The digitally engaged patient: Self-monitoring and self-care in the digital health era

Peer-to-peer sharing in public health interventions: strategies when people share health-related personal information on social media

PURPOSE

As sharing on social media has become an integrated part of everyday life, health and public health actors have started to show interest in the potential of people's peer-to-peer sharing of health-related personal information (HRI) for health interventions. In this article we focus on how people make sense of sharing HRI on social media.

METHODS

Twenty-two people between the ages 40 and 60 who had taken part in a regional health intervention were interviewed. Using theories about social media sharing, we explore their understandings and negotiations about whether, how much, and how to share HRI and discuss the results in relation to peer-to-peer sharing as a strategy in interventions.

RESULTS

We identified three aspects that were perceived as particularly risky: loss of control, effects on identity, and affecting others negatively, along with strategies that were used to manage risks in practice: avoiding sharing, allocating, and embedding HRI.

CONCLUSIONS

By allocating and embedding HRI, people can unlock motivating affordances for health work. However, strategies to manage risks can also be counterproductive. For actors to provide equality in health promotion, initiatives that include social media sharing need to be mindful of the sometimes counterproductive effects this may have on people's engagement.

Visualising, navigating and making time: The use of a digital solution in treatment and rehabilitation from low back pain

Illness trajectories are particularly characterised by the temporal dimension of human existence. In the area of low back pain, patients often have challenging temporal experiences such as unproductive waiting time and fragmented, repetitive consultations over many years. This study seeks to investigate relationships between digital technologies, temporal agency, and illness, through describing how users experienced a new digital solution, BackTrace, targeting patients with low back pain. The study builds on six months of ethnographic fieldwork, including semi-structured interviews, participant observation and a workshop. The study shows how the introduction of the digital solution could facilitate new possibilities of temporal actions for individuals living with and receiving care for low back pain. For many research participants, the use of BackTrace facilitated a useful visualisation of their past and present low back pain state; BackTrace could assist participants in navigating different external temporal demands; and it allocated time devoted to managing their back pain in everyday life and in consultations with health professionals. The study discusses how temporality can be a useful analytical entrance point to operationalise and explore the often-desired goal of empowerment in patient pathways.

Use of AI in Mental Health Care: Community and Mental Health Professionals Survey

Background

Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support.

Objective

This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs).

Methods

This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted.

Results

The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28% (30/108) of CMs used AI, primarily for quick support (18/30, 60%) and as a personal therapist (14/30, 47%). Among MHPs, 43% (37/86) used AI; mostly for research (24/37, 65%) and report writing (20/37, 54%). While the majority found AI to be generally beneficial (23/30, 77% of CMs and 34/37, 92% of MHPs), specific harms and concerns were experienced by 47% (14/30) of CMs and 51% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback.

Conclusions

Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time.

A Technology-Based Intervention Impacts Quality of Life for Low-Income Older Adults by Reducing Loneliness and Improving Healthcare Self-Efficacy and Self-Rated Health

This paper describes a technology program aimed at developing technical skills and confidence, reducing social isolation and loneliness, and increasing healthcare self-management and self-efficacy among older adults. We conducted a mixed-methods study using surveys collected at baseline and 12 months from 90 older adults. Focus group data (n = 7) collected at 12 months were examined for convergence with key quantitative outcomes, emergent value-related themes, and evaluation of program structure and staff. Outcome data showed improvements in loneliness (Cohen's d = -0.24, p = .004) (validated by qualitative data), self-rated health (d = 0.23, p = .011), and healthcare self-efficacy (d = 0.31, p = .004). Participants with higher healthcare self-efficacy (β = 0.24, p = .03) and higher negative emotions (β = 0.28, p = .01) had greater frequency of internet use to search for health information. Qualitative findings described program mechanisms supporting increases in self-efficacy, including increased technology use and confidence, and values statements demonstrating the meaningfulness of learning technology and its impact on multiple domains of quality of life.

Living with Sjögren's Syndrome: An Analysis of YouTube Vlogs on the Autoimmune Disease

People who experience symptoms of autoimmune diseases often have to struggle for illness recognition. Women experiencing such symptoms face additional challenges as their accounts of pain are frequently treated with skepticism. This study examines experiences of people living with Sjögren's Syndrome, an autoimmune disease which is primarily diagnosed in women, by conducting an analysis of individual vlogs posted on YouTube using the themes of gender, chronic illness and neoliberal governmentality. Sjögren's Syndrome is the second most common rheumatic disease after rheumatoid arthritis and affects nearly 4 million people in the United States alone. An analysis of 70 vlogs posted by people living with the disease revealed the challenges faced by them including diagnostic delays and perceived attitudinal biases amongst medical professionals, especially in the context of the gender of the patients. Apart from highlighting the impact of the disease on their gendered roles, the vloggers urged viewers to conduct their own research on the disease and advocate for themselves during interactions with physicians. The study illuminates how dissatisfaction with healthcare services reinforces neoliberal rationalities such as individual advocacy, resilience and self-labor. The findings of the study delineate the role of neoliberal governmentality in making self-management of chronic illnesses such as Sjögren's Syndrome an internalized ideal for women living with the disease. Additionally, the study provides empirical evidence of the need for addressing the medical and socio-cultural factors that contribute to delays in the diagnosis and management of Sjögren's Syndrome.

Conceptualizing Patient as an Organization With the Adoption of Digital Health

The concept of viewing a patient as an organization within the context of digital healthcare is an innovative and evolving concept. Traditionally, the patient-doctor relationship has been centered around the individual patient and their interactions with healthcare providers. However, with the advent of technology and digital healthcare solutions, the dynamics of this relationship are changing. Digital healthcare platforms and technologies enable patients to have more control and active participation in managing their health and healthcare processes. This shift empowers patients to take on a more proactive role, similar to how an organization functions with various stakeholders, goals, and strategies. The prevalence of mobile phones and wearables is regarded as an important factor in the acceptance of digital health.

Objective

This study aimed to identify the factors affecting adoption intention using the TAM (Technology Acceptance Model), HB (Health Belief model), and the UTAUT (Unified Theory of Acceptance and Use of Technology). The argument is made that the adoption of the technology enables patients to create resources (ie, data), transforming patients from mere consumers to producers as well.

Results

PLS analysis showed that health beliefs and perceived ease of use had positive effects on the perceived usefulness of digital healthcare, and system capabilities positively impacted perceived ease of use. Furthermore, perceived service, the customer's willingness to change and reference group influence significantly impacted adoption intention (b > 0.1, t > 1.96, P < .05). However, privacy protection and data security, online healthcare resources, and user guidance were not positively associated with perceived usefulness.

Conclusions

Perceived usefulness, the customer's willingness to change, and the influence of the reference group are decisive variables affecting adoption intention among the general population, whereas privacy protection and data security are indecisive variables. Online resources and user guides do not support adoption intentions.

