Mobile health readiness factors: From the perspectives of mobile health users in Indonesia

Improving access to cardiovascular care for 1.4 billion people in China using telehealth

Cardiovascular diseases (CVDs) pose a significant health burden in China, where the large population and vast geography limit access to care. Telehealth (tHealth) services provide a virtual model of care that can enhance CVD management. This study aims to describe the trajectory of tHealth services for cardiovascular care between 2016 and 2020 in China, assess their utilization, and discuss their implications for improving access to care in resource-scarce regions. Data were collected on patient-facing, operational tHealth apps in Mainland China. In 2016, 45.8% of tertiary hospitals were accessible via tHealth apps, with a 10.7% annual growth rate. Wealthier regions had better tHealth coverage, irrespective of CVD burden. In 2016 and 2020, 34% and 67% of patients, respectively, consulted doctors located outside of their provinces, primarily in wealthier areas. The most common CVDs managed were hypertension, coronary artery disease, and arrhythmia. These findings suggest that tHealth services improve care access, especially in underdeveloped regions, but widespread technology adoption remains crucial.

Assessing the Digital Advancement of Public Health Systems Using Indicators Published in Gray Literature: Narrative Review

BACKGROUND

Revealing the full potential of digital public health (DiPH) systems requires a wide-ranging tool to assess their maturity and readiness for emerging technologies. Although a variety of indices exist to assess digital health systems, questions arise about the inclusion of indicators of information and communications technology maturity and readiness, digital (health) literacy, and interest in DiPH tools by the society and workforce, as well as the maturity of the legal framework and the readiness of digitalized health systems. Existing tools frequently target one of these domains while overlooking the others. In addition, no review has yet holistically investigated the available national DiPH system maturity and readiness indicators using a multidisciplinary lens.

OBJECTIVE

We used a narrative review to map the landscape of DiPH system maturity and readiness indicators published in the gray literature.

METHODS

As original indicators were not published in scientific databases, we applied predefined search strings to the DuckDuckGo and Google search engines for 11 countries from all continents that had reached level 4 of 5 in the latest Global Digital Health Monitor evaluation. In addition, we searched the literature published by 19 international organizations for maturity and readiness indicators concerning DiPH.

RESULTS

Of the 1484 identified references, 137 were included, and they yielded 15,806 indicators. We deemed 286 indicators from 90 references relevant for DiPH system maturity and readiness assessments. The majority of these indicators (133/286, 46.5%) had legal relevance (targeting big data and artificial intelligence regulation, cybersecurity, national DiPH strategies, or health data governance), and the smallest number of indicators (37/286, 12.9%) were related to social domains (focusing on internet use and access, digital literacy and digital health literacy, or the use of DiPH tools, smartphones, and computers). Another 14.3% (41/286) of indicators analyzed the information and communications technology infrastructure (such as workforce, electricity, internet, and smartphone availability or interoperability standards). The remaining 26.2% (75/286) of indicators described the degree to which DiPH was applied (including health data architecture, storage, and access; the implementation of DiPH interventions; or the existence of interventions promoting health literacy and digital inclusion).

CONCLUSIONS

Our work is the first to conduct a multidisciplinary analysis of the gray literature on DiPH maturity and readiness assessments. Although new methods for systematically researching gray literature are needed, our study holds the potential to develop more comprehensive tools for DiPH system assessments. We contributed toward a more holistic understanding of DiPH. Further examination is required to analyze the suitability and applicability of all identified indicators in diverse health care settings. By developing a standardized method to assess DiPH system maturity and readiness, we aim to foster informed decision-making among health care planners and practitioners to improve resource distribution and continue to drive innovation in health care delivery.

Evaluation of usability and user feedback to guide telepharmacy application development in Indonesia: a mixed-methods study

BACKGROUND

In Indonesia, the adoption of telepharmacy was propelled by the COVID-19 pandemic, prompting the need for a user-friendly application to support both the general population and pharmacists in accessing healthcare services. Therefore, this study aimed to evaluate usability and user feedback of a pioneering telepharmacy application known as Tanya Obat (translating to "Ask about Medications") in Indonesia, from the perspectives of the general population and pharmacists.

METHODS

A mixed-methods sequential study was conducted with the early-stage Tanya Obat application in Bandung City. Participants, including the general population and pharmacists, were instructed to use the application for a week. Questionnaires for the general population and pharmacists were distributed from March to May and February to June 2023, respectively. The System Usability Scale questionnaire was adopted to describe usability of the developed application. Further exploration of the quantitative results required collecting open-ended feedback to assess the impressions of the participants, difficulties encountered, and desired features for enhanced user-friendliness. The collected statements were summarized and clustered using thematic analysis. Subsequently, the association between the characteristics of participants and perceived usability was determined with the Chi-square test.

