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Baines R, Stevens S, Austin D, Anil K, Bradwell H, Cooper L, Maramba ID, Chatterjee A, Leigh S. Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review. J Med Internet Res 2024; 26:e50421. [PMID: 38441944 PMCID: PMC10951832 DOI: 10.2196/50421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses. OBJECTIVE This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses. METHODS A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach. RESULTS Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level. CONCLUSIONS There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized.
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Affiliation(s)
- Rebecca Baines
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Sebastian Stevens
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
| | - Daniela Austin
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Hannah Bradwell
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Leonie Cooper
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Arunangsu Chatterjee
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon Leigh
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
- Warwick Medical School, University of Warwick, Conventry, United Kingdom
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Gupta R, Iyengar R, Sharma M, Cannuscio CC, Merchant RM, Asch DA, Mitra N, Grande D. Consumer Views on Privacy Protections and Sharing of Personal Digital Health Information. JAMA Netw Open 2023; 6:e231305. [PMID: 36862410 PMCID: PMC9982693 DOI: 10.1001/jamanetworkopen.2023.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
IMPORTANCE Digital health information has many potential health applications, but privacy is a growing concern among consumers and policy makers. Consent alone is increasingly seen as inadequate to safeguard privacy. OBJECTIVE To determine whether different privacy protections are associated with consumers' willingness to share their digital health information for research, marketing, or clinical uses. DESIGN, SETTING, AND PARTICIPANTS This 2020 national survey with an embedded conjoint experiment recruited US adults from a nationally representative sample with oversampling of Black and Hispanic individuals. Willingness to share digital information across 192 different scenarios reflecting the product of 4 possible privacy protections, 3 uses of information, 2 users of information, and 2 sources of digital information was evaluated. Each participant was randomly assigned 9 scenarios. The survey was administrated between July 10 and July 31, 2020, in Spanish and English. Analysis for this study was conducted between May 2021 and July 2022. MAIN OUTCOMES AND MEASURES Participants rated each conjoint profile on a 5-point Likert scale measuring their willingness to share their personal digital information (with 5 indicating the most willingness to share). Results are reported as adjusted mean differences. RESULTS Of the 6284 potential participants, 3539 (56%) responded to the conjoint scenarios. A total of 1858 participants (53%) were female, 758 (21%) identified as Black, 833 (24%) identified as Hispanic, 1149 (33%) had an annual income less than $50 000, and 1274 (36%) were 60 years or older. Participants were more willing to share health information with the presence of each individual privacy protection, including consent (difference, 0.32; 95% CI, 0.29-0.35; P < .001), followed by data deletion (difference, 0.16; 95% CI, 0.13-0.18; P < .001), oversight (difference, 0.13; 95% CI, 0.10-0.15; P < .001), and transparency of data collected (difference, 0.08; 95% CI, 0.05-0.10; P < .001). The relative importance (importance weight on a 0%-100% scale) was greatest for the purpose of use (29.9%) but when considered collectively, the 4 privacy protections together were the most important (51.5%) factor in the conjoint experiment. When the 4 privacy protections were considered separately, consent was the most important (23.9%). CONCLUSIONS AND RELEVANCE In this survey study of a nationally representative sample of US adults, consumers' willingness to share personal digital health information for health purposes was associated with the presence of specific privacy protections beyond consent alone. Additional protections, including data transparency, oversight, and data deletion may strengthen consumer confidence in sharing their personal digital health information.