Self-Testing for Dementia: A Phenomenological Analysis of Fear

Following the growing economic relevance of mobile health (mHealth) and the increasing global prevalence of dementia, self-testing apps for dementia and mild neurocognitive disorder (MCD) have been developed and advertised. The apps' promise of a quick and easy tool has been criticized in the literature from a variety of angles, but as we argue in this article, the celebratory characterization of self-testing also stands in disbalance to the various kinds of fears that may be connected to taking the test. By drawing on Sara Ahmed's phenomenological theory on emotions and by referring to illustrative experiences from two users with a particular dementia self-testing app, we explore four dimensions of fear derived from phenomenology: performative, ontological, embodied, and temporal dimensions. We argue that fear (1) motivates one to take the self-test and to try to take control over one's health; (2) is shaped by and shapes the ways in which we make sense of ourselves and others as cognitively deficient; (3) constructs and is constructed by our differently embodied presence in the world; and that (4) testing makes a fearful future self as cognitively deficient more tangible. In outlining these different dimensions of fear, this article expands the understanding of the meaning of experiencing self-testing in comparison to the mostly quantitative literature on this topic.

Un-tracking menopause: How not using self-tracking technologies mediates women's self-experiences in menopause

Self-tracking in general, and by women in particular is increasingly researched. In the literature, however, women's interactions with selftracking technologies in menopause-a change that (almost) every woman will go through-is largely taken for granted. This paper addresses this lacuna by asking whether and how menopausal women use self-tracking technologies, and how this (non-) usage mediates their self-experiences. In doing so, it elaborates on another understudied phenomenon: the constitutive significance of "un-tracking"-that is, of various shades and levels of not using self-tracking technologies-in menopause. Most of the 13 interviewed women in this study reported that they stopped, drastically reduced, or resisted self-tracking in menopause. By framing the discussion of these accounts of "un-tracking" within the tradition of post-phenomenology and a phenomenology of situated bodily self-awareness, we show that these women experience their bodies as (1) wise and eu-appearing, (2) unmoldable and dysappearing, and (3) longing for disappearance. Herein, their experientially mediating un-tracking practices are temporally and socio-culturally contextualized in complex ways and bear substantial existential significance. This study establishes the potential harmful ways in which self-tracking mediates self-experiences, as well as the fruitful ways in which un-tracking may do so. Against the background of this observation, this paper makes an appeal to take a step back from uncritically celebrating self-tracking in healthcare contexts, and critically evaluates whether (the promotion of) using (more) self-tracking technologies in these contexts is desirable to begin with.

How does mHealth influence consulting practice between health professionals and individuals with low back pain? - A qualitative study from the perspective of health professionals

PURPOSE

This study explored how health professionals experience in what way a digital self-monitoring solution influences their consulting practice targeting individuals with low back pain.

MATERIAL AND METHODS

This was a qualitative study adopting a constructivist grounded theory approach. Nineteen health professionals participated in the pilot test of the digital self-monitoring solution BackTrace. Data were collected cross-sectionally and consisted of: (a) audio recordings from focus groups with health professionals, (b) field notes from participant observation of online meetings with health professionals, (c) field notes from participant observations of consultations between health professionals and individuals with low back pain and (d) audio recordings from workshops with health professionals.

RESULTS

Two main themes and one sub-theme were identified, describing how BackTrace enabled more focused consulting practices, supported patient-self management and improved the relationship between individuals with low back pain and health professionals. Barriers were identified describing how the implementation of digital health solutions required a change in workflow, resources and culture - as well as management support.

CONCLUSIONS

Findings indicated a need for a change at the system level, including a changed view of digitisation in healthcare systems containing a more supporting approach.

Supportive eHealth Technologies and Their Effects on Physical Functioning and Quality of Life for People With Lung Cancer: Systematic Review

BACKGROUND

Despite advancements in treatment and early diagnosis, people with lung cancer are not living as long as those with other cancers. The more common symptoms of lung cancer, such as breathlessness, fatigue, and depression, can be alleviated by improving patients' physical functioning. Therefore, good symptom management and improved health-related quality of life (HRQoL) are priorities in this patient group. However, current health care services have limited capacity to provide this support. One way to address this issue of health care resources is to empower patients to self-manage their condition using eHealth technologies.

OBJECTIVE

The purpose of this review was to identify and assess available research on technologies that support persons with lung cancer to improve or maintain their physical functioning, HRQoL, or both.

METHODS

Six databases-PubMed, Web of Science, CINAHL, MEDLINE, SPORTDiscus, and PsycINFO-were searched from January 1, 1990, to April 30, 2023. Studies were suitable for inclusion if the participants included people with lung cancer aged >18 years who had been exposed to a physical activity, exercise, or training intervention that was delivered via an electronic or web-based application with or without a comparator. Furthermore, the study had to report on the impact of the intervention on physical functioning and HRQoL. Studies that focused on telemedicine without a digital intervention were excluded. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the quality of the included papers. Due to the heterogeneity of the studies, a narrative synthesis was undertaken.

RESULTS

This review is reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 794 papers were initially identified through our search, of which, after screening, 8 (1%) were confirmed suitable for inclusion in the review. As 2 (25%) of the 8 papers reported on different stages of the same study, we included only 7 studies in our analysis. The studies were undertaken between 2010 and 2018 across multiple countries and aimed to develop a technology and test its feasibility or acceptance. The 7 technologies identified included web-based applications, mobile apps, and gaming consoles. The studies demonstrated impact on walking distance, muscle strength, balance, dyspnea symptoms, and cancer-related fatigue. HRQoL scores also showed improvement.

CONCLUSIONS

The findings indicate that eHealth technologies can positively impact physical functioning and well-being for people with lung cancer, but there are limited studies that demonstrate the impact of these digital interventions over longer periods. None of the studies reported on the implementation or adoption of a mobile health or eHealth intervention in routine clinical practice, highlighting the need for further research in this area.

TRIAL REGISTRATION

PROSPERO CRD42023414094; https://tinyurl.com/39hhbwyx.

Definitions and surveillance methods of running-related injuries: A scoping review

Inconsistent and restricted definitions of injury have contributed to limitations in determining injury rates and identifying risk factors for running-related injuries (RRIs). The aim of this scoping review was to investigate the definitions and surveillance methods of RRIs. A systematic electronic search was performed using PubMed, Scopus, SPORTDiscuss, MEDLINE, and Web of Science databases. Included studies were published in English between January 1980 and June 2023 which investigated RRIs in adult running populations, providing a definition for a general RRI. Results were extracted and collated. 204 articles were included. Three primary criteria were used to define RRIs: physical description, effect on training and medical intervention, while three secondary criteria are also associated with definitions: cause/onset of injury, location, and social consequences. Further descriptors and sub-descriptors form these criteria. The use of Boolean operators resulted in nine variations in definitions. Inconsistency is evident among definitions of RRIs. Injury definitions seem to be important for two main reasons: firstly, determining accurate injury rates, and secondly, in research examining risk factors. For the latter, definitions seem to be very limited, only capturing severe injuries and failing to recognise the full development process of RRIs, precluding the identification of conclusive risk factors. A potential two-approach solution is the initial use of a broad definition acting as a gatekeeper for identifying any potential injury, and follow-up with an extensive surveillance tool to capture the specific consequences of the varying severity of RRIs.

