of the variety of types of technology, data, collection methods, analytical approaches, and therapeutic applications within this growing body of evidence. To unlock the full potential of DHT for measuring health outcomes and capturing digital biomarkers, there is a need for more rigorous research that goes beyond technology validation to demonstrate whether robust real-world data can be reliably captured from patients in their daily life and whether its capture improves patient outcomes. This study provides a valuable repository of DHT studies to inform subsequent research by health care providers, policy makers, and the life sciences industry.

TRIAL REGISTRATION

Open Science Framework 5TMKY; https://osf.io/5tmky/.

Evaluating pollution-related damage and restoration success in urban forests with participatory monitoring and digital tools

Peri-urban forest monitoring requires indicators of vegetation damage. An example is the sacred fir (Abies religiosa) forests surrounding Mexico City, which have been heavily exposed to tropospheric ozone, a harmful pollutant, for over 4 decades. We developed a participatory monitoring system with which local community members and scientists generated data on ozone tree damage. Santa Rosa Xochiac rangers (13) used the digital tool KoboToolBox to record ozone damage to trees, tree height, tree ages, tree condition, tree position, and whether the tree had been planted. Thirty-five percent of the trees (n = 1765) had ozone damage. Younger trees had a lower percentage of foliage damaged by ozone than older trees (p < 0.0001), and asymptomatic trees tended to be younger (p < 0.0001). Symptomatic trees were taller than asymptomatic trees of the same age (R2 c  = 0.43, R2 m  = 0.27). Involving local communities facilitated forest monitoring and using digital technology improved data quality. This participatory system can be used to monitor forest condition change over time and thus aids restoration efforts driven by government or local communities' interests, facilitating local decision-making.

Health science staff and student experiences of teaching and assessing clinical skills using digital tools: a qualitative study

INTRODUCTION

Once considered a supplement to traditional teaching approaches, digital tools now play a pivotal role in building core clinical competencies. This study aims to explore staff and student experiences of navigating the challenges of teaching and assessing clinical skills using digital technology. It also aims to provide insight into what skills, or aspects of skills, may be best suited to digitally enhanced teaching, thereby advancing the future of health science education.

METHODS

This qualitative study comprises the second phase of data generation for a mixed-methods research project entitled DEPTH (Digitally Enhanced Practical Teaching in Health Science). Health science staff and students expressed interest in taking part in the current study during the first stage of data collection. Qualitative data was collected in January 2022 through semi-structured group interviews and individual semi-structured interviews. An interpretivist qualitative research design underpinned by a critical realist epistemological position was used. Themes were generated following Braun and Clarke's 6-step process for reflexive thematic analysis.

RESULTS

Overall, 10 staff and 8 students across 11 health science disciplines participated in this research. Fourteen hours of transcripts were analysed and 4 themes generated. Our findings highlight the suitability of digitally enhanced teaching for low-stake skills requiring visual and auditory training, while skills requiring tactile training require in-person practice to build student competency. Importantly, our findings indicate a desire for increased remote teaching. While our work was not specifically aimed at documenting experiences related to the Covid-19 pandemic, all participants had lived experience teaching or learning during the pandemic and many spoke specifically about this.

CONCLUSIONS

The timing of this paper captures a novel moment in the history of clinical pedagogy. Staff and students advocate for the continued integration of technology into health science education generally, and clinical skills teaching specifically. For this to be successful, judicious selection of methods, skills, skill components and technology, that can be appropriately mapped onto specific learning outcomes, is required.

Twelve tips for co-production of online learning

In the digital age, experts in digital learning tools, or learning technologists (LTs), play an increasingly important role in the creation and delivery of online learning in health professions education. However, their expertise in the selection, curation and implementation of digital tools is often underutilized due to imbalanced relationships and lack of effective collaboration between faculty and LTs. Here, we describe how the co-production model can be applied to build equal and synergistic partnerships between faculty and LTs, so as to optimize the use of digital affordances and enhance online learning.

Improving Home-Based Scoliosis Therapy: Findings From a Web-Based Survey

BACKGROUND

Conservative scoliosis therapy in the form of assisted physiotherapeutic scoliosis exercises is supplemented by self-contained training at home, depending on the approach (eg, Schroth, the Scientific Exercises Approach to Scoliosis). Complex exercises, lack of awareness of the importance of training, and missing supervision by therapists often lead to uncertainty and reduced motivation, which in turn reduces the success of home-based therapy. Increasing digitalization in the health care sector offers opportunities to close this gap. However, research is needed to analyze the requirements and translate the potential of digital tools into concrete solution concepts.

OBJECTIVE

The aim of this study is to evaluate the potential for optimizing home-based scoliosis therapy in terms of motivation, assistive devices, and digital tools.

