Digital Health Behavior Change Technology: Bibliometric and Scoping Review of Two Decades of Research

Current trends and hotspots of depressive disorders with colorectal cancer: A bibliometric and visual study

BACKGROUND

Depression is strongly associated with colorectal cancer (CRC). Few bibliometric analyses have systematically summarized the research focus and recent progress in this field.

AIM

To determine the research status and hotspots by bibliometric analysis of relevant publications on the relationship between CRC and depression.

METHODS

Articles on depression in CRC patients were collected from the Web of Science Core Collection. CiteSpace and VOSviewer software were used to visualize bibliometric networks.

RESULTS

From 2001 to 2022, Supportive Care in Cancer, the United States, Tilburg University, and Mols were the most productive and influential journal, country, institution, and author name. Co-occurrence cluster analysis of keywords placed quality of life, anxiety, and psychological stress in the center of the visual network diagram. Further clustering was performed for the clusters with studies of the relevant mechanism of action, which showed that: (1) Cytokines have a role essential for the occurrence and development of depressive disorders in CRC; (2) MicroRNAs have a role essential for the development of depressive disorders in CRC; (3) Some anticancer drugs have pro-depressant activity; and (4) Selective serotonin reuptake inhibitors have both antitumor and antidepressant activity.

CONCLUSION

Life quality and psychological nursing of the cancer population were key topics. The roles of cytokines and microRNAs, the pro-depression activity of anticancer drugs and their antitumor properties deserve in-depth study.

Mapping Digital Public Health Interventions Among Existing Digital Technologies and Internet-Based Interventions to Maintain and Improve Population Health in Practice: Scoping Review

BACKGROUND

The rapid progression and integration of digital technologies into public health have reshaped the global landscape of health care delivery and disease prevention. In pursuit of better population health and health care accessibility, many countries have integrated digital interventions into their health care systems, such as web-based consultations, electronic health records, and telemedicine. Despite the increasing prevalence and relevance of digital technologies in public health and their varying definitions, there has been a shortage of studies examining whether these technologies align with the established definition and core characteristics of digital public health (DiPH) interventions. Hence, the imperative need for a scoping review emerges to explore the breadth of literature dedicated to this subject.

OBJECTIVE

This scoping review aims to outline DiPH interventions from different implementation stages for health promotion, primary to tertiary prevention, including health care and disease surveillance and monitoring. In addition, we aim to map the reported intervention characteristics, including their technical features and nontechnical elements.

METHODS

Original studies or reports of DiPH intervention focused on population health were eligible for this review. PubMed, Web of Science, CENTRAL, IEEE Xplore, and the ACM Full-Text Collection were searched for relevant literature (last updated on October 5, 2022). Intervention characteristics of each identified DiPH intervention, such as target groups, level of prevention or health care, digital health functions, intervention types, and public health functions, were extracted and used to map DiPH interventions. MAXQDA 2022.7 (VERBI GmbH) was used for qualitative data analysis of such interventions' technical functions and nontechnical characteristics.

RESULTS

In total, we identified and screened 15,701 records, of which 1562 (9.94%) full texts were considered relevant and were assessed for eligibility. Finally, we included 185 (11.84%) publications, which reported 179 different DiPH interventions. Our analysis revealed a diverse landscape of interventions, with telemedical services, health apps, and electronic health records as dominant types. These interventions targeted a wide range of populations and settings, demonstrating their adaptability. The analysis highlighted the multifaceted nature of digital interventions, necessitating precise definitions and standardized terminologies for effective collaboration and evaluation.

CONCLUSIONS

Although this scoping review was able to map characteristics and technical functions among 13 intervention types in DiPH, emerging technologies such as artificial intelligence might have been underrepresented in our study. This review underscores the diversity of DiPH interventions among and within intervention groups. Moreover, it highlights the importance of precise terminology for effective planning and evaluation. This review promotes cross-disciplinary collaboration by emphasizing the need for clear definitions, distinct technological functions, and well-defined use cases. It lays the foundation for international benchmarks and comparability within DiPH systems. Further research is needed to map intervention characteristics in this still-evolving field continuously.

TRIAL REGISTRATION

PROSPERO CRD42021265562; https://tinyurl.com/43jksb3k.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/33404.

Global trend of nondrug and nonsedativehypnotic treatment forinsomnia: a bibliometric study

OBJECTIVE

To present a bibliometric analysis of global scientific publications on the nondrug and nonsedative hypnotic treatment of insomnia with regard to influential institutions, publications, countries, research hotspots, trends, and frontiers.

METHODS

A literature review was conducted by searching the Web of Science Core Collection (WoSCC) and China National Knowledge Infrastructure (CNKI) databases to identify all publications related to the nondrug and nonsedative hypnotic treatment of insomnia from 2000 to 2021. Eligible publications were reviewed, including annual publication increments, citation analyses, international collaborations, and keyword analyses. The data were analysed using CiteSpace (vers5.8.R3, 6.1.R2 and 6.1.6, College of Computing and Informatics, Philadelphia, PA, USA) and virtualized by knowledge maps. RESULTS：In total, 9832 publications were included in this analysis. The results from the WoSCC showed that the United States of America (Count = 2268, 40.33%), Stanford University (Count = 141, 2.51%), and the United States Department of Health and Human Services were the leading country, institute, and funding agency regarding the number of publications, respectively. 'Cognitive-behavioural therapy" was the most popular research topic generated from the cocited reference. The most frequently co-occurring keywords were insomnia, cognitive behavioural therapy, disorder, depression, quality of life, Meta-analysis, older adult, sleep, prevalence and efficacy, while keywords including clinical practice guideline, guideline, and Tai Chi remained popular after 2021. Circadian rhythm was the strongest research frontier for 2000-2021. In China, Chengdu University of Traditional Chinese Medicine (Count = 69, 4.79%) was the most productive institute in this field. The most frequently co-occurring keywords from Chinese literature were sleep disorder, sleep quality, acupuncture and moxibustion, Parkinson's disease, transcranial magnetic stimulation, health education, music therapy, chronic insomnia, quality of life, and nonmotor symptoms. Traditional Chinese medicine was the strongest research frontier for 2019-2021.

CONCLUSION

This bibliometric study provides an exhaustive mapping encompassing pertinent institute, publications, influential articles, researchers and topics of the global trend of nondrug and nonsedative hypnotic treatment for insomnia. The results show that the research trend has shifted from primary studies on the efficacy and safety of nondrug and nonsedative hypnotic treatment for insomnia to comorbidity studies. Clinical practice guidelines will potentially become the research frontier for this field post-2021. The findings are important for researchers, clinicians, journal editors, and policy-makers working in the field of nondrug and nonsedative hypnotic treatment for insomnia to understand the strengths and potentials in the current studies and guide future clinical practice, research, and science policy.

Digital Behavior Change Intervention Designs for Habit Formation: Systematic Review

BACKGROUND

With the development of emerging technologies, digital behavior change interventions (DBCIs) help to maintain regular physical activity in daily life.

OBJECTIVE

To comprehensively understand the design implementations of habit formation techniques in current DBCIs, a systematic review was conducted to investigate the implementations of behavior change techniques, types of habit formation techniques, and design strategies in current DBCIs.

METHODS

The process of this review followed the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases were systematically searched from 2012 to 2022, which included Web of Science, Scopus, ACM Digital Library, and PubMed. The inclusion criteria encompassed studies that used digital tools for physical activity, examined behavior change intervention techniques, and were written in English.

RESULTS

A total of 41 identified research articles were included in this review. The results show that the most applied behavior change techniques were the self-monitoring of behavior, goal setting, and prompts and cues. Moreover, habit formation techniques were identified and developed based on intentions, cues, and positive reinforcement. Commonly used methods included automatic monitoring, descriptive feedback, general guidelines, self-set goals, time-based cues, and virtual rewards.