RESULT

A total of 176 participants, comprising 100 individuals from the general population and 76 pharmacists, engaged in this study. In terms of usability, the questionnaire showed that Tanya Obat application was on the borderline of acceptability, with mean scores of 63.4 and 64.1 from the general population and pharmacists, respectively. Additionally, open-ended feedback targeted at achieving a more compelling user experience was categorized into two themes, including concerns regarding the functionality of certain features and recommendations for improved visual aesthetics and bug fixes. No significant associations were observed between the characteristics of participants and perceived usability (p-value > 0.05).

CONCLUSION

The results showed that the perceived usability of Tanya Obat developed for telepharmacy was below average. Therefore, feature optimizations should be performed to facilitate usability of this application in Indonesia.

Digital rights and mobile health in Southeast Asia: A scoping review

Objective

Digital technology has the potential to support or infringe upon human rights. The ubiquity of mobile technology in low- and middle-income countries (LMICs) presents an opportunity to leverage mobile health (mHealth) interventions to reach remote populations and enable them to exercise human rights. Yet, simultaneously, the proliferation of mHealth results in expanding sensitive datasets and data processing, which risks endangering rights. The promotion of digital health often centers on its role in enhancing rights and health equity, particularly in LMICs. However, the interplay between mHealth in LMICs and digital rights is underexplored. The objective of this scoping review is to bridge this gap and identify digital rights topics in the 2022 literature on mHealth in Southeast Asian LMICs. Furthermore, it aims to highlight the importance of patient empowerment and data protection in mHealth and related policies in LMICs.

Methods

This review follows Arksey and O'Malley's framework for scoping reviews. Search results are reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Frequency and content analyses were applied to summarize and interpret the data.

Results

Three key findings emerge from this review. First, the digital rights topics covered in the literature are sparse, sporadic, and unsystematic. Second, despite significant concerns surrounding data privacy in Southeast Asian LMICs, no article in this review explores challenges to data privacy. Third, all included articles state or allude to the role of mHealth in advancing the right to health.

Conclusions

Engagement in digital rights topics in the literature on mHealth in Southeast Asian mHealth is limited and irregular. Researchers and practitioners lack guidance, collective understanding, and shared language to proactively examine and communicate digital rights topics in mHealth in LMIC research. A systematic method for engaging with digital rights in this context is required going forward.

An Empirical Study on the Use of Digital Technologies to Achieve Cost-Effectiveness in Healthcare Management

Objectives: Healthcare cost reduction is one of the major challenges of the current era. This study was based on the general system theory-based view to assess the significance of sensing communication technologies and processing actuation technologies in improving healthcare quality, leading to cost reduction. Moreover, the contingent rule of healthcare supply chain management in enhancing the influence of improved quality on healthcare cost reduction was also empirically tested. Methods: The sample of the study comprised 337 middle and senior healthcare managers employed in various government and private hospitals and health institutions in Jakarta, Indonesia. The administrative departments of each hospital and health institution was visited to take their consent to conduct this survey at their clinical and non-clinical departments. The data collected was analyzed using SmartPLS ver. 4 software. Results: Results reveal a significant direct and indirect influence of sensing communication technologies and processing actuation technologies on achieving cost-effectiveness in the healthcare sector, in the presence of perceived quality improvement as a mediator. However, the strength of the associations varied and was based on highly reliable and familiar nature of sensing communication technologies compared to processing actuation technologies which were emerging and gaining popularity in recent years. Conclusion: Considering the healthcare cost as a critical factor based on limited resources in emerging economies, healthcare institutions/centers should use digital technologies to achieve cost-effectiveness for providing healthcare facilities in the industry 4.0 era.

The Interaction of Perceived Susceptibility with Predictors of mHealth Technology Usage

Objectives: Based on the significance of mobile healthcare (mHealth) technologies in the dynamic and competitive environment, the current study examined the interactive effect of individuals' perceived susceptibility of being ill with the performance expectancy, social influence, and facilitating conditions on their intentions and actual usage of mHealth technologies during medical emergencies/disastrous situations. Methods: Surveying 417 mHealth users in Indonesia, the current study applied structural equational modeling in SmartPLS ver.4 software to analyze the collected data. Results: Results revealed the importance of individuals' expectations regarding the performance of mHealth technologies along with the views of their social networks and facilitating conditions provided by the healthcare organizations to influence mHealth technologies' use during medical emergencies. However, results showed the strongest influence of facilitating conditions on the usage of mHealth technologies reflecting the significance of ease of use. Additionally, findings showed the significant contingent role of the perceived susceptibility of users to augment their intentions to adopt the mHealth technologies. Conclusion: The current study is expected to bring valuable insights to health service providers, health professionals, medical institutions, and practitioners by highlighting factors that facilitate individuals to use mHealth technologies during emergencies.