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Affiliation(s)
- Ravi Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, Maryland
- Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Meghana Sharma
- Perelman School of Medicine, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Carolyn C. Cannuscio
- Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Wharton School, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - David Grande
- Perelman School of Medicine, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Neal D, Gaber S, Joddrell P, Brorsson A, Dijkstra K, Dröes RM. Read and accepted? Scoping the cognitive accessibility of privacy policies of health apps and websites in three European countries. Digit Health 2023; 9:20552076231152162. [PMID: 36698427 PMCID: PMC9869200 DOI: 10.1177/20552076231152162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
Objective Trust and accessibility are vital to adoption of health and wellness apps. This research scoped three elements of cognitive accessibility of health app privacy policies: availability, ease of navigation, and readability. Methods For this cross-sectional study, quantitative data collected in the Netherlands, Sweden, and the United Kingdom included: whether privacy information was in a country's official language (availability); number of distracting visual elements (ease of navigation); word count and Common European Framework of Reference (CEFR) reading level (readability). Health app privacy policies were compared to policies from a purposively selected sample of websites, and to benchmarks, including CEFR reading level B1. Results Health app privacy policies were less often available in countries' official languages compared to sampled websites (Chi-Square [1, 180] = 57.470, p < 0.001) but contained fewer distracting visual elements. More UK privacy policies were in the country's official language, whereas Swedish privacy policies contained fewest words and fewest potentially distracting design elements. Only one privacy policy met the CEFR reading level benchmark. Conclusions Lack of privacy information in non-Anglophone app-users' native languages and high reading levels may be major barriers to cognitive accessibility. Web and app developers should consider recommendations arising from this study, to stimulate trust in and adoption of health and wellness apps.
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Affiliation(s)
- David Neal
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc/Amsterdam Public Health Research Institute, Amsterdam, The Netherlands,David Neal, Department of Psychiatry Amsterdam UMC, Location VUmc, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands.
| | - Sophie Gaber
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Phil Joddrell
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Anna Brorsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Karin Dijkstra
- Research Group Smart Health, School of Health, Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc/Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Grande D, Mitra N, Iyengar R, Merchant RM, Asch DA, Sharma M, Cannuscio CC. Consumer Willingness to Share Personal Digital Information for Health-Related Uses. JAMA Netw Open 2022; 5:e2144787. [PMID: 35072717 PMCID: PMC8787615 DOI: 10.1001/jamanetworkopen.2021.44787] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Consumers routinely generate digital information that reflects on their health. OBJECTIVE To evaluate the factors associated with consumers' willingness to share their digital health information for research, health care, and commercial uses. DESIGN, SETTING, AND PARTICIPANTS This national survey with an embedded conjoint experiment recruited US adults from a nationally representative sample, with oversampling of Black and Hispanic panel members. Participants were randomized to 15 scenarios reflecting use cases for consumer digital information from a total of 324 scenarios. Attributes of the conjoint analysis included 3 uses, 3 users, 9 sources of digital information, and 4 relevant health conditions. The survey was conducted from July 10 to 31, 2020. MAIN OUTCOMES AND MEASURES Participants rated each conjoint profile on a 5-point Likert scale (1-5) measuring their willingness to share their personal digital information (with 5 indicating the most willingness to share). Results reflect mean differences in this scale from a multivariable regression model. RESULTS Among 6284 potential participants, 3543 (56%) responded. A total of 1862 participants (53%) were female, 759 (21%) identified as Black, 834 (24%) identified as Hispanic, and 1274 (36%) were 60 years or older. In comparison with information from electronic health care records, participants were less willing to share information about their finances (coefficient, -0.56; 95% CI, -0.62 to -0.50), places they visit from public cameras (coefficient, -0.28; 95% CI, -0.33 to -0.22), communication on social media (coefficient, -0.20; 95% CI -0.26 to -0.15), and their search history from internet search engines (coefficient, -0.11; 95% CI, -0.17 to -0.06). They were more willing to share information about their steps from applications on their phone (coefficient, 0.22; 95% CI, 0.17-0.28). Among the conjoint attributes, the source of information (importance weight: 59.1%) was more important than the user (17.3%), use (12.3%), and health condition (11.3%). Four clusters of consumers emerged from the sample with divergent privacy views. While the context of use was important, these 4 groups expressed differences in their overall willingness to share, with 337 participants classified as never share; 1116 classified as averse to sharing (mean rating, 1.64; 95% CI, 1.62-1.65); 1616 classified as uncertain about sharing (mean rating, 2.84; 95% CI, 2.81-2.86); and 474 classified as agreeable to sharing (mean rating, 4.18; 95% CI, 4.16-4.21). Respondents who identified as White and non-Hispanic, had higher income, and were politically conservative were more likely to be in a cluster that was less willing to share (ie, never or averse clusters). CONCLUSIONS AND RELEVANCE These findings suggest that although consumers' willingness to share personal digital information for health purposes is associated with the context of use, many have strong underlying privacy views that affect their willingness to share. New protections may be needed to give consumers confidence to be comfortable sharing their personal information.