CONCLUSIONS

A total of 32 commonly design strategies of habit formation techniques were summarized and mapped to the proposed conceptual framework, which was categorized into target-mediated (generalization and personalization) and technology-mediated interactions (explicitness and implicitness). Most of the existing studies use the explicit interaction, aligning with the personalized habit formation techniques in the design strategies of DBCIs. However, implicit interaction design strategies are lacking in the reviewed studies. The proposed conceptual framework and potential solutions can serve as guidelines for designing strategies aimed at habit formation within DBCIs.

Behavior Change Approaches in Digital Technology-Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

BACKGROUND

Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions.

OBJECTIVE

This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT.

METHODS

Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1).

RESULTS

From a total of 1973 identified sources, 103 (5%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67%). Almost half (45/103, 44%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56%), and almost two-thirds (65/103, 63%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56/103, 54%), goals and planning (33/103, 32%), and shaping knowledge (33/103, 32%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality.

CONCLUSIONS

Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation.

The transition from genomics to phenomics in personalized population health

Modern health care faces several serious challenges, including an ageing population and its inherent burden of chronic diseases, rising costs and marginal quality metrics. By assessing and optimizing the health trajectory of each individual using a data-driven personalized approach that reflects their genetics, behaviour and environment, we can start to address these challenges. This assessment includes longitudinal phenome measures, such as the blood proteome and metabolome, gut microbiome composition and function, and lifestyle and behaviour through wearables and questionnaires. Here, we review ongoing large-scale genomics and longitudinal phenomics efforts and the powerful insights they provide into wellness. We describe our vision for the transformation of the current health care from disease-oriented to data-driven, wellness-oriented and personalized population health.

The potential and limitations of large language models in identification of the states of motivations for facilitating health behavior change

IMPORTANCE

The study highlights the potential and limitations of the Large Language Models (LLMs) in recognizing different states of motivation to provide appropriate information for behavior change. Following the Transtheoretical Model (TTM), we identified the major gap of LLMs in responding to certain states of motivation through validated scenario studies, suggesting future directions of LLMs research for health promotion.

OBJECTIVES

The LLMs-based generative conversational agents (GAs) have shown success in identifying user intents semantically. Little is known about its capabilities to identify motivation states and provide appropriate information to facilitate behavior change progression.

MATERIALS AND METHODS

We evaluated 3 GAs, ChatGPT, Google Bard, and Llama 2 in identifying motivation states following the TTM stages of change. GAs were evaluated using 25 validated scenarios with 5 health topics across 5 TTM stages. The relevance and completeness of the responses to cover the TTM processes to proceed to the next stage of change were assessed.

RESULTS

3 GAs identified the motivation states in the preparation stage providing sufficient information to proceed to the action stage. The responses to the motivation states in the action and maintenance stages were good enough covering partial processes for individuals to initiate and maintain their changes in behavior. However, the GAs were not able to identify users' motivation states in the precontemplation and contemplation stages providing irrelevant information, covering about 20%-30% of the processes.

DISCUSSION

GAs are able to identify users' motivation states and provide relevant information when individuals have established goals and commitments to take and maintain an action. However, individuals who are hesitant or ambivalent about behavior change are unlikely to receive sufficient and relevant guidance to proceed to the next stage of change.

CONCLUSION

The current GAs effectively identify motivation states of individuals with established goals but may lack support for those ambivalent towards behavior change.

Gamification of Behavior Change: Mathematical Principle and Proof-of-Concept Study

BACKGROUND

Many people want to build good habits to become healthier, live longer, or become happier but struggle to change their behavior. Gamification can make behavior change easier by awarding points for the desired behavior and deducting points for its omission.

OBJECTIVE

In this study, we introduced a principled mathematical method for determining how many points should be awarded or deducted for the enactment or omission of the desired behavior, depending on when and how often the person has succeeded versus failed to enact it in the past. We called this approach optimized gamification of behavior change.

METHODS

As a proof of concept, we designed a chatbot that applies our optimized gamification method to help people build healthy water-drinking habits. We evaluated the effectiveness of this gamified intervention in a 40-day field experiment with 1 experimental group (n=43) that used the chatbot with optimized gamification and 2 active control groups for which the chatbot's optimized gamification feature was disabled. For the first control group (n=48), all other features were available, including verbal feedback. The second control group (n=51) received no feedback or reminders. We measured the strength of all participants' water-drinking habits before, during, and after the intervention using the Self-Report Habit Index and by asking participants on how many days of the previous week they enacted the desired habit. In addition, all participants provided daily reports on whether they enacted their water-drinking intention that day.

RESULTS

A Poisson regression analysis revealed that, during the intervention, users who received feedback based on optimized gamification enacted the desired behavior more often (mean 14.71, SD 6.57 times) than the active (mean 11.64, SD 6.38 times; P<.001; incidence rate ratio=0.80, 95% CI 0.71-0.91) or passive (mean 11.64, SD 5.43 times; P=.001; incidence rate ratio=0.78, 95% CI 0.69-0.89) control groups. The Self-Report Habit Index score significantly increased in all conditions (P<.001 in all cases) but did not differ between the experimental and control conditions (P>.11 in all cases). After the intervention, the experimental group performed the desired behavior as often as the 2 control groups (P≥.17 in all cases).

CONCLUSIONS

Our findings suggest that optimized gamification can be used to make digital behavior change interventions more effective.

TRIAL REGISTRATION

Open Science Framework (OSF) H7JN8; https://osf.io/h7jn8.

Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities

BACKGROUND

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas. This paper describes the co-design of a digital intervention to improve vegetable intake with rural community members and research partners.

METHODS

Active participants in the co-design process were adults ≥ 18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population. Eight online workshops and a community survey were conducted between July and December 2021. The MoSCoW prioritisation method was used to help participants identify the 'Must-have, Should-have, Could-have, and Won't-have or will not have right now' features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community.

RESULTS

Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on (i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, (ii) access to personalisation options and behaviour change support, and (iii) improving the community food environment by providing information on and access to local food initiatives.

CONCLUSIONS

Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This research will inform the development of the prototyping (evaluation phase) and feasibility testing (post-design phase) of this intervention.

Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries

BACKGROUND

Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups.

OBJECTIVE

In this study, we aimed to identify consumers' most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers' BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis.

METHODS

A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland.

RESULTS

"Home work out suggestions," "exercise tips," and "progress charts" were the most preferred app features, whereas "gift vouchers" and "shopping discounts" were the most preferred rewards. "Connections with other communication apps" was the least preferred feature, and "charitable giving" was the least preferred reward. Importantly, consumers' positive attitude toward the "social support and connectedness and mindfulness" app feature predicted willingness to pay for such an app (β=.229; P=.004). Differences in consumers' health status, motivational factors, and basic demographics moderated these results and consumers' intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app.

CONCLUSIONS

This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers' health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps.

A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study

BACKGROUND

A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms.

OBJECTIVE

This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants' engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels.

METHODS

This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Barkley Adult ADHD Rating Scale-IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability.

RESULTS

The study retention rate was 97% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive symptoms and 46.4% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57% and 18/30, 60%, respectively) of the participants. This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5.

CONCLUSIONS

The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy.

Potential associations between behavior change techniques and engagement with mobile health apps: a systematic review

Introduction

Lack of engagement is a common challenge for digital health interventions. To achieve their potential, it is necessary to understand how best to support users' engagement with interventions and target health behaviors. The aim of this systematic review was to identify the behavioral theories and behavior change techniques being incorporated into mobile health apps and how they are associated with the different components of engagement.

Methods

The review was structured using the PRISMA and PICOS frameworks and searched six databases in July 2022: PubMed, Embase, CINAHL, APA PsycArticles, ScienceDirect, and Web of Science. Risk of bias was evaluated using the Cochrane Collaboration Risk of Bias 2 and the Mixed Methods Appraisal Tools.

Analysis

A descriptive analysis provided an overview of study and app characteristics and evidence for potential associations between Behavior Change Techniques (BCTs) and engagement was examined.