Healthism, rural individualism and self-help: youth mental health in Northwest Tasmania

Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people's lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths' help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth.

Breaking down the Digital Fortress: The Unseen Challenges in Healthcare Technology-Lessons Learned from 10 Years of Research

Healthcare is undergoing a fundamental shift in which digital health tools are becoming ubiquitous, with the promise of improved outcomes, reduced costs, and greater efficiency. Healthcare professionals, patients, and the wider public are faced with a paradox of choice regarding technologies across multiple domains. Research is continuing to look for methods and tools to further revolutionise all aspects of health from prediction, diagnosis, treatment, and monitoring. However, despite its promise, the reality of implementing digital health tools in practice, and the scalability of innovations, remains stunted. Digital health is approaching a crossroads where we need to shift our focus away from simply looking at developing new innovations to seriously considering how we overcome the barriers that currently limit its impact. This paper summarises over 10 years of digital health experiences from a group of researchers with backgrounds in physical therapy-in order to highlight and discuss some of these key lessons-in the areas of validity, patient and public involvement, privacy, reimbursement, and interoperability. Practical learnings from this collective experience across patient cohorts are leveraged to propose a list of recommendations to enable researchers to bridge the gap between the development and implementation of digital health tools.

A typology of evaluative health platforms: Commercial interests and their implications for patient voice

Interactions in the healthcare system today involve an important new set of actors: evaluative health platforms (EHPs). These platforms are not neutral intermediaries, but active moderators of how patients express opinions, choose providers, and consume health-related information. This paper adds to our understanding of the varied and evolving commercial interests of EHPs and the implications these have for patient voice. We analyze 71 platforms in the USA, UK, and Germany and identify five ideal types: subscribers, analyzers, advertisers, regulators, and scammers. Each platform type enacts a unique competitive strategy through an evaluative infrastructure which constrains but also generates possibilities for patient voice. Based on our typology, we develop three contributions. First, we nuance universalizing claims about the consequences of platform capitalism by specifying the diverse strategies underpinning competition between EHPs in different countries, and showing how each strategy leads evaluative infrastructures to develop in ways that impact patient voice. Second, we show how patients can navigate the challenges of a complex EHP space by exercising their ability to choose between platforms. Finally, we outline the conditions platforms need to fulfil to become empowering. Overall, this study highlights the varied and complex relationship between platform business models and user voice, which exists not only in healthcare, but also in many other fields.

Rethinking Health Recommender Systems for Active Aging: An Autonomy-Based Ethical Analysis

Health Recommender Systems are promising Articial-Intelligence-based tools endowing healthy lifestyles and therapy adherence in healthcare and medicine. Among the most supported areas, it is worth mentioning active aging. However, current HRS supporting AA raise ethical challenges that still need to be properly formalized and explored. This study proposes to rethink HRS for AA through an autonomy-based ethical analysis. In particular, a brief overview of the HRS' technical aspects allows us to shed light on the ethical risks and challenges they might raise on individuals' well-being as they age. Moreover, the study proposes a categorization, understanding, and possible preventive/mitigation actions for the elicited risks and challenges through rethinking the AI ethics core principle of autonomy. Finally, elaborating on autonomy-related ethical theories, the paper proposes an autonomy-based ethical framework and how it can foster the development of autonomy-enabling HRS for AA.

Which behaviour change techniques work best for diabetes self-management mobile apps? Results from a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Self-management is pivotal in addressing noncommunicable diseases, such as diabetes. The increased availability of digital behaviour change interventions (DBCIs) delivered through mobile health apps offers unprecedented opportunities to enhance self-management and improve health outcomes. However, little is known about the characteristics of DBCIs for diabetes that significantly impact glycaemic control. Therefore, our systematic review with meta-analysis aimed to summarize characteristics and behaviour change components in DBCIs for diabetes self-management and explore potential associations with metabolic outcomes.

METHODS

A systematic search was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scopus to identify randomized controlled trials published until November 2023. The main outcome variable was the change in the mean difference of HbA1c levels between baseline and follow-up across intervention and control groups. Random-effects meta-regression was used to explore variation in glycaemic control as a function of prespecified characteristics of study designs and app interventions.

FINDINGS

A total of 57 studies was included in the analysis, showing a statistically significant percentage point reduction in HbA1c for the intervention group compared to the control arm (-0.36, 95% CI = -0.46 to -0.26, p < 0.001). The inclusion of "self-monitoring of behaviour" as a behaviour change technique (β = -0.22, p = 0.04) and "taking medication" as a target behaviour (β = -0.20, p = 0.05) was associated with improved metabolic outcomes.

INTERPRETATION

Our analyses endorse the use of diabetes self-management apps, highlighting characteristics statistically associated with intervention effectiveness and guiding the design of more effective DBCIs.

FUNDING

This project received funding from the European Union's Horizon 2020 programme.

The Political Economy of Digital Health Equity: Structural Analysis

Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.

Detecting value(s): Digital biomarkers for Alzheimer's disease and the valuation of new diagnostic technologies

This article explores how the meanings and values of diagnosis are being reconfigured at the interface between technological innovation and imaginaries of precision medicine. From genome sequencing to biological and digital 'markers' of disease, technological innovation occupies an increasingly central space in the way we imagine future health and illness. These imaginaries are usually centred on the promise of faster, more precise and personalised diagnosis, and the associated hope that if detected early enough disease can be effectively treated and prevented. Underpinning and reproduced through these narratives of the future is a re-conceptualisation of diagnostic processes and categories around the anticipation of future risk, as noted by recent theoretical developments in the sociology of diagnosis and related disciplines. Adding to this literature, in this article we explore what makes these emerging diagnostic arrangements valuable, to whom and how. Drawing on interviews with experts involved in the development of digital biomarkers for Alzheimer's disease, we trace how multiple and at times conflicting applications of the tools, and the value(s) attached to them, are coproduced. We thus ask what possibilities are pursued, or foreclosed, through the work of imagining the future of diagnosis.

Encircling discourses-A guide to critical discourse analysis in caring science

AIM

The aim of this article was to introduce Fairclough's critical discourse analysis (CDA) in caring and nursing science, to provide a guide on how to perform such an analysis, and to describe the wider context of discourse epistemology.

DESIGN

The article is designed as a methodological paper, including (a) epistemological roots of discourse analysis, (b) an overview of discourse analytical research within caring and nursing science which points out an increased trend, and (c) a guide to conducting a CDA.

ANALYSIS

It is important that discourse analysis is available and accessible to nursing and caring researchers. Through the process of encircling discourses, valuable insight is given into fields that otherwise would be lost or would not be available.

CONCLUSION

Our summary stance is that discourse analysis as it is presented in this article is strongly advisable for use in nursing and caring sciences.