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Affiliation(s)
- David Grande
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | | | - Raina M. Merchant
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Meghana Sharma
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Carolyn C. Cannuscio
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia
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Cestari VRF, Florêncio RS, Garces TS, Souza LCD, Negreiros FDDS, Pessoa VLMDP, Moreira TMM. CODESING DE APLICATIVO CUIDATIVO-EDUCACIONAL PARA PESSOAS COM INSUFICIÊNCIA CARDÍACA: IDEAÇÃO, PROTOTIPAGEM E CO-IMPLANTAÇÃO. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0163pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo descrever o processo de ideação, prototipagem e co-implantação do protótipo de aplicativo cuidativo-educacional à pessoa com insuficiência cardíaca em vulnerabilidade, seus familiares/cuidadores e equipe de saúde. Método estudo metodológico, com cinco fases: Constructo; Ideação; Prototipagem; Co-implantação e Adequação, realizadas de setembro de 2020 a julho de 2021. A equipe do Codesign envolveu 72 atores (15 pacientes com IC, 19 familiares/cuidadores, 35 profissionais da saúde, dois pesquisadores e um designer e desenvolvedor), que contribuíram com dados linguísticos e visuais. Resultados foi produzido o protótipo InCare®, representado pelo fluxograma de interação do usuário e esboços estruturais. Foram definidas cores para composição das telas e escolhidos recursos do protótipo, com delineamento da descrição, proposta e requisitos funcionais. O aplicativo envolveu temáticas relevantes (definição da doença e vulnerabilidade, etiologia, classificação, sinais e sintomas, cuidados diários e abordagens paliativistas, tratamentos, alimentação, atividade física e redes de suporte, benefícios) e aglutinou funcionalidades conforme necessidades e preferências da equipe, sendo considerado inovador e um incentivo ao autocuidado. Conclusão O Codesign permitiu a ideação de recursos, conteúdos, esboços das telas, fluxo do usuário, prototipagem e nome do protótipo, em processo criativo e participativo, para promoção da saúde da pessoa com insuficiência cardíaca em situação de vulnerabilidade em saúde.
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Cestari VRF, Florêncio RS, Garces TS, Souza LCD, Negreiros FDDS, Pessoa VLMDP, Moreira TMM. CODESIGN OF A CARE-EDUCATIONAL APP FOR PEOPLE WITH HEART FAILURE: DESIGN, PROTOTYPING AND CO-IMPLEMENTATION. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0163en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective to describe the process corresponding to the design, prototyping and co-implementation of a care-educational app prototype for vulnerable people with heart failure, their family members/caregivers and the health team. Method a methodological study with five phases: Construct, Design, Prototyping, Co-implementation and Adaptation, all performed from September 2020 to July 2021. The Codesign team involved 72 actors (15 patients with HF, 19 family members/caregivers, 35 health professionals, two researchers and a designer and developer), who contributed with linguistic and visual data. Results the InCare® prototype was produced, represented by the flowchart corresponding to the user's interaction and structural sketches. Colors were defined to compose the screens and the prototype resources were chosen, outlining the description, proposal and functional requirements. The app involved relevant themes (definition of the disease and vulnerability, etiology, classification, signs and symptoms, daily care measures and palliative approaches, treatments, diet, physical activity and support networks, benefits) and gathered functionalities according to the team's needs and preferences, being considered innovative and encouraging for self-care. Conclusion codesign allowed designing resources, contents, screen sketches, user flow, prototyping and prototype name, in a creative and participatory process to promote the health of people with heart failure in vulnerable health situations.
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