Results

The final analysis included 28 studies. Six BCTs were repeatedly associated with user engagement: goal setting, self-monitoring of behavior, feedback on behavior, prompts/cues, rewards, and social support. There was insufficient data reported to examine associations with specific components of engagement, but the analysis indicated that the different components were being captured by various measures.

Conclusion

This review provides further evidence supporting the use of common BCTs in mobile health apps. To enable developers to leverage BCTs and other app features to optimize engagement in specific contexts and individual characteristics, we need a better understanding of how BCTs are associated with different components of engagement.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022312596.

Novel behaviour change frameworks for digital health interventions: A critical review

Digital health interventions - interventions delivered over digital media to support the health of users - are becoming increasingly prevalent. Utilising an intervention development framework can increase the efficacy of digital interventions for health-related behaviours. This critical review aims to outline and review novel behaviour change frameworks that guide digital health intervention development. Our comprehensive search for preprints and publications used PubMed, PsycINFO, Scopus, Web of Science and the Open Science Framework repository. Articles were included if they: (1) were peer-reviewed; (2) proposed a behaviour change framework to guide digital health intervention development; (3) were written in English; (4) were published between 1/1/19 and 1/8/2021; and (5) were applicable to chronic diseases. Intervention development frameworks considered the user, intervention elements and theoretical foundations. However, the timing and policy of interventions are not consistently addressed across frameworks. Researchers should deeply consider the digital applicability of behaviour change frameworks to improve intervention success.

Research trends in complementary and alternative treatments for insomnia over the past decade: A bibliometrics analysis

Insomnia is the most common sleep disorder, with persistent insomnia being associated with greater risk and leading to a range of functional consequences that place a heavy burden on patients and healthcare systems. A weight of evidence has shown that complementary and alternative medicine (CAM) seems to have a positive effect on improving sleep. However, the research trends of CAM intervention for insomnia have not been studied systematically through bibliometrics. We searched the relevant literature over the past decade in the Web of Science Core Collection database on September 20, 2022 and used CiteSpace and gCLUTO to visually analyze and cluster countries, institutions, authors, journals and keywords. Through screening, 1655 papers were included. In the past decade, the number of articles published in this field shown an annual trend of growth, with explosive growth in 2020. The USA has the largest number of publications, the University of Hong Kong is the leading institution in this field, and the most cited journal is Sleep. Mental condition and quality of life in patients with insomnia, insomnia related to cancer, effect of mindfulness meditation, yoga and aromatherapy on insomnia and the psychiatric symptoms resulting from the COVID-19 pandemic are at the forefront of this field. In this study, bibliometrics and visualization analysis were performed on related studies on CAM intervention for insomnia. This will be the focus and development direction of insomnia treatment in the future to formulate structured treatment plans for traditional Chinese medicine-related CAM, validate large-scale clinical trials, solve cancer comorbidity insomnia and related psychiatric symptoms and deal with mental health-related insomnia after public health outbreaks.

The association between COVID-19 preventive strategies, virtual reality exercise, use of fitness apps, physical, and psychological health: testing a structural equation moderation model

Background

Directly or indirectly, individual psychosocial characteristics, motivation, and health consciousness factors help to maintain physical and psychological health through maintaining physical activity.

Objective

In the current study, we investigated how fitness apps moderate the links among COVID-19 preventive strategies, virtual reality exercise, physical health, and psychological health in Chinese society.

Method

A nationwide online survey across China was conducted under a snowball sampling design from February to June 2022. A total of 3,000 questionnaires were distributed across China via online platforms. A total of 2,795 complete detailed replies were included in the final analysis. Structural equation modeling techniques were employed to analyze the collected data through Smart-PLS 3.0.

Results

It has been statically proved that all the scales used in this inquiry to determine the mean scores, standard deviation, excess kurtosis, and skewness values were reliable and produced satisfactory results. The overall results (H1: β = 0.385, t = 15.699, p = 0.000; H2: β = 0.159, t = 7.405, p = 0.000; H3: β = 0.122, t = 5.435, p = 0.000; H4: β = 0.143, t = 6.493, p = 0.000; H5: β = 0.157, t = 6.444, p = 0.000; H6: β = 0.184, t = 9.071, p = 0.000; H7: β = 0.192, t = 9.319, p = 0.000; H8: β = 0.235, t = 11.899, p = 0.000; H9: β = -0.114, t = 4.872, p = 0.000; H10: β = 0.042, t = 2.872, p = 0.004; H11: β = 0.041, t = 2.699, p = 0.007) supported our hypothetical model and explained that using fitness apps and virtual reality exercise benefits physical and psychological health.

Conclusion

The fitness app's primary purpose during and after the pandemic is to motivate users to keep up with their regular at-home workouts. Exercise and active living are helpful in the prevention of risk factors associated with physical inactivity.

A systematic appraisal of the information, engagement, aesthetic and functional quality of nutrition-related smartphone apps for children and adolescents

OBJECTIVE

Nutrition-related smartphone applications (apps) could improve children's nutrition knowledge and skills. However, little is known about the quality of nutrition-related apps for children. This study aimed to identify and evaluate the quality of nutrition-related smartphone apps designed for children ages 4-17.

DESIGN

This systematic appraisal is guided by the Protocol for App Store Systematic Reviews.

SETTING

Using Google's Advanced Search, we identified 1814 apps/1184 additional apps in an updated search on iOS, of which twenty-four were eligible. The apps' objective and subjective quality were evaluated using the twenty-three-item, five-point Mobile App Rating Scale. The objective quality scale consists of four subscales: engagement, functionality, aesthetics and information.

RESULTS

Most of the apps (75 %) focussed solely on promoting nutrition skills, such as making food dishes, rather than nutrition knowledge. Of the twenty-four apps, 83 % targeted children 4-8 years old. The app objective quality mean score was 3·60 ± 0·41. The subscale mean scores were 3·20 ± 0·41 for engagement, 4·24 ± 0·47 for functionality, 4·03 ± 0·51 for aesthetics and 2·94 ± 0·62 for information. The app subjective quality mean score was 2·10 ± 0·90.

CONCLUSIONS

More robust approaches to app development leveraging co-design approaches, including involving a multidisciplinary team of experts to provide evidence-based nutrition information, are warranted.

Digital interventions for genomics and genetics education, empowerment, and service engagement: A systematic review

BACKGROUND

Patient-facing digital technologies may reduce barriers to and alleviate the burden on genetics services. However, no work has synthesised the evidence for patient-facing digital interventions for genomics/genetics education and empowerment, or to facilitate service engagement more broadly. It is also unclear which groups have been engaged by digital interventions.

AIM

This systematic review explores which existing patient-facing digital technologies have been used for genomics/genetics education and empowerment, or to facilitate service engagement, and for whom and for which purposes the interventions have been developed.

METHODS

The review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eight databases were searched for literature. Information was extracted into an Excel sheet and analysed in a narrative manner. Quality assessments were conducted using the Mixed Methods Appraisal Tool.

RESULTS

Twenty-four studies were included, of which 21 were moderate or high quality. The majority (88%) were conducted in the United States of America or within a clinical setting (79%). More than half (63%) of the interventions were web-based tools, and almost all focussed on educating users (92%). There were promising results regarding educating patients and their families and facilitating engagement with genetics services. Few of the studies focussed on empowering patients or were community-based.

CONCLUSION

Digital interventions may be used to deliver information about genetics concepts and conditions, and positively impact service engagement. However, there is insufficient evidence related to empowering patients and engaging underserved communities or consanguineous couples. Future work should focus on co-developing content with end users and incorporating interactive features.