Deep breathing in your hands: designing and assessing a DTx mobile app

Digital Therapeutics (DTx) are experiencing rapid advancements within mobile and mental healthcare sectors, with their ubiquity and enhanced accessibility setting them apart as uniquely effective solutions. In this evolving context, our research focuses on deep breathing, a vital technique in mental health management, aiming to optimize its application in DTx mobile platforms. Based on well-founded theories, we introduced a gamified and affordance-driven design, facilitating intuitive breath control. To enhance user engagement, we deployed the Mel Frequency Cepstral Coefficient (MFCC)-driven personalized machine learning method for accurate biofeedback visualization. To assess our design, we enlisted 70 participants, segregating them into a control and an intervention group. We evaluated Heart Rate Variability (HRV) metrics and collated user experience feedback. A key finding of our research is the stabilization of the Standard Deviation of the NN Interval (SDNN) within Heart Rate Variability (HRV), which is critical for stress reduction and overall health improvement. Our intervention group observed a pronounced stabilization in SDNN, indicating significant stress alleviation compared to the control group. This finding underscores the practical impact of our DTx solution in managing stress and promoting mental health. Furthermore, in the assessment of our intervention cohort, we observed a significant increase in perceived enjoyment, with a notable 22% higher score and 10.69% increase in positive attitudes toward the application compared to the control group. These metrics underscore our DTx solution's effectiveness in improving user engagement and fostering a positive disposition toward digital therapeutic efficacy. Although current technology poses challenges in seamlessly incorporating machine learning into mobile platforms, our model demonstrated superior effectiveness and user experience compared to existing solutions. We believe this result demonstrates the potential of our user-centric machine learning techniques, such as gamified and affordance-based approaches with MFCC, which could contribute significantly to the field of mobile mental healthcare.

Agent-based social simulations for health crises response: utilising the everyday digital health perspective

There is increasing recognition of the role that artificial intelligence (AI) systems can play in managing health crises. One such approach, which allows for analysing the potential consequences of different policy interventions is agent-based social simulations (ABSS). Here, the actions and interactions of autonomous agents are modelled to generate virtual societies that can serve as a "testbed" for investigating and comparing different interventions and scenarios. This piece focuses on two key challenges of ABSS in collaborative policy interventions during the COVID-19 pandemic. These were defining valuable scenarios to simulate and the availability of appropriate data. This paper posits that drawing on the research on the "everyday" digital health perspective in designing ABSS before or during health crises, can overcome aspects of these challenges. The focus on digital health interventions reflects a rapid shift in the adoption of such technologies during and after the COVID-19 pandemic, and the new challenges this poses for policy makers. It is argued that by accounting for the everyday digital health in modelling, ABSS would be a more powerful tool in future health crisis management.

The ubiquity of 'self-care' in health: Why specificity matters

Despite increased interest in self-care for health, little consensus exists around its definition and scope. The World Health Organization has published several definitions of self-care, including in a 2019 Global Guideline rooted in sexual and reproductive health and rights (SRHR), later expanded to encompass health more generally. To establish a robust understanding of self-care, this exploratory study inventorises, consolidates, presents and analyses definitions of self-care beyond the SRHR field. A pragmatic review identified definitions and conceptualisations of self-care from peer-reviewed and grey literature published between 2009 and 2021. The search identified 91 definitions of self-care from 116 relevant publications. Data extraction informed analysis to identify recurring themes and approaches, revealing three key areas of variation: self-care being: (1) defined directly or descriptively; (2) situated within individual, interpersonal or structural contexts; (3) defined broadly or topic-specifically. A multilevel conceptualisation can guide a more broadly applicable understanding of self-care: first, as an aspect of healthcare; second, as a concept operating at individual, interpersonal and institutional levels; third, as a concept that impacts specific health fields and contexts differently. A comprehensive but adaptable framework works in service of improving health and wellbeing for all, acknowledging the linkages between self-care and health-related human rights.

Reconciling healthism and techno-solutionism: An observational study of a digital mental health trial

In a growing trend in digital psychiatry, algorithmic systems are used to determine correlations between data that is collected using wearable devices and self-reports of mood. They then offer recommendations for behaviour modification for improved mood. The present study consists of observations of the development of one of these systems. Descriptions of the trial emphasise the powerful role of the intrinsically motivated, responsible participant on one hand and the empowering machine learning (ML)-based technology on the other. This conceptualisation is shown to extend the neoliberal paradox of a freedom that, to be maintained, must be continually adjusted through discipline. Because of the paradoxical nature of this formulation, laboratory members disagree about the balance of agency between the objective machine learning system and the empowered participant. The guides who help participants interpret ML outputs and implement system recommendations are ascribed a replaceable role in formal accounts. Observations of this guidance practice make clear not only the important role played by guides but also how their work is relegated to the technological side of the broader formulation of the trial and further how this conceptualisation affects the way they conduct their work.

The Ontology of Oncology: Navigating Cyborgs and Assemblages Through Cancer Treatment

Through narrative, the subjective experience of illness offers a corrective to biomedicine's interpretive grip. Narrative is both process and product and illness narratives, in particular, are examples of embodied research. This ecopathography - drawing upon embodied experiences of treatment and recovery from late stage Non-Hodgkin's lymphoma - enlists Haraway's cyborg and Lupton's digital assemblage in an effort to make broader claims about patient care in the United States, and specifically, the role of technology in healthcare and in the construction of patient identity. A surgically implanted port (facilitating blood draws and the delivery of chemotherapy) and the patient portal (representing the results of those blood draws as well as a medium for communication) provide a foundation for how cyborgian assemblages both assist and trouble the cancer experience. At stake is the fluidity and ambiguity of boundaries (human/machine, human/animal, and physical/virtual) and the management of those boundaries with regard to patient care.

Data management in the digital health environment scale development study

PURPOSE

This study aims to develop a scale that measures individuals' perceptions of privacy, security, use, sharing, benefit and satisfaction in the digital health environment.

METHOD

Within the scope of the study, in the scale development process; The stages of literature review, creation of items, getting expert opinion, conducting a pilot study, ensuring construct and criterion validity, and reliability analyses were carried out. The literature was searched for the formation of the question items. To evaluate the created question items, expert opinion was taken, and the question items were arranged according to the feedback from the experts. In line with the study's purpose and objectives, the focus group consisted of individuals aged 18 and above within the community. The convenience sampling method was employed for sample selection. Data were collected using an online survey conducted through Google Forms. Before commencing the survey, participants were briefed on the research's content. A pilot study was conducted with 30 participants, and as a result of the feedback from the participants, eliminations were made in the question items and the scale was made ready for application. The research was conducted by reference to 812 participants in the community. Expert evaluations of the question items were obtained, and a pilot study was conducted. A sociodemographic information form, a scale developed by the researcher, Norman and Skinner's e-Health Literacy Scale, and the Mobile Health and Personal Health Record Management Scale were used as data collection tools.

