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Wendrich K, Krabbenborg L. Negotiating with digital self-monitoring: A qualitative study on how patients with multiple sclerosis use and experience digital self-monitoring within a scientific study. Health (London) 2024; 28:333-351. [PMID: 37198747 PMCID: PMC11041077 DOI: 10.1177/13634593231175321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Research shows that patients can have values and use practices that are different from those envisioned by technology developers. Using sociomaterialism as an analytical lens, we show how patients negotiated with digital self-monitoring in the context of a scientific study. Our paper draws on interviews with 26 patients with the chronic neurological disease multiple sclerosis (MS) who were invited to use an activity tracker and a self-monitoring app for a period of 12 months as part of their everyday life. Our study aims to fill a gap: relatively little is known about how digital self-monitoring becomes materialized in the everyday lives of patients with chronic diseases. We show that patients engaged in digital self-monitoring because they are eager to participate in research to contribute knowledge that will benefit the larger community of patients rather than to improve their personal self-management. Although respondents adhered to digital self-monitoring during the study, it is not self-evident that they would do so for private self-monitoring purposes. It became clear that respondents did not necessarily perceive digital self-monitoring as useful for their self-management practices due to their established knowledge and routines. Moreover, respondents referred to the inconvenience of having to perform self-monitoring tasks and the emotional burden of being reminded of the MS because of the digital self-monitoring. We conclude by indicating what could be considered when designing scientific studies, including the suitability of conventional study designs for evaluating technologies used daily by patients and the challenge of integrating patients' experiential knowledge into scientific practices.
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Myneni S, Zingg A, Singh T, Ross A, Franklin A, Rogith D, Refuerzo J. Digital health technologies for high-risk pregnancy management: three case studies using Digilego framework. JAMIA Open 2024; 7:ooae022. [PMID: 38455839 PMCID: PMC10919928 DOI: 10.1093/jamiaopen/ooae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 12/20/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
Objective High-risk pregnancy (HRP) conditions such as gestational diabetes mellitus (GDM), hypertension (HTN), and peripartum depression (PPD) affect maternal and neonatal health. Patient engagement is critical for effective HRP management (HRPM). While digital technologies and analytics hold promise, emerging research indicates limited and suboptimal support offered by the highly prevalent pregnancy digital solutions within the commercial marketplace. In this article, we describe our efforts to develop a portfolio of digital products leveraging advances in social computing, data science, and digital health. Methods We describe three studies that leverage core methods from Digilego digital health development framework to (1) conduct large-scale social media analysis (n = 55 301 posts) to understand population-level patterns in women's needs, (2) architect a digital repository to enable women curate HRP related information, and (3) develop a digital platform to support PPD prevention. We applied a combination of qualitative coding, machine learning, theory-mapping, and programmatic implementation of theory-linked digital features. Further, we conducted preliminary testing of the resulting products for acceptance with sample of pregnant women for GDM/HTN information management (n = 10) and PPD prevention (n = 30). Results Scalable social computing models using deep learning classifiers with reasonable accuracy have allowed us to capture and examine psychosociobehavioral drivers associated with HRPM. Our work resulted in two digital health solutions, MyPregnancyChart and MomMind are developed. Initial evaluation of both tools indicates positive acceptance from potential end users. Further evaluation with MomMind revealed statistically significant improvements (P < .05) in PPD recognition and knowledge on how to seek PPD information. Discussion Digilego framework provides an integrative methodological lens to gain micro-macro perspective on women's needs, theory integration, engagement optimization, as well as subsequent feature and content engineering, which can be organized into core and specialized digital pathways for women engagement in disease management. Conclusion Future works should focus on implementation and testing of digital solutions that facilitate women to capture, aggregate, preserve, and utilize, otherwise siloed, prenatal information artifacts for enhanced self-management of their high-risk conditions, ultimately leading to improved health outcomes.
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Affiliation(s)
- Sahiti Myneni
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Alexandra Zingg
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Tavleen Singh
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Angela Ross
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Amy Franklin
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Deevakar Rogith
- Department of Clinical and Health Informatics at McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Jerrie Refuerzo
- Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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Schulze A, Lindemann AK, Brand F, Geppert J, Menning A, Stehr P, Reifegerste D, Rossmann C. Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review. Interact J Med Res 2023; 12:e45258. [PMID: 37672312 PMCID: PMC10512123 DOI: 10.2196/45258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. OBJECTIVE This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. METHODS In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app's architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. CONCLUSIONS The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies.