Leveraging Mobile Technology for Public Health Promotion: A Multidisciplinary Perspective

Health behaviors are inextricably linked to health and well-being, yet issues such as physical inactivity and insufficient sleep remain significant global public health problems. Mobile technology-and the unprecedented scope and quantity of data it generates-has a promising but largely untapped potential to promote health behaviors at the individual and population levels. This perspective article provides multidisciplinary recommendations on the design and use of mobile technology, and the concomitant wealth of data, to promote behaviors that support overall health. Using physical activity as anexemplar health behavior, we review emerging strategies for health behavior change interventions. We describe progress on personalizing interventions to an individual and their social, cultural, and built environments, as well as on evaluating relationships between mobile technology data and health to establish evidence-based guidelines. In reviewing these strategies and highlighting directions for future research, we advance the use of theory-based, personalized, and human-centered approaches in promoting health behaviors.

Digital behaviour change interventions to increase vegetable intake in adults: a systematic review

BACKGROUND

Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness.

METHODS

A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials.

RESULTS

Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain.

CONCLUSION

Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.

Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study

BACKGROUND

Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design.

OBJECTIVE

The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design?

METHODS

This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach.

RESULTS

Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice.

CONCLUSIONS

When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice.

Different Approaches to Appraising Systematic Reviews of Digital Interventions for Physical Activity Promotion Using AMSTAR 2 Tool: Cross-Sectional Study

High-quality systematic reviews (SRs) can strengthen the evidence base for prevention and health promotion. A 16-item AMSTAR 2 tool allows the appraisal of SRs by deriving a confidence rating in their results. In this cross-sectional study, we aimed to assess and compare two approaches to appraising 30 SRs of digital interventions for physical activity (PA) promotion using AMSTAR 2. Approach 1 (appraisals with 2/16 items) was used to identify SRs with critically low confidence ratings. Approach 2 (appraisals with all 16 items) was used (1) to derive the confidence ratings, (2) to identify SR strengths and weaknesses, and (3) to compare SR strengths among subgroups of SRs. The appraisal outcomes were summarized and compared using descriptive statistics. Approach 1 was quick (mean of 5 min/SR) at identifying SRs with critically low confidence ratings. Approach 2 was slower (mean of 20 min/SR), but allowed to identify SR strengths and weaknesses. Approach 2 showed that confidence ratings were low to critically low in 29/30 SRs. More strengths were identified in SRs with review protocols relative to SRs without review protocols and in newer SRs (published after AMSTAR 2 release) relative to older SRs. Only two items on AMSTAR 2 can quickly identify SRs with critical weaknesses. Although most SRs received low to critically low confidence ratings, SRs with review protocols and newer SRs tended to have more strengths. Future SRs require review protocols and better adherence to reporting guidelines to improve the confidence in their results.

Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review

BACKGROUND

Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited.

OBJECTIVE

The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any.

METHODS

A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records.

RESULTS

In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use.

CONCLUSIONS

The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.

Bibliometric and visualized analysis of sodium-Glucose cotransporter 2 inhibitors

Background: Sodium-glucose cotransporter 2 inhibitors have proved to be extremely effective and reliable in reducing hyperglycemia, and have also been used for the treatment of cardiovascular and renal disease in patients with or without type 2 diabetes. Thousands of research articles on SGLT2 inhibitors have been published in the past, but few bibliometric analyses have systematically been studied this field. We aimed to visualize the global research hotspots and trends of SGLT2 inhibitors using a bibliometric analysis to provide new evidence and ideas for researchers and clinicians in this field. Methods: We retrieved publications from Science Citation Index Expanded of Web of Science Core Collection in 2004-2022 on 1 July 2022. Microsoft Excel, CiteSpace and VOSviewer were employed to collect publication data, analyze publication trends, and visualize relevant results. Results: We identified 4,419 original research articles on SGLT2 inhibitors published between 2004 and the first half of 2022. Global SGLT2 inhibitors-related research increased rapidly from 2004 to 2022, especially recently. United States made the greatest contribution to the topic, with (1,629, 36.86%) publications and citations (88,892). AstraZeneca was the most prolific institutions (272, 6.16%). Heerspink HJL published the most related articles (98), whereas Zinman B was cited the most frequently (1,784 citations). Diabetes Obesity and Metabolism was the journal with the most studies (406, 9.19%), and The New England Journal of Medicine was the most commonly cited journal (11,617 citations), with nine of the top 10 co-cited references published in this journal. The emerging keywords "heart failure," "diabetic cardiomyopathy," "ejection fraction," "mortality," "biomarker," "fibrosis," "ampk," and "guideline" appeared the most recently as research frontiers. Conclusion: United States is the leader in SGLT2 inhibitor research. Recently, the research on SGLT2 inhibitors has focused on clinical trials, related mechanisms, and therapy. In the future, the research on SGLT2 inhibitors will delve into molecular mechanisms, especially those related to fibrosis and AMPK, revealing the link between SGLT2 inhibitors and heart failure and diabetic cardiomyopathy will be the next research hotspot.

Low– and Medium–Socioeconomic-Status Group Members’ Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study

Background

Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable as digital solutions often do not fit users’ needs and barriers. This is especially poignant for priority communities in society. Involving these groups in citizen science may have great benefits even beyond the increase in knowledge of the lives and experiences of these groups. However, this requires specialized skills. Participants from priority groups could benefit from an approach that offers sensitization and discussion to help them voice their needs regarding healthy nutrition and technology to support healthy eating.

Objective

This study aimed to gather insights into people’s thoughts on everyday eating practices, self-regulation in healthy eating, and skill acquisition and on applying technological innovations to these domains.

Methods

Participants answered 3 daily questionnaires to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating and make it easier for them to collect their thoughts and experiences (sensitization). Within a week of filling out the 3 questionnaires, participants took part in a web-based focus group discussion session. All sessions were transcribed and analyzed using a thematic qualitative approach.

Results

A total of 42 people took part in 7 focus group interviews of 6 people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as measuring the effect their personal nutrition has on their individual health, providing them with reliable product information, giving them practical guidance for healthy eating and snacking, and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost were major concerns for the participants.

Conclusions

This study shows that people from low– and medium–socioeconomic-status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation and see technology as a means to achieve this.

Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study

AIMS

To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes.

METHODS

Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis.

RESULTS

Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement.

CONCLUSIONS

Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.

Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review

BACKGROUND

Digital health interventions are efficacious in health-promoting behaviors (eg, healthy eating and regular physical activity) that mitigate health risks and menopausal symptoms in midlife. However, integrated evidence-based knowledge about the mechanisms of change in these interventions is unclear.

OBJECTIVE

This systematic review aimed to evaluate studies on behavior change techniques (BCTs) and mechanisms of change in digital health interventions aimed at promoting health-enhancing behaviors in midlife women (aged 40-65 years).

METHODS

A systematic literature search of the electronic databases PubMed, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials in the Cochrane Library was conducted. In total, 2 independent reviewers selected the studies for inclusion, extracted data, and completed BCT mapping of eligible studies. The mechanism of action and intervention functions of eligible studies were evaluated using the behavior change wheel framework. Reporting of psychological theory use within these interventions was explored using the Theory Coding Scheme. Mode of delivery, psychological theory, and BCTs were presented as descriptive statistics.

RESULTS

In total, 13 interventions (including 1315 women) reviewed used 13 (SD 4.30, range 6-21) BCTs per intervention on average. The "Shaping knowledge" and "Repetition and substitution" behavior change categories were used most frequently, with 92% (12/13) of the interventions implementing at least one of the BCTs from these 2 categories. Only 13.98% (169/1209) of the 93 available BCTs were used, with "Instructions on behaviour" most frequently used (12/13, 92%). The behavior change wheel mapping suggests that half of the intervention content aimed to increase "Capability" (49/98, 50% of the intervention strategies), "Motivation" (41/98, 42%), and "Opportunity" (8/98, 8%). "Behavioural Regulation" was the most frequently used mechanism of action (15/98, 15%), followed by increasing "Knowledge" (13/98, 13%) and "Cognitive and Interpersonal skills" (10/98, 10%). A total of 78% (7/9) of the intervention functions were used in the studies to change behavior, primarily through "Enablement" (60/169, 35.5%), whereas no study used "Restriction" or "Modelling" functions. Although 69% (9/13) of the interventions mentioned a psychological theory or model, most (10/13, 77%) stated or suggested rather than demonstrated the use of a theoretical base, and none reported explicit links between all BCTs within the intervention and the targeted theoretical constructs. Technological components were primarily based on web-based (9/13, 69%) modes of delivery, followed by phone or SMS text message (8/13, 62%) and wearables (7/13, 54%).