RESULTS

The content validity of the research was carried out by taking expert opinions and conducting a pilot study. Exploratory factor analysis and confirmatory factor analysis were performed to ensure construct validity. The total variance explained by the scale was 60.43%. The results of confirmatory factor analysis indicated that the 20-Item 5-factor structure exhibited good fit values. According to the analysis of criterion validity, there are significant positive correlations among the Data Management in the Digital Health Environment Scale, Norman and Skinner's e-Health Literacy Scale and the Mobile Health and Personal Health Record Management Scale (p < 0.01; r = .669, .378). The Cronbach's alpha value of the scale is .856, and the test-retest reliability coefficient is .909.

CONCLUSION

The Data Management in the Digital Health Environment Scale is a valid and reliable measurement tool that measures individuals' perceptions of privacy, security, use, sharing, benefit and satisfaction in the digital health environment.

Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review

Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.

The promise of digital healthcare technologies

Digital health technologies have been in use for many years in a wide spectrum of healthcare scenarios. This narrative review outlines the current use and the future strategies and significance of digital health technologies in modern healthcare applications. It covers the current state of the scientific field (delineating major strengths, limitations, and applications) and envisions the future impact of relevant emerging key technologies. Furthermore, we attempt to provide recommendations for innovative approaches that would accelerate and benefit the research, translation and utilization of digital health technologies.

Health Lifestyle Theory in a Changing Society: The Rise of Infectious Diseases and Digitalization

Social change produces alterations in society that necessitate changes in sociological theories. Two significant changes affecting health lifestyle theory are the behaviors associated with the COVID-19 pandemic and the digitalization of society. The health-protective practices emerging from the ongoing pandemic and the recent parade of other newly emerging infectious diseases need to be included in the theory's framework. Moreover, the extensive digitalization of today's society leads to the addition of connectivities (electronic networks) as a structural variable. Connectivities serve as a computational authority influencing health lifestyle practices through health apps and other digital resources in contrast to collectivities (human social networks) as a normative authority. The recent literature supporting these features in an updated and expanded model of health lifestyle theory is discussed.

A Descriptive Comparative Pilot Study: Association Between Use of a Self-monitoring Device and Sleep and Stress Outcomes in Pregnancy

Pregnancy is a challenging time for maintaining quality sleep and managing stress. Digital self-monitoring technologies are popular because of assumed increased patient engagement leading to an impact on health outcomes. However, the actual association between wear time of such devices and improved sleep/stress outcomes remains untested. Here, a descriptive comparative pilot study of 20 pregnant women was conducted to examine associations between wear time (behavioral engagement) of self-monitoring devices and sleep/stress pregnancy outcomes. Women used a ring fitted to their finger to monitor sleep/stress data, with access to a self-monitoring program for an average of 9½ weeks. Based on wear time, participants were split into two engagement groups. Using a linear mixed-effects model, the high engagement group showed higher levels of stress and a negative trend in sleep duration and quality. The low engagement group showed positive changes in sleep duration, and quality and experienced below-normal sleep onset latency at the start of the pilot but trended toward normal levels. Engagement according to device wear time was not associated with improved outcomes. Further research should aim to understand how engagement with self-monitoring technologies impacts sleep/stress outcomes in pregnancy.

A Mapping Review of Netnography in Nursing

People use the Web to seek health-related information and to discuss health issues with peers. Netnography, a qualitative research methodology, has gained the attention of researchers interested in people's health and health issues. However, no previous reviews have accounted for how netnography is used in nursing research. The purpose of this mapping review was to generate a map of netnographic research in nursing. The search was conducted in PubMed, Academic Search Elite, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Scopus, and Web of Science. Data were extracted from 53 original articles. The results show an increasing trend in published netnographies over time; 34% of the total sample was published in 2021. Of the total, 28% originated from Sweden, and 81% had used a covert approach. In studies in which the researchers used more participatory designs, the time spent on online forums ranged between 4 weeks and 20 months. Informed consent is found to be an issue in netnographic studies. We discuss the fact that nursing researchers have used netnography to address a wide range of research topics of concern and interest, from self-care support in an online forum for older adults to nursing students' perspectives on effective pedagogy. In line with the digital transformation in society in general, we discuss the fact that netnography as a research methodology offers great opportunities for nurse researchers to monitor new spaces and places that presuppose online methodological knowledge.

Liquid Health. Medicine in the age of surveillance capitalism

Digital health technologies transform practices, roles, and relationships in medicine. New possibilities for a ubiquitous and constant data collection and the processing of data in real-time enable more personalized health services. These technologies might also allow users to actively participate in health practices, thus potentially changing the role of patients from passive receivers of healthcare to active agents. The crucial driving force of this transformation is the implementation of data-intensive surveillance and monitoring as well as self-monitoring technologies. Some commentators use terms like revolution, democratization, and empowerment to describe the aforementioned transformation process in medicine. The public debate as well as most of the ethical discourse on digital health tends to focus on the technologies themselves, mostly ignoring the economic framework of their design and implementation. Analyzing the transformation process connected to digital health technologies needs an epistemic lens that also considers said economic framework, which I argue is surveillance capitalism. This paper introduces the concept of liquid health as such an epistemic lens. Liquid health is based on Zygmunt Bauman's framing of modernity as a process of liquefaction that dissolves traditional norms and standards, roles, and relations. By using liquid health as an epistemic lens, I aim to show how digital health technologies reshape concepts of health and illness, change the scope of the medical domain, and liquify roles and relationships that surround health and healthcare. The basic hypothesis is that although digital health technologies can lead to personalization of treatment and empowerment of users, their economic framework of surveillance capitalism may undermine these very goals. Using liquid health as a concept allows us to better understand and describe practices of health and healthcare that are shaped by digital technologies and the specific economic practices they are inseparably attached to.

Long-term effects on depression and anxiety of an internet-based stepped care intervention for patients with cancer and symptoms of depression and anxiety. The U-CARE AdultCan trial

Background

Cancer is a serious disease that commonly causes significant psychological distress. The internet-based intervention (iCAN-DO), utilizing a stepped care approach for the treatment of anxiety and depression in individuals with cancer, has been shown to have favorable results for symptoms of depression at the primary endpoint, 10 months after randomization compared to standard care (SC). The aim of the present study was to evaluate the long-term effects of the intervention 18 and 24 months after randomization.

Methods

Patients with breast, colorectal, or prostate cancer and a score > 7 on either of the Hospital Anxiety and Depression Scale (HADS) subscales (n = 245) were recruited to the study in conjunction with a regular hospital visit. They were randomized to access to the stepwise iCAN-DO intervention for 24 months or to SC. Step 1 of the intervention comprised psycho-educative online material. In Step 2, internet-based cognitive-behavioral therapy with individual online support from a therapist was added. Step 2 was offered to those who reported persistent anxiety or depression symptoms (>7 on HADS), also at 1, 4, and/or 7 months after randomization. Missing data were imputed using the last rank carried forward method and used for the main analyses according to the intention-to-treat approach. Effects sizes (Cohen's d), and minimally clinically important difference (MCID) were calculated. Linear mixed models were used to analyze intervention effects over time.