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Affiliation(s)
- Annett Schulze
- Department of Risk Communication, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Ann-Kathrin Lindemann
- Department of Risk Communication, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Fabian Brand
- Department of Risk Communication, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Johanna Geppert
- Department of Risk Communication, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Axel Menning
- Department of Risk Communication, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Paula Stehr
- Department of Media and Communication, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Doreen Reifegerste
- Department of Prevention and Health Promotion, Bielefeld University, Bielefeld, Germany
| | - Constanze Rossmann
- Department of Media and Communication, Ludwig-Maximilians-University Munich, Munich, Germany
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Ceuterick M, Christiaens T, Creupelandt H, Bracke P. And they slept happily ever after: Online interpretive repertoires on the use of benzodiazepines and z-drugs. Health (London) 2023; 27:847-866. [PMID: 34818938 DOI: 10.1177/13634593211060770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drawing on a critical social-psychological framework for discourse analysis, data from a popular forum for people over 50 were analysed to study how the habitual use of benzodiazepines and Z-drugs (BZD/Z) is discursively negotiated by Flemish older adults. We present five different repertoires (risk and addiction; alternative pathways; suffering; rationalisation; cessation) that illustrate how a pharmaceutical imaginary of these medications is constructed online and how posters act as reflexive users taking on a health role. Most repertoires emerge from a tacit norm on the undesirability of medication use for sleeping problems. In the alternative pathways and cessation repertoires this norm is implicitly accepted by focussing on how to either prevent or overcome chronic use with various alternative solutions or through tapering off, while the risk and addiction repertoire is used to more openly defend and discursively magnify the idea that medication has to be avoided at all cost. We discuss how this reflects a prevailing imperative of health and ethos of healthicisation of sleep. The rationalisation and suffering repertoires on the other hand challenge this norm by defending medication use. We further explore how these repertoires are used to self-position as either 'noble non-user', 'deserving and/or compliant patient' or 'rational user', reflecting previously found moral positions in offline settings. Our data add another position that has thus far not been discussed extensively with regard to prescription medication use, namely that of a 'recovered user'. As such, this study shows how this particular online community is a site for contestation of health promotion and medical/pharmaceuticalised discourses on sleep by users and non-users alike and offers a unique insight into how people in the age group that is known to use most BZD/Z discursively negotiate the use of these medications in pseudonymised online interactions.
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Malerbi FK, Nakayama LF, Gayle Dychiao R, Zago Ribeiro L, Villanueva C, Celi LA, Regatieri CV. Digital Education for the Deployment of Artificial Intelligence in Health Care. J Med Internet Res 2023; 25:e43333. [PMID: 37347537 PMCID: PMC10337407 DOI: 10.2196/43333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/19/2023] [Accepted: 04/05/2023] [Indexed: 06/23/2023] Open
Abstract
Artificial Intelligence (AI) represents a significant milestone in health care's digital transformation. However, traditional health care education and training often lack digital competencies. To promote safe and effective AI implementation, health care professionals must acquire basic knowledge of machine learning and neural networks, critical evaluation of data sets, integration within clinical workflows, bias control, and human-machine interaction in clinical settings. Additionally, they should understand the legal and ethical aspects of digital health care and the impact of AI adoption. Misconceptions and fears about AI systems could jeopardize its real-life implementation. However, there are multiple barriers to promoting electronic health literacy, including time constraints, overburdened curricula, and the shortage of capacitated professionals. To overcome these challenges, partnerships among developers, professional societies, and academia are essential. Integrating specialists from different backgrounds, including data specialists, lawyers, and social scientists, can significantly contribute to combating digital illiteracy and promoting safe AI implementation in health care.
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Affiliation(s)
| | - Luis Filipe Nakayama
- Ophthalmology Department, Sao Paulo Federal University, Sao Paulo, Brazil
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, United States
| | | | - Lucas Zago Ribeiro
- Ophthalmology Department, Sao Paulo Federal University, Sao Paulo, Brazil
| | - Cleva Villanueva
- Escuela Superior de Medicina, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, United States
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Torenholt R, Langstrup H. Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making. Health (London) 2023; 27:41-59. [PMID: 33685260 DOI: 10.1177/1363459321996741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools - involving algorithmic sorting - in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians' expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.