CONCLUSIONS

The findings of this review indicate an overall weak use of theory, low levels of treatment fidelity, insignificant outcomes, and insufficient description of several interventions to support the assessment of how specific BCTs were activated. Thus, the identified limitations in the current literature provide an opportunity to improve the design of lifestyle health-enhancing interventions for women in midlife.

TRIAL REGISTRATION

PROSPERO CRD42021259246; https://tinyurl.com/4ph74a9u.

Global trends and hotspots in research on extended reality in sports: A bibliometric analysis from 2000 to 2021

Objective

Extended reality technologies (e.g. virtual reality (VR), augmented reality (AR) and mixed reality (MR)) are gaining popularity in sports owing to their unique advantages. This study aims to analyse the progress of the application of extended reality technology in sports and reveal its cooperative features, research hotspots and development trends.

Methods

We searched the literature in the Web of Science Core Collection (WoSCC) database within the period 2000 to 2021 and conducted a bibliometric analysis. The analysis methods included statistical, co-occurrence, hierarchical clustering and social network analyses.

Results

A total of 340 articles were gathered. The literature related to its research showed an increasing trend over time. The paper collaboration rate was 90.88% (309/340 papers), and the degree of author collaboration was 3.96 (1345/340). VR was found to be the most productive journal, and Queen's University Belfast was the most productive institution. The United States, China and the United Kingdom were the three main contributors to the field. The foundational themes in sports extended reality research were (i) sports games and extended reality systems, (ii) virtual simulation devices and artificial intelligence, (iii) sports training and performance and (iv) age-appropriate physical activity, sports rehabilitation and physical education.

Conclusion

The level of author collaboration was low, but the degree of author collaboration is largely on the rise. The closeness of the collaboration between institutions and countries was also low. In addition, the subject of sport extended reality is relatively fragmented. Therefore, more research is needed to strengthen it in the future.

COVID-19 from the perspective of otorhinolaryngology: An analysis of bibliometrics

Background

Since it began in December 2019, the coronavirus disease 2019 (COVID-19) outbreak has not been completely contained. COVID-19 has attracted the interest of nations throughout the globe. The global coronavirus outbreak has had an especially devastating effect on otolaryngology. The virus is commonly associated with otorhinolaryngological symptoms. COVID-19 research is becoming more common in otorhinolaryngology. Although various studies on covid-19-related Otorhinolaryngology manifestations have been published, there has been no bibliometric analysis of these articles concentrating on COVID-19-related Otorhinolaryngology research.

Methods

Original publications on Otolaryngological symptoms on COVID-19 were extracted from the Social Sciences Citation Index (SSCI) and the Science Citation Index-Expanded (SCI-E) databases in Clarivate Analytics' Web of Science Core Collection (WoSCC) between January 2020 and May 2022. CiteSpace and VOSviewer were utilized to detect and assess the research focus and trends in this field by extracting the country/region, institution, author, journal, references, and keywords related to this topic.

Results

A total of 631 journals from 97 countries were included in the total of 1,528 articles. Most of the articles on this topic were published in the United States, which had the most citations and the highest H-index. Huazhong University of Science and Technology is the institution with the largest number of articles in the research of COVID-19-related Otorhinolaryngology diseases. Claire Hopkins was the most prolific author belonging to Guy's and St. Thomas' NHS Foundation Trust. Huang CL from Jin Yin-tan Hospital received the most citations among all authors. The most cited article was Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, which was created by Huang CL. Most of the studies relating to COVID-19 and Otorhinolaryngology diseases were published in the European Archives of Oto-Rhino-Laryngology.

Conclusion

COVID-related research in the field of otorhinolaryngology has been studied in terms of descriptive quantitative metrics, which show that academics from around the world are working together to combat this pandemic.

Evolution of research trends in artificial intelligence for breast cancer diagnosis and prognosis over the past two decades: A bibliometric analysis

Objective

In recent years, among the available tools, the concurrent application of Artificial Intelligence (AI) has improved the diagnostic performance of breast cancer screening. In this context, the present study intends to provide a comprehensive overview of the evolution of AI for breast cancer diagnosis and prognosis research using bibliometric analysis.

Methodology

Therefore, in the present study, relevant peer-reviewed research articles published from 2000 to 2021 were downloaded from the Scopus and Web of Science (WOS) databases and later quantitatively analyzed and visualized using Bibliometrix (R package). Finally, open challenges areas were identified for future research work.

Results

The present study revealed that the number of literature studies published in AI for breast cancer detection and survival prediction has increased from 12 to 546 between the years 2000 to 2021. The United States of America (USA), the Republic of China, and India are the most productive publication-wise in this field. Furthermore, the USA leads in terms of the total citations; however, hungry and Holland take the lead positions in average citations per year. Wang J is the most productive author, and Zhan J is the most relevant author in this field. Stanford University in the USA is the most relevant affiliation by the number of published articles. The top 10 most relevant sources are Q1 journals with PLOS ONE and computer in Biology and Medicine are the leading journals in this field. The most trending topics related to our study, transfer learning and deep learning, were identified.

Conclusion

The present findings provide insight and research directions for policymakers and academic researchers for future collaboration and research in AI for breast cancer patients.

Study protocol for the description and evaluation of the "Habit Coach" - a longitudinal multicenter mHealth intervention for healthy habit formation in health care professionals

BACKGROUND

The adoption of a healthy lifestyle plays a crucial role for the health and well-being of health care professionals. Previous e- and mHealth interventions relied on deliberative psychological processes (e.g., intention, planning) to target lifestyle changes, while revealing mixed efficacy. The additional potential of non-deliberative, automatic processes (i.e., habits) for behavior change has been understudied in interventions so far. The Habit Coach mHealth intervention combines deliberative and non-deliberative processes to support health care professionals in forming healthy physical activity, nutrition and mindfulness habits in daily life. The aim of this paper is to outline the study protocol including a detailed description of the mHealth intervention, evaluation plan, and study design. The purpose of this trial is to understand healthy habit formation in health care professionals over time.

METHODS

A one-arm, multicenter mHealth intervention study will be conducted. Behavioral and psychosocial predictors will be collected via within-app questionnaires across a 100-day period at baseline, post, as well as at weekly assessments. To understand habit formation across time, linear mixed models will be used.

DISCUSSION

This trial aims to unravel the role of motivational and volitional determinants for healthy habit formation across multiple health behaviors in health care professionals embedded in a mHealth intervention.

TRIAL REGISTRATION

This trial is registered in the German Clinical Trials Register, DRKS-ID DRKS00027156. Date of registration 17 November 2021.

Swap Up Your Meal: A Mass Media Nutrition Education Campaign for Oklahoma Teens

To address a statewide need for obesity prevention, the Oklahoma Tobacco Settlement Endowment Trust launched Swap Up in 2021, a mass media nutrition education effort for teens, ages 13-18. Swap Up utilizes the SAVI messaging approach, an audience-centric message development framework that recognizes barriers to healthy living and offers realistic solutions. Five months into the campaign, an online survey was conducted (n = 200) to assess short-term program goals related to campaign delivery, engagement, and relevance. A secondary, long-term goal related to documenting and understanding self-reported changes in past month nutrition-related behaviors was also explored. A majority of participants (72%) reported aided awareness of the campaign brand logo/advertisements, and awareness (83%) of at least one main message. Nearly half (44%) of the participants reported at least one engagement with digital media. Main message recognition, perceived relevance, and self-reported nutritional behaviors were consistently highest among those reporting both campaign awareness and digital engagement. Ultimately, Swap Up reached and delivered nutrition education messages to Oklahoma teens within the first year of launch, as intended, and was associated with self-reported changes in recent behavior. This study provides evidence that SAVI offers a promising approach for nutrition education, and underscores why digital and social media engagement strategies are critical for mass media teen behavior change campaigns. Campaign implementation and evaluation are ongoing.