Results

Symptoms of depression decreased significantly (p < 0.05) in the iCAN-DO group compared with the SC group from baseline to 18 months (d = 0.29), but not to 24 months (d = 0.27). Even though the average iCAN-DO group participant surpassed a MCID in symptoms of anxiety (>2 p) at both long-term follow-ups, the differences did not reach statistical significance, either at 18 months (p = 0.10) or 24 months (p = 0.09). Positive effects of iCAN-DO compared with the SC were also shown for some secondary HRQoL-outcomes; social functioning at 18 months (p = 0.02) and 24 months (p = 0.001), and sleep problems at 24 months (p = 0.01).

Conclusion

A stepped-care internet-based intervention that has previously shown positive results for symptoms of depression at 10 months did show similar positive long-term effects also at 18 months. For symptoms of anxiety, no effect could be shown. The internet may provide an effective format for interventions to reduce symptoms of depression after cancer at patients' own choice of time, regardless of distance to a psycho-oncology clinic.

Health information seeking behaviour and decision making by patients undergoing breast cancer surgery: A qualitative study

BACKGROUND

Information is critical for patients having to decide about the best treatment option, and an in-depth understanding of their information behaviour can help health and information services to improve and facilitate their access to reliable information.

OBJECTIVE

To investigate the health information-seeking behaviour and information sources and their roles in decision making among breast cancer patients in Romania in the context of the surgical treatment.

METHODS

Semi-structured interviews were conducted with 34 patients who were treated surgically for breast cancer at the Bucharest Oncology Institute.

RESULTS

Most participants searched for information independently, before and after the operation, and their information needs evolved during the progression of their disease. The surgeon was regarded as the most trusted source of information. Most patients adopted a paternalistic or a shared approach for decision making.

DISCUSSION

Besides findings consistent with research from other countries, our study also revealed findings in contrast to previous research. None of the interviewed patients made any reference to the library as a source of information even if books were mentioned.

CONCLUSIONS

Health information specialists should develop a detailed guide and online information services to help physicians and other health professionals to provide relevant and reliable health care information to surgical inpatients from Romania.

Empowerment through health self-testing apps? Revisiting empowerment as a process

Empowerment, an already central concept in public health, has gained additional relevance through the expansion of mobile health (mHealth). Especially direct-to-consumer self-testing app companies mobilise the term to advertise their products, which allow users to self-test for various medical conditions independent of healthcare professionals. This article first demonstrates the absence of empowerment conceptualisations in the context of self-testing apps by engaging with empowerment literature. It then contrasts the service these apps provide with two widely cited empowerment definitions by the WHO, which describe the term as a process that, broadly, leads to knowledge and control of health decisions. We conclude that self-testing apps can only partly empower their users, as they, we argue, do not provide the type of knowledge and control the WHO definitions describe. More importantly, we observe that this shortcoming stems from the fact that in the literature on mHealth and in self-testing marketing, empowerment is understood as a goal rather than a process. This characterises a shift in the meaning of empowerment in the context of self-testing and mHealth, one that reveals a lack of awareness for relational and contextual factors that contribute to empowerment. We argue that returning to a process-understanding of empowerment helps to identify these apps' deficits, and we conclude the article by briefly suggesting several strategies to increase self-testing apps' empowerment function.

Using Ballistocardiogram and Impedance Plethysmogram for Minimal Contact Measurement of Blood Pressure Based on a Body Weight-Fat Scale

Electronic health (eHealth) is a strategy to improve the physical and mental condition of a human, collecting daily physiological data and information from digital apparatuses. Body weight and blood pressure (BP) are the most popular and important physiological data. The goal of this study is to develop a minimal contact BP measurement method based on a commercial body weight-fat scale, capturing biometrics when users stand on it. The pulse transit time (PTT) is extracted from the ballistocardiogram (BCG) and impedance plethysmogram (IPG), measured by four strain gauges and four footpads of a commercial body weight-fat scale. Cuffless BP measurement using the electrocardiogram (ECG) and photoplethysmogram (PPG) serves as the reference method. The BP measured by a commercial BP monitor is considered the ground truth. Twenty subjects participated in this study. By the proposed model, the root-mean-square errors and correlation coefficients (r2s) of estimated systolic blood pressure and diastolic blood pressure are 7.3 ± 2.1 mmHg and 4.5 ± 1.8 mmHg, and 0.570 ± 0.205 and 0.284 ± 0.166, respectively. This accuracy level achieves the C grade of the corresponding IEEE standard. Thus, the proposed method has the potential benefit for eHealth monitoring in daily application.

Digital self-report instruments for repeated measurement of mental health in the general adult population: a protocol for a systematic review

INTRODUCTION

Digital technologies present tremendous opportunities for enabling long-term measurement of mental health in the general population. Emerging studies have established preliminary efficacy of collecting self-report data digitally. However, a key challenge when developing a new self-report instrument is navigating the abundance of existing instruments to select relevant constructs for measurements. This review is a precursor to developing a novel future integrated digital instrument for repeated measurements. We interrogate the literature as the first step towards optimal measurement of the multifaceted mental health concept, in the context of digital repeated measurement. This review aims to identify (1) digital self-report instruments administered repeatedly to measure the mental health of the general adult population; (2) their structure and format; (3) their psychometric properties; (4) their usage in empirical studies; and (5) the constructs these instruments were designed to measure (as characterised in the original publication), and the constructs the instruments have been used to measure in the identified empirical studies.

METHODS AND ANALYSIS

Five major electronic databases will be searched. Studies administering mental health instruments (in English) repeatedly to community dwellers in the general adult population are eligible. A reviewer will preliminarily screen for eligible studies. Then, two reviewers will independently screen the full text of the eligible articles and extract data. Both reviewers will resolve any disagreement through discussion or with a third reviewer. After the data extraction, a reviewer will manually search for the structure, format, psychometric properties and the original constructs these instruments were developed to measure. This review will synthesise the results in a narrative approach. The reporting in this review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

ETHICS AND DISSEMINATION

Ethical approval is not required as no data will be collected. Findings of the systematic review will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42022306547.

Spoiled for Choice? Personalized Recommendation for Healthcare Decisions: A Multiarmed Bandit Approach

Choice overload is a common problem in many online settings, including healthcare. Online healthcare platforms tend to provide a large variety of behavior intervention information or programs to help individuals modify their lifestyles to improve wellness. However, having too many options can significantly increase searching cost, prevent users from discovering the truly relevant interventions, and harm users’ long-term healthcare decision-making efficiency. This motivates us to propose a personalized healthcare recommendation system to provide tailored support for individuals’ intervention participation. The proposed framework, a deep-learning and diversity-enhanced multiarmed bandit (DLDE-MAB), integrates several predictive and prescriptive analytics components to combat the unique challenges presented in the healthcare recommendation setting. It leverages online machine learning to provide adaptive and real-time support, a theory-guided diversity promotion scheme to cover multiple healthcare needs, and deep learning to further enhance dynamic context representation. Through extensive experiments, we show that the proposed framework outperforms various competing models in terms of its adaptivity to data dynamics, diversity, and uncertainty. The proposed model and evaluation results provide important implications for business intelligence and personalized, contextualized, and agile healthcare decision making.