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Rich E, Lupton D. Rethinking digital biopedagogies: How sociomaterial relations shape English secondary students' digital health practices. Soc Sci Med 2022; 311:115348. [PMID: 36152403 DOI: 10.1016/j.socscimed.2022.115348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022]
Abstract
It is widely recognised that while many young people in high-income countries are active users of digital health technologies, their engagement can be short term. In this article, we draw on feminist materialism theory to analyse findings from the two qualitative phases of a mixed-methods three phase study of English secondary students' digital health practices. Bringing together work on biopedagogies alongside more-than-human thinking, we analyse our participants' accounts of their intra-actions with human and nonhuman affordances and materialities. Our findings reveal how young people's capacity for navigating the digital health landscape and translating knowledge into health practice is highly contingent on the complex engagement of different actors in digital health assemblages, including more-than-digital relational connections. Our study found that key human actors - typically in face-to-face settings - were crucial in doing the affective work necessary to guide adolescents through the tensions and conflicts they experienced when dealing with competing knowledges and expectations. The research underlines the ways in which feminist materialism perspectives can supplement scholarship on biopedagogies, specifically contributing to the theorising on young people's learning and embodiment through digital practices.
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GEHDE KARLAMARGARETE, RAUSCH FLORIAN, LEKER JENS. BUSINESS MODEL CONFIGURATIONS IN DIGITAL HEALTHCARE–A GERMAN CASE STUDY ABOUT DIGITAL TRANSFORMATION. INTERNATIONAL JOURNAL OF INNOVATION MANAGEMENT 2022. [DOI: 10.1142/s1363919622400187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Digital ventures are flooding the healthcare market in Germany and setting new standards for innovative digital health systems and tools. A key challenge in this sector from both academic and practitioner perspectives remains the intransparency of business model configurations applied by digital health. We tackle this problem by conducting a comparative case study of 237 digital health ventures. These ventures are examined on the business model level, exploring the digital technology components of each company and relating them to the identified areas of activity. The resulting dominant combinations of the two dimensions highlight four key areas of activity and two technological core elements. Within these dominant combinations we identify intriguing configurations of business model activities. The dominant Software(-as-a-Service) logic supports the criteria of interoperability on different levels. This research contributes to the growing academic literature stream of digital technology and entrepreneurship in healthcare.
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Affiliation(s)
- KARLA MARGARETE GEHDE
- Institute of Business Administration at the Department of Chemistry and Pharmacy, University of Münster, Leonardo Campus 1, 48149 Münster, Germany
| | - FLORIAN RAUSCH
- Institute of Business Administration at the Department of Chemistry and Pharmacy, University of Münster, Leonardo Campus 1, 48149 Münster, Germany
| | - JENS LEKER
- Institute of Business Administration at the Department of Chemistry and Pharmacy, University of Münster, Leonardo Campus 1, 48149 Münster, Germany
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Lolich L, Pirhonen J, Turja T, Timonen V. Technology in the Home Care of Older People: Views from Finland and Ireland. J Cross Cult Gerontol 2022; 37:181-200. [DOI: 10.1007/s10823-022-09449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/18/2022]
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10
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Koinig I, Diehl S. “Where There Is Light, There Is Also Darkness”: Discussing Young Adults’ Willingness to Disclose Data to Use Wearables and Health Applications—Results from a Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031556. [PMID: 35162577 PMCID: PMC8835701 DOI: 10.3390/ijerph19031556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
Abstract
In recent years, the Internet of Medical Things (IoMT) has gained momentum. This development has only been intensified by the current COVID-19 crisis, which promotes the development of applications that can help stop the virus from spreading by monitoring people’s movements and their social contacts. At the same time, it has become increasingly difficult for individuals to control the use of their private data by commercial companies. While Internet users claim to be highly interested in protecting their privacy, their behaviors indicate otherwise. This phenomenon is discussed in literature as the so-called privacy paradox. The existence of the privacy paradox has also been confirmed by previous studies, which found individuals’ claims and actions to contradict one another. The present study investigates the following research questions: (1) What significance do individuals attribute to protecting their privacy, with a special focus on the health sector? (2) To what extent are they willing to grant commercial parties access to their data in order to use applications in general and health applications in particular? Results from seven focus groups with 40 respondents aged 20–30 years were conducted in an urban setting in Austria in late 2019. The respondents’ inputs are meant to provide answers to these questions. The results indicate that, overall, the young generation is well-informed about the growing data collection and is quite critical of it. As such, their willingness to share information in the health context is only moderately pronounced. Thus, only a moderately pronounced privacy paradox can be detected for the health sector when compared to other sectors. In conclusion, implications and directions for further research are addressed.