Training the next generation of behavioral medicine scientists to accelerate digital health

We trace the evolution of digital health industry careers for behavioral medicine specialists. We discuss the current misalignment of career opportunities in the private sector with the predominant graduate education training model that emphasizes the pursuit of academic positions. We describe the potential risks to the profession and public health if the field does not adapt professional training models to be inclusive of private sector industry roles. Finally, we offer a series of recommendations aimed at trainees, faculty advisors, and training programs to better prepare trainees for meaningful careers in industry.

Digital Technologies for Health Promotion and Disease Prevention in Older People: Protocol for a Scoping Review

BACKGROUND

Digital technologies could contribute to health promotion and disease prevention. It is unclear if and how such digital technologies address the health needs of older people in nonclinical settings (ie, daily life).

OBJECTIVE

This study aims to identify digital technologies for health promotion and disease prevention that target the needs of older people in nonclinical settings by performing a scoping review of the published literature. The scoping review is guided by the framework of Arksey and O'Malley.

METHODS

Our scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The information sources are bibliographic databases (MEDLINE, PsycINFO, CINAHL, and SCOPUS) and bibliographies of any included systematic reviews. Manual searches for additional studies will be performed in Google Scholar and most relevant journals. The electronic search strategy was developed in collaboration with a librarian who performed the search for studies on digital technologies for health promotion and disease prevention targeting the needs of older people. Study selection and data coding will be performed independently by 2 authors. Consensus will be reached by discussion. Eligibility is based on the PCC (Population, Concept, and Context) criteria as follows: (1) older people (population); (2) any digital (health) technology, such as websites, smartphone apps, or wearables (concept); and (3) health promotion and disease prevention in nonclinical (daily life, home, or community) settings (context). Primary studies with any design or reviews with a systematic methodology published in peer-reviewed academic journals will be included. Data items will address study designs, PCC criteria, benefits or barriers related to digital technology use by older people, and evidence gaps. Data will be synthesized using descriptive statistics or narratively described by identifying common themes. Quality appraisal will be performed for any included systematic reviews, using a validated instrument for this study type (A Measurement Tool to Assess Systematic Reviews, version 2 [AMSTAR2]).

RESULTS

Following preliminary literature searches to test and calibrate the search syntax, the electronic literature search was performed in March 2022 and manual searches were completed in June 2022. Study selection based on titles and abstracts was completed in July 2022, and the full-text screen was initiated in July 2022.

CONCLUSIONS

Our scoping review will identify the types of digital technologies, health targets in the context of health promotion and disease prevention, and health benefits or barriers associated with the use of such technologies for older people in nonclinical settings. This knowledge could guide further research on how digital technologies can support healthy aging.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37729.

Application of Telemedicine in COVID-19: A Bibliometric Analysis

Background

Telemedicine as a tool that can reduce potential disease spread and fill a gap in healthcare has been increasingly applied during the COVID-19 pandemic. Many studies have summarized telemedicine's technologies or the diseases' applications. However, these studies were reviewed separately. There is a lack of a comprehensive overview of the telemedicine technologies, application areas, and medical service types.

Objective

We aimed to investigate the research direction of telemedicine at COVID-19 and to clarify what kind of telemedicine technology is used in what diseases, and what medical services are provided by telemedicine.

Methods

Publications addressing telemedicine in COVID-19 were retrieved from the PubMed database. To extract bibliographic information and do a bi-clustering analysis, we used Bicomb and gCLUTO. The co-occurrence networks of diseases, technology, and healthcare services were then constructed and shown using R-studio and the Gephi tool.

Results

We retrieved 5,224 research papers on telemedicine at COVID-19 distributed among 1460 journals. Most articles were published in the Journal of Medical Internet Research (166/5,224, 3.18%). The United States published the most articles on telemedicine. The research clusters comprised 6 clusters, which refer to mental health, mhealth, cross-infection control, and self-management of diseases. The network analysis revealed a triple relation with diseases, technologies, and health care services with 303 nodes and 5,664 edges. The entity “delivery of health care” was the node with the highest betweenness centrality at 6,787.79, followed by “remote consultation” (4,395.76) and “infection control” (3,700.50).

Conclusions

The results of this study highlight widely use of telemedicine during COVID-19. Most studies relate to the delivery of health care and mental health services. Technologies were primarily via mobile devices to deliver health care, remote consultation, control infection, and contact tracing. The study assists researchers in comprehending the knowledge structure in this sector, enabling them to discover critical topics and choose the best match for their survey work.

Motivating Machines: The Potential of Modeling Motivation as MoA for Behavior Change Systems

The pathway through which behavior change techniques have an effect on the behavior of an individual is referred to as the Mechanism of Action (MoA). Digitally enabled behavior change interventions could potentially benefit from explicitly modelling the MoA to achieve more effective, adaptive, and personalized interventions. For example, if ‘motivation’ is proposed as the targeted construct in any behavior change intervention, how can a model of this construct be used to act as a mechanism of action, mediating the intervention effect using various behavior change techniques? This article discusses a computational model for motivation based on the neural reward pathway with the aim to make it act as a mediator between behavior change techniques and target behavior. This model’s formal description and parametrization are described from a neurocomputational sciences prospect and elaborated with the help of a sub-question, i.e., what parameters/processes of the model are crucial for the generation and maintenance of motivation. An intervention scenario is simulated to show how an explicit model of ‘motivation’ and its parameters can be used to achieve personalization and adaptivity. A computational representation of motivation as a mechanism of action may also further advance the design, evaluation, and effectiveness of personalized and adaptive digital behavior change interventions.

Research on Digital Technology Use in Cardiology: Bibliometric Analysis

Background

Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area.

Objective

We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field.

Methods

The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization.

Results

The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues.

Conclusions

Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth.

Global Scientific Research Landscape on Medical Informatics From 2011 to 2020: Bibliometric Analysis

Background

With the emerging information and communication technology, the field of medical informatics has dramatically evolved in health care and medicine. Thus, it is crucial to explore the global scientific research landscape on medical informatics.

Objective

This study aims to present a visual form to clarify the overall scientific research trends of medical informatics in the past decade.

Methods

A bibliometric analysis of data retrieved and extracted from the Web of Science Core Collection (WoSCC) database was performed to analyze global scientific research trends on medical informatics, including publication year, journals, authors, institutions, countries/regions, references, and keywords, from January 1, 2011, to December 31, 2020.

Results

The data set recorded 34,742 articles related to medical informatics from WoSCC between 2011 and 2020. The annual global publications increased by 193.86% from 1987 in 2011 to 5839 in 2020. Journal of Medical Internet Research (3600 publications and 63,932 citations) was the most productive and most highly cited journal in the field of medical informatics. David W Bates (99 publications), Harvard University (1161 publications), and the United States (12,927 publications) were the most productive author, institution, and country, respectively. The co-occurrence cluster analysis of high-frequency author keywords formed 4 clusters: (1) artificial intelligence in health care and medicine; (2) mobile health; (3) implementation and evaluation of electronic health records; (4) medical informatics technology application in public health. COVID-19, which ranked third in 2020, was the emerging theme of medical informatics.

Conclusions

We summarize the recent advances in medical informatics in the past decade and shed light on their publication trends, influential journals, global collaboration patterns, basic knowledge, research hotspots, and theme evolution through bibliometric analysis and visualization maps. These findings will accurately and quickly grasp the research trends and provide valuable guidance for future medical informatics research.

Integrating Behavioral Science and Design Thinking to Develop Mobile Health Interventions: Systematic Scoping Review

Background

Mobile health (mHealth) interventions are increasingly being designed to facilitate health-related behavior change. Integrating insights from behavioral science and design science can help support the development of more effective mHealth interventions. Behavioral Design (BD) and Design Thinking (DT) have emerged as best practice approaches in their respective fields. Until now, little work has been done to examine how BD and DT can be integrated throughout the mHealth design process.