METHODS

In collaboration with the Institute of Physiotherapy at the Jena University Hospital, a survey was initiated to address patients with scoliosis and physical therapists. A digital questionnaire was created for each target group and distributed via physiotherapies, scoliosis forums, the Bundesverband für Skoliose Selbsthilfe e. V. newsletter via a link, and a quick response code. The survey collected data on demographics, therapy, exercise habits, motivation, assistive devices, and digital tools. Descriptive statistics were used for evaluation.

RESULTS

Of 141 survey participants, 72 (51.1%; n=62, 86.1%, female; n=10, 13.9%, male) patients with scoliosis with an average age of 40 (SD 17.08) years and 30 scoliosis therapists completed the respective questionnaires. The analysis of home-based therapy showed that patients with scoliosis exercise less per week (2 times or less; 45/72, 62.5%) than they are recommended to do by therapists (at least 3 times; 53/72, 73.6%). Patients indicated that their motivation could be increased by practicing together with friends and acquaintances (54/72, 75%), a supporting therapy device (48/72, 66.7%), or a digital profile (46/72, 63.9%). The most important assistive devices, which are comparatively rarely used in home-based therapy, included balance boards (20/72, 27.8%), wall bars (23/72, 31.9%), mirrors (36/72, 50%), and long bars (40/72, 55.6%). Therapists saw the greatest benefit of digital tools for scoliosis therapy in increasing motivation (26/30, 87%), improving home therapy (25/30, 83%), monitoring therapy progress (25/30, 83%), and demonstrating exercise instructions (24/30, 80%).

CONCLUSIONS

In this study, we investigated whether there is any potential for improvement in home-based scoliosis therapy. For this purpose, using online questionnaires, we asked patients with scoliosis and therapists questions about the following topics: exercise habits, outpatient and home-based therapy, motivation, supportive devices, and digital tools. The results showed that a lack of motivation, suitable training equipment, and tools for self-control leads to a low training workload. From the perspective of the patients surveyed, this problem can be addressed through community training with friends or acquaintances, a supportive therapy device, and digital elements, such as apps, with training instructions and user profiles.

The Role of Novel Digital Clinical Tools in the Screening or Diagnosis of Obstructive Sleep Apnea: Systematic Review

BACKGROUND

Digital clinical tools are a new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA), notwithstanding the crucial role of polysomnography, the gold standard.

OBJECTIVE

This study aimed to identify, gather, and analyze the most accurate digital tools and smartphone-based health platforms used for OSA screening or diagnosis in the adult population.

METHODS

We performed a comprehensive literature search of PubMed, Scopus, and Web of Science databases for studies evaluating the validity of digital tools in OSA screening or diagnosis until November 2022. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies. The sensitivity, specificity, and area under the curve (AUC) were used as discrimination measures.

RESULTS

We retrieved 1714 articles, 41 (2.39%) of which were included in the study. From these 41 articles, we found 7 (17%) smartphone-based tools, 10 (24%) wearables, 11 (27%) bed or mattress sensors, 5 (12%) nasal airflow devices, and 8 (20%) other sensors that did not fit the previous categories. Only 8 (20%) of the 41 studies performed external validation of the developed tool. Of these, the highest reported values for AUC, sensitivity, and specificity were 0.99, 96%, and 92%, respectively, for a clinical cutoff of apnea-hypopnea index (AHI)≥30. These values correspond to a noncontact audio recorder that records sleep sounds, which are then analyzed by a deep learning technique that automatically detects sleep apnea events, calculates the AHI, and identifies OSA. Looking at the studies that only internally validated their models, the work that reported the highest accuracy measures showed AUC, sensitivity, and specificity values of 1.00, 100%, and 96%, respectively, for a clinical cutoff AHI≥30. It uses the Sonomat-a foam mattress that, aside from recording breath sounds, has pressure sensors that generate voltage when deformed, thus detecting respiratory movements, and uses it to classify OSA events.

CONCLUSIONS

These clinical tools presented promising results with high discrimination measures (best results reached AUC>0.99). However, there is still a need for quality studies comparing the developed tools with the gold standard and validating them in external populations and other environments before they can be used in clinical settings.

TRIAL REGISTRATION

PROSPERO CRD42023387748; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387748.

The NYCKidSeq randomized controlled trial: Impact of GUÍA digitally enhanced genetic counseling in racially and ethnically diverse families

Background

Digital solutions are needed to support rapid increases in the application of genetic and genomic tests (GT) in diverse clinical settings and patient populations. We developed GUÍA, a bi-lingual web-based platform that facilitates disclosure of GT results. The NYCKidSeq randomized controlled trial evaluated GUÍA's impact on understanding of GT results.