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Nickel S, Bremer K, Dierks ML, Haack M, Wittmar S, Borgetto B, Kofahl C. Digitization in health-related self-help – Results of an online survey among self-help organizations in Germany. Digit Health 2022; 8:20552076221120726. [PMID: 36046635 PMCID: PMC9421018 DOI: 10.1177/20552076221120726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic. Design The online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30–40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed. Results SHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a “high” or “very high” benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups). Conclusions At many points in the survey it was shown that digital media can be a useful extension of “traditional” collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help. Patient or Public Contribution The study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish.
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Affiliation(s)
- Stefan Nickel
- University Medical Center Hamburg-Eppendorf, Germany
| | | | | | | | - Silke Wittmar
- University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Germany
| | - Bernhard Borgetto
- University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Germany
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12
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Trupia DV, Mathieu-Fritz A, Duong TA. The Sociological Perspective of Users' Invisible Work: A Qualitative Research Framework for Studying Digital Health Innovations Integration. J Med Internet Res 2021; 23:e25159. [PMID: 34734832 PMCID: PMC8603174 DOI: 10.2196/25159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/22/2021] [Accepted: 07/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND When new technology is integrated into a care pathway, it faces resistance due to the changes it introduces into the existing context. To understand the success or failure of digital health innovations, it is necessary to pay attention to the adjustments that users must perform to make them work, by reshaping the context and sometimes by altering the ways in which they perform activities. This adaptation work, most of which remains invisible, constitutes an important factor in the success of innovations and the ways in which they transform care practices. OBJECTIVE This work aims to present a sociological framework for studying new health technology uses through a qualitative analysis of the different types of tasks and activities that users, both health professionals and patients, must perform to integrate these technologies and make them work in their daily routine. METHODS This paper uses a three-part method to structure a theoretical model to study users' invisible work. The first part of the method includes a thematic literature review, previously published by one of the coauthors, of major sociological studies conducted on digital health innovations integration into existing care organizations and practices. The second part extends this review to introduce definitions and applications of the users' invisible work concept. The third part consists of producing a theoretical framework to study the concept according to the different contexts and practices of the users. RESULTS The paper proposes four dimensions (organizational, interactional, practical, and experiential), each composed of a set of criteria that allow a comparative analysis of different users' work according to different health technologies. CONCLUSIONS This framework can be applied both as an analytical tool in a research protocol and as an agenda to identify less visible adoption criteria for digital health technologies.
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Affiliation(s)
- Dilara Vanessa Trupia
- LATTS, Univ Gustave Eiffel, CNRS, Ecole des Ponts, Marne-la-Vallée, France.,INSERM, Chaire Avenir Santé Numérique IMRB U955, Équipe 8, University of Paris-Est Créteil, Créteil, France
| | | | - Tu Anh Duong
- INSERM, Chaire Avenir Santé Numérique IMRB U955, Équipe 8, University of Paris-Est Créteil, Créteil, France.,AP-HP, Department of Dermatology, Hôpital Henri-Mondor, Créteil, France
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Benn R, Shaw A. Examining the barriers to accepting big health data from a health marketeer's perspective. Health Mark Q 2021; 40:1-18. [PMID: 34720070 DOI: 10.1080/07359683.2021.1994115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Studies have shown that the sharing of big health data can improve patient management across primary and secondary care sectors. It can also reduce costs and can enhance the medical research process. Unfortunately, many big health data initiatives are being impeded because of a range of complex issues. This study was initiated to identify the said issues and develop a tool for health marketers to use to negate the barriers in big healthcare data projects. The study demonstrates how the Interactive Communication Technology Adoption Model can be operationalized to support qualitative researchers.
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Affiliation(s)
| | - Alan Shaw
- Leeds Business School, Leeds Beckett University, Leeds, UK
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De Panfilis L, Peruselli C, Tanzi S, Botrugno C. AI-based clinical decision-making systems in palliative medicine: ethical challenges. BMJ Support Palliat Care 2021; 13:183-189. [PMID: 34257065 DOI: 10.1136/bmjspcare-2021-002948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/28/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Improving palliative care (PC) is demanding due to the increase in people with PC needs over the next few years. An early identification of PC needs is fundamental in the care approach: it provides effective patient-centred care and could improve outcomes such as patient quality of life, reduction of the overall length of hospitalisation, survival rate prolongation, the satisfaction of both the patients and caregivers and cost-effectiveness. METHODS We reviewed literature with the objective of identifying and discussing the most important ethical challenges related to the implementation of AI-based data processing services in PC and advance care planning. RESULTS AI-based mortality predictions can signal the need for patients to obtain access to personalised communication or palliative care consultation, but they should not be used as a unique parameter to activate early PC and initiate an ACP. A number of factors must be included in the ethical decision-making process related to initiation of ACP conversations, among which are autonomy and quality of life, the risk of worsening healthcare status, the commitment by caregivers, the patients' psychosocial and spiritual distress and their wishes to initiate EOL discussions CONCLUSIONS: Despite the integration of artificial intelligence (AI)-based services into routine healthcare practice could have a positive effect of promoting early activation of ACP by means of a timely identification of PC needs, from an ethical point of view, the provision of these automated techniques raises a number of critical issues that deserve further exploration.