Objective

The aim of this scoping review was to map the evidence on how insights from BD and DT can be integrated to guide the design of mHealth interventions. The following questions were addressed: (1) what are the main characteristics of studies that integrate BD and DT during the mHealth design process? (2) what theories, models, and frameworks do design teams use during the mHealth design process? (3) what methods do design teams use to integrate BD and DT during the mHealth design process? and (4) what are key design challenges, implementation considerations, and future directions for integrating BD and DT during mHealth design?

Methods

This review followed the Joanna Briggs Institute reviewer manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Studies were identified from MEDLINE, PsycINFO, Embase, CINAHL, and JMIR by using search terms related to mHealth, BD, and DT. Included studies had to clearly describe their mHealth design process and how behavior change theories, models, frameworks, or techniques were incorporated. Two independent reviewers screened the studies for inclusion and completed the data extraction. A descriptive analysis was conducted.

Results

A total of 75 papers met the inclusion criteria. All studies were published between 2012 and 2021. Studies integrated BD and DT in notable ways, which can be referred to as “Behavioral Design Thinking.” Five steps were followed in Behavioral Design Thinking: (1) empathize with users and their behavior change needs, (2) define user and behavior change requirements, (3) ideate user-centered features and behavior change content, (4) prototype a user-centered solution that supports behavior change, and (5) test the solution against users’ needs and for its behavior change potential. The key challenges experienced during mHealth design included meaningfully engaging patient and public partners in the design process, translating evidence-based behavior change techniques into actual mHealth features, and planning for how to integrate the mHealth intervention into existing clinical systems.

Conclusions

Best practices from BD and DT can be integrated throughout the mHealth design process to ensure that mHealth interventions are purposefully developed to effectively engage users. Although this scoping review clarified how insights from BD and DT can be integrated during mHealth design, future research is needed to identify the most effective design approaches.

Evaluation of Digital Interventions for Physical Activity Promotion: Protocol for a Scoping Review

Background

Digital interventions (DIs) could support physical activity (PA) promotion, according to recent reviews. However, it remains unclear if and how DIs for PA promotion are evaluated; thus, it is unclear if they support behavior change in real-world settings. A mapping of evidence from published reviews is required to focus on the evaluation of DIs for PA promotion.

Objective

The aim of our study is to investigate evaluation strategies for any outcome in the context of DIs for PA promotion by conducting a scoping review of published reviews.

Methods

Our scoping review adheres to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The information sources include bibliographic databases (MEDLINE, PsycINFO, and CINAHL) and the bibliographies of the selected studies. The electronic search strategy was developed and conducted in collaboration with an experienced database specialist. The electronic search was conducted in English with no limits up to March 19, 2021, for sources with the terms digital intervention AND evaluation AND physical activity in titles or abstracts. After deduplication, 300 reviews selected from 4912 search results were assessed for eligibility by 2 authors working independently. The inclusion criteria were (1) healthy or clinical samples (population), (2) DIs for PA promotion (intervention), (3) comparisons to any other intervention or no intervention (comparison), (4) evaluation strategies (methods, results, or frameworks) for any outcome in the context of DIs for PA promotion (outcome), and (5) any published review (study type). According to the consensus reached during a discussion, 40 reviews met the inclusion criteria—36 from the electronic search and 4 from the manual search of the bibliographies of the 36 reviews. All reviews reported the evaluation strategies for any outcomes in the context of DIs for PA promotion in healthy or clinical samples. Data coding and the quality appraisal of systematic reviews are currently being performed independently by 2 authors.

Results

Our scoping review includes data from 40 published reviews (1 rapid review, 9 scoping reviews, and 30 systematic reviews). The focus of data coding is on evaluation strategies in the context of DIs for PA promotion and on the critical appraisal of the included systematic reviews. The final consensus regarding all data is expected in early 2022.

Conclusions

Interventions for PA promotion that are supported by digital technologies require evaluation to ensure their efficacy in real-world settings. Our scoping review is needed because it addresses novel objectives that focus on such evaluations and are not answered in the published reviews identified in our search. The evaluation strategies addressing DIs for PA promotion will be mapped to synthesize the results that have been reported in published reviews so far.

International Registered Report Identifier (IRRID)

DERR1-10.2196/35332

Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE (Preprint)

Background

Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed.

Objective

This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance.

Methods

This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches.

Results

A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief.

Conclusions

Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance.

Trial Registration

ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

Digital health for quality healthcare: A systematic mapping of review studies

Objective

To systematically catalogue review studies on digital health to establish extent of evidence on quality healthcare and illuminate gaps for new understanding, perspectives and insights for evidence-informed policies and practices.

Methods

We systematically searched PubMed database using sensitive search strings. Two reviewers independently conducted two-phase selection via title and abstract, followed by full-text appraisal. Consensuses were derived for any discrepancies. A standardized data extraction tool was used for reliable data mining.

Results

A total of 54 reviews from year 2014 to 2021 were included with notable increase in trend of publications. Systematic reviews constituted the majority (61.1%, (37.0% with meta-analyses)) followed by scoping reviews (38.9%). Domains of quality being reviewed include effectiveness (75.9%), accessibility (33.3%), patient safety (31.5%), efficiency (25.9%), patient-centred care (20.4%) and equity (16.7%). Mobile apps and computer-based were the commonest (79.6%) modalities. Strategies for effective intervention via digital health included engineering improved health behaviour (50.0%), better clinical assessment (35.1%), treatment compliance (33.3%) and enhanced coordination of care (24.1%). Psychiatry was the discipline with the most topics being reviewed for digital health (20.3%).

Conclusion

Digital health reviews reported findings that were skewed towards improving the effectiveness of intervention via mHealth applications, and predominantly related to mental health and behavioural therapies. There were considerable gaps on review of evidence on digital health for cost efficiency, equitable healthcare and patient-centred care. Future empirical and review studies may investigate the association between fields of practice and tendency to adopt and research the use of digital health to improve care.

Exploring the perspectives of primary care providers on use of the electronic Patient Reported Outcomes tool to support goal-oriented care: a qualitative study

BACKGROUND

Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and web portal designed to support goal-oriented care. To better understand implementation drivers and barriers primary care providers' usage behaviours are compared to their perspectives on ePRO utility and fit to support care for patients with complex care needs.

METHODS

This qualitative sub-analysis was part of a larger trial evaluating the use of the ePRO tool in primary care. Qualitative interviews were conducted with providers at the midpoint (i.e. 4.5-6 months after ePRO implementation) and end-point (i.e. 9-12 months after ePRO implementation) of the trial. Interviews explored providers' experiences and perceptions of integrating the tool within their clinical practice. Interview data were analyzed using a hybrid thematic analysis and guided by the Technology Acceptance Model. Data from thirteen providers from three distinct primary care sites were included in the presented study.

RESULTS

Three core themes were identified: (1) Perceived usefulness: perceptions of the tool's alignment with providers' typical approach to care, impact and value and fit with existing workflows influenced providers' intention to use the tool and usage behaviour; (2) Behavioural intention: providers had a high or low behavioural intention, and for some, it changed over time; and (3) Improving usage behaviour: enabling external factors and enhancing the tool's perceived ease of use may improve usage behaviour.

CONCLUSIONS

Multiple refinements/iterations of the ePRO tool (e.g. enhancing the tool's alignment with provider workflows and functions) may be needed to enhance providers' usage behaviour, perceived usefulness and behavioural intention. Enabling external factors, such as organizational and IT support, are also necessary to increase providers' usage behaviour. Lessons from this study advance knowledge of technology implementation in primary care.

TRIAL REGISTRATION

Clinicaltrials.gov Identified NCT02917954. Registered September 2016, https://www.clinicaltrials.gov/ct2/show/study/NCT02917954.

Digitization and Health in Germany: Cross-sectional Nationwide Survey

Background

Digital technologies are shaping medicine and public health.