Methods

NYCKidSeq enrolled diverse children with neurologic, cardiac, and immunologic conditions who underwent GT. Families were randomized to genetic counseling with GUÍA (intervention) or standard of care (SOC) genetic counseling for results disclosure. Parents/legal guardians (participants) completed surveys at baseline, post-results disclosure, and 6-months later. Survey measures assessed the primary study outcomes of perceived understanding of and confidence in explaining their child's GT results and the secondary outcome of objective understanding. We used regression models to evaluate the association between the intervention and the study outcomes.

Results

The analysis included 551 participants, 270 in the GUÍA arm and 281 in SOC. Participants' mean age was 41.1 years and 88.6% were mothers. Most participants were Hispanic/Latino(a) (46.3%), White/European American (24.5%), or Black/African American (15.8%). Participants in the GUÍA arm had significantly higher perceived understanding post-results (OR=2.8, CI[1.004,7.617], P=0.049) and maintained higher objective understanding over time (OR=1.1, CI[1.004, 1.127], P=0.038) compared to those in the SOC arm. There was no impact on perceived confidence. Hispanic/Latino(a) individuals in the GUÍA arm maintained higher perceived understanding (OR=3.9, CI[1.6, 9.3], P=0.003), confidence (OR=2.7, CI[1.021, 7.277], P=0.046), and objective understanding (OR=1.1, CI[1.009, 1.212], P=0.032) compared to SOC .

Conclusions

This trial demonstrates that GUÍA positively impacts understanding of GT results in diverse parents of children with suspected genetic conditions. These findings build a case for utilizing GUÍA to deliver complex and often ambiguous genetic results. Continued development and evaluation of digital applications in diverse populations are critical for equitably scaling GT offerings in specialty clinics.

Trial Registration

Clinicaltrials.gov identifier NCT03738098.

Facilitating person-centred care: integrating an electronic client feedback tool into continuous quality improvement processes to deliver client-responsive HIV services in the Democratic Republic of Congo

INTRODUCTION

Engaging communities in the design, implementation and monitoring of health services is critical for delivering high-quality, person-centred services that keep people living with HIV engaged in care. The USAID-funded Integrated HIV/AIDS Project in Haut-Katanga (IHAP-HK) integrated an electronic client feedback tool into continuous quality improvement (CQI) processes. We aimed to demonstrate this system's impact on identifying and improving critical quality-of-care gaps.

METHODS

Through stakeholder and empathy mapping, IHAP-HK co-designed a service quality monitoring system-comprising anonymous exit interviews and ongoing monitoring through CQI cycles-with people living with HIV, facility-based providers and other community stakeholders. IHAP-HK trained 30 peer educators to administer oral, 10- to 15-minute exit interviews with people living with HIV following clinic appointments, and record responses via the KoboToolbox application. IHAP-HK shared client feedback with facility CQI teams and peer educators; identified quality-of-care gaps; discussed remediation steps for inclusion in facility-level improvement plans; and monitored implementation of identified actions. IHAP-HK tested this system at eight high-volume facilities in Haut-Katanga province from May 2021 through September 2022.

RESULTS

Findings from 4917 interviews highlighted wait time, stigma, service confidentiality and viral load (VL) turnaround time as key issues. Solutions implemented included: (1) using peer educators to conduct preparatory tasks (pre-packaging and distributing refills; pulling client files) or escort clients to consultation rooms; (2) limiting personnel in consultation rooms during client appointments; (3) improving facility access cards; and (4) informing clients of VL results via telephone or home visits. Due to these actions, between initial (May 2021) and final interviews (September 2022), client satisfaction with wait times improved (76% to 100% reporting excellent or acceptable wait times); reported cases of stigma decreased (5% to 0%); service confidentiality improved (71% to 99%); and VL turnaround time decreased (45% to 2% informed of VL results 3 months after sample collection).

CONCLUSIONS

Our results showed the feasibility and effectiveness of using an electronic client feedback tool embedded in CQI processes to collect client perspectives to improve service quality and advance client-responsive care in the Democratic Republic of Congo. IHAP-HK recommends further testing and expansion of this system to advance person-centred health services.

Mindcraft, a Mobile Mental Health Monitoring Platform for Children and Young People: Development and Acceptability Pilot Study

BACKGROUND

Children and young people's mental health is a growing public health concern, which is further exacerbated by the COVID-19 pandemic. Mobile health apps, particularly those using passive smartphone sensor data, present an opportunity to address this issue and support mental well-being.

OBJECTIVE

This study aimed to develop and evaluate a mobile mental health platform for children and young people, Mindcraft, which integrates passive sensor data monitoring with active self-reported updates through an engaging user interface to monitor their well-being.

METHODS

A user-centered design approach was used to develop Mindcraft, incorporating feedback from potential users. User acceptance testing was conducted with a group of 8 young people aged 15-17 years, followed by a pilot test with 39 secondary school students aged 14-18 years, which was conducted for a 2-week period.