The state of the art in telerehabilitation for musculoskeletal conditions

BACKGROUND

Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future.

MAIN BODY

Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users.

CONCLUSIONS

Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.

Quality and content analysis of female urethroplasty videos on YouTube

OBJECTIVES

In this study, we aimed to analyze scientific quality and content of female urethroplasty videos on YouTube.

METHODS

We searched YouTube using the "female urethroplasty", "female urethral stricture", and "urethroplasty" keywords on February 22, 2022. The quality and content of videos were analyzed using the Global Quality Score (GQS) and Female Urethroplasty-Specific Checklist Score (FUSCS) which was developed by our clinic. Video analysis was performed by two independent urologists. The relationship between the video characteristics and GQS and FUSCS was examined.

RESULTS

A total of 38 videos were analyzed. Fourteen (36.8%) videos were uploaded by academic sources such as urology societies and universities/hospitals, while 24 (63.2%) videos were uploaded by urologists. The median GQS was 3 (range, 2-4) and the median FUSCS was 8 (range, 5-9) for all videos. The Cohen's kappa was 0.834 for GQS and 0.899 for FUSCS, indicating a high level of agreement between the observers. The median GQS was 4 (range, 4-5) and the median FUSCS was 9 (range, 8-10) for academic videos, indicating a statistically significantly higher scores than the urologists videos (p = .002 and p < .001, respectively).

CONCLUSION

Academic videos on female urethroplasty on YouTube have adequate scientific quality and content for both patients and healthcare professionals. The number of videos by academic sources on female urethroplasty should be increased and individuals should be encouraged to search such videos on search engines.

Understanding maternity care providers' use of data in Southern Tanzania

INTRODUCTION

Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers' perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use.

METHODS

We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand maternity providers' interaction with data in two rural hospitals in Southern Tanzania. Constant comparative data analysis was applied to develop initial and focused codes, subcategories and categories were continuously validated through peer and member checks.

RESULTS

Maternity care providers found routine health information data of little use to reconcile demands from managers, the community and their challenging working environment within their daily work. They thus added informal narrative documentation sources. They created alternative narratives through data of a maternity care where mothers and babies were safeguarded. The resulting documentation system, however, led to duplication and increased systemic complexity.

CONCLUSIONS

Current health information systems may not meet all data demands of maternity care providers, or other healthcare workers. Policy makers and health information system specialists need to acknowledge different ways of data use beyond health service planning, with an emphasis on healthcare providers' data needs for clinical documentation.

Artifact removal from sEMG signals recorded during fully unsupervised daily activities

Objective

In this study, we propose a method for removing artifacts from superficial electromyography (sEMG) data, which have been widely proposed for health monitoring because they encompass the basic neuromuscular processes underlying human motion.

Methods

Our method is based on a spectral source decomposition from single-channel data using a non-negative matrix factorization. The algorithm is validated with two data sets: the first contained muscle activity coupled to artificially generated noises and the second comprised signals recorded under fully unsupervised conditions. Algorithm performance was further assessed by comparison with other state-of-the-art approaches for noise removal using a single channel.

Results

The comparison of methods shows that the proposed algorithm achieves the highest performance on the noise-removal process in terms of signal-to-noise ratio reconstruction, root means square error, and correlation coefficient with the original muscle activity. Moreover, the spectral distribution of the extracted sources shows high correlation with the noise sources traditionally associated to sEMG recordings.

Conclusion

This research shows the ability of spectral source separation to detect and remove noise sources coupled to sEMG signals recorded during unsupervised daily activities which opens the door to the implementation of sEMG recording during daily activities for motor and health monitoring.

Prevalence and correlates of use of digital technology for managing hypertension among older adults

Hypertension is prevalent among older adults (60 years and above), but control of blood pressure (BP) remains suboptimal. While there is increasing interest in using digital technology for managing hypertension, information about the extent and potential correlates of such use among older adults remains scant. We assessed the prevalence and correlates of the use of digital technology for managing hypertension among older adults with hypertension. We also investigated if the use of digital technology was associated with BP or hypertension control. The use of digital technology (internet or digital apps) for information about or managing BP or hypertension was assessed among 1729 older adults diagnosed with hypertension participating in a national survey in Singapore. Regression analysis was used to assess the correlates (based on the Unified Theory of Use and Acceptance of Technology), and whether such use was associated with hypertension control or BP values. Digital technology for managing hypertension was used by 7.1% of older adults with hypertension. Those of higher age and with limitations in one or more activities or instrumental activities of daily living were less likely, while those with secondary education and above, and with stronger social network were more likely to use digital technology. There was no association between the use of digital technology and hypertension control. While users of digital technology had lower systolic (by 2.1 mmHg, adjusted p value = 0.12) and diastolic (by 1.6 mmHg, adjusted p value = 0.13) BP than non-users, the differences were not statistically significant. Given its low prevalence, there is potential for increased use of digital technology for managing hypertension among older adults with hypertension in Singapore. Initiatives to increase digital health use should target specific older adult subgroups.

From research to market: correlation between publications, patent filings, and investments in development and production of technological innovations in biosensors

As the global population grows and science and technology development evolve, fulfilling basic human needs has been even more linked to technological solutions. In this review, we present an overview of the biosensor market and discuss the factors that make certain countries more competitive than others in terms of technology and innovation and how this is reflected in the trends in publication and patent filling. Additionally, we expose briefly how the COVID-19 pandemic acts as a catalyst for the integration of research and development, business, and innovation sectors to bring solutions and ideas that have been predicted as tendencies for the future.

Women's views on moderate and low alcohol consumption: stages of the subjective transition from pregnancy to postpartum

BACKGROUND

Alcohol consumption during pregnancy and breastfeeding is associated with a risk for the child's healthy development. Nevertheless, about 16 to 25% of all women in the European region, including Switzerland, consume alcohol during pregnancy and probably even more during breastfeeding. Little is known about how women perceive this risk and how risk perception changes during the transition to motherhood. The present study aims to explore the subjective transition from the woman's perspective, focusing on perceptions of alcohol as a risk, changes in alcohol consumption in daily life and experienced support from health professionals in this period.

METHODS

The longitudinal qualitative, semi-structured interview study was jointly designed and conducted by health sociologists and midwifery researchers. Using the theoretical framework of sociocultural risk and life course transition, we interviewed 46 women from the French and German speaking part of Switzerland during pregnancy and until six months after birth.

RESULTS

In our study, we found that pregnant and breastfeeding women perceive alcohol consumption as a risk to the health of the child. Abstinence is sought especially during pregnancy, but this does not preclude occasional and low-level consumption according to some women. Alcohol consumption and risk perception change during the transition to motherhood. We identified five stages that characterise this transition in terms of alcohol consumption and risk perception. From the women's perspective, there was a lack of counselling from health professionals, and the women expressed a desire for respectful and more individualised counselling.

CONCLUSION

Many women express a need for guidance and counselling by health care professionals at some stages of the transition to motherhood. The stages identified can be used as pointers to address the subject of alcohol consumption in professional practice. The stage around conception and early pregnancy should be taken more into account, as women experience themselves as particularly vulnerable during this time. Low-threshold counselling services should be therefore offered to women before or in the stage around conception and be continued until the end of the breastfeeding period.

Factors related to moderate exercise during COVID-19 for overweight and obese individuals: A secondary analysis of HINTS data

Objective

COVID-19 has exacerbated pre-existing rates of overweight and obesity in the United States. mHealth technologies are gaining in popularity for its potential to reduce obesity, if facilitated by patient-centered communication. This study explores predictors of overweight and obese individuals' exercise levels during COVID-19.

Methods

2191 respondents who visited a doctor in the past year and self-reported being overweight were selected from the 2020 Health Information National Trends Survey (HINTS). Respondents reported their physical activity, beliefs about obesity, health tracking behaviors, and communication with providers during the pandemic. Structural equation modeling was used to explore connections among the variables.

Results

Patient-provider (e-)communication was significantly associated with changes in people's obesity-related beliefs and mHealth tracking usage, predicting moderate exercise during the pandemic.

Conclusion

The findings illustrate the need for patient-centered communication encounters to include discussions on mHealth technologies and accessible methods of engaging in physical activity.Innovation: This study examined secondary data provided by overweight and obese individuals from the early days of the COVID-19 pandemic; this population may benefit from targeted health interventions using mHealth technologies. Our findings suggest that healthcare providers should engage patients through mHealth technology and seek to improve digital health literacy to progress physical activity nationwide.

Challenges of anticipation of future decisions in dementia and dementia research

Anticipation of future decisions can be important for individuals at risk for diseases to maintain autonomy over time. For future treatment and care decisions, advance care planning is accepted as a useful anticipation tool. As research with persons with dementia seems imperative to develop disease-modifying interventions, and with changing regulations regarding research participation in Germany, advance research directives (ARDs) are considered a solution to include persons with dementia in research in an ethically sound manner. However, little is known about what affected people deem anticipatable.This contribution provides a critical reflection of the literature on anticipation and of a qualitative study on the assessment of ARDs with persons with cognitive impairment in Germany. It combines theoretical and empirical reflections to inform the ethical-legal discourse.Anticipation involves the conceptual separation of the past, the present, and the future. Including dimensions such as preparedness, injunction, and optimization helps in establishing a framework for anticipatory decision-making. While dementia may offer a window of time to consider future decisions, individual beliefs about dementia including fears about stigma, loss of personhood, and solitude strongly impact anticipating sentiments. Concepts of anticipation can be useful for the examination of uncertainty, changing values, needs, and preferences interconnected with the dementia trajectory and can serve as a means to make an uncertain future more concrete. However, fears of losing one's autonomy in the process of dementia also apply to possibilities of anticipation as these require cognitive assessment and reassessment of an imagined future with dementia.

Can you be a manual therapist without using your hands?

BACKGROUND

To align with current best practices, manual therapists have refined their treatment options to include exercise and pain education for people with chronic musculoskeletal pain. In this commentary, we suggest that manual therapists should also add telehealth to their toolbox. Thus, we aim to discuss the use of telehealth by manual therapists caring for patients with musculoskeletal disorders.

MAIN BODY

Telehealth can be delivered to the patient in different modes, such as real-time clinical contact or asynchronously. Platforms vary from websites and smartphone apps to virtual reality systems. Telehealth may be an effective approach, especially for improving pain and function in people with musculoskeletal pain, and it has the potential to reduce the individual and socioeconomic burden of musculoskeletal conditions. However, the certainty of evidence reported in systematic reviews is often low. Factors such as convenience, flexibility, undivided attention from the clinician, user-friendly platforms, goal setting, and use of evidence-based information are all enablers for telehealth use and improving patients' knowledge, self-efficacy, and self-management. Barriers to widening the use of telehealth in musculoskeletal care include the reliability of technology, data privacy issues, difficult to build therapeutic alliance, one-size-fits-all approaches, digital health literacy, and payment models.

CONCLUSION

We suggest that practitioners of manual medicine make telehealth part of their clinical toolbox where it makes sense and where there is evidence that it is beneficial for people who seek their care.

Selective adoption of therapeutic devices among people with type 1 diabetes

This paper contributes to the debate regarding the adoption/rejection of technologies by focusing on the selective use of therapeutic devices among people with type 1 diabetes. I show that patients often refuse to use a device (either insulin pumps or sensors for glycaemic control), despite suggestions from diabetologists. The study was conducted in Italy in 2019. Theoretically, the paper relied on a perspective that amalgamates actor-network theory and postphenomenology around the key concept of multistability. I then detected the three main features of stabilities that explain device use/non-use: relation to embodied users, contextual embedment (within larger social assemblages), concrete tailoring. Findings helped to stress the relevance of not only focusing on the type of device and its technical functioning, but also unveiling the underlying ongoing and situated socio-technical processes. Selective adoption of devices should be investigated at the level of the whole patient-device assemblage in order to assess the diverse stabilities that may arise from such networks.

The use of E-health during the COVID-19 pandemic: a case study in China's Hubei province

Globally, the use of e-health has accelerated dramatically during the coronavirus pandemic. Based on both quantitative and qualitative data collected in China's Hubei province (i.e. the first epicentre of COVID-19), this research explores how the pandemic influences the practices of e-health from the perspective of users. Through analysis of 1,033 surveys and 14 in-depth interviews, we find that e-health has played a crucial role in residents' healthcare during the COVID-19 pandemic. Certain external factors influence the choice of digital health, including the high risk of infection outdoors, the shutting down of transport systems, and dysfunctional healthcare facilities that neglect non-COVID-19 patients' clinical demands. Against this backdrop, we argue digital health acts as a functional equivalent to traditional medical treatment and has largely satisfied patients and users in the crisis period. Additionally, the COVID-19 pandemic has unintentionally sped up the diffusion of digital medicine over the long term as respondents expressed their willingness to continue use of e-health in the post-COVID-19 phase. However, we assert that despite the increasing use of e-health, it cannot fully substitute traditional offline treatment. Thus, we suggest a combination of online and offline healthcare will be more commonly practiced in the future.

The effect of web-based genital hygiene education provided to the women with disabilities on their self-care agency and genital hygiene behaviors: A randomized controlled trial

In this study, we examined the effect of web-based genital hygiene education provided to women with orthopedically disability on self-care agency and genital hygiene behaviors. The research was conducted as a randomized controlled trial. 62 participants in the sample group were randomly assigned. There were statistically significant differences between the pretest, mid-test and post-test total mean scores of Self-Care Scale, Genital Hygiene Behavior Scale and all sub-dimensions in the expiremental group (p < 0.001) and there was not a significant difference in the control group (p > 0.05).