Objective

The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey.

Methods

We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use.

Results

The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001).

Conclusions

Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions.

Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators

Digital mental health technologies such as mobile health (mHealth) tools can offer innovative ways to help develop and facilitate mental health care provision, with the COVID-19 pandemic acting as a pivot point for digital health implementation. This viewpoint offers an overview of the opportunities and challenges mHealth innovators must navigate to create an integrated digital ecosystem for mental health care moving forward. Opportunities exist for innovators to develop tools that can collect a vast range of active and passive patient and transdiagnostic symptom data. Moving away from a symptom-count approach to a transdiagnostic view of psychopathology has the potential to facilitate early and accurate diagnosis, and can further enable personalized treatment strategies. However, the uptake of these technologies critically depends on the perceived relevance and engagement of end users. To this end, behavior theories and codesigning approaches offer opportunities to identify behavioral drivers and address barriers to uptake, while ensuring that products meet users’ needs and preferences. The agenda for innovators should also include building strong evidence-based cases for digital mental health, moving away from a one-size-fits-all well-being approach to embrace the development of comprehensive digital diagnostics and validated digital tools. In particular, innovators have the opportunity to make their clinical evaluations more insightful by assessing effectiveness and feasibility in the intended context of use. Finally, innovators should adhere to standardized evaluation frameworks introduced by regulators and health care providers, as this can facilitate transparency and guide health care professionals toward clinically safe and effective technologies. By laying these foundations, digital services can become integrated into clinical practice, thus facilitating deeper technology-enabled changes.

Developing eHealth tools for diverse older adults: Lessons learned from the PREPARE for Your Care Program

BACKGROUND/OBJECTIVES

Electronic Health (eHealth) tools offer opportunities for people to access health information online; yet, most tools are not designed to meet the unique needs of diverse older adults, leading to health disparities. Our goal was to provide guidance for the development of eHealth tools for diverse older populations for use in geriatric care models.

DESIGN

Guidance for eHealth tools was compiled from user design resources and eHealth design literature. Pragmatic examples were provided from an evidenced-based eHealth tool called PREPAREforYourCare.org (PREPARE). We used quantitative feasibility data from PREPARE research studies and qualitative analysis of PREPARE focus groups, cognitive interviews, and feedback from randomized trials to further inform our recommendations.

RESULTS

Guidance and lessons learned include: (1) define clear objectives and a conceptual framework; (2) co-create with the target population; (3) optimize the design and layout for accessibility and ease of use, such as text at the 5th grade reading level, closed captioning, etc.; (4) use simple, standardized navigation design; (5) use actionable information to enhance behavior change, such as modeling of behaviors; (6) align accompanying written materials with the eHealth tool; and (7) create tracking mechanisms for ongoing user feedback. PREPARE is used as a case example to provide pragmatic illustrations for how the guidance may be operationalized.

CONCLUSION

eHealth tools can be tailored to the unique characteristics, preferences, and needs of diverse older populations. Following the "lessons learned" may help decrease health disparities among diverse older adults and ensure eHealth tools are readily accessible and culturally appropriate.

Smartphone-Based Interventions to Reduce Sedentary Behavior and Promote Physical Activity Using Integrated Dynamic Models: Systematic Review

BACKGROUND

Traditional psychological theories are inadequate to fully leverage the potential of smartphones and improve the effectiveness of physical activity (PA) and sedentary behavior (SB) change interventions. Future interventions need to consider dynamic models taken from other disciplines, such as engineering (eg, control systems). The extent to which such dynamic models have been incorporated in the development of interventions for PA and SB remains unclear.

OBJECTIVE

This review aims to quantify the number of studies that have used dynamic models to develop smartphone-based interventions to promote PA and reduce SB, describe their features, and evaluate their effectiveness where possible.

METHODS

Databases including PubMed, PsycINFO, IEEE Xplore, Cochrane, and Scopus were searched from inception to May 15, 2019, using terms related to mobile health, dynamic models, SB, and PA. The included studies involved the following: PA or SB interventions involving human adults; either developed or evaluated integrated psychological theory with dynamic theories; used smartphones for the intervention delivery; the interventions were adaptive or just-in-time adaptive; included randomized controlled trials (RCTs), pilot RCTs, quasi-experimental, and pre-post study designs; and were published from 2000 onward. Outcomes included general characteristics, dynamic models, theory or construct integration, and measured SB and PA behaviors. Data were synthesized narratively. There was limited scope for meta-analysis because of the variability in the study results.

RESULTS

A total of 1087 publications were screened, with 11 publications describing 8 studies included in the review. All studies targeted PA; 4 also included SB. Social cognitive theory was the major psychological theory upon which the studies were based. Behavioral intervention technology, control systems, computational agent model, exploit-explore strategy, behavioral analytic algorithm, and dynamic decision network were the dynamic models used in the included studies. The effectiveness of quasi-experimental studies involved reduced SB (1 study; P=.08), increased light PA (1 study; P=.002), walking steps (2 studies; P=.06 and P<.001), walking time (1 study; P=.02), moderate-to-vigorous PA (2 studies; P=.08 and P=.81), and nonwalking exercise time (1 study; P=.31). RCT studies showed increased walking steps (1 study; P=.003) and walking time (1 study; P=.06). To measure activity, 5 studies used built-in smartphone sensors (ie, accelerometers), 3 of which used the phone's GPS, and 3 studies used wearable activity trackers.

CONCLUSIONS

To our knowledge, this is the first systematic review to report on smartphone-based studies to reduce SB and promote PA with a focus on integrated dynamic models. These findings highlight the scarcity of dynamic model-based smartphone studies to reduce SB or promote PA. The limited number of studies that incorporate these models shows promising findings. Future research is required to assess the effectiveness of dynamic models in promoting PA and reducing SB.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) CRD42020139350; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=139350.

Mapping digital public health interventions in practice: Protocol for a scoping review of existing digital technologies and Internet-based interventions to maintain and improve population health (Preprint)

Background

Rapid developments and implementation of digital technologies in public health domains throughout the last decades have changed the landscape of health delivery and disease prevention globally. A growing number of countries are introducing interventions such as online consultations, electronic health records, or telemedicine to their health systems to improve their populations’ health and improve access to health care. Despite multiple definitions for digital public health and the development of different digital interventions, no study has analyzed whether the utilized technologies fit the definition or the core characteristics of digital public health interventions. A scoping review is therefore needed to explore the extent of the literature on this topic.

Objective

The main aim of this scoping review is to outline real-world digital public health interventions on all levels of health care, prevention, and health. The second objective will be the mapping of reported intervention characteristics. These will include nontechnical elements and the technical features of an intervention.

Methods

We searched for relevant literature in the following databases: PubMed, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), IEEE (Institute of Electrical and Electronics Engineers) Xplore, and the Association for Computing Machinery (ACM) Full-Text Collection. All original study types (observational studies, experimental trials, qualitative studies, and health-economic analyses), as well as governmental reports, books, book chapters, or peer-reviewed full-text conference papers were included when the evaluation and description of a digital health intervention was the primary intervention component. Two authors screened the articles independently in three stages (title, abstract, and full text). Two independent authors will also perform the data charting. We will report our results following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.

Results

An additional systematic search in IEEE Xplore and ACM, performed on December 1, 2021, identified another 491 titles. We identified a total of 13,869 papers after deduplication. As of March 2022, the abstract screening state is complete, and we are in the state of screening the 1417 selected full texts for final inclusion. We estimate completing the review in April 2022.

Conclusions

To our knowledge, this will be the first scoping review to fill the theoretical definitions of digital public health with concrete interventions and their characteristics. Our scoping review will display the landscape of worldwide existing digital public health interventions that use information and communication technologies. The results of this review will be published in a peer-reviewed journal in early 2022, which can serve as a blueprint for the development of future digital public health interventions.

International Registered Report Identifier (IRRID)

DERR1-10.2196/33404