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Affiliation(s)
- Ludovica De Panfilis
- Bioethics Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Carlo Peruselli
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Carlo Botrugno
- Research Unit on Everyday Bioethics and Ethics of Science, Department of Legal Sciences, University of Florence, Firenze, Toscana, Italy
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Ardissone A. From loyalty to resignation: Patient-doctor figurations in type 1 diabetes. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1388-1404. [PMID: 34050536 PMCID: PMC8453939 DOI: 10.1111/1467-9566.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 04/17/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
This paper contributes to the debate on the patient-doctor relationship by focussing on a specific chronic disease: type 1 diabetes. This field is characterised by an increasing use of technology, specifically therapeutic devices and a significant requirement of patient self-management. This paper presents the main findings of research conducted in Italy in 2018. It is argued that this relationship is more properly described as an interdependent figuration of actors characterised by a dynamic process of power balances, which recalls Elias' (What is sociology? Columbia University Press, 1978) figurational-processual and relational sociology. In this theoretical context, patients may manage their (dis)satisfaction with their diabetologists by choosing different behaviours that stem from Hirschman's archetype (Exit, voice, and loyalty. Responses to decline firms, organizations, and states. Harvard University Press, 1970): voice, exit, loyalty and, we would add, resignation. These categories are fluid, and all of them can be experienced by patients over time, depending on the quality of the figurations built among these transactors.
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Subjectivities in motion: Dichotomies in consumer engagements with self-tracking technologies. COMPUTERS IN HUMAN BEHAVIOR 2021. [DOI: 10.1016/j.chb.2021.106699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Georgieva I, Beaunoyer E, Guitton MJ. Ensuring social acceptability of technological tracking in the COVID-19 context. COMPUTERS IN HUMAN BEHAVIOR 2021. [DOI: 10.1016/j.chb.2020.106639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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18
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Botrugno C. Information technologies in healthcare: Enhancing or dehumanising doctor-patient interaction? Health (London) 2019; 25:475-493. [PMID: 31849239 DOI: 10.1177/1363459319891213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the very emergence of the information technologies in healthcare, a major concern has been raised about the potential of remote services to undermine the intimacy, immediacy and humanity intrinsic to conventional, face-to-face medical practice. By contrast, notable literature reports the benefits of information technology-mediated services and their potential to improve efficiency and economic convenience of healthcare systems. This article aims to shed light on this ambivalence by retracing the evolution of doctor-patient interaction in relation to the main technological advancements in healthcare, and in particular, to services mediated by information technologies. Consequently, the reduction of cues and clues associated with the use of these services is framed into the reductionism of the biomedical paradigm, which provides a key to interpret the nature, scope and features of this process of technological innovation, along with its potential and limits.
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Henwood F, Marent B. Understanding digital health: Productive tensions at the intersection of sociology of health and science and technology studies. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41 Suppl 1:1-15. [PMID: 31599984 DOI: 10.1111/1467-9566.12898] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio-material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long-standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time-lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision-making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research.
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Affiliation(s)
- Flis Henwood
- School of Applied Social Science, University of Brighton, Brighton, UK
| | - Benjamin Marent
- School of Applied Social Science, University of Brighton, Brighton, UK
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Ebeling MFE. Patient disempowerment through the commercial access to digital health records. Health (London) 2019; 23:385-400. [DOI: 10.1177/1363459319848038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Gambier-Ross K, McLernon DJ, Morgan HM. A mixed methods exploratory study of women's relationships with and uses of fertility tracking apps. Digit Health 2018; 4:2055207618785077. [PMID: 30225095 PMCID: PMC6136106 DOI: 10.1177/2055207618785077] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/31/2018] [Indexed: 11/16/2022] Open
Abstract
Digital self-tracking is rising, including tracking of menstrual cycles by women using
fertility tracking apps (FTAs). However, little is known about users’ experiences of FTAs
and their relationships with them. The aim of this study was to explore women’s uses of
and relationships with FTAs. This exploratory study employed a mixed methods approach,
involving the collection and analysis of an online survey and follow-up interviews.