RESULTS

Mindcraft showed encouraging user engagement and retention. Users reported that they found the app to be a friendly tool helping them to increase their emotional awareness and gain a better understanding of themselves. Over 90% of users (36/39, 92.5%) answered all active data questions on the days they used the app. Passive data collection facilitated the gathering of a broader range of well-being metrics over time, with minimal user intervention.

CONCLUSIONS

The Mindcraft app has shown promising results in monitoring mental health symptoms and promoting user engagement among children and young people during its development and initial testing. The app's user-centered design, the focus on privacy and transparency, and a combination of active and passive data collection strategies have all contributed to its efficacy and receptiveness among the target demographic. By continuing to refine and expand the app, the Mindcraft platform has the potential to contribute meaningfully to the field of mental health care for young people.

Digital Devices Use and Fine Motor Skills in Children between 3-6 Years

(1) Background: The principal aim of our research was to explore the relationship between digital devices use and fine motor skills in children aged three to six years and to explore the effect of some socio-demographic factors. (2) Methods: we enrolled 185 children aged between three to six years. The parents of all the participants fulfilled a questionnaire to explore the digital device use, and their children performed a standardized test to assess fine motor skills (APCM-2). We performed the Spearman correlation test to explore the relationship between different variables. (3) Results: the children spent an average of 3.08 ± 2.30 h/day on digital devices. We did not find a significant association between the time of use of digital devices and fine motor skills (p = 0.640; r = -0.036). The youngest children experienced digital tools earlier than older ones (p < 0.001; r = 0.424) and they were also the ones who used digital tools more time afterwards (p = 0.012; -0.202). The children who had working parents spent more time on digital devices (p = 0.028; r = 0.164/p = 0.037; r = 0.154) and used digital devices earlier (p = 0.023; r = 0.171). (4) Conclusions: This data suggest that it would be useful to monitor the use of digital tools, especially in the very first years of life. Future studies are needed to further explore this topic.

Integrative Digital Tools to Strengthen Data Management for Antimicrobial Resistance Surveillance in the "One Health" Domain in Nepal

Antimicrobial resistance (AMR) is increasing and represents one of the greatest public health challenges of our time, accounting for considerable morbidity and mortality globally. A "One Health" surveillance strategy, which integrates data concerning the resistant organisms circulating in humans, animals, and the environment, is required to monitor this issue and enable effective interventions. The timely collection, processing, analysis, and reporting of AMR surveillance data are necessary for the effective delivery of the information generated from such surveillance. Nepal has greatly improved its surveillance activities through a network of human and animal health laboratories; however, the data reported by sentinel laboratories are often inconsistent, incomplete, and delayed, causing challenges in terms of data cleaning, standardization, and visualization on a national level. To overcome these issues, innovative methods and procedures have been adopted in Nepal, with the development and customization of digital tools that reduce the human time and effort spent on data cleaning and standardization, with concomitant improvements in the accuracy of data. These standardized data can be uploaded to the district health information system 2 (DHIS2) One Health AMR surveillance portal, enabling the generation of reports that will help decision-makers and policy planners to combat the global problem of AMR.

How Interactive Visualizations Compare to Ethical Frameworks as Stand-Alone Ethics Learning Tools for Health Researchers and Professionals

BACKGROUND

Despite the bourgeoning of digital tools for bioethics research, education, and engagement, little research has empirically investigated the impact of interactive visualizations as a way to translate ethical frameworks and guidelines. To date, most frameworks take the format of text-only documents that outline and offer ethical guidance on specific contexts. This study's goal was to determine whether an interactive-visual format supports frameworks in transferring ethical knowledge by improving learning, deliberation, and user experience.

METHODS

An experimental comparative study was conducted with a pre-, mid-, and post-test design using the online survey platform Qualtrics. Participants were university based early-stage health researchers who were randomly assigned to either the control condition (text-only document) or the experimental condition (interactive-visual). The primary outcome variables were learning, (measured using a questionnaire), deliberation (using cases studies) and user experience (measured using the SED/UD Scale). Analysis was conducted using descriptive statistics and mixed-effects linear regression.

RESULTS

Of the 80 participants, 44 (55%) used the text-only document and 36 (45%) used the interactive-visual. Results of the knowledge-test scores showed a statistically significant difference between participants' post-test scores, indicating that the interactive-visual format better supported understanding, acquisition, and application of the framework's knowledge. Findings from the case studies showed both formats supported ethical deliberation. Results further indicated the interactive-visual provided an overall better episodic and remembered user experience compared with the text-only document.

CONCLUSIONS

Our findings show that ethical frameworks formatted with interactive and visual qualities provide a more pleasing user experience and are effective formats for ethics learning and deliberation. These findings have implications for practitioners developing and deploying ethical frameworks and guidelines (e.g., in educational or employee-onboarding settings), in that the knowledge generated can lead to more effective dissemination practices of normative guidelines and health data ethics concepts.