Qualitative analysis of survey and interview data informed hypothesis development. Online
surveys yielded 241 responses and 11 follow-up interviews were conducted. Just over a
third of women surveyed had experience of using FTAs (89/241) and follow-up interviews
were conducted with a proportion of respondents (11/241). Four main motivations to use
FTAs were identified: (a) to observe cycle (72%); (b) to conceive (34%); (c) to inform
fertility treatment (12%); and (d) as contraception (4%). Analysis of the free-text survey
questions and interviews using grounded theory methodology highlighted four themes
underpinning women’s relationships with FTAs: (a) medical grounding; (b) health trackers
versus non-trackers; (c) design; and (d) social and ethical aspects. Participants who used
other health apps were more likely to use FTAs (p = 0.001).
Respondents who used contraception were less likely to use FTAs compared with respondents
who did not use contraception (p = 0.002). FTA usage also
decreases (p = 0.001) as age increases. There was no
association between FTA usage and menstrual status (p = 0.259). This research emphasises the differing motivations for FTA use.
Future research should further explore the diverse relationships between different
subgroups of women and FTAs.
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Affiliation(s)
- Katie Gambier-Ross
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Heather M Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Ahmadvand A, Gatchel R, Brownstein J, Nissen L. The Biopsychosocial-Digital Approach to Health and Disease: Call for a Paradigm Expansion. J Med Internet Res 2018; 20:e189. [PMID: 29776900 PMCID: PMC5984274 DOI: 10.2196/jmir.9732] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/10/2018] [Accepted: 02/10/2018] [Indexed: 01/22/2023] Open
Abstract
Digital health is an advancing phenomenon in modern health care systems. Currently, numerous stakeholders in various countries are evaluating the potential benefits of digital health solutions at the individual, population, and/or organizational levels. Additionally, driving factors are being created from the customer-side of the health care systems to push health care providers, policymakers, or researchers to embrace digital health solutions. However, health care providers may differ in their approach to adopt these solutions. Health care providers are not assumed to be appropriately trained to address the requirements of integrating digital health solutions into daily everyday practices and procedures. To adapt to the changing demands of health care systems, it is necessary to expand relevant paradigms and to train human resources as required. In this article, a more comprehensive paradigm will be proposed, based on the ‘biopsychosocial model’ of assessing health and disease, originally introduced by George L Engel. The “biopsychosocial model” must be leveraged to include a “digital” component, thus suggesting a ‘biopsychosocial-digital’ approach to health and disease. Modifications to the “biopsychosocial” model and transition to the “biopsychosocial-digital” model are explained. Furthermore, the emerging implications of understanding health and disease are clarified pertaining to their relevance in training human resources for health care provision and research.
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Affiliation(s)
- Alireza Ahmadvand
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Robert Gatchel
- Department of Psychology, College of Science, University of Texas at Arlington, Arlington, TX, United States
| | - John Brownstein
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Digital Health Research Methods and Tools: Suggestions and Selected Resources for Researchers. ADVANCES IN BIOMEDICAL INFORMATICS 2018. [DOI: 10.1007/978-3-319-67513-8_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gonsalves CA, McGannon KR, Schinke RJ. Social media for health promotion: What messages are women receiving about cardiovascular disease risk by the Canadian Heart and Stroke Foundation? J Health Psychol 2017; 25:1017-1029. [PMID: 29226735 DOI: 10.1177/1359105317743802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to explore the meanings of women's cardiovascular disease constructed within the Canadian Heart and Stroke Foundation Facebook page. Posts from Heart and Stroke Foundation and public user comments surrounding the launch of the Heart and Stroke Foundation re-branding were of interest. Ethnographic content analysis was employed to analyse text (n = 40), images (n = 32), videos (n = 6), user comments and replies (n = 42) from November 2016 to March 2017. Constructions (re)presented on Facebook of 'typical' women at risk and risk reduction were problematic as women most at risk were excluded through the use of consumerist, medicalized identities which also excluded promotion of healthy behaviour changes.
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Mort M, Mary Roberts C, Furbo MK, Wilkinson J, Mackenzie A. Biosensing: how citizens’ views illuminate emerging health and social risks. HEALTH, RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2015.